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Tue January 22, 2013
'We Have No Choice': A Story Of The Texas Sonogram Law
Originally published on Wed January 23, 2013 9:19 am
Tuesday marks the 40th anniversary of Roe v. Wade, the Supreme Court decision legalizing abortion. But in some states, access to facilities that perform abortions remains limited.
In part, that stems from another Supreme Court ruling from 20 years ago that let states impose regulations that don't cause an "undue burden" on a woman's abortion rights.
Texas, for instance, requires that a woman seeking an abortion receive a sonogram from the doctor who will be performing the procedure at least 24 hours before the abortion. During the sonogram, the doctor is required to display sonogram images and make the heartbeat audible to the patient.
The law went into effect on Feb. 6, 2012; Carolyn Jones had an abortion two weeks later. It thrust her into the complicated world of abortion politics and led her to write an article in the Texas Observer titled "We Have No Choice: One Woman's Ordeal with Texas' New Sonogram Law."
Following that article's publication, Jones wrote a series for the Observer examining the impact of cuts to family planning services in Texas. Jones reported that since the state Legislature voted in 2011 to cut Texas' family planning program by two-thirds, 146 clinics lost state funds, and more than 60 of those clinics closed.
Jones talks about these cuts with Fresh Air's Terry Gross, and tells the story of her own encounter with the sonogram law.
Pregnant with her second child, Jones went for a routine sonogram and was told by her doctor that he was worried about the shape of her baby's head. A second sonogram that day at a specialist's office revealed a problem that was preventing her son's brain, spine and legs from developing correctly. The specialist warned that if the child made it to term, he would suffer greatly and need a lifetime of care. Jones and her husband decided she would have an abortion.
Although she'd had two sonograms that day, the new Texas law required that she get another, administered by her abortion doctor, and listen to a state-mandated description of the fetus she was about to abort. (Four days after that sonogram, the state issued technical guidelines for its new mandatory sonogram law, indicating that if a fetus has an irreversible medical condition, as Jones' did, the pregnant woman does not have to hear a description of the sonogram.)
In her article, Jones asks: "What good is a law that adds only pain and difficulty to perhaps the most painful and difficult decision a woman can make?"
Jones tells Gross: "The politicians wanted women to have the sonograms so that they can see the life of the child that they are about to end, so it's an entirely ideological justification for why a woman would have to have a sonogram."
A full transcript of this interview is posted below.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. Today is the 40th anniversary of Roe v. Wade, the Supreme Court decision that legalized abortion. But since then, many states have passed laws that restrict women's access to abortion. According to the Guttmacher Institute, more state-level abortion restrictions were enacted in 2011 than in any prior year. And last year brought the second-highest number of restrictions ever.
We're going to look at what's happening in Texas, with a journalist who wrote about her abortion under the new Texas sonogram law. Later, we'll hear from the executive director of two Christian-run pregnancy centers, in Dallas, that encourage teens and women with unplanned pregnancies to keep the baby or put it up for adoption.
My first guest, Carolyn Jones, learned halfway through her pregnancy with her second child that the baby she was carrying had a severe developmental problem. She and her husband wanted a baby very much. But they decided to get an abortion, a decision she describes as heartbreaking.
She had her abortion in Austin, last February; just two weeks after Texas implemented its mandatory sonogram law. For reasons she'll explain, this law made the abortion even more heartbreaking. Her personal experience led her to write a series of articles for the Texas Observer, about how the state legislature has restricted access to abortion and has cut off state funding to Planned Parenthood clinics.
Carolyn Jones, welcome to FRESH AIR. Let's talk about some of the things you learned about changes in the Texas abortion law, from your own abortion experience. You wanted this child very much. You were hoping to have a brother for your little girl. And you had the abortion in January of last year. You had had a sonogram halfway through the pregnancy. What did the sonogram reveal?
