Planned Parenthood Leaders Weigh in on the State of the Reproductive Rights Movement
Iris Harvey and Leana Wen are navigating some tricky political waters. On the state level, Harvey leads as President and CEO of Planned Parenthood of Greater Ohio against anti-abortion attacks from the state’s succession of conservative legislators and governors. And on the national level, Wen, President of the Planned Parenthood Federation of America, oversees a battlefield of wins and losses on both sides of the abortion rights debate. CU sat down with Harvey and Wen to discuss Ohio’s new governor Mike DeWine, and the challenges ahead for the pro-choice movement.
So, we’re leaving behind this administration under John Kasich, who passed 21 reproductive health restrictions in his time. And now his successor, Mike DeWine, is coming in. A lot of pro-choice activists are saying he’s going to be even more conservative on these issues. Should we expect another Heartbeat Bill? Should we expect something more extreme? Should we expect them to pass?
Iris: [DeWine] has been clear on his intention to continue his anti-choice legislation and support of it.* He’s probably supported more bills across the country as the attorney general by signing onto other states. So, I wouldn’t expect his behavior or his ideology to change as a governor.
But, he’s clear on what he’ll do. The confusion with Governor Kasich was that while he wanted to take a stand and present himself as being a moderate, as you say, he’s passed 21 bills that have a negative impact on safe and legal abortion and reproductive healthcare, including birth control. So, you speak one thing and do another, and the attorney general is quite clear where he stands.
*Mike DeWine has been a vocal challenger of Planned Parenthood throughout his political career, advocating to block the organization from receiving Medicaid funds for preventative healthcare in 2015. The former attorney general also went head to head with Planned Parenthood that year, first alleging that the organization was selling fetal tissue, then asserting that fetal remains are disposed of in landfills. DeWine backed a bill in 2018 that would require anyone seeking an abortion to decide to either bury or cremate the fetal remains, though the same requirement was not applied to miscarriages or still births. As attorney general, DeWine also opposed contraceptive coverage under the Affordable Care Act, and in 2017 filed a brief to block an unaccompanied minor in Texas from getting an abortion.
Ohio has joined a number of other states that are looking to put extreme bans on abortion, and anti-abortion organizations have been pretty clear about their goal with that: to get them in front of the Supreme Court. Can the Supreme Court outright overturn Roe? If it’s not overturned, how can we expect its protections to change, and how nervous should pro-choicers be about that possibility?
I: There are three- or four-hundred pieces of legislation, and there are, I think, thirteen pieces of legislation* that are one step away from being able to go to the Supreme Court that are strictly related to abortion, and then another eleven pieces of legislation that are related to reproductive healthcare.
Any of those can go to the Supreme Court, have a decision that could have a domino effect, and essentially send the decision back to the states. So, we know when decisions go back to the states, there are some states that protections are there and other states that they aren’t. Leana, maybe you want to speak to it from a national perspective?
Leana: Absolutely. You’re right… We talk about reproductive choice, but that choice doesn’t exist for so many people who live in states where access already isn’t there. There are seven states as of last count that only have one abortion provider left in the entire state.
You were saying, Iris, about the cases that are pending that are one step away from the Supreme Court. We face the situation where any of those cases could be heard by the Supreme Court, could be taken up by the Supreme Court within the next year.
We face a real probability that 25 million women, which is one in three women of reproductive age in this country, could be living in states where abortion is criminalized and outlawed. And that’s terrifying. I come to this as a doctor. I see what happens when patients can’t have access to reproductive healthcare, and as a doctor I know that abortion is standard medical care. It’s part of the full spectrum of reproductive healthcare, along with birth control, cancer screenings, STI tests. It’s part of the spectrum. It’s standard care.
*Legislation waiting to be heard by the Supreme Court challenges everything from funding, to methods and procedures, to timing of abortions. Louisiana and Kansas would like to deny Planned Parenthood funds from Medicaid; Indiana wants to outlaw abortions based on gender, race or disability, and require the choice of burial or cremation for fetal remains; other states are regulating clinics themselves, requiring them to meet surgical center standards or mandating that physicians have admitting privileges at a nearby hospital.
These bans that might make it to the Supreme Court — is there a way that they could affect other areas of reproductive health and change circumstances outside the realm of abortion?
I: We were talking about the Trump administration’s attack on birth control, and you know, when both educational institutions and employers are allowed to decide not to cover birth control in their insurance plan for moral, ideological reasons, all of those things have an impact. The way Planned Parenthood will be eliminated from Title X — it’s not an outright ban, but it basically is the institution of a gag rule.
