Susan Dunlap saw the writing on the wall.
As president and CEO of Planned Parenthood Los Angeles, she has spent the past several years preparing for the possibility of this summer’s U.S. Supreme Court ruling that ended the nearly 50-year constitutional right to abortion. With eight states already banning abortion, she’s seeing a “dramatic and substantial increase” in the number of out-of-state patients inquiring about or traveling to Los Angeles for abortion care. It’s 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.
“But what has surprised me,” says Ms. Dunlap, “is how angry I feel and how sad” at the “cruel” disruption of families, futures, and health care. “We do a good job of planning, but planning hasn’t protected any of us, best I can see, from the hurt, and the anger, and the pain, and the shock.”
She hears all of that in the voices of parents who call her because their daughters are suddenly asking them whether it’s safe to attend college in a state with a ban. She sees increased fear in patients from outside California who don’t 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 – and the years ahead – Planned Parenthood and other abortion providers will need compassion, says Ms. Dunlap, who has worked for the nation’s leading provider of reproductive health care services for nearly 25 years. “[It’s] 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.”
At this historic time, when half the states are expected to ban or severely restrict abortion – affecting potentially 36 million women of reproductive age – 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 – the largest provider of abortion in the nation. Veterans like Ms. Dunlap spoke of compassion, and she and others also pointed to strategic persistence – 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.
“We’ve watched anti-abortion folks for decades,” says Jessica Pinckney, executive director of Access Reproductive Justice – a California fund that offers financial help for abortions with targeted support for people who face barriers to care, such as women of color. “I think we need that same level of persistence, if not more, to build back and to build back better.”
Going for more than a century
Planned Parenthood’s roots stretch back more than a century to Margaret Sanger, a nurse who wanted to educate women about birth control – illegal at the time, along with the women’s vote. Sanger, together with her sister and an activist, opened the country’s 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’s largest provider of sexual and reproductive health services and education.
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 4% of its business, but that option plays a large role in the lives of women. Despite dramatic drops in abortion rates, nearly 1 in 4 women will have an abortion by age 45, according to a 2017 report by the Guttmacher Institute, a reproductive-rights research and advocacy group.
Planned Parenthood’s abortion services have made its facilities and staff a target of aggression, including bombings, arson, protests, and even killings.The organization has weathered government funding restrictions and cuts, and an undercover video exposé alleging that Planned Parenthood illegally sold fetal tissue. Various investigations and courts found no wrongdoing.
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 “desirable traits.” Eager for any audience to spread her birth control message, she also spoke before the women’s auxiliary of the Ku Klux Klan, and she endorsed the 1927 Supreme Court ruling that states could forcibly sterilize “unfit” people without their consent.
Planned Parenthood has forcefully rejected Sanger’s beliefs. But the stain lingers, for instance, in the opinions of Supreme Court Justices Clarence Thomas and Samuel Alito, who referenced it in a footnote in his majority opinion in this summer’s case, Dobbs v. Jackson Women’s Health Organization, which reversed Roe.
“Planned Parenthood has obviously come a long way from Margaret Sanger” to address the eugenics issue, says Ms. Pinckney of Access Reproductive Justice. But there’s more work to be done, she says, considering the “abysmal” access to abortion care for Black women. Black, Hispanic, and Native American women are two to three times more likely to die from pregnancy-related causes than are white women, according to the Centers for Disease Control and Prevention.
She points particularly to the need for the Planned Parenthood Federation to Boost 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’s optimistic about cooperation in California. “I think we’ve really come together in the last year or so, particularly as we prepared for this influx of people.”
Two years ago, the Planned Parenthood Federation appointed its first Black CEO and president since 1978, Alexis McGill Johnson. Because of “centuries of racism and discrimination,” she said in a statement about Dobbs, “we 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.”
In media interviews, Ms. McGill Johnson has identified a three-pronged strategy in the wake of this summer’s 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.
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.
Yet Ms. Dunlap says their health centers have been able to ensure prompt access to surgical abortion – 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 “shifting rapidly.” Meanwhile, a network of specialized navigators helps connect people with services, advice, and funds – including for out-of-state patients who need help with child care, travel, hotels, and abortion costs.
“I watch the data every day and I’m very proud of where our teams are now,” says Ms. Dunlap.
Preparation for this moment began five to seven years ago. Persistently, she set about building a pipeline for the future – partnering with the UCLA School of Law 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’s expanded services, including behavioral health care for traumatized patients and staff.