CAROLYN JONES: What we'd expected the sonogram to reveal was the gender of the baby, the sex of the baby, which it did; but it also revealed that our baby had a major neurological flaw. And his brain, spine and legs had not developed correctly. And the doctor wasn't even sure whether he would make it to term - that the flaw was so serious - but that if he did make it to term, he would lead a life of great suffering. He would be in and out of hospitals, and it would be a life of pain and suffering for him.
GROSS: This was a hard choice for you to make. Can you talk a little bit about how you and your husband chose to proceed with an abortion instead of having the baby?
JONES: Mm-hmm. For me and my husband, we already have one child - a daughter; she's almost 3. And we love her so intensely. And I know that anyone else who, as a parent - will understand that intense parental impulse to protect your child from anything; absolutely any pain, you want to protect them from it. And when we heard that our second, very much-wanted child, if we brought him into the world, his life would be one of constant pain and suffering - to us, it was an instinctive response to think for this very brief moment, we have a choice about whether to introduce him to a life of pain or not.
And so to us, it was actually - it was a terrible choice; it was a heart-wrenching one. But it was also a simple one because as his parents, we chose what we believed was best for him, to prevent him from knowing a life of pain. And that was, in fact, quite a quick choice we were able to make as well, within minutes of my doctor giving us the terrible news. It was also almost an instinctive response about the choice that we would make. And this month, it's almost a year to the day that we made that decision. It was still the right decision for us because it was an instinctive one about protecting our child from pain.
GROSS: Once you made that choice, there were several steps you had to go through before the state permitted you to have the abortion that you chose to have. One of those steps had to do with a mandatory sonogram. You had already had a sonogram, the one that revealed the defect in the baby's nervous system. Why did you have to have another?
JONES: I actually, I'd had two sonograms that day. The first one was the one that revealed the anomaly. The second one was, we went straight to a specialist to confirm it. Those were both medically necessary sonograms, to understand exactly what the problem was. The third sonogram was one that was mandated by the state of Texas. It was a new law that had come into effect just two weeks prior to that day. And the law was intended to - let's see, the way the politicians described it, was to promote informed consent. The politicians want women who are having abortions to have the sonograms so that they can see the life of the child that they're about to end. So it's an entirely ideological justification for why a woman would have to have a sonogram. It's got nothing to do with - there are no medical reasons that the state required me to have it.
GROSS: Now, as it turns out - before we go any further, I want to mention that, you know, the law had just gone into effect, and a lot of health care providers weren't sure what they were mandated to do. As it turns out, under the law, you wouldn't have had to undergo this mandatory sonogram because the baby you were carrying had irreversible developmental problems.
JONES: That's right.
GROSS: But your doctor didn't know that yet because it was so unclear, and I don't think...
JONES: That's right, yeah.
GROSS: Yeah. So you had the mandatory sonogram that women - with few exceptions - have to get in Texas now. So what are the requirements surrounding the mandatory sonogram? And as we just explained, you ended up having this sonogram because your doctors didn't realize yet that you were exempted.
JONES: The requirements are that a woman must have the sonogram 24 hours before the abortion procedure can go ahead. The doctor who performs the abortion must also perform the sonogram - which, as you can imagine, creates all sorts of logistical nightmares for clinicians who are traveling from clinic to clinic. They're now having to add in this extra day, to provide the sonograms as well.
On top of providing the sonogram that every woman - with a few exceptions - must undergo before having an abortion, every woman must then wait for 24 hours. And, I mean, even though I was technically exempt from having had the sonogram, I wasn't exempt from the 24-hour waiting period.
Sorry, just to go back to the sonogram itself, the doctor would then have to describe the physical characteristics of the fetus. And the doctor - he or she - would also play the fetal heartbeat as well, for you to hear. The doctor would then have to read through a formal script, written by the state, about the abortion procedure as well as the risks of abortions. And two of the risks that are mentioned in this list are an increased chance of getting breast cancer, as a result of having an abortion; and an increased chance of having negative psychological outcomes - both of which, I should point out, have been discredited by mainstream medical science. Nonetheless, these two discredited facts, as well as - sort of unnecessarily graphic description of the abortion procedure itself, are part of the government script that a clinician must read to a patient before the abortion can go ahead.
