At the age of 17, Iliana Neumann was orphaned when her mother, a single mom working two to three jobs, died at 38 of breast cancer.
A lack of access to affordable preventive health care kept her mother from getting the mammogram she needed, said Neumann, now a family practice doctor at the Family Health Center in Waco.
In light of proposed changes to the nearly half-century-old Title X law, more low-income women could again be left in a similar position as her mother, without easy access to preventive health care that could save their life, Neumann said.
In 2016, 4 million patients nationwide and 166,538 in Texas, received free or low-cost health care through U.S. Department of Health and Human Services Title X programs, according to data from the National Family Planning and Reproductive Health Association. There are 94 service sites in Texas.
More than 75 percent of Title X patients have incomes below 150 percent of the federal poverty level, according to a 2017 report by the Office of Population Affairs.
Health care services provided include breast and cervical cancer detection, screening and treatment for sexually transmitted diseases, HIV testing, wellness exams and contraception. Title X grants do not cover abortions, and a summary in the federal register states the proposed rule change is intended “to ensure compliance with, and enhance implementation of, the statutory requirement that none of the funds appropriated for Title X may be used in programs where abortion is a method of family planning.”
Susan Duty, a single mother and rising senior at Baylor University in 2013, received free health care services thanks to the Title X funded health care clinic Planned Parenthood of Greater Texas operates in Waco. Though Planned Parenthood programs offer abortion services, it qualifies for Title X money because its facilities that offer abortions are funded and operated separately from its other operations.
The Planned Parenthood abortion clinic in Waco was closed in recent years because of a state law that was eventually found unconstitutional, but the rest of the organization’s services in Waco continued during that time.
“Per law, family planning and abortion services are physically and financially separate,” spokeswoman Stephanie Mabry said when Planned Parenthood opened a new facility in Waco last year. “They are two separate licensed health care centers.”
When Duty went in for her annual women’s wellness exam in 2013, she had no real concern for her health, she said. Soon after her appointment, she got a call from a nurse at the clinic. The nurse told Duty her pap smear showed abnormal cells, and she would need a colposcopy, a special cervix exam, to find out if the cells could be cancerous.
“I started thinking my daughter could grow up without a mother,” she said. “What do I do? I have no money. Who is going to take care of my kid, and what if I can’t afford the procedure?”
The nurse reassured Duty her procedure would be free, because she qualified for Title X funded health care.
“My regular routine was to drop my daughter off at day care, go to class all day, pick her up, feed her, bathe her, go to bed, and stay up, read and do homework,” she said. “So when I went to this appointment, I had to go home and read. How do you read? And I’m a filmmaker, how do you read about lighting when I could have cancer right now? I just remember thinking, ‘Okay, we’re going to do this.’”
Within a month, Duty had the procedure at Planned Parenthood, found out the cervical cells were not cancerous and graduated college later that year. She said she is forever grateful to Planned Parenthood and is still a patient of the Waco clinic to this day.
“I’ve always grown up with the understanding that Planned Parenthood is where women can receive health care,” she said. “If you don’t have insurance it’s a place where you can go to receive quality health care from a compassionate individual. …This is not about abortion. This is about access to health care.”
About 4,000 Title X funded clinics across the nation, not just Planned Parenthood clinics, are waiting anxiously to see how the Trump administration changes Title X funding, said Audrey Sandusky, spokeswoman for the National Family Planning and Reproductive Health Association. As it stands, those clinics will receive Title X funding through August. What happens in September is anyone’s guess, Sandusky said.
“The entire network is waiting with bated breath to see how funding is going to trickle out to health providers across the community,” she said. “It certainly remains to be seen how the federal government intends to distribute the funding. Our existing provider network has a longstanding and esteemed reputation in communities for providing the best possible family planning care to their patient base.”
Sandusky said the proposed funding changes constitute an attack on low-income families across the country.
“It’s an attack on people’s access to the care they need to stay healthy,” she said. “This is an attack on the important health care people need and the network of providers that offer that care. … When people have access to the high-quality reproductive health care they need, their loved ones, their families and their communities thrive.”
Neumann, the local Family Health Center physician, said the proposed regulations will disproportionately harm low-income women, those who lack access to health insurance, transportation and the money needed to seek care anywhere in the Waco area.
“A few years ago … a lot of Planned Parenthoods started closing and we saw an immediate impact on women not being able to get the health care that they needed,” she said.
Preventive health care for low-income communities is why Neumann entered the medical field.
“I went into health care because I lost my mom under those circumstances,” she said. “I want to do for other families what I didn’t have access to. I take my responsibility to care for people very seriously, not only in my exam room, my delivery room, the (neonatal intensive care unit), but that means being an advocate for patients and making sure that people are being treated fairly and justly and not letting politics get in the way of what makes sense.
“I think it’s time for us to stop playing with women’s health and the health of their babies.”
The Department of Health and Human Services is seeking public comment until July 31 on the Trump administration’s proposed change to Title X funding. The department had received more than 49,000 comments as of Friday.