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How the next Supreme Court justice could affect your access to birth control

The politics of abortion and contraception are converging in the Trump era. Administration officials are exploring changes to the federal program that funds birth control for low-income, uninsured women. And contraception access could be impacted heavily by the next Supreme Court nominee, as well. Special correspondent Sarah Varney reports in collaboration with Kaiser Health News.

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  • Amna Nawaz:

    Of course, most of the attention around Judge Kavanaugh is focused on the allegations of assault. But his views on other issues will return front and center if his confirmation goes forward.

    During his confirmation hearings, Kavanaugh was questioned about prior cases he dealt with when it came to the question of birth control. His vote is considered pivotal to future Supreme Court rulings on the subject.

    As special correspondent Sarah Varney reports, there's already a major push at the state level to limit or restrict access to contraception. Some conservatives are now hoping to take it further at the federal level with a Supreme Court more amenable to their views.

    This story was produced in collaboration with our partner Kaiser Health News.

  • Sarah Varney:

    Twenty-three-year-old Nikia Jackson came to this clinic run by the Obria Group in Lawrenceville, Georgia, outside Atlanta, to get tested for a sexually transmitted infection.

    Millions of women like Jackson could soon get their medical care at Obria clinics if CEO Kathleen Bravo has her way. Bravo is positioning her growing company to become a nationwide alternative to Planned Parenthood. But with one key difference: Obria doesn't offer abortions, condoms or any kind of birth control, except fertility awareness methods that many call natural family planning.

    She's a devout Catholic, opposed to contraception, whose own abortion decades ago shaped her anti-abortion position. The company so far has 38 clinics in six states. Women can get ultrasounds and prenatal care, as well as tests for pregnancy, HIV and cervical cancer.

  • Obria employee:

    Our ultrasound is a limited ultrasound. There's a $20 fee.

  • Sarah Varney:

    But if the patient wants to prevent pregnancy, the only option Obria offers is natural family planning, which requires women track their periods and refrain from sex when most fertile.

    The Centers for Disease Control and Prevention says, when followed exactly, the method is 76 percent effective. Bravo says more young women today are looking for an alternative to clinical birth control.

  • Kathleen Bravo:

    We're a holistic clinic. We do holistic care. We offer alternatives to the pill and IUDs. I think that women feel very much empowered by understanding how beautiful their body is made. I mean, it's exciting to know that, 'Wow, I understand now how my cycle works. I understand what's going on in my body.'

  • Sarah Varney:

    Now, Bravo is taking her vision to Washington, meeting with federal officials who she hopes can help ramp up her company's expansion.

  • Vice President Mike Pence:

    Life is winning again in America.


  • Sarah Varney:

    With Vice President Mike Pence, an evangelical Christian, as a key ally, religious conservatives say this is their moment to shape women's sexual health care.

  • Dr. Diane Foley:

    There is not a science textbook in any of our schools that doesn't say that, when the sperm joins with the egg, there's a unique human being that is formed, and that is a different person.

  • Sarah Varney:

    A former CEO of a Christian anti-abortion group, Dr. Diane Foley, is now the deputy assistant secretary for the Office of Population Affairs, which distributes federal family planning funds to health clinics. As the politics of abortion and contraception have converged, Foley is one of several anti-abortion and abstinence education advocates in key federal positions.

    Together, they have made fast work, rolling back an Obama-era rule that required employers cover birth control in their health insurance plans. And they proposed new restrictions aimed at closing Planned Parenthood clinics and promoting clinics that do not offer the full range of contraception or abortion services.

    In many ways, those ideas have already been tested in Texas.

    When Planned Parenthood clinics like this one became a target in Texas, more than 80 family planning clinics around the state, and not just Planned Parenthoods, were forced to close. And contraception became much harder to get.

    Women across Texas suddenly found their birth control needs caught up amid the fight against abortion.

  • Kathryn Hearn:

    The state of Texas cut the family planning program, really slashed it, and changed a lot of rules. And those rules led to clinic closures. Like, this center right here used to be the site of one of our part-time clinics.

  • Sarah Varney:

    Kathryn Hearn of Access Esperanza says after Texas lawmakers slashed state funding by 66 percent in 2011, four of her organization's eight sites closed, even though they never offered abortion care.