Other parts of the requirements, as well, is that before the woman can go ahead with the abortion, she must also listen to a government script that tells her that the father of the child is liable to pay child support, whether he wants the abortion or not; and that the state may or may not pay for your maternity care. So these are all things that have to be included in the script that the woman hears, regardless of whether she wants to have this abortion or not.
GROSS: Let me just back up a bit. So the doctor performing the abortion, that has to be the same doctor who's doing the sonogram ...
GROSS: ...and describing what he or she sees, to the woman who's having an abortion. So does that mean - like, in your case, the sonogram reveals terrible developmental problems in the fetus. Would the doctor be required to tell you that? Or is the doctor just supposed to say, I see arms; I see beginnings of legs; I see a little head - do you know what I'm saying?
JONES: I do, and I do think there is - you know, there are sort of formal characteristics that the doctor is required to describe. I have to admit that I imagine that the doctor, if he or she saw, you know, anomalies, they would describe them. But I have to admit, with the doctor, when he began to read this description to me - describe it to me, I found it so traumatizing that I heard the beginning; where he said that he could see four healthy chambers of the heart. And it's true - is that my very unwell child did have a healthy heart; not much else that was healthy, but the heart was. And to hear that was so traumatizing, that I did try and turn away, and try not to listen. So I really can't say what is part of the formal (technical difficulties), but I do imagine that they would have described what they saw, and perhaps my doctor did. I can't say.
GROSS: It sounds like the nurse wanted to help you not listen...
JONES: Mm-hmm. That's right.
GROSS: ...because she saw how traumatized you were, and she turned up the volume of the radio as the doctor was describing the fetus while reading the sonogram. Did that make you feel any better - like, at least somebody was trying to protect you from this mandatory sonogram?
JONES: In a very strange way, it did because in the room, at the time, was me, my husband, the doctor and the nurse. And there was not one of us in that room who wanted to go through that process of having to go through the sonogram. And, you know - and the doctor said to me, before it all started - and I was, you know, I was in a very emotionally fragile state. He did say to me, I'm so sorry I have to do this but if I don't, I will lose my license.
And that actually really helped; to imagine that all four of us were in it together, in a way. They showed such compassion for me in that no one agreed with it. And that did, in a strange way, help. And also, with the nurse turning the radio on - you know, I think it was, you know, maybe a D.J. or perhaps a commercial for used cars or something, clattering in the background. It was, you know, a slightly surreal experience. But again, the whole experience was so unpleasant that I appreciated any efforts they could make to stay within the law but still, you know, behave compassionately towards me and my husband.
GROSS: And one more sonogram question. You know, we've heard so much about transvaginal ultrasounds being mandated; you know, attempts to mandate that in some states. In Texas, it's not transvaginal; it's just an on-the-belly sonogram, right?
JONES: Actually, it is transvaginal. For anyone in the early stages of pregnancy, the only way that you can actually get a good look at the fetus is to use a transvaginal probe. For me, because I was at 20 weeks of pregnancy, I had the old - what would be called the jelly on the belly; which is, you know, the wand that you pass over your stomach. But for any woman in early stages of pregnancy - and in fact, you know, thousands of women in the last year have had to have a government-mandated transvaginal probe, for no medical reason.
GROSS: The goal of the mandated sonogram is to get the woman who is planning on having an abortion, to reconsider. What impact did the sonogram, and the recitation of the information that the government mandates the doctor to tell you - which is intended to discourage the woman from having an abortion - what impact did that actually have on you, and on your frame of mind, when you proceeded with the abortion?