So, from an ethical standpoint, we believe our patients deserve a full range of understanding of their options for their reproductive health and their choice on pregnancy. Any of those can make a difference in how a patient receives care, how they receive ethical information, and actually, if you don’t give people information, the choices that they make*, which could have a negative impact on their health. So I think all of these things can make their way up the ladder.
L: If I could just add to what Iris was saying — medically, we need to see reproductive healthcare as a whole. You can’t separate one aspect of reproductive healthcare from other aspects, in the same way that if you’re talking about heart care and cardiac care, you don’t say, ‘Well I believe in diet modifications and medications but not in procedures,’ or, ‘I believe in procedures but not medications.’ It just doesn’t make sense.
When you start attacking one aspect of reproductive healthcare, or one aspect of healthcare, you harm the rest of it, by definition, because that’s how medicine works. We have to see the person as a whole, the patient as a whole. We see what happens when clinics close. For so many of our patients around the country, Planned Parenthood is their only source of healthcare.
I come to this also as a patient. I first got to know Planned Parenthood myself because my mother was a patient of Planned Parenthood when she had nowhere else to go for care, when we first immigrated here. I was a patient of Planned Parenthood, and we know the consequence if we close clinics. People are not going to go elsewhere for care. There’s a huge unmet need for healthcare in this country and that’s what’s at stake. It’s about people’s lives.
*As of 2014, there were 788 reproductive healthcare and abortion clinics across the United States, compared to 4,000 crisis pregnancy centers (CPCs). CPCs are run by anti-abortion organizations that try to lead women away from seeking an abortion. In an investigation by NARAL Pro-Choice America, it was found that CPCs routinely mislead or lie to women about the risks of birth control and abortion, implying links between abortion and “breast cancer, infertility, miscarriage, and ‘post-abortion depression’ that results in suicide.” In actuality, a legal abortion is 14 times safer for a pregnant person than childbirth.
Say we do enter a post-Roe U.S. Right now, women are still able to get abortions using tinctures, herbs and anecdotal stories on the internet and books, and there are also organizations helping women to go out of state if they need to to get an abortion, or they’re covering that last $100 of the procedure. Can we expect attacks on those organizations, and should we expect to see that underground network further formalize?
I: I guess the way I would answer that is, I’m a Baby Boomer, and so I lived through and I lived in poor working class communities before abortions were safe and legal*, and women got abortions, and often they were successful, but a lot of times they were dangerous and they died. And people knew how to get to practitioners or providers of abortion. So I see no reason why we shouldn’t expect that another round of pathways to abortion providers will happen. the question will be, if it’s illegal, you can’t separate it from good healthcare, so who will people migrate through in these underground pathways. will they be migrating to ethical providers who are risking their license to do an illegal abortion or will they migrate to people who are not medical professionals and therefore they’re risking their lives. I think for me that’s the question of what happens when abortion has to go underground.
L: We know that there are multiple states where the state law says that abortion is illegal and there are state laws that criminalize doctors and women who receive abortions. that’s what’s at stake if Roe v Wade is overturned. Before Roe v Wade came to be, thousands of women died every year because they didn’t have access to safe, legal abortions. we can’t go back.
*Though abortion is a federally guaranteed right, many states are underserved, with women needing to travel hundreds of miles to get to the nearest clinic. But women, particularly poor women and women of color, have been managing their own reproductive healthcare for generations, and that network hasn’t gone away.
On the contrary, in a grassroots movement, women are learning how to safely terminate their pregnancies at home. DIY methods, such as tinctures, herbs, Del-Ems (a suction device invented by activists in the 70s), or manual vacuum aspiration (MVA), are used by those who live nowhere near their state’s abortion clinic, those who can’t afford a clinical abortion, or those who’ve had bad experiences with the healthcare system, either targeted for their race, income, gender identity, or marital status.
Beyond abortion rights, reproductive healthcare in the U.S. and Ohio are just not in the best shape. We have some of the worst infant and maternal mortality rates among developed nations. STI rates are at record highs. What’s happening here? Why are we sliding so far back in our quality of life here, and can we point to any specific policies where we can say, “That’s where we went wrong”?
I: Well, we could start with maybe the lowest hanging fruit, in that we are the last state in the country that does not have a health education curriculum prescribed, and certainly as part of that, there is no sexual education prescribed. And so a state that really puts its attention and its stamp of approval on abstinence only until marriage, which is not evidence-based in terms of sexual education, you’re really letting young people go through their adolescence without understanding their sexual being, their anatomy. They don’t understand how to negotiate not to have sex, how to have safe sex, and things of that nature.
But, I think there are other issues. The social determinants, you know, we have a large number of people who are still low income and not covered by health insurance. We have housing issues. In Columbus, the number of homeless people is, at a per capita basis, higher than New York City, and we’re a small city.
