Houston

United States of America / Texas / Houston

OVERVIEW

As a major American city, Houston has an incredible range of medical facilities and providers. Due to federal regulations, contraception is legal, though a prescription is required. Emergency contraception is also legal and no prescription is required; it can be purchased at pharmacies, drug stores and many clinics. However, there have been reported cases of pharmacists refusing to sell emergency contraception due to personal religious or moral beliefs. In general, Texas as a state is largely conservative with a strong religious Christian base. This heavily impacts the political and social climate of the state, and in particular abortion law. While abortion is legal in Texas, as it was ruled to be a legal right in Roe v. Wade (1973), abortion has been consistently challenged in Texas. There have been many laws passed since 2013 that have limited the ability of abortion clinics to operate as well as the ability of women to obtain abortions. Some of these provisions, most notably HB 2, have been challenged and struck down by the United States Supreme Court. But many other restrictions remain in place, creating frustrating circumstances for women. Overall, Houston is a huge city and Texas is a huge state. This means that, while there are certainly restrictions that impose great difficulty, there are also a wealth of resources that can be sought after.

Contraception

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Texas, contraception is generally legal but restrictions apply. You need a prescription to obtain birth control. Furthermore, if you are under 18 years old, you typically need permission from your parents. In fact, Texas is one of only two US states that does not allow state funds to be used for contraceptive use without parental consent. If you cannot get permission from your parents, you can confidentially get birth control from Title X clinics (see section below where you can find them in Houston). Note that Title X clinics are available to all people, regardless of their age or if they have parental consent, and they may even be able to give you birth control at a reduced cost or no cost at all depending on your financial situation. Also, if you're on Medicaid, you can get birth control at Texas clinics that accept Medicaid (even if you're under 18 and with no parental consent required). For many women, access to contraception in Texas is hampered by little government funding. This began in 2011, when 66% of state funds for Planned Parenthood in were cut. Later in 2013, the state replaced its Medicaid program with the Texas Women's Health Program, thereby allowing them to cut all former Medicaid funding for Planned Parenthood. These Planned Parenthood facilities served 60% of the state's low-income women.

As reported by the Houston Chronicle, "In Texas, limits on abortion get the big headlines. But access to effective birth control has been weakened in the crossfire. When lawmakers kicked Planned Parenthood out of the state's Women's Health Program in 2013, they assured Texans that women would find providers elsewhere for family planning. This week, a University of Texas study published in the New England Journal of Medicine produced strong evidence that Texas has failed to fill the void. In counties affected by the Planned Parenthood exclusion, claims for long-acting contraceptives dropped by more than 35 percent, and requests for injectable contraceptives dropped 31 percent. Meanwhile, Medicaid-paid births spiked among women who previously had used injectable methods."

Furthermore, the decreased accessibility of affordable birth control has increased pregnancy rates. As reported by the LA Times, "The researchers calculated that the relative increase in births was 27% for women who lost access to Planned Parenthood. Many of these births were probably unplanned, since the increase was only seen in counties where women faced new hurdles in access to contraception, the study authors wrote... The study doesn’t prove that the change in Texas policy was directly responsible for the increase in births, the researchers noted. But after making it more difficult for women to get safe, reliable birth control, women switched to less reliable contraceptive methods, or skipped them altogether. The result is dozens of additional babies born to some of the thousands of women who had been served by the shuttered clinics."

From an educational standpoint, contraception has also struggled to receive state support. In 2009, it was found over half of Texas teenagers lost their virginity in high school. However, 94% of Texas high school students receive an abstinence-only education. This is largely due to the fact that Texas financially awards schools that teach abstinence-only curricula whereas it does not provide financial incentives for those that do. Furthermore, schools often feel that they need to cater to the needs of their students' parents who may object to sex-education.

What to Get & Where to Get It

Title X Clinics in Houston:

• HACS – Spring Cypress: 17010 Sugar Pine Dr., Houston, Texas 77090 Directions | Website
• City of Houston HHS – Sharpstown Health Services - 6201 Bonhomme, Suite 300, Houston Texas 77036
• HACS – Main Campus - 2150 W. 18th St., Suite 300, Houston, Texas 77008
• Legacy Baker-Ripley Campus - 6500 Rookin St. Bldg B, Suite 200, Houston, Texas 77074
• Legacy Mapleridge Campus: 6550 Mapleridge St., Suite 106, Houston, Texas 77081.

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

Emergency contraception is available without a prescription in Texas. There are no age restrictions for purchase. According to Tex. Health and Safety Code Ann. § 323.005, the Department of Health Services must provide information to sexual assault survivors, including methods to prevent pregnancy and STIs. Furthermore, emergency rooms in Texas are required to provide information on EC. But, unlike emergency rooms in many other states, they are not required to actually dispense EC on request.