    The impact was swift and widespread. Researchers found the number of women on the most effective forms of birth control — IUDs, implants and injections — plunged by a third. And birth by poor women on Medicaid increased 27 percent between 2011 and 2014.

    Hearn says 13,000 of her patients lost medical care. In the aftermath, clinics here became almost entirely dependent on a program called Title X, which pays for birth control and sexual health care for low-income women. But now they're bracing for new rules proposed by the Trump administration that would divert some Title X money to clinics that only offer natural family planning and would make it nearly impossible for those getting federal Title X money to refer patients to abortion providers.

    Hearn says clinics like Access Esperanza that offer the full range of FDA-approved birth control could be replaced by those like Obria.

  • Kathryn Hearn:

    So, today, a woman can come into a Title X clinic, any clinic in the United States, in Texas, and be offered a wide range of contraceptive methods. With these proposed rules, she could walk into a Title X clinic and only be offered abstinence.

    Well, if she says, 'I'm married' or 'I'm in a relationship. That doesn't work for me. I need real contraceptive care. I need real help' … And so with these new rules, those are the changes.

  • Sarah Varney:

    Ofelia Alonso says it's already difficult for many young women in Texas to tell the difference between so-called crisis pregnancy centers and medical clinics.

    The 22-year-old community organizer with Texas Rising says young Texans don't have all the information they need to make informed decisions.

  • Ofelia Alonso:

    Abstinence-only, and then crisis pregnancy centers, anti-abortion propaganda, defunding our family clinics… so, like, what is left for us? What are we going to do? We're going to have these like weird centers where you can't get anything?

  • Sarah Varney:

    But women seeking contraception have to go somewhere. And one alternative, she says, is to cross the nearby border into Mexico to buy birth control.

  • Ofelia Alonso:

    But it shouldn't have to be that way. Like, we shouldn't have to travel to another country to get what we need.

  • Sarah Varney:

    So, some patients, like Claire Hammons, have looked for other alternatives. She runs a hotel in Llano, a small city with no full-service women's health clinic.

    The vast geography here, combined with widespread clinic closures, has led to so-called 'contraception deserts.' As this map shows in blue, some 10 million Texans live at least half-an-hour from a clinic, a common standard used to determine health care shortages.

    Hammons lives in one of these contraception deserts, and when she couldn't afford health insurance, she turned to the Internet for help. She now gets her birth control straight from the mailbox, from a San Francisco-based company called Nurx, and pays about $15 a month.

  • Claire Hammons:

    So, pretty much every three months, they send this to me in the mail, this package…

  • Sarah Varney:

    She can message with her Nurx doctor, Jessica Rubino, who sits in Austin.

    Rubino reviews Hammons' medical history and renews her prescription without any additional cost. She sees what happens to women who live in contraception deserts.

  • Dr. Jessica Rubino:

    I'm also an abortion provider, and I do that outside of Nurx and at another facility. And I find patients, I have patients — I had one last week who drove to see me five hours. And the entire reason that she came to see me for the abortion is because she didn't have any access to contraception.

  • Sarah Varney:

    That lack of access worries physicians in many clinics, like the People's Community Clinic, that receive Title X funding.

    Kami Geoffray has been meeting with them. She runs the group that decides which clinics in Texas receive federal money. She says, if the Trump administration's overhaul of Title X succeeds, it will undermine the goal of the program that the federal government has operated since the 1970s.

  • Kami Geoffray:

    So we know that every dollar we spend on Title X saves $7 across other government programs, including Medicaid. We avert Medicaid births very frequently by contracepting clients and preventing unplanned pregnancy.

  • Sarah Varney:

    But back in suburban Atlanta, at the Obria medical clinic, Kathleen Bravo says it's time for companies like hers to put a bigger mark on reproductive health care. And the company is launching a $240 million capital campaign to open more clinics.

  • Kathleen Bravo:

    If Obria is a comprehensive primary care clinic for women that is an alternative model to Planned Parenthood, that we have a choice, we're in. We're all for it.

  • Sarah Varney:

    But exactly what 'comprehensive' means, and the care women can receive at Title X clinics, will likely be decided by the Trump administration in the coming months.

    For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney in McAllen, Texas.

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