JONES: It had no impact on my decision to go ahead with the abortion; none whatsoever. It was a private choice I'd made, and I was going to stick with that private choice no matter the people who tried to interfere with me. In terms of my broader frame of mind, it did make me feel very angry, and I still do. I still feel very angry that someone who has absolutely no say in, you know, my personal decisions, could still be there at that moment. The darkest day of my life was the day that we - I found out that information and had to make that decision. That someone could invade upon that - a politician, who has absolutely no jurisdiction over my private life - that they could invade upon that and so reduce my dignity, I do feel that that's an incredible injustice; and I still do, which is why I felt the need to write about it.
GROSS: We've talked a little about the abortion that you had because you were carrying a baby that had severe neurological impairments; and the doctor told you if the baby survived to the point of childbirth, that it would be basically condemned to a life of suffering. Let's broaden that discussion into what the Texas state legislature has been doing in the area of women's reproductive health care. In the 2011 session, the legislature cut the state's family planning program by two-thirds. What was the program, and who was most affected? What services were most affected?
JONES: The program - this would have been the state family planning budget; and before the 2011 legislature, it accounted for about $112 million. And that pot of money funded family planning and well-women services for about 220,000 of the poorest men and women in Texas. And not only did that provide birth control but also well-women exams and STD screenings, and breast cancer and cervical cancer screens. So it was really quite a comprehensive program.
During the 2011 legislature, that budget was slashed by two-thirds. It brought it down to about $40 million. Now, the reason that this money was slashed was because the conservative legislature wanted to starve Planned Parenthood of any state funding. And in a very unfortunate development, the legislature had somehow conflated abortion with family planning.
And these are not big chains, family planning chains across Texas. Many of them are actually small, mom-and-pop providers out in the rural areas, working with very small communities. You know, what we discovered at the Texas Observer was that within about six to eight months of these cuts happening, more than 60 family planning clinics across Texas were forced to close.
GROSS: Now, you write that many clinics that didn't close rely on funding from another endangered source in Texas, the Women's Health Program. What is that program?
JONES: That's right. The Women's Health Program, before the 1st of January of this year, was a federally funded program aimed at - again - the poorest men and women in Texas. I think it covered about 115,000 men and women. And it provided them with contraception and well-women care, and breast and cancer screening. As I said, it was federally funded; which means that for every $1 that Texas spent on this service, the federal government spent another 9. So as you can imagine, this was a good program for us to have in Texas.
Now, Planned Parenthood was the dominant provider of women's health program services in Texas. Forty-five percent of the clients in this program were seen by Planned Parenthood providers. And because this is Texas - and the conservative legislature have a vendetta against Planned Parenthood - in the 2011 legislature, they decided they needed to do whatever they could, to get Planned Parenthood out of Texas. So another way that they chose to do that was to exercise another law that meant that - it was called the affiliate rule - which claimed that Planned Parenthood would not be able to access federal funds because they were affiliated with abortion providers.
So Texas tried to exercise this affiliate rule. The federal government said it was not legal to remove one of the providers from the program. And it was then litigated in court; back and forth, between Planned Parenthood and the state of Texas, about whether they can or cannot be within this program. On the 31st of December, the federal government said that they would not be able to provide federal funding towards a fund that had evicted one of the providers.
And so the state of Texas said they would happily walk away from that 9-to-1 federal match because they really did not want to have to have Planned Parenthood in the program itself. So on the 31st of December, we lost the federal funding for that program. On the 1st of January this year, it became an entirely Texas-funded program. So it's now called the Texas Women's Health Program.
GROSS: Is there an estimate of how much money Texas is walking away from?
JONES: Yes, I think in - over a two-year period, it will probably cost Texas $70 million that they wouldn't have had to have spent if they'd stayed within the Medicaid program.
GROSS: We've talked about cuts to women's reproductive health care. We've talked about counseling against having abortion. What effect do you think all of this is having on the quality of women's health care and access to women's health care in Texas?