In Texas, anyone (male or female) can purchase EC in pharmacies, clinics or Planned Parenthood facilities. They are legally entitled to buy EC. However, there are reported cases throughout Texas of pharmacists refusing to sell EC, particularly due to personal moral or religious beliefs. For example, in 2004, a rape victim was denied EC at a Texas pharmacy. The pharmacist cited religious reasons for his denial, despite the fact that he was legally required to provide EC to the woman. In 2010, Adam Drake was denied the right to buy non-prescription EC at a Walgreen's in Houston.

As the Princeton EC website writes: "You have the right to buy progestin-only EC at a pharmacy without showing ID. If someone denies you EC, let us know. The American Society for Emergency Contraception has a fact sheet explaining the current regulations for purchase of EC that you can print and bring to the pharmacy: Emergency Contraception: A Guide for Pharmacies and Retailers." Also, we have provided a list below (see 'What to Get & Where to Get It') for legitimate EC sellers in the Dallas area.

Warning: There are misinformation campaigns in Texas that falsely state that certain emergency contraceptives are abortion pills. For example, when one searches for information on ellaOne in Texas via Google, the Texas Right to Life website comes up very high in Google rankings. This website falsely claims that ellaOne induces abortion, and it provides absolutely no medical reports or scientific studies to back up this claim. Be careful to read international and medically valid reports, rather than PR pieces from special interest groups, about your health care.

What to Get & Where to Get It

Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. Check to see if your country carries ellaOne. If your country doesn't carry ellaOne, copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

In the United States, you'll generally be able to find Plan B One-Step, Next Choice One-Dose and My Way in pharmacies. Here's a full breakdown of what you can expect to find, thanks to the Princeton EC Website:

Dedicated Products / Anti-Progestin Take 1 pill within 120 hours after unprotected sex:

• ella

Dedicated Products / Progestin Only Take 1 pill within 120 hours after unprotected sex:

• My Way
• Next Choice One Dose
• Plan B One-Step
• Take Action

Take 2 pills within 120 hours after unprotected sex:

• Levonorgestrel Tablets (available from a pharmacist without a prescription)

If you can't access emergency contraception, many oral contraceptives can be used as replacement EC. The list of potential contraceptives that can be used for this purpose is very long, and instructions vary according to the specific brand. So, to find specific instructions based on the brands you may have available, please check out the Princeton EC Website. You can search for EC under "United States" and see recommended pills and dosages on that site.

Costs

Generally, EC will cost between $30-65 in the States. Average seems to be about $50.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Testing Facilities

Support

HIV/AIDS Organizations, provided by TheBody.com:

• A Sister's Gift: "Offers social services and support for women/girls in Dallas and abroad. Services target and attract women who are mothers, disabled, low income, have limited food, clothing and support."
• AIDS Arms Inc: "Provides medication assistance and case management. Also has a clinic and does outreach in prisons."
• AIDS Interfaith Network: "A multicultural, non-profit, faith-based HIV/AIDS organization that provides services for persons living with HIV/AIDS, gives support to the people who care for them, and educates persons who are at risk of HIV infection."
• Bryan's House: "A community-based program to focus on children and families who are impacted by HIV and AIDS."
• Samaritan House: "Housing, nutrition, transportation, treatment and job training for homeless, low-income HIV-positive people."

Medications & Vaccines

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

You'll be able to find pads, pantyliners, tampons and menstrual cups in Dallas. For DivaCups, you can find them at many CVS and Walgreen's locations (check out the website for a full list). For Mooncup, note that it is often sold under the brand name MCUK in the US but it's the same thing.

Gynecological Exams

Pregnancy

Laws & Social Stigmas

In Texas, women are protected from any discrimination in the workplace due to pregnancy. You cannot be fired, disciplined or treated differently due to pregnancy. However, Texas state laws have no maternity leave requirements. The only maternity leave requirements in place are at the federal level under the Family and Medical Leave Act (FMLA). Under this law, certain companies are required to give 12 weeks off in a 12-month period for certain health-related needs, including pregnancy. For a company to fall under FMLA standards, it must have at least 50 employees for at least 20 weeks of current calendar year or the immediately preceding calendar year. You must also have worked at your company for at least 12 months and for a total of 1,250 hours (within the 12 month period preceding the time off) in order to be covered. For more details, click here.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

Texas women protest SB 5/HB 2.

Since 1973, abortion has been legal in the United States under the Roe vs. Wade Supreme Court decision. Yet in Texas, abortion has been consistently challenged, where additional restrictions have been placed on clinics, health care providers and women seeking abortions.

One of the most controversial laws came in 2013, when Texas Governor Rick Perry signed House Bill 2 (known as "HB 2"), an anti-abortion bill. According to this law, "Abortion doctors must have admitting privileges at a hospital within 30 miles of the abortion clinic." Furthermore, abortion clinics must align by standards meant for ambulatory surgical centers, which have strict regulations on buildings, equipment and staff. Because nearly all abortion doctors have no admitting privileges to such hospitals in Texas, and because the hospitals have no incentives to provide such access, this forced many clinics to close down. Furthermore, because most abortion clinics don't have the funding or resources to abide by ambulatory standards, this also forced abortion clinics to close down. In the years following HB 2, Texas went from having 40 abortion clinics to only 19. This lead to a situation in which many Texas women did not have access to abortion clinics in their areas, and they were forced to travel very long distances, oftentimes out of state, to obtain abortions.

