Around the clinic, coordinator Judy Guinn is known as “The Condom Queen” because of her attention-grabbing bouquets of condoms on popsicle sticks. Nurse Kay Wadsworth makes her high school patients promise to come see her before they head off to college. Director Carole Parker knows almost everyone’s name who walks through her door.
Together, they are a three-woman show, operating Midway Family Planning clinic in Brownwood, about 80 miles southeast of Abilene. For almost 20 years, the clinic has provided contraception, STD testing and Pap smears from a building in Brownwood’s public housing projects, an unusual setting that puts the services amid some of the town’s poorest residents. But Midway almost shut down in late 2012 after the Texas Legislature made deep cuts to the state family planning program. The clinic limped along on a volunteer basis for months until funding through the federal family planning program, Title X, kicked in in mid-2013.
Title X has been a regular target of Republican lawmakers at both the state and federal levels, because some of the money reaches Planned Parenthood health centers. In 2012, after the Legislature slashed Texas’ family planning funds, the feds rerouted Title X money away from state oversight and to the nonprofit Women’s Health and Family Planning Association of Texas (WHFPAT), instead. Now, the nonprofit, instead of Texas, is responsible for getting those funds to providers like Midway.
“On average it costs less than $240 dollars to provide a year’s worth of family-planning services to each client,” Fran Hagerty, president and CEO of WHFPAT, wrote to the Observer this summer, responding to lawmakers’ latest proposal to defund the program. “Compare that to the cost of just one Medicaid-paid birth at over $12,000, and it doesn’t take a math whiz to figure out the financial benefit of the Title X program to Texas and the nation.”
But Parker and her team don’t have time for politics. For their patients, who are often uninsured, homeless, parentless, or just struggling to get by, Midway Family Planning is the only place nearby that offers free reproductive health services, including long-acting reversible contraception (LARC). Because of rules unique to Title X, the clinic can’t turn away anyone, regardless of ability to pay. Minors can get birth control without their parents’ consent. The clinic is also the only place in town that offers free STD and HIV testing.
If patients “had unprotected sex over the weekend, they feel comfortable that they can walk in and get birth control,” Parker said. “If a girl had sex with a person who is HIV positive, we’re right here where she is, she can talk to us.”
Parker became director of Midway Family Planning in 2011, after her mother, Joy Parker, who founded the clinic in 1998, fell ill with breast cancer. In the conservative community of Brownwood, where Mike Huckabee headlined the local crisis pregnancy center’s “Everyone Deserves a Birthday” event earlier this year, Parker says the family planning and STD prevention services she provides are sometimes met with resistance because some community members associate birth control with abortion.
“You can say we’re really about prevention, but they don’t hear that,” Parker said. “It’s not as bad as it was about two years ago, but there’s still a slow undercurrent.”
Midway is located inside of one of Brownwood’s seven public housing complexes. To qualify to live in one of Brownwood Housing Authority’s 236 public housing apartments, a family of four must earn less than $42,000 a year. The seven complexes are always full, and there is currently a wait list.
“A lot of these people don’t have vehicles, money, and to be able to walk right across the street and be able to be seen by a clinic like this, it’s incredible,” said Christy Mercer, managing agent supervisor at the Brownwood Housing Authority. Midway Family Planning staff, she said, “are a true asset to our complex.”
Parker aims to create a place where people not only have to come, but want to come, for health care. Patients are warmly greeted when they enter the nondescript clinic, which has the homey feel of your great aunt’s living room, decorated with faux flowers, leopard-print curtains and comfortable furniture. After seeing either the nurse or nurse practitioner, who visits once a week, patients can grab one of Guinn’s gift bags of condoms on their way out.
Texas receives about $14 million a year in Title X funding, which WHFPAT has managed since 2013. Title X providers in Texas served 140,000 patients in WHFPAT’s first year overseeing the program, up from 132,000 patients under state management the year before. That year, the Texas Department of State Health Services left approximately $2.3 million in Title X funds unspent.
But providers like Midway can find a use for every dollar. With the $76,000 a year Midway Family Planning receives, Parker has been able to pay medical staff, who volunteered after the state cuts. Midway is also expanding its space and buying more medical equipment. Last year, the clinic served about 900 patients and is on track to see more than 1,000 by the end of this year.
As family planning providers statewide have shut down, reduced clinic hours or started charging for previously free services, and more than half of Texans receiving reproductive health services report access challenges, places like Midway have become more critical. The clinic sees patients from as far away as Ranger, 70 miles to the north, as well as Ballinger, San Angelo and Comanche. Some can’t find affordable health services in their hometowns, or others, like 22-year-old Megan Todd, have health insurance, but other providers are at capacity.
On a recent visit to Brownwood from Abilene, where she lives and works as a retail store manager, Todd “swung by” to get her birth control shot.
“You know that they care,” she said. “They make things less stressful, and it’s nice to have a place that you can rely on.”