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By Rick Jervis, USA TODAY

AUSTIN - Emily Howell's frequent trips to the Planned Parenthood clinic on East Seventh Street here have less to do with preventing unwanted pregnancies and more about keeping cancer from creeping back into her body.

Eleven years ago, Howell beat a malignant tumor in her stomach. Today, she visits the clinic for free cervical exams, breast screenings, STD testing and birth control pills - none of which she could afford.

"It's a huge burden off me," says Howell, 30, an environmental sciences student at Austin Community College. "Pregnancy and cervical cancer are the last things I need to worry about."

Those services, however, may soon vanish in an ongoing struggle between conservative Texas lawmakers and women's groups here to curtail funding for Planned Parenthood and other clinics affiliated with abortion providers.

Last year, the Republican-controlled Legislature slashed $74 million from the Family Planning Program, resulting in the closings of 155 clinics across the state. The clinics offered services such as cervical exams, breast exams and free birth control but, under state law, could not provide abortions.

In another move, lawmakers passed a law essentially shutting out Planned Parenthood from funding through the state's Medicaid Women's Health Program. Together, the two moves would cut services to more than 300,000 low-income women annually across Texas, according to the Texas Legislative Budget Board.

On Monday, a U.S. District judge ruled that Texas cannot exclude Planned Parenthood from the Women's Health Program. The ruling is a temporary injunction, and a final ruling is expected later.

"The ruling today is great news for Texas women," says Sarah Wheat, interim chief executive officer of Planned Parenthood of the Texas Capital Region. "It's a clear message that politics doesn't belong in women's health care."

Gov. Rick Perry's administration, which supports the cuts, appealed the ruling. "Texas has a long history of protecting life, and we are confident in Attorney General (Greg) Abbott's appeal to defend the will of Texans and our state law, which prohibits taxpayer funds from supporting abortion providers and affiliates in the Women's Health Program," Catherine Frazier, the Republican governor's press secretary, said in a statement.

'Death by a thousand cuts'
Supporters of the cuts say they are part of a belt-tightening effort to deflate the state's $27 billion deficit - with a special focus on cutting funds for abortion-related groups.

"We went after not just the abortionists but those who did the health checks, screenings and would refer people to the abortionists," says state Rep. Wayne Christian, a Republican, who voted for the cuts. "Citizens in Texas do not want to support abortions with their tax dollars."

Women's rights advocates decry the cuts as an attack on women's reproductive rights. The moves will lead to more unwanted pregnancies and potentially more abortions, especially in a state that ranks third in the USA in teen pregnancies and has the highest percentage of uninsured residents in the country, says Regina Rogoff, chief executive officer of People's Community Clinic, which lost $526,000 of its operating budget to the cuts. "It's a concerted effort to set back the rights of women," she says. "It's death by a thousand cuts."

The Texas cuts are the latest in a nationwide effort by states to defund family planning services, says Elizabeth Nash of the Guttmacher Institute, a New York-based policy and research center that advocates reproductive health rights for women.

Last year, lawmakers across the USA introduced more than 1,100 reproductive-health and rights-related provisions, up from 950 the year before, Nash says. "We have never seen so many attacks on family planning as we did last year," she says.

Recent examples:
•New Hampshire lawmakers last year voted to cut more than $1 million from the state family planning budget, says Jennifer Frizzell, senior policy adviser with the Planned Parenthood of Northern New England.

•Two Tennessee Planned Parenthood groups filed a federal lawsuit against the state in February for redirecting more than $150,000 in federal grant money away from the non-profit clinics, according to court documents.

•Arizona lawmakers are considering a bill that would prohibit the state from contracting with any group that performs abortion or runs a facility where abortions are performed, according to the Center for Arizona Policy.

Affects low-income women
In Texas, one of the biggest casualties of the cuts was Planned Parenthood, which had to close 11 of its 76 clinics across the state, mostly in poorer areas, such as the Rio Grande Valley to the south, Wheat says. None of the closed clinics performed abortions.

Clinics in Austin and other large cities were able to stay open through last-minute fundraising, she says. But without new funding streams, the future of the clinics is uncertain. "We're literally in brand-new, uncharted waters," Wheat says.

Community Action Network, a group that serves low-income women in rural areas, had to close two of its four clinics in central Texas - an abrupt loss of services low-income women have relied on for four decades, executive director Carole Belver says.

"It's taken 45 years to build up the infrastructure we have in the state of Texas to provide health care services for low-income women," Belver says. "This is going to unravel all of it."

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