On a warm afternoon in January, Lucy Felix steers down a bumpy dirt road in a dusty black Honda Element, a white megaphone in her lap. She hangs a right into the driveway of a dilapidated mobile home with boarded-up windows. “Ladies!” the bespectacled 43-year-old hollers in Spanish through the megaphone. “Meet us down the street in an hour! Come! There will be free food and prizes!”
Felix’s cries of mujeres and gratis could be confused for the promotional dance-club vans that roll around parts of Latin America, blaring Reggaeton at ungodly hours. But she's shouting about Pap smears, not complimentary drinks before 11 p.m., and she's in Texas’s Rio Grande Valley, not Mexico City.
Felix, a Texas field organizer for the National Latina Institute for Reproductive Health, and her petite, perfectly coiffed 65-year-old mother, Lucila Ceballos, have been leading reproductive health workshops in the valley, an economically depressed stretch of borderland at the state's southernmost tip, since 2011. That's when the GOP-controlled Texas legislature slashed $73 million from the state’s family-planning budget, leaving approximately 147,000 women without access to affordable preventative health care and shuttering more than 50 clinics statewide. It’s a move that women’s rights advocates—and some legislators—say is more about restricting access to abortion and contraception than saving money. "Of course this is a war on birth control and abortions and everything—that's what family planning is supposed to be about," declared state Rep. Wayne Christian, a Republican, in an interview with The Texas Tribune. Lawmakers also passed a ban on "abortion affiliates," thereby barring all Planned Parenthood health centers from receiving state funding. The legislation is estimated to impact upwards of 50,000 women, many of them with low incomes.
The cuts have created a public health disaster, especially for the state’s Latina community, which is plagued by high rates of cervical cancer and other reproductive health problems. “We are witnessing the dismantling of a safety net that took decades to build and could not easily be recreated even if funding were restored soon,” wrote a doctor and three academics in a New England Journal of Medicine article in 2012. Conservative politicians have since felt the political repercussions of their decisions. Reeling from accusations of a "war on women," Republican state senators last year proposed adding $100 million for women’s health services back into the state’s primary-care program. But advocates say it’s too little, too late. "It’s hard to put back together a system that’s been dismantled," said Sarah Wheat, vice president for community affairs for Planned Parenthood of Greater Texas.
The cuts have had a disproportionate impact on the million-plus residents living in the overwhelmingly Latino, notoriously impoverished Rio Grande Valley. Nine of the valley’s 32 state-funded family planning clinics have shut down, while others reduced services and raised fees, according to a joint report from the Center for Reproductive Rights and National Latina Institute for Reproductive Health. Before the cuts, basic reproductive services like Pap tests, breast exams, contraceptive services and counseling, and STI testing, were available at clinics for little to no cost. But the shutdowns have ushered in a new era for Texas women: higher costs, fewer services. Between 2010 and 2012, the number of women in the valley getting family-planning services at clinics funded by the Texas Department of State Health Services plummeted by 72 percent, according to the NLIRH report.
Now, “they have nowhere to go,” Felix says, curving around a bend. “In Brownsville, there were two Planned Parenthood clinics and now there's only one. They just have to wait here until there's a change in the system, or more funding, which is exactly what we're fighting for.”
This morning's workshop is in a colonia called Luz del Cielo, some 20 miles away from the Planned Parenthood in Brownsville, which does not perform abortions but remains a target of the anti-choice crusade. A lot of national media attention has been paid to Texas’s assault on women’s reproductive rights, as conservative legislators have enacted a string of radical policies in an effort to wipe abortion off the state map: Come September, the state is expected to have just six abortion clinics, down from 40 in 2011.
But the consequences of 2011's family-planning cuts may be just as profound. According to an analysis by the state’s nonpartisan Legislative Budget Board, the cuts could result in more than 20,500 additional unplanned births, costing Medicaid more than $230 million. “Before the abortion clinics closed, the birth control clinics closed,” said Kimberly Inez McGuire, Director of Public Affairs at the National Latina Institute for Reproductive Health. “The mammogram clinics closed. And it’s unfortunate that it took things getting this bad for a real conversation to begin.”
That conversation is underway, but too late for many women in the Rio Grande Valley.
The Rio Grande Valley is one of the poorest regions in the country: more than one-third of the population lives in poverty; unemployment is soaring; and nearly one third of the adult population has less than a ninth-grade education. These factors already make it difficult for uninsured residents to access affordable healthcare. Texas has more uninsured adults than any other state in the nation—six million, or 25 percent of the population—and the valley’s Hidalgo County has the highest rate of uninsured residents living in urban counties in the entire U.S.
