With Roe gone, Planned Parenthood charts a new path
saw the writing on the wall.听
As president and CEO of Planned Parenthood Los Angeles, she has spent the past several years preparing for the possibility of this summer鈥檚 U.S. Supreme Court that ended the nearly 50-year constitutional right to abortion. With already banning abortion, she鈥檚 seeing a 鈥渄ramatic and substantial increase鈥� in the number of out-of-state patients inquiring about or traveling to Los Angeles for abortion care. It鈥檚 what she anticipated, considering that California is among the most abortion-friendly states in the nation, and so far, she says, her team has been able to handle the surge.听聽
鈥淏ut what has surprised me,鈥� says Ms. Dunlap, 鈥渋s how angry I feel and how sad鈥� at the 鈥渃ruel鈥� disruption of families, futures, and health care. 鈥淲e do a good job of planning, but planning hasn鈥檛 protected any of us, best I can see, from the hurt, and the anger, and the pain, and the shock.鈥�
Why We Wrote This
A story focused onPlanned Parenthood is synonymous with reproductive rights in America. Post-Roe, the organization is managing a new labyrinth of pregnancy options, while looking to a long-term strategy that combines persistence with abortion access, courts, and ballot boxes.
She hears all of that in the voices of parents who call her because their daughters are suddenly asking them whether it鈥檚 safe to attend college in a state with a ban. She sees increased fear in patients from outside California who don鈥檛 want to reveal where they are from; or who book appointments for one kind of service, and then reveal once they arrive that they came in to end a pregnancy.
To meet this moment 鈥� and the years ahead 鈥� Planned Parenthood and other abortion providers will need compassion, says Ms. Dunlap, who has worked for the nation鈥檚 leading provider of reproductive health care services for nearly 25 years. 鈥淸It鈥檚] really going to take deep, deep empathy and compassion for what it means to provide care or to need a safe place to turn, in what can be a very private, very personal moment.鈥澛�
At this historic time, when half the states are expected to ban or severely restrict abortion 鈥� affecting potentially of reproductive age 鈥� the Monitor spoke with leaders of Planned Parenthood affiliates, as well as others familiar with this nonprofit, about the way forward for their core mission of reproductive rights and access to care and information. Many others provide abortions or are abortion activists. But Planned Parenthood is the face of this movement 鈥� the聽 of abortion in the nation. Veterans like Ms. Dunlap spoke of compassion, and she and others also pointed to strategic persistence 鈥� the same kind of persistence that abortion opponents expressed in their decadeslong fight against Roe v. Wade, the 1973 Supreme Court ruling that made abortion a constitutional right.
鈥淲e鈥檝e watched anti-abortion folks for decades,鈥� says Jessica Pinckney, executive director of 鈥� a California fund that offers financial help for abortions with targeted support for people who face barriers to care, such as women of color. 鈥淚 think we need that same level of persistence, if not more, to build back and to build back better.鈥�
Going for more than a century
Planned Parenthood鈥檚 roots stretch back more than a century to Margaret Sanger, a nurse who wanted to educate women about birth control 鈥� illegal at the time, along with the women鈥檚 vote. Sanger, together with her sister and an activist, opened the country鈥檚 first birth control clinic in the Brooklyn borough of New York City in October 1916. Persistence personified, she endured legal interference and jail time to establish what is now the nation鈥檚 largest provider of sexual and reproductive health services and education.听聽
Today, the nonprofit Planned Parenthood Federation of America is a network of 49 affiliates that run more than 600 health centers around the country. Services include birth control, routine checks such as mammograms, screening and treatment of sexually transmitted diseases, and transgender health care. Abortion makes up just , but that option plays a large role in the lives of women. Despite dramatic drops in abortion rates, will have an abortion by age 45, according to a 2017 report by the Guttmacher Institute, a reproductive-rights聽research and advocacy group.听
Planned Parenthood鈥檚 abortion services have made its of aggression, including bombings, arson, protests, and even killings.The organization has weathered government funding restrictions and cuts, and an undercover video expos茅 alleging that Planned Parenthood illegally sold fetal tissue. Various investigations and courts .听
But to this day, it is still dealing with a painful legacy of its founder. Sanger believed in eugenics, which holds that society could be improved by breeding for 鈥渄esirable traits.鈥� Eager for any audience to spread her birth control message, she also spoke before the women鈥檚 auxiliary of the Ku Klux Klan, and she endorsed the 1927 Supreme Court ruling that states could forcibly sterilize 鈥渦nfit鈥� people without their consent.听聽
Planned Parenthood has Sanger鈥檚 beliefs. But the stain lingers, for instance, in the opinions of Supreme Court Justices Clarence Thomas and Samuel Alito, who in his majority opinion in this summer鈥檚 case, Dobbs v. Jackson Women鈥檚 Health Organization, which reversed Roe.听
鈥淧lanned Parenthood has obviously come a long way from Margaret Sanger鈥� to address the eugenics issue, says Ms. Pinckney of . But there鈥檚 more work to be done, she says, considering the 鈥渁bysmal鈥� access to abortion care for Black women. Black, Hispanic, and Native American women are 聽more likely to die from pregnancy-related causes than are white women, according to the Centers for Disease Control and Prevention.听
She points particularly to the need for the Planned Parenthood Federation to improve its relationship with reproductive justice organizations, which are often an afterthought. Ms. Pinckney has a staff of two to handle hotline calls, which have doubled in the last year. Still, she鈥檚 optimistic about cooperation in California. 鈥淚 think we鈥檝e really come together in the last year or so, particularly as we prepared for this influx of people.鈥澛�
Two years ago, the Planned Parenthood Federation appointed its first Black CEO and president since 1978, Alexis McGill Johnson. Because of 鈥渃enturies of racism and discrimination,鈥� she said in a statement about Dobbs, 鈥渨e already know who will feel the consequences of this horrific decision most acutely: Black, Latino, and Indigenous communities, people with disabilities, those living in rural areas, young people, immigrants, and those having difficulties making ends meet.鈥澛犅�
In media interviews, Ms. McGill Johnson has identified a three-pronged strategy in the wake of this summer鈥檚 ruling: greater access to abortion, taking the fight to state courts, and winning at the ballot box.
