Losing Babies

Jodie’s baby Kamryn is healthy and happy, thanks in part to the help Jodie received from Healthy Start, a federally funded program operated by Catholic Charities of Fort Worth. The program provides high-risk, low-income women with job placement assistance, lessons on healthy living, and general information on caring for a newborn. It follows them through their pregnancies and for two years after their babies are born.

Without programs like Healthy Start, Tarrant County’s statistics would be even grimmer.

Between 2009 and 2010, only 52 percent of pregnant mothers in Tarrant County received prenatal care during their first trimester. Those three months are critical: Proper medical care then can help prevent premature births — the most common reason for newborn deaths in Tarrant County, according to the county report. Early care also gives doctors the chance to detect and treat sexually transmitted infections before the fetus is affected and to counsel women on the need to take prenatal vitamins and stop smoking, drinking, or using other harmful drugs during their pregnancies.

“It takes hearing it over and over again for it to sink in and for a patient to do it,” said Dr. Elizabeth Henderson, pediatric physician with Baylor Colleyville Family Medicine. “Any opportunity to counsel a pregnant woman on lifestyle changes is important.”

But for low-income women, getting healthcare of any kind — including prenatal care — is getting harder. Almost half of all new mothers in Texas lack private health insurance.

In 2011, the Texas Legislature cut two-thirds of the funding from the state’s family planning program, leaving more than 130,000 women without access to preventive care and causing 55 clinics to close their doors, including 14 run by Planned Parenthood. The North Arlington clinic that closed had provided care to more than 4,000 patients in 2010.

When the legislature banned Planned Parenthood from receiving any support through the federally funded women’s health program, the federal government replied by cutting the state off from the program entirely. Texas then created its own women’s health program. Planned Parenthood, which supplied health services to about 50,000 Texas women last year, had been the single largest provider in the old program, serving 60 percent of the patients enrolled in the women’s program in 2011.

In 2004, about 15 percent of adults in Tarrant County told researchers they couldn’t afford to go to a doctor. By 2010, that percentage had risen to 18. During that time, the infant mortality rate was also rising. And that was before the end of the federally funded program.

According to Planned Parenthood, only three of Texas’ 254 counties had more women in need of publicly funded family planning services than Tarrant. More than 96,000 women in Tarrant County need healthcare services but are now less likely to get them.

“Good healthcare for poor people is hard to come by,” said Alexis, a mother of two from Fort Worth and a former member of the federally funded women’s healthcare program.

Alexis, 32, asked that only her first name be used. She had been going to a Planned Parenthood clinic in Fort Worth for annual well-woman exams and birth control since her early 20s.

“I was really overweight, and I smoked a lot,” she said. When she went to Planned Parenthood for an annual exam, they said her blood pressure had reached a point where it was no longer safe to take birth control pills.

“So I just quit taking birth control,” she said. Alexis had an underlying medical condition that made getting pregnant difficult, so she didn’t think it would happen.

But it did. “I got pregnant right away,” she said. She was 23 — “young and stupid,” she said — and married to an alcoholic.

“They [Planned Parenthood] were trying to be very assuring and calming. I’m sure I was white as a ghost” when she got the news, Alexis said.

With the help of Planned Parenthood, she found a doctor and got her pregnancy off to a healthy start.

Although Planned Parenthood doesn’t offer prenatal care, it does provide pregnancy testing and counseling, prenatal vitamins, screening for gestational diabetes, and referrals for further pregnancy care, in addition to providing cancer screenings and testing for sexually transmitted infections. In 2011, Planned Parenthood performed about 390,000 tests for sexually transmitted infections throughout Texas.

In January, State Rep. Lon Burnam had his office staffers contact 104 providers in and near Fort Worth who were listed with the new state-run Women’s Health Program. Staffers found that only 11 providers on the list would accept WHP patients, and only eight of those provided a full range of medical services. Since then, the Texas Health and Human Services Commission has pulled down and revised its list.

A couple of months ago, Alexis did a little research of her own with the WHP providers online. People are being laid off at her workplace, and she’s worried about her future and her family’s health insurance. She wanted to see what it would be like if she had to depend on the new WHP.

She called 20 phone numbers before she found a doctor who could see her without a wait of two months, Alexis said.

“I’ve gone down the list of available doctors in my area, and a lot of them don’t take it [WHP coverage],” she said. “It’s some of the laziest list-making I’ve ever seen.”

Wells, the Planned Parenthood spokeswoman, said it was “outrageous that Texas lawmakers continue to play politics with women’s health.

“Already, 130,000 Texas women are going without basic preventive healthcare” because of the legislature’s funding cuts, she said. “If Planned Parenthood continues to be banned from the Texas Women’s Health Program, this will jeopardize healthcare access for tens of thousands more.”

When the state cuts back on public support for prenatal care for poor women, the result can be tantamount to Texas shooting itself in the foot, financially. The March of Dimes estimated in 2005, for instance, that a year of care for a full-term baby cost about $3,325. But the first year of care for a preemie runs almost 10 times that, or about $32,325. And early pregnancy care can help detect and treat conditions that lead to higher premature birth rates. With Texas having cut itself out of the federal women’s healthcare program, that means more of those costs end up being paid by Texas taxpayers.

Not that Texas makes it easy for poor women to obtain public health benefits like Medicaid.

“The state of Texas makes it relatively difficult … . You have to have a doctor’s note to verify pregnancy before you can go on Medicaid, which means you have to go somewhere and pay for a pregnancy test,” said Dr. G. Sealy Massingill, chair of obstetrics and gynecology at John Peter Smith Hospital. “And a lot of patients don’t go on Medicaid until the second or third trimester, so they’re not getting early access to care.

“At JPS we have signs that say ‘walk-in pregnancy test,’ ” Massingill said, so that poor women can get that first test that will let them know they need prenatal care and also put them on the road to qualifying for public health assistance.

For many poor women, Alexis said, getting to a doctor’s appointment is already complicated, requiring arrangements for child care, transportation, and time off from work. And if they have to drive long distances to find a provider, many women just won’t make the appointment, she said. “Time is a luxury that’s not afforded to people who can’t pay for it.”

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