Ms. Dunlap finds “hope in the fight,” and comments how fortunate she is to be in the safe haven state of California. Here, Medi-Cal (the state’s Medicaid program) and private insurance are required to cover the cost of abortions. State legislators are in the process of passing a dozen bills to expand access, including to people from out of state – 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 – from Texas
While California is a sanctuary state for abortion, Texas is the opposite. Abortion is now banned in the Lone Star State, the birthplace of Roe.
Ken Lambrecht, president and CEO of Planned Parenthood of Greater Texas, says they are following “the strictest terms of the law” at their affiliate, which is the largest and oldest in the state with 25 health centers. “My job is to keep them open” so that they can persist in providing contraception, testing and treatment, transgender and education services. “We’ve been in Texas for 87 years. We’re not going anywhere.”
The personal stories of people who have come to Planned Parenthood’s clinics seeking abortion assistance since Roe’s reversal are “heartbreaking,” says Mr. Lambrecht. He recalls a single mother – most abortion patients already have children – 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.
Another woman, with eight children, visited a health center to terminate a pregnancy and was referred out of state. “After multiple hours in tears, she left.”
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 “it’s gut wrenching that we can’t provide abortion here in Texas, because we believe people will die.”
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 abortionfinder.org. His affiliate has also handed out more than 100,000 free pregnancy-prevention “empowerment kits” that contain emergency contraception, a pregnancy test, and condoms.
Planned Parenthood has a legal strategy in Texas, says Mr. Lambrecht, but he doesn’t want to talk about it for fear of jeopardizing it. He has six law firms on tap for advice. “I feel like I’m surrounded by lawyers.”
Since the June 24 decision, Planned Parenthood and its courtroom partners, the American Civil Liberties Union and the Center for Reproductive Rights, have filed lawsuits in 11 states. In many cases they argue that bans or very restrictive laws violate a state’s own constitution – such as right-to-privacy protections that cover abortion or rights to personal or bodily autonomy.
But it’s going to be an “uphill battle” in the anti-abortion states, says Cary Franklin, faculty director for the Center on Reproductive Health, Law, and Policy at UCLA School of Law – the same center that Ms. Dunlap pushed for, and which estimates that 8,000 to 16,000 people will come to California for abortion services each year.
Professor Franklin describes a persistent, step-by-step, state-by-state, generational fight that will have “mixed” results because Republicans were more focused on getting judges friendly to their abortion views in courthouses than were Democrats. “We’re 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’re going to do that.”
Victories will require creative thinking, and Professor Franklin hopes the new center at UCLA will become a hub for that. Abortion proponents “clung to Roe” and now they have to “build up a new set of arguments for the 21st century.” One route might be to argue abortion rights under the equal protection clause of the 14th Amendment instead of the “privacy” argument. And some strict state laws may fall on their own because of the harm or death they cause to pregnant women, she says.
But, she says, “it won’t be possible to litigate our way out of this problem.”
Rallying the vote
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 Anamarie Rebori Simmons, communications director for Planned Parenthood of the Great Plains (Kansas).
Last month, President Joe Biden declared that “the only way” to restore a woman’s right to choose “is by voting.” 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, “They will have to take their case to the American people to support specific candidates or legislation,” says Carol Tobias, president of the National Right to Life Committee, the nation’s oldest and largest anti-abortion group.
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 – “to realize, as a country, that unborn children deserve protection – but that’s going to take many years.”
Ms. Tobias describes a “weakness” in the message of Planned Parenthood and others: “They are insisting on abortion for all nine months for any reason,” she says. “That does not have overwhelming support in the country.” In practice, nearly 93% of abortions are in the first trimester, and less than 1% occur in the third, according to the CDC.
Some 57% of Americans disagree with the Supreme Court’s decision and 62% believe abortion should be legal in most or all cases, according to a poll by the Pew Research Center taken after the ruling.
“The 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,” says Rachel VanSickle-Ward, a political scientist at Pitzer College in Claremont, California, and author of the book “The Politics of the Pill.”
This election, Planned Parenthood and abortion advocates Emily’s List and NARAL are spending $150 million on targeted races. That’s a “major effort,” says Democratic pollster Celinda Lake. Abortion can motivate audiences, like younger women, and it can persuade swing voters, like suburban women. “It’s an issue that does that without any backlash because the other side’s already motivated, and it can definitely be a determinant in close races.”
She believes it can gain Democrats at least two Senate seats, but “in the House, it’s hard.” Traditionally, voters turn against the party of the president in the first midterm, and President Biden’s approval ratings hit a new low in July – 31%, according to a Quinnipiac University poll.
“I can’t say I’m particularly hopeful over the next year, but I am if we’re talking in generational terms, because most Americans support termination in some circumstances and they don’t agree with this decision,” says Professor Franklin. “This is going to be a long story.”