Dr. Wen can speak a lot more to the social determinants of health, but I think when you look at infant mortality, when you look at maternal mortality, it’s not just about reproductive healthcare, it’s about the conditions that you’re living in — your access to education, to transportation, to food, to a safe environment. And we also know that for infant mortality and maternal mortality, they’re highest among African-American women.* And we know that the issues of racism in America have a great deal to do with that. All the research has shown us that a well-educated, college graduate, African-American woman is more likely to have either maternal death or infant mortality than a high school dropout white woman.
So, you have to ask, ‘What is the element, what is the environment that puts that woman’s body in such stress that even if she’s getting great healthcare and knows all the things to do, why does this still happen?’
Going back to Title X — conservative legislators have talked for a long time about taxpayer-funded abortions. The Hyde Amendment, established 40 years ago, has effectively prohibited any taxpayer money from being used that way. How has that narrative of taxpayer-funded abortions persisted?
I: You know, because someone speaks falsehood doesn’t change the way either politicians or the public consume the information. I think most Americans believe, number one, that women should have access to safe and legal abortion, and they understand that taxpayer money doesn’t pay for that. We try to make sure that the community understands that there is not a federal or state line-item that says ‘fund Planned Parenthood.’ we are a provider of great healthcare, and in the provision of that service is like any other healthcare provider: we are reimbursed for the provision of service. So, we’re not using the money for anything but healthcare, that is reproductive care. We don’t use it for abortion, but that’s a good question of why it still persists.
Well, it’s a tough time for facts and truth and information.
I: It is.
L: Well, here’s my theory about it, is that politicians want to stigmatize Planned Parenthood, because it further isolates reproductive healthcare and women’s healthcare. We are, as Iris said very well, a healthcare system, a healthcare provider, just like any other that I’ve ever worked for. We don’t receive a line-item from the budget, but rather we get reimbursed for services that are delivered, same as any other hospital, healthcare system that I’ve ever worked for. We need to understand what we do as standard medical care, and reproductive healthcare, women’s healthcare should be treated no differently than the rest of healthcare, which we strongly believe is a human right.
*Ohio’s new governor Mike DeWine has advocated for the “defunding” of Planned Parenthood for years, but the result would not change abortion statistics. There’s no credible report detailing what percentage of Planned Parenthood’s services abortions account for, as both Planned Parenthood and anti-abortion groups have used flawed methods resulting in a range spanning 3-94 percent. But, as funding isn’t allotted for abortion services, “defunding” Planned Parenthood would only impact Medicaid users who rely on the organization for its other preventative services, such as cancer screenings, STI and HIV tests, and prenatal care.
I feel like the pro-choice movement’s last offensive move was 40 years ago. How do you get back on the offense?
L: I think we are doing both. Nationally, we are doing both. It’s hard because there are places like Ohio, where just holding the line and keeping going every day is a success*. And I applaud you so much for being resilient in the face of extraordinary attacks every day. We have to hold the line. We have to fight back against these onerous restrictions that are happening around the country.
But, we also have to acknowledge that, around the country, in many different states, there is now the opportunity to fight back. In these last midterms we saw women, particularly women of color, rise up and vote for a strongly pro-reproductive health majority in the House of Representatives. Which means that, by virtue of having a pro-reproductive health majority in the House, that’s a firewall against defunding efforts by the Trump Administration.
That’s huge, and we do need to celebrate that. There are now also 25 pro-reproductive health governors in the U.S., 19 state legislatures including in DC that are pro-reproductive health that are working on proactive legislation. New York state, earlier this week, Governor Cuomo just announced a plan to codify Roe v Wade in the state constitution. Oregon is introducing the Reproductive Health Equity Act that we hope is a type of model legislation for the rest of the country.
So, both of these things have to happen at the same time. We recognize that this is the fight of our time and that we have to be on the defensive. But it’s also an opportunity for us to affirm a core value that abortion access is part of the full spectrum of access to healthcare and that we have to be expanding reproductive healthcare as a right.
I: I also think that we can’t look at healthcare in isolation. We have to look at healthcare and we have to look at housing. We have to look at education. We have to look at employment. We have to look at, ‘What is the wage that people are receiving? Can they live?’
And if we put our issues and our energy along with those other issues, then that’s how we fight back, because you can’t ignore all of the issues.
It’s easy to single out reproductive healthcare and single us out. So, I think as we fight for healthcare, we recognize that, when we’re advocating on behalf of a person or a segment of a population, we’re also advocating for them to have a better life, and healthcare is just one part of it.
*Ohio pro-choice activists did celebrate a win in 2018, when grassroots advocacy kept Toledo’s last abortion clinic from closing. Activists lobbied a local hospital to make a deal with the clinic, averting DeWine’s efforts to force it out of business using patient transfer agreement laws.