Member of the Month: Janet Realini, MD, MPH

A patron saint of Texas women’s health

By Perdita Henry

posted 04.12.17

The 1960s was a time of change, resistance, and demands for equality. In fact, amongst this background of change, a pill revolutionized family planning and the lives of women forever. The birth control pill provided women with more control over their reproductive choices and therefore expanded their opportunities.

In 2017, the struggle continues and right here in Texas many are still fighting the good fight to make sure women maintain access to health care and education needed to make the best decisions for their futures.

Janet Realini MD, MPH, a native San Franciscan, came of age in the era of women gaining reproductive rights. The women’s rights movement is a part of what inspired her career journey and led her to become something of a patron saint for women’s health care in the state. She is the president of Healthy Futures of Texas and chair of Texas Women’s Healthcare Coalition. As summer approaches and she prepares to step down from her role as president, I caught up with her to find out what she thinks about the health care challenges facing Texas and the joy she’s found in building relationships within the world of advocacy.

Tell me a little about yourself and your career.
I grew up in San Francisco and came to San Antonio for my family medicine training. I served 18 years teaching on the faculty at UT Health in San Antonio. After receiving my Masters of Public Health, I spent 10 years at San Antonio Metro Health, where I served as medical director of the family planning program and helped to start Project WORTH, the city of San Antonio’s youth development and teen pregnancy prevention program.

I quit my “day job” to focus on Healthy Futures of Texas, which has grown and developed, with a great team of stars who provide and promote what works to prevent unplanned and teen pregnancy in San Antonio and across the state.

I wrote “Big Decisions” to ensure that youth have access to the basic information they need to make healthy choices about sex, with their parent or guardian’s permission. “Big Decisions” is abstinence-plus and designed to be Texas friendly, i.e., comfortable for conservative communities to embrace.

The Texas Women’s Healthcare Coalition is a project that Healthy Futures developed after the devastating family planning cuts of 2011. Now with 67 organizational members, TWHC has brought together health care, faith, community, and advocacy groups to speak with one powerful voice to support access to preventive care — including contraception — for all Texas women.

Why did you choose family medicine and what’s your favorite aspect of it? Were you inspired by anyone?
Family medicine has always been my idea of what a doctor should be. My favorite aspect of it is the relationships that a family doctor develops with their patients. That is the part I miss most, since I have been devoted to outside-the-exam-room work.

What is your favorite part of advocacy work?
Relationships are my favorite part of the advocacy work. Working with other advocates, with legislators, agency staff, providers, and community stakeholders is exciting when we are working for an important cause like access to preventive care and contraception. But it is the relationships that make the work a true joy.

You’ve been a long-time champion of women’s health. What inspired you to enter advocacy?
I have felt close to adolescent and women’s health issues since before I can remember. I grew up in a time when the new birth control pill changed the landscape for women, allowing them to choose when and if they become pregnant. For me, this has meant the opportunity for education and career — to fulfill more roles and contribute more to the world. For women and for our society, this has meant a transformation with women having the power to contribute in many ways. My journey has been one of exciting opportunities and many privileges. I want all adolescents to have such opportunities for their lives. I want all women and men to be able to find fulfillment as people — and as parents, when they choose to become parents.

When facing the challenges and setbacks of making sure Texas women have access to health care, what keeps you going?
The importance of the work keeps me going. My goals have been to safeguard contraception in the setting of conflicts over abortion and to bring together “pro-life” and “pro-choice” people to work on effective prevention methods for unplanned pregnancies.

Texas has made substantial progress since the 2011 family planning cuts. I am heartened by the strong bipartisan support for contraception in the Texas Legislature, but we still have far to go. Every day I think about how I can best make a difference so that all people have access to the information and the health care they need.

From your perspective, how would you characterize the most important public health threats Texas women face?
Texas women have the highest maternal mortality rate of any state — higher than many third-world countries. Preventive care and contraception are incredibly important in addressing this issue in two ways: preventing unplanned pregnancies that can stress women with health issues and serving as an entry to health care for women with health risks.

Texas also needs better access to care for women — and men — with diabetes, hypertension, obesity, substance abuse, and depression. Our number and percentage of uninsured is the highest in the nation.

Zika virus is another lurking threat to future pregnancies and children. With increasing temperatures in the spring and summer, Zika could make a return to our state. Here again, preventive care and contraception are essential services.

What has been the proudest moment or a biggest success in your public advocacy career so far?
It is hard to single out any one moment as our proudest. In 2013, the restoration of women’s health funding was a great success for the TWHC, along with other advocates. In 2015, we helped to ensure that the Family Planning Program continued and would be able to increase in size and reach. In 2017, we are hoping for even stronger women’s health programs going forward.

What public health initiatives do you wish more Family Physicians’ would champion?
I would say simply, “Get involved!” TAFP and the Texas Medical Association do excellent work, and both are members of TWHC. Your perspectives and your leadership are important in the advocacy for women and all people of Texas. If you can, volunteer to serve on a committee, commission, or council. Know your representatives and your state senator, and let them know how you feel about the public health issues you see.

For more information about Healthy Texas Futures visit www.hf-tx.org, and for more information about Texas Women’s Healthcare Coalition visit www.texaswhc.org.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. View past Members of the Month here.