Building access in LA
As women and girls in ban states seek abortion beyond their borders, wait times can be up to three weeks in legal states such as Illinois and Kansas. On Aug. 2, Kansas voters decide whether to remove abortion protections from their state constitution.听聽
Planned Parenthood Los Angeles, which operates 24 health centers, is also seeing a surge in patients, particularly from neighboring Arizona, where providers have halted abortions due to confusion over the law.听
Yet Ms. Dunlap says their health centers have been able to ensure prompt access to surgical abortion 鈥� either the same day or within 24 hours. They are striving for swift access to medication abortion as well, but the laws and legal understanding of that is 鈥渟hifting rapidly.鈥� Meanwhile, a network of specialized navigators helps connect people with services, advice, and funds 鈥� including for out-of-state patients who need help with child care, travel, hotels, and abortion costs.听聽
鈥淚 watch the data every day and I鈥檓 very proud of where our teams are now,鈥� says Ms. Dunlap.
Preparation for this moment began five to seven years ago. Persistently, she set about building a pipeline for the future 鈥� partnering with the UCLA聽 to grow the next generation of reproductive-rights lawyers and coordinating with medical schools to train more doctors and nurse practitioners. She changed the footprint of clinics to be closer to transportation hubs and medical centers for delayed care. And she鈥檚 expanded services, including behavioral health care for traumatized patients and staff.听
Ms. Dunlap finds 鈥渉ope in the fight,鈥� and comments how fortunate she is to be in the safe haven state of California. Here, Medi-Cal (the state鈥檚 Medicaid program) and private insurance . State legislators are in the process of passing a dozen bills to expand access, including to people from out of state 鈥� helping to cover abortion expenses and building legal walls of protection around providers and patients. In November, voters will decide whether to enshrine abortion rights in the state constitution.
Finding care 鈥� from Texas
While California is a sanctuary state for abortion, Texas is the opposite. in the Lone Star State, the birthplace of Roe.听聽
, president and CEO of Planned Parenthood of Greater Texas, says they are following 鈥渢he strictest terms of the law鈥� at their affiliate, which is the largest and oldest in the state with 25 health centers. 鈥淢y job is to keep them open鈥� so that they can persist in providing contraception, testing and treatment, transgender and education services. 鈥淲e鈥檝e been in Texas for 87 years. We鈥檙e not going anywhere.鈥澛�
The personal stories of people who have come to Planned Parenthood鈥檚 clinics seeking abortion assistance since Roe鈥檚 reversal are 鈥渉eartbreaking,鈥� says Mr. Lambrecht. He recalls a single mother 鈥� most abortion patients 鈥� with an ill child in a local hospital who had to leave the state to end her pregnancy because she could not parent a second child while caring for her sick child. Planned Parenthood worked with others to get her child care while she was gone.听
Another woman, with eight children, visited a health center to terminate a pregnancy and was referred out of state. 鈥淎fter multiple hours in tears, she left.鈥澛�
Because of confusion over multiple laws, the medical profession in Texas is perplexed about how to treat pregnancies gone awry and miscarriages. Mr. Lambrecht says assuredly that doctors are allowed to manage miscarriages, but 鈥渋t鈥檚 gut wrenching that we can鈥檛 provide abortion here in Texas, because we believe people will die.鈥�
Legally, Texans cannot tell other Texans where to go for an abortion or do hands-on navigation, says Mr. Lambrecht. The most they can do is refer people to informational websites, such as . His affiliate has also handed out more than 100,000 free pregnancy-prevention 鈥渆mpowerment kits鈥� that contain emergency contraception, a pregnancy test, and condoms.