JONES: Well, we already know that at least 60 clinics across Texas have closed. We also know that even those clinics that still receive state funding, it was much less than what they were receiving before. So where they were providing family planning services for free, now they must share the costs with the patients. And that's very tough for these women, these low-income women who are in dire economic straits as it is. The other impact that we're seeing is that the family planning clinics that are still able to stay open, they aren't able to offer some of the more expensive yet more effective contraceptive options. So that's reducing women's choices as well.
Something else we're seeing, too, is that the Texas Health and Human Services Commission - the state agency that's responsible for all of this - they've already started their projected budget for 2014 and 2015. And they have projected 24,000 extra births as a result of these cuts to the family planning budget. And they have said that their budget will need, probably, about $273 million in order to cover the costs of all of these extra births. Now, this has more than doubled the size of the family planning budget that was slashed so dramatically in 2011.
We won't yet see exactly how many births there are, for a while. We won't see the impact of women whose cancer screenings - who weren't picked up in time. Those will come later. But, I mean, if the state agency itself is already projecting for so many extra births and so many greater costs, I think we can be sure that the collateral damage from those decisions made in 2011, will be far-reaching - and very damaging for women and men in low-income state, across Texas.
GROSS: I don't know if you can answer this, but are the extra births because women are deciding against abortion, or because they don't have access to contraception?
JONES: I would guess that there are both. I mean, we won't know this until we've got the figures. But I would imagine that there will be extra births from lack of access to contraception, and more women being funneled towards crisis pregnancy centers whilst those family planning clinics they might have gone to before have closed.
GROSS: The state of Texas is funding a program called Alternatives to Abortion, and this is a state program that funds crisis pregnancy centers.
GROSS: What are these centers?
JONES: Crisis pregnancy centers are - their sole raison d'etre is to convince women with unplanned pregnancies to keep the child rather than have an abortion. And they're often Christian organizations, and they promote either parenting or adoption. And they really do their very best to persuade women that abortions are not the right decision for them.
GROSS: So what do you know about the information that is provided, and if there is information that is withheld for women at these centers?
JONES: Yes. The information that they will provide is, in fact, the same information that was provided to me when I went to the abortion clinic. It comes from a pamphlet written by the state, called "A Woman's Right to Know," which describes exactly - which describes the abortion procedure in very graphic detail. They speak about suctioned body parts and crushed skulls. It's really a very graphic, and very upsetting description.
And they also - the pamphlet will also speak about the link between having an abortion and getting breast cancer; the link between abortion and thoughts of suicide or depression; all of which, as I said before, have been discounted by the medical community. So this is the information that crisis pregnancy centers - or certainly, the ones that are receiving funding from the state - will give to women who come in there; women that they call - in their terms, abortion-minded women.
The information that they will give to them about parenting or adoption is overwhelmingly positive information. And, for example, the one crisis pregnancy center I was looking at in Abilene, Texas, the information they'll say is: Now that you are pregnant, you are already a mommy. And if you choose adoption, it's the most unselfish choice you can make for your child. So they lay out the choices that these women have. But as you can see, you know, they weight them all very differently.
GROSS: Since Texas has cut funding to family planning centers and to clinics that provide abortions, where is the money for the Texas Alternatives to Abortion program coming from?
JONES: The money came, interestingly, from the family planning budget. So during the - the one that was slashed so heavily in the last legislative session. Each session that goes by - the Alternatives to Abortion program has been running since 2005; it gets more and more money siphoned towards it. So that money is coming out of a program that is designed to prevent unwanted pregnancies, and is now going towards a program that's designed to promote childbirth and prevent abortion. It's sort of missing out the middle bit - which is, you know, the trying to help women prevent the pregnancies that would lead them to have an abortion, or lead them to end up in a crisis pregnancy center.
GROSS: In discussing alternatives to abortion, does the state allow the crisis pregnancy centers to discuss birth control with women who, after they deliver the baby, they can - if they so choose - not get pregnant again in the near future, until they're ready?