Many of the uninsured can be found in the valley’s many colonias: geographically isolated, unincorporated border communities often lacking in infrastructure like clean water, electricity, sewage systems, and paved roads. There are more than 2,200 colonias scattered throughout Texas (the majority are located along the border) and an estimated 400,000 Texans live in them. Though up-to-date statistics about the colonias are hard to come by, a 1994 study by the Texas Department of Housing and Community Affairs found that the average per capita annual income for families residing in colonias outside of the Valley’s Hidalgo County was $8,899. The colonias, in short, are generally the poorest, most remote neighborhoods in one of the poorest, most remote regions in the country. Getting them preventative care would be difficult even in a generous, progressive state.
But since they're in Texas, that access essentially doesn't exist anymore, which translates into health problems. Though cervical cancer is on the decline for U.S.-born women, and cervical cancer prevention and treatment is rising nationally, the disease is becoming increasingly common among Latinas. In Texas, Latinas have higher incidences of cervical cancer (12.4 percent per 100,000 women) than white women (9.2 percent) or African American women (10.4 percent). The numbers are even worse in the valley. In Cameron County, the rate of cervical cancer deaths for Latinas is twice the rate for white women, and Latinas living in counties that straddle the Texas-Mexico border are 31 percent more likely to die of cervical cancer than white Texans, and 26 percent more likely to die of the disease than other Latinas nationally.
This isn’t all new. According to a study by the Cancer Prevention and Research Institute of Texas, Latinas had the state’s highest incidences of cervical cancer between 1997 and 2006. But now, with fewer family planning clinics in the state than ever, these numbers are almost certain to rise. “This is particularly heartbreaking because cervical cancer could be almost completely eliminated with prevention,” said Inez McGuire. “At the early stages cervical cancer is highly treatable. And yet women are dying because they’ve never had a Pap smear, they’ve never seen a doctor.”
Educating valley residents about human papillomavirus (HPV), a leading risk factor for cervical cancer, among other reproductive issues often falls to volunteer promotoras like Felix. But her role can be frustratingly limiting: She can show a woman how to perform a self-breast exam, but if she finds a lump, she may have nowhere to send the woman. Some women don’t have cars, private transportation is expensive, and public transportation is barely accessible. (Only two cities in the valley, Brownsville and McAllen, have bus systems, according to the NLIRJ report.) “We know transportation is a huge, huge barrier for women in the Valley,” said Inez McGuire. “Even if the best clinic in the world was an hour away, it wouldn’t mean much to a woman who has no transportation.”
Even women who are educated on the issues are struggling to get care. Jessica Alvarez*, a 35-year-old native of Reynosa, Mexico, has been a promotora with the Texas Latina Advocacy Network since 2008. In 2013, after using her local Planned Parenthood’s services for seven years, she dropped by the clinic for a routine checkup and learned that its funding had run out and would soon close. Alvarez has HPV. Doctors have advised her to get a Pap test every six months, but the single mother of two can’t foot the $60 bill twice a year. She pays $350 a month for the lot her mobile home sits on, and says she rarely has enough money to buy her children food and milk.
Before the cuts, Alvarez and the majority of low-income valley women could get free or very cheap exams (ranging from $10 to $25), according to the NLIRH report. Alvarez says the lack of medical attention makes her uneasy. She’s already had surgery to remove cervical cysts and now is “worried about the HPV coming back, getting worse,” she said. “I’m afraid of getting cancer. That’s why I’m an activist, in this network. To encourage women to get their annual exams, so this doesn’t happen to them.”
Alejandra Gomez*, a workshop participant who spent three years in Mexico getting treatment for a bladder tumor and damage caused by a botched Caesarian section, says she knew women who would cross the border for care, and sneak back into Texas by wading acrossthe Rio Grande river. But with increased violence in neighboring Mexican towns like Reynosa, where drug cartels kidnap migrants for ransom, and a border many are unwilling to cross for fear of not being able to return to the U.S, it’s a gamble many aren’t willing to take.
After driving around Luz del Cielo for the morning, Felix and Ceballos lead a workshop outside Alvarez’s mobile home. A dozen women huddle underneath a shaded overhang, bobbing babies and shushing toddlers. At the end of the workshop, Felix quizzes a few volunteers about what they learned, handing out candy and prizes. A few women ham crack jokes. Others are more somber. “I hope to God I don’t get sick again,” Gomez says. “I don’t know what I would do.”
*Asked to change her name because of immigration status.
Erica Hellerstein is a freelance journalist based in the Bay Area. You can follow her on Twitter @E_Hellerstein.