Planned Parenthood has a legal strategy in Texas, says Mr. Lambrecht, but he doesn鈥檛 want to talk about it for fear of jeopardizing it. He has six law firms on tap for advice. 鈥淚 feel like I鈥檓 surrounded by lawyers.鈥�
Legal assault聽
Since the , Planned Parenthood and its courtroom partners, the American Civil Liberties Union and the Center for Reproductive Rights, have filed . In many cases they argue that bans or very restrictive laws violate a state鈥檚 own constitution 鈥� such as right-to-privacy protections that cover abortion or rights to personal or bodily autonomy.听
But it鈥檚 going to be an 鈥渦phill battle鈥� in the anti-abortion states, says , faculty director for the Center on Reproductive Health, Law, and Policy at UCLA School of Law 鈥� the same center that Ms. Dunlap pushed for, and which estimates that 8,000 to 16,000 people will for abortion services each year.
Professor Franklin describes a persistent, step-by-step, state-by-state, generational fight that will have 鈥渕ixed鈥� results because Republicans were more focused on getting judges friendly to their abortion views in courthouses than were Democrats. 鈥淲e鈥檙e now in the position that anti-abortion groups were a generation ago. ... They worked. They were flexible. And they kept going to court and arguing, and we鈥檙e going to do that.鈥�
Victories will require creative thinking, and Professor Franklin hopes the new center at UCLA will become a hub for that. Abortion proponents 鈥渃lung to Roe鈥� and now they have to 鈥渂uild up a new set of arguments for the 21st century.鈥� One route might be to argue abortion rights under the equal protection clause of the 14th Amendment instead of the 鈥減rivacy鈥� argument. And some strict state laws may fall on their own because of the harm or death they cause to pregnant women, she says.听
But, she says, 鈥渋t won鈥檛 be possible to litigate our way out of this problem.鈥�
Rallying the vote聽
Kansas becomes the first state test on Aug. 2, when voters decide whether to remove abortion rights from the state constitution and hand it to state legislators. Abortion-rights voters were caught off guard by Dobbs, but the decision and the possibility of a state ban by legislators has energized them, says , communications director for Planned Parenthood of the Great Plains (Kansas).听
Last month, President Joe Biden declared that 鈥溾�� to restore a woman鈥檚 right to choose 鈥渋s by voting.鈥� He called for voters to elect two more senators who support abortion rights and a Democratic House in order to codify Roe in national legislation. On Monday, a bipartisan group of senators unveiled a bill that would codify Roe, but is expected to face an uphill battle. Advocates are also intensely focusing on state and local races.
The anti-abortion side also agrees that the road for abortion advocates runs mainly through the electoral process. After their Waterloo at the Supreme Court, 鈥淭hey will have to take their case to the American people to support specific candidates or legislation,鈥� says , president of the , the nation鈥檚 oldest and largest anti-abortion group.听
Ms. Tobias says it took persistence over decades and a strategy of incrementalism for her side to pass hundreds of state laws to restrict access to abortion and to finally overturn Roe at the Supreme Court. Their goal remains the same 鈥� 鈥渢o realize, as a country, that unborn children deserve protection 鈥� but that鈥檚 going to take many years.鈥澛�
Ms. Tobias describes a 鈥渨eakness鈥� in the message of Planned Parenthood and others: 鈥淭hey are insisting on abortion for all nine months for any reason,鈥� she says. 鈥淭hat does not have overwhelming support in the country.鈥� In practice, nearly are in the first trimester, and less than 1% occur in the third, according to the CDC.听
Some 57% of Americans disagree with the Supreme Court鈥檚 decision and 62% believe abortion should be legal in most or all cases, by the Pew Research Center taken after the ruling.
鈥淭he potential that Planned Parenthood has at the moment is that a lot of the country views them favorably, and that gives them a platform to promote abortion rights,鈥� says , a political scientist at Pitzer College in Claremont, California, and author of the book 鈥溾�澛�
This election, Planned Parenthood and abortion advocates and are spending $150 million on targeted races. That鈥檚 a 鈥渕ajor effort,鈥� says . Abortion can motivate audiences, like younger women, and it can persuade swing voters, like suburban women. 鈥淚t鈥檚 an issue that does that without any backlash because the other side鈥檚 already motivated, and it can definitely be a determinant in close races.鈥澛�
She believes it can gain Democrats at least two Senate seats, but 鈥渋n the House, it鈥檚 hard.鈥� Traditionally, voters turn against the party of the president in the first midterm, and President Biden鈥檚 approval ratings hit a new low in July 鈥� , according to a Quinnipiac University poll.听聽
鈥淚 can鈥檛 say I鈥檓 particularly hopeful over the next year, but I am if we鈥檙e talking in generational terms, because most Americans support termination in some circumstances and they don鈥檛 agree with this decision,鈥� says Professor Franklin. 鈥淭his is going to be a long story.鈥�
