Q&A: Rep. Donna Howard on reproductive health care in Texas

Representative Donna Howard has served in the Texas Legislature for 14 years, working in numerous policy areas including women’s health and nursing policy. She previously worked as a critical care nurse and is a former president of the Texas Nurses Association. This session, she sits on the House Appropriations and State Affairs committees. She is also the Chair of the Women’s Health Caucus in the Texas House of Representatives.

In this Q&A, she speaks with State of Reform about her efforts to expand access to reproductive health for Texas women in the midst of the majority party’s attempts to do the opposite. She also discusses the benefits of establishing a state immunization registry and the necessity of protecting health care workers from workplace violence.


Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.


Eli Kirshbaum: What made you sponsor HB 4389, your bill to eliminate numerous statutory restrictions to abortions and other reproductive health supports? Since it hasn’t received a committee hearing yet, what are your predictions for its future?

Rep. Donna Howard: “I have been active in women’s health care issues for quite a while, but this session in particular, I am Chair of the Women’s Health Caucus, so I have more of a leadership role in addressing these issues. And it’s not just about abortion, it’s about all women’s health issues, whether it’s about abortions, access to care — whether it’s through expanding post-partum Medicaid or increasing access to contraceptives — making sure that we’re addressing maternal morbidity and maternal mortality, and even looking at sexual harassment and sexual assault issues. But certainly, reproductive health care and abortion in particular is something that we continually need to address in the Women’s Health Caucus, as that has come up every session.

The bill you’re referring to in particular, HB 4389, the ‘Abortion is Health Care Act,’ is an omnibus bill that attempts to rescind the decades worth of legislation that has been passed by the Texas Legislature, that has impeded and obstructed access to this legal medical procedure.

More than likely, it will not get a hearing, but it’s still making a statement about the fact that these are cumulative pieces of legislation that have eroded access to abortion. It’s quite an extensive list, and certainly we would want to repeal as much of that as possible, but I guess you could classify this as putting a major statement out there about what all has been done in counterpoint to what [the Legislature] continually puts before us … So it has not been filed with the expectation that it will even get a hearing, much less come to the House floor, much less get to the Senate or pass out of this Legislature. But it’s still making a statement.”

EK: Have you had any conversations with opponents of this bill? Is it something that’s negotiable, where you might consider introducing a modified version in the future?

DH: “We’ve often-times offered bits and pieces of this, and typically even taking a small step in met with total resistance. We are clearly in the minority in terms of votes in the Legislature, so it’s almost a fool’s errand to figure what can be done to really reverse some of the damage that’s been done. That doesn’t mean we won’t keep trying and that we can’t still find ways to break down small pieces that somehow could make it through. But right now, this is an issue that is so fundamental to those that have the majority votes in the Legislature, that there has been little to no willingness to negotiate anything — to do anything other than what they have the majority vote to be able to do.”

EK: Speaking of which, SB 8 — a broad bill to restrict abortions — is making its way through the Legislature. Do you think this will pass?

DH: “Indeed, I do think that it’s quite possible that it would have the support to pass. It’s being called the ‘six week ban’ because of the way the wording is. It’s not just having a heartbeat, which doesn’t exist at that point in time, but any electrical activity is what is defined in the bill as being the cutoff point at which you can have an abortion. So, there are electrical cells that exist at that time that do emit some kind of electrical pulsation, but there is no heart, there are no chambers, there is no pumping of blood — none of that is occurring at this point gestationally. But again, it’s how you frame it as a narrative, and they’ve been able to capture the narrative, referring to it as the ‘heartbeat bill,’ though there is no heartbeat at this time.

There are a couple of things that I think are important to think about here with that piece of legislation. One is that we determine gestational age based on the last menstrual period, and more often than not you don’t get pregnant until at least two weeks or longer since your last period. So we’re in essence talking about a four week pregnancy. We refer to gestation, as I said, from your last period, so that’s why it’s called ‘six weeks.’ That’s the common terminology used in medicine. 

But many people, of course, who get pregnant, don’t even know they’re pregnant at that time, especially if they have irregular periods or they aren’t paying attention exactly to when they had their period. Two weeks later than you normally would have had it is not particularly unusual for many … This is not a hyperbole: it can occur before you even know you’re pregnant, so that you don’t have the opportunity to even consider the choice.

What’s also made this particular piece of legislation more critical for its immediate impact is that they have attached a private cause of action to it. So basically, anyone who wants … Can sue anyone who helps in accessing the abortion, or certainly, [in] providing the abortion. So anyone can sue the woman herself, the provider of the abortion, anybody who may have provided a referral, anyone who may have provided the monetary assistance to get the abortion, anyone who may have provided transportation — anything. If you’ve done anything at all to aid the performance of the abortion, you may be sued based on this language, which opens up a huge can of worms in terms of the potential for massive litigation. That has not been part of these six week ban bills that have been passed in other parts of the country. 

