When the Truth Doesn't Match Your Narrative

A Planned Parenthood demonstration in July (Photo by Jana Birchum)

When anti-choice lawmakers decided to kick Planned Parenthood out of a lifesaving preventative health program in 2013, medical professionals cautioned that the move would severely jeopardize low-income women's ability to access basic reproductive health care.

Turns out, they were right. A February study published in the prestigious New Eng­land Journal of Medicine, co-authored by two Texas health department employees, showed that after booting the reproductive health provider from the Texas Women's Health Program, areas affected by the exclusion experienced a strain in contraception access and a rise in taxpayer-funded births. There were 35% fewer claims for long-acting, reversible contraceptives, researchers found, and a 27% increase in Medicaid births among injectable contraceptive users ("Study: Less Contraception, More Medicaid Births After Planned Parenthood Ban," Feb. 3). The study has garnered national attention since its publication.

In the face of a public relations nightmare, the state Health and Human Services Com­mission and the same lawmakers who supported the rule are now crying foul and using every tool at their disposal to distance themselves from the dire reality created by their choice to cut basic, preventative care to poor women. In a letter addressed to the HHSC on Feb. 12, Sen. Jane Nelson, R-Flower Mound, an advocate and architect of Planned Parent­hood's removal from preventative state health programs, slammed the study and called its accuracy into question. Nelson requested the agency conduct its own review of the study and report back with an analysis of the paper's methodology and conclusions. She also criticized the two HHSC employees for their involvement with the findings. Her outcry yielded consequences for one of them – Rick Allgeyer, director of research, stepped down from his post after 20 years.

In a response letter to Nelson, Executive Com­mis­sioner Chris Traylor agreed with the senator's critiques, writing that the study was "misleading" and didn't provide the whole picture. Traylor requested the NEJM completely remove HHSC's affiliation with the article. "The views expressed in this article are those of the authors and do not necessarily represent the views or policies of the Texas Health and Human Services Com­mis­sion," an amendment to the article now reads.

The overly defensive criticism mainly revolves around the study not taking into account other women's health programs, including the Family Planning and Expanded Primary Health Care Program, when making its assessment. "To report on the effects of women's health funding and only mention TWHP is incomplete and misleading," writes Traylor. However, the study doesn't purport to take other programs into consideration – instead they are openly focusing on a narrow population.

"The paper is very clearly focused on women who were being served by Planned Parenthood in the Women's Health Program, not any other program," Dr. Joseph Potter, study co-author with the UT-Austin-based Texas Policy Evaluation Project, tells the Chronicle. "To date, there hasn't been a criticism, including from the state, that in any way invalidates the findings that are published in the paper." Potter points out the research underwent rigorous substantive and statistical review from several editors at the well-respected NEJM. And contrary to the message from certain officials, collaboration between academia and state agencies is normal. (On that note, not including the agency in data collection and research about reproductive health care might be a valid criticism.)

The backlash caught the attention of health care advocate Rep. Donna Howard, D-Austin, who recently penned an op-ed in the Austin American-Statesman criticizing state officials for ignoring "the explicit and limited scope of the study, as well as the inconvenient truth of the outcomes." Howard worries the state's pushback could inhibit future studies. "I'm concerned with the chilling effect this could have on research in a wide variety of areas, from education to water to other health issues," she tells the Chronicle. "We need to have the best information possible so we can make the kind of public policy that reflects what the evidence indicates. So my worry here is that if the results of the research are not what the state would like to hear, we just end up shooting the messenger."

She continues, saying that the level of defensive posturing to maintain the appearance of a successful women's health program by certain members of state leadership is palpable. "If anything comes out that doesn't support their narrative, I think there's a knee-jerk reaction against it." Howard adds that information she requested long ago of how many state employees receive public health care assistance was further delayed due to Allgeyer's resignation. "We're already seeing the ripple effects," she says.

This is hardly the state's first PR disaster when it comes to the TWHP. Researchers with George Washington University's School of Public Health as well as more than two dozen lawmakers questioned the HHSC's initial analysis of the exclusion's impact in 2012. The commission drastically underestimated how far the more than 50,000 women left without their local medical clinic would need to travel for care, and devised an inaccurate provider website database that sent displaced women to labs, children's doctors, and even a Subway sandwich shop. But maybe this isn't the best time to remind them.