Texas has yet again set the standard for terrible reproductive health policy.
This time it’s a decision by an Amarillo-based federal judge to make it impossible for any teen under 18 to secure birth control without parental consent.
U.S. District Judge Matthew Kacsmaryk, a 2019 Trump appointee and former religious liberties lawyer, has ruled that the family-planning program known as Title X violates a parent’s “fundamental right to control and direct the upbringing of his minor children.”
Kacsmaryk’s final judgment says Title X’s protection of confidentiality for minors seeking contraceptives cannot preempt state law that requires parental consent.
Every Body Texas, the state’s Title X administrator, has since instructed the 32 agencies that operate 156 clinic sites to immediately stop birth-control options without proof of consent.
Deanda v. Becerra was filed by former state solicitor general Jonathan Mitchell, the same man who designed the 2021 Texas law banning abortions after about six weeks and allowing private citizens to snitch on anyone involved in them.
Mitchell brought the Title X case on behalf of Alexander Deanda, who says he wants to ensure his daughters can’t get contraceptives because his Christian values require abstinence from sexual intercourse until marriage.
Kacsmaryk’s ruling is the latest indication that, with the constitutional right to abortion now gone, rolling back birth control is next in a number of Republican-controlled states.
His final judgment, delivered Christmas week and mostly overlooked amid holiday distractions, has chilling real-life consequences.
Program providers, often referred to as Title X clinics, have been teens’ only avenue to get confidential birth control in Texas and other states with parental-consent laws.
Title X’s provisions, in place since 1970, include free and confidential contraception to anyone, regardless of age, income or immigration status.
While Kacsmaryk’s ruling faces certain appeal, Title X clinics and the young women they serve are reeling — and likely will be for some time.
“This ruling adds insult to injury in the continuing pervasive attacks on people’s reproductive well-being in Texas,” Raegan McDonald-Mosley, CEO of Power to Decide, a national leader on contraceptive access, told me.
The ruling threatens the provider-patient relationship for young people in Texas — and possibly beyond, she said.
Texas ranks ninth in the nation in teen birth rate, according to 2020 data, the latest available, and second in the rate of repeat births among teens.
Stephanie LeBleu, acting Title X project director at Every Body Texas, told me, “despite all legal understanding to the contrary,” Kacsmaryk’s ruling dictates that the state’s parental-consent law trumps the Title X protections.
LeBleu said offering contraception without consent now creates a potential legal threat to Title X health care providers, so she directed all clinics to immediately shut down that part of their operation.
Every Body Texas hopes the work can resume during the expected appeals process so that minors in Texas receive “the sexual and reproductive care they need and deserve with or without parental consent,” LeBleu said.
In Dallas County, the court ruling affects 12 Title X operations, including Parkland’s 10 Women Infant Health Specialty clinics. Those health care outlets handled more than 45,000 family planning appointments in 2022.
In his decision, Kacsmaryk, who as a lawyer worked on cases seeking to overturn protections for contraception, disregarded long-standing court rulings that parents do not have a constitutional right to target government programs providing birth control.
In many situations, under-18 girls can and do talk with their parents before seeking out contraceptives. But that’s not always a safe option, and research shows that without confidentiality, many teens will not reach out to clinics.
A survey by the Guttmacher Institute, whose research and policy work is designed to advance reproductive health, found that among teenage girls ages 15‒17 who had ever had sex, only 22% of those who expressed confidentiality concerns received contraceptive counseling or services in the previous year.
Among the many reproductive-health advocates shaken by this rollback of teen rights is senior director Kate McCollum and her team at Trust Her, an initiative intent on ensuring that every woman in Dallas County has same-day access to all methods of contraception, regardless of her ability to pay.
McCollum’s operation is the reproductive and maternal health piece of the Child Poverty Action Lab, whose goal is to cut the Dallas County child poverty rate in half over the next 20 years.
Trust Her’s reproductive-justice strategy, which I wrote about in March, puts women in the driver’s seat of their own lives and bends the curve on devastating realities that define too many North Texas families, including teen pregnancies.
After the Supreme Court overturned Roe in June, Trust Her’s strategies to create seamless access to contraception became more important than ever.
Yet now comes another roadblock, this one aimed at teens.
McCollum said the court ruling has huge implications. “It is especially troubling because we believe that every woman, regardless of age or income or status, deserves equal access to contraception.”
Title X clinics in Dallas County are following Every Body Texas’ guidance, but McCollum said they are worried on behalf of the many teens they see every day.
Clinic staffers understand better than anyone what it took for the teens to seek out help. Now they are scared for the young people trying to do the safe, responsible thing on birth control and now being abruptly turned away.
“These are young people for whom they just want to provide equitable care,” McCollum said.
Her team did extensive interviews with teens to create their strategies and repeatedly heard a blunt reality: For some teens, talking to a parent in order to get consent for a contraceptive would mean being kicked out of their home.
Nearly all of the 40 teens involved in the conversations said they wanted to discuss birth control with their family but strict religious beliefs or cultural differences often make that impossible.
For these teens, their only option for securing contraceptives is to do so confidentially — and now that’s not possible.
As a practicing OB-GYN as well as leader of Power to Decide, McDonald-Mosley has seen the importance of access to all contraceptive options in allowing young people to continue their education and to make important health care decisions.
“This ruling decreases access at a time when we should be investing in increasing access,” she said.
McDonald-Mosley is impressed by the work of the Trust Her initiative and contraceptive-access projects across the country. But access should not be dependent on nonprofits and activists, she said.
“We should be pushing for state and federal policies providing access for all,” she said. “Policymakers and public health professionals can’t be allowed to abdicate their responsibility.”
It’s unconscionable to see the growing battle over reproductive rights use young people as political puppets when their life trajectory could be so dramatically damaged by lack of access to contraception.
Even if the Title X decision is eventually overturned, how many young people, their families and their communities will be harmed in the interim?