JONES: The terms of the contract are pretty sparse. So no, the state does not require the crisis pregnancy centers to discuss family planning with their clients. And in fact, that many of the crisis pregnancy centers - but they choose to discuss it anyway, and many of the crisis pregnancy centers promote abstinence as the only form of birth control. And this has much to do with the sort of religious affiliation of many of these crisis pregnancy centers; where they believe that chastity is actually the only effective form of birth control. And in fact, there are a few crisis pregnancy centers who believe that abstinence is also the only form of birth control for women who are married.
So that's quite an extreme position to take. And anyone who is at a crisis pregnancy center is, by definition, sexually active. So for these centers to promote abstinence as the only way to prevent future pregnancies is very irresponsible, from a public health perspective; and very troubling that the state does not require these centers - that are receiving state funding - to actually give them scientifically valid information about preventing future pregnancies. And not only is this concerning for women in that they're not receiving the information they need about preventing future unwanted pregnancies, but it's also, they're not giving them information about preventing things like sexually transmitted infections.
Again, these centers, crisis pregnancy centers will talk about the dangers of sexually transmitted disease; but again, they'll say that the only way that they can prevent getting a sexually transmitted infection is to abstain from having sex. But in fact, for teens and women in their 20s and 30s, that's not a realistic choice for many people. And again, it's - you know, very worrying, from a public health perspective, that these centers are promoting this information and in fact, they are receiving state funding to do so whilst at the same time, the evidence-based centers that were providing women with medically accurate information about their health, are being de-funded.
GROSS: But Texas doesn't mandate that these crisis pregnancy centers have an abstinence-only approach.
JONES: No, not according to the contract that these centers have with the state. It's not mandated. But it's also - there's nothing included in there, that says that they should give them accurate advice, either.
GROSS: You grew up in Zimbabwe, and I have no idea what Zimbabwe's abortion policies are. But is there anything that's particularly surprised you about the abortion debate in America, compared to who - what you were exposed to in Zimbabwe?
JONES: Mm-hmm. You know, I can't really speak to the abortion policies in Zimbabwe. But I can certainly just say, it surprised me just how restricted women's access is, in the U.S. I - honestly, before my personal experience, I was extremely naive about what kind of rights we have in the U.S. I mean, my understanding - and it was, as I said, very naive understanding - was since Roe versus Wade 40 years ago, women in the U.S. had the right to have an abortion. And to me, it was as simple as that, really.
And it wasn't until I had my own, personal experience that I started looking into this and thinking actually, though women have a legal right to an abortion, that those rights are being chipped away at - all of these different states. And in fact, what surprised me the most is that the legal right to abortion was enshrined, in 1973, for all women in the U.S. But then the Hyde Amendment - then actually removed that right for low-income women. The Hyde Amendment prohibited federal funds from paying for women's abortions unless - in the cases of, I think, rape or incest, or perhaps fetal anomaly as well; there were fewer - exceptions but essentially, it took away women's economic access to having an abortion. And that that has had a huge impact on women in the U.S.
So we may have a legal choice to have an abortion in the U.S. but actually, our choices are very much constrained by the kind of social and economic access that we have in society. And I'm horrified by how hollowed out that legal choice actually is.
GROSS: Well, Carolyn Jones, I want to thank you very much for talking with us.
JONES: Thank you for having me, Terry.
GROSS: Carolyn Jones has written about her abortion, the Texas mandatory sonogram law, and state cutbacks to family planning centers, for the Texas Observer. You'll find links to some of her articles on our website, freshair.npr.org.
Coming up: Carolyn Cline, the CEO of a Christian group that runs centers that discourage women with unplanned pregnancies from having abortions; and offers counseling and assistance to help with their pregnancies.
This is FRESH AIR. Transcript provided by NPR, Copyright National Public Radio.