So this is a new tactic that has made this an even more dangerous piece of legislation in that [in] a lot of the obstructionist bills, you can get injunctions in court and still be able to perform an abortion while you’re waiting on court rulings. With this private cause of action being attached to this, there’s not the opportunity to pursue that legal remedy, and therefore, there would be an immediate halt to abortions in that anyone who would perform it at that point would be liable for a lawsuit immediately.”

EK: Can you talk about the bill you’re sponsoring to establish a state immunization registry, HB 325? Why do you feel the state needs such a registry?

DH: “I have sponsored legislation about modernization our ImmTrac registry system almost since I got to the capitol. I’ve had multiple bills that have made little steps forward here and there, but the big issue here when you get down to it is whether or not it’s an ‘opt out’ or an ‘opt in’ system, and we are one of only a couple of states in the country that have continued to require that you have to opt in, which has established additional bureaucratic steps and costs to making that happen. And that is actually only catering to probably about 5% of the population, who are primarily self-identified as people who are opposed to vaccinations, and even though you’re not required to have a vaccination to utilize ImmTrac, it’s been conflated with that issue, and those in the Legislature who are swayed by that and arguments of privacy — even though we have strong privacy safeguards around this — have been unwilling to let this kind of legislation go forward.

We’ve always been warning that an epidemic or a pandemic will happen eventually, and that we need a modernized, robust registry system to help us be able to adeptly manage our vaccinations for that pandemic — and here we are. So what has happened is COVID has really opened a lot of eyes about how the system needs to be revised. And what we have seen is that because we have kind of a backwards system compared to the rest of the country, [for] the standards that are used everywhere else, you have to retrofit in Texas. 

And that has added additional burdens for the providers who administer the vaccines. They have had to actually manually administer a lot of the data, which means it’s not timely, and it’s got more potential for errors, and it’s this information that is used to track where the vaccines have gone, where we need to make sure we get more. When you have a system where you have more than one dose that’s required, [providers have to make sure] that’s in the system so you can follow up with folks and make sure they get their second dose. There may be booster shots that will be required later, you would have that information in the system. So there’s just a lot of reason to maintain the registry in a way that better serves the information we need to manage epidemics.

It’s a much simpler way to do it, it takes less time, it’s more accurate, this is what the providers have wanted because they’re spending an inordinate amount of their time [during which] they could be taking care of patients, and instead having to do this manual entry of data. So it’s really just that simple.

There is another ImmTrac-related bill that has had a hearing. That is a bill that is authored by the Chair of [the] Public Health Committee, Stephanie Klick. Hers doesn’t have the same opt-out, opt-in [provisions] to it, but it does have an easier consent mechanism for first responders. So it’s somewhat related. And what we’re looking at here is perhaps amending HB 325 to her bill, which just passed out of committee yesterday … We’re starting to run out of time. Hers has the potential to get to the floor, and if we can get ours amended onto that, then we will use that as a vehicle to try to get this through. But these are the things that you just try.”

EK: HB 326, your bill to increase protection from violence for health care workers, has gained bipartisan support and recently passed out of the House. Can you describe why you’re sponsoring this bill?

DH: “This is also something I have worked on incrementally over the years. I have worked with the stakeholders in terms of the nursing association as well as the hospital association, and other providers too, as we have tried to find ways to create a safer workplace for nurses and other health care providers without making it a cookie cutter, one-size-fits-all, because not all hospital regions are the same, and may need different approaches. 

We have had a study done in one session, we’ve had grants for some demonstration projects and best practices, and now this session, we’re actually at a point of requiring that every hospital actually have a committee that addresses safety issues in the workplace, and that actually has some policies and procedures in place. That has reporting mechanisms, that ensures that necessary treatment is provided to anyone who is the recipient of violence in the workplace. So there’s a lot of things now that we are pushing into the next level, but we are doing it with full agreement of those providers, so it’s been a real effort to continually work with the stakeholders.

Some people don’t understand that working in health care carries a higher risk of violence than just about any other workplace you might find yourself in. OSHA [the Occupational Safety and Health Administration] reported that health care workers were four times more likely to experience serious workplace violence. The state has as Center for Nursing Workforce Studies in the Department of State Health Services, and they did a study a few years back that showed that almost 50% of all nurses they surveyed have had some kind of physical violence [directed at] themselves in the workplace over their career. But only 40% of them actually reported their incidents, because it’s been expected to just be a part of the job.

I’m carrying the bill, but I have as my joint author Stephanie Klick. We are both nurses — me a Democrat, Stephanie a Republican. We’ve both, in our history of working in nursing, have had violence … The thing that needs to be clear here is that most of this is not being done maliciously. You have people who are medicated, who may have psychiatric issues, all kinds of reasons, who nurses are called upon to care for, and who, unfortunately, get subjected to this violence that you wouldn’t expect necessarily.”

This interview has been edited for clarity and length.