In June 2016, the United States Supreme Court struck down HB 2 in a 5-3 decision. As written by Justice Stephen G. Breyer, “We conclude that neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes. Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the federal Constitution.”

Yet, other restrictions in Texas remain in place, particularly those passed in December 2015. Under these new restrictions, a woman must receive an ultrasound before obtaining an abortion. The health care provider must show and describe the ultrasound image to the woman. The ultrasound must be obtained at least 24 hours before an abortion, which imposes difficulties on women who do not live close to abortion providers. Furthermore, a woman must receive counseling before obtaining an abortion. During counseling, the woman will be discouraged from getting an abortion. Following counseling, she must wait at least 24 hours before receiving an abortion. Furthermore, minors must receive parental consent if they wish to obtain an abortion. The use of telemedicine for the performance of a medical abortion is prohibited.

There are also strict timelines to consider. Before 20 weeks of post-fertilization, all reasons for an abortion are permitted. However, at or after 20 weeks, an abortion can only be performed if the woman's life is endangered, the pregnancy puts her at significant health risk, or if the pregnancy is "medically futile," which is "based on the spurious assertion that a fetus can feel pain at that point."

Furthermore, on January 1 2016, Texas House Bill 3994 ("HB 3994") went into effect. As explained by Planned Parenthood, "The law assumes all women seeking abortions are minors until they prove otherwise, and places the burden of proof on the physician performing the abortion to request a proof of identity and age.

Despite the severe restrictions placed on Texas women, they continue to seek abortions every year. According to studies, in 2011, 14% of pregnancies in Texas resulted in abortion. Overall, 13.5 out of 1000 women received abortions, though one should remember that some of these women may have been from out-of-state and some Texas women may have received abortions in other states.

What to Get & Where to Get It

• Houston Women's Abortion Clinic: They provide surgical abortions and MAYBE medical abortions (we'll need to confirm this). About $100 total for sonogram and pregnancy options counseling. "Since 1976, the Houston Women's Clinic has been the trusted leader in providing safe, compassionate and confidential abortion care." Address: 4820 San Jacinto Street, Houston, TX 77004. Hours: Mon – Fri 7:30 am – 5 pm, Sat 7:30 am – until done. Phone: 713-868-4483, 1-800-646-4483 (Toll Free).
• Planned Parenthood Center for Choice Ambulatory Surgical Center (Abortion)- Houston , TX: Services offered: abortion pill (medication abortion), in-clinic abortion, sedation options (medication to make the abortion more comfortable), pre- and post-abortion patient education, post-abortion follow-up exams, referrals for other abortion services, as needed. About $150 total for sonogram and pregnancy options counseling. "Please contact this health center for abortion services pricing information. They may not perform abortions on minors under 15 or on pregnant minors who are over 11 weeks pregnant.

If you are uninsured, you may be eligible to receive financial assistance for your procedure. You can confidentially find out if you qualify by calling us at 713.535.2400." Address: 4600 Gulf Freeway, Ste.300, Houston, TX 77023. p: 713.535.2400 | f: 713.535.2418.

• Aaron Family Planning Clinic/Women’s Pavilion: Provides surgical abortions for up to 20 weeks. May not provide medical abortions (abortion pill), so you should call to confirm. About $100 total for sonogram and pregnancy options counseling. They don't provide medical abortions (the abortion pill). Address: 2505 North Shepherd Dr., Houston, TX 77008. Phone: 713-272-6900.
• Suburban Women’s Medical Center of Northwest Houston: Provides medical abortions (for up to 7 weeks) and surgical abortions (for up to 15 weeks & 6 days). About $200-$250 for sonogram and pregnancy options counseling. "Some insurance plans cover abortion services and we accept insurance. We must verify this information before your appointment. Please call the office so that we may verify coverage prior to your appointment." They have 2 locations. Address #1: 17070 Red Oak Dr., Ste. 505, Houston, TX 77090. Phone: 800-233-0608, 281-440-1796. Address #2: 3101 Richmond #250, Houston, TX 77098. Phone: 713-222-9832.

Costs

Nationwide, the abortion pill can cost $800, but often less. For an in-clinic procedure, abortions can cost $1500, but often less. You can often find cheaper options at Planned Parenthood or some clinics. In Texas, Medicaid does not cover abortion.

Advocacy & Counseling

What to Get & Where to Get It

• National Domestic Abuse Hotline: 1-800-799-7233 | 1-800-787-3224 (TTY)

List of Additional Resources

• NARAL Pro-Choice Texas: "NARAL Pro-Choice Texas’ mission is to develop and sustain a constituency that uses the political process to guarantee every Texan the right to make personal reproductive health decisions and to guarantee access to the full range of options, including preventing unintended pregnancy, bearing healthy children, and accessing legal abortion."