What Is Planned Parenthood Fighting For?

BY PAMELA PAUL

To American feminists, the Planned Parenthood brand symbolizes liberation and empowerment. To Medicaid recipients and rural women, it means access to affordable contraceptives, testing and treatment for sexually transmitted infections, and cancer screenings. To conservatives and opponents of abortion, it means the devaluation of human life and dissolution of the family.

But to many young people encountering Planned Parenthood today, the organization, founded in 1916 as a grassroots movement to provide family planning to poor women, means something else entirely. When a 3- to 5-yearold asks, “Is that a boy or a girl?” Planned Parenthood, currently the country’s leading provider of sex education, suggests replying, “Only an individual can define their gender identity. Gender identity is separate from what body parts a person has.” (Planned Parent--hood is also now the country’s second largest provider of cross-sex hormones for transgender treatments.)

On Instagram, where young people are most likely to seek information, Planned Parenthood offers decidedly liberationist advice, including graphic descriptions of sexual techniques. Posts celebrate Pansexual Pride Day and declare that “virginity is a social con-struct.” In keeping with the organiza tion’s racial justice agenda, which includes support for #DefundthePolice, its TikTok account displays a video of a Black woman seemingly fleeing and then laughing, with the tag, “Running from the police, but then they say, suspect is an abortion-rights baddie.”

All of these aspects of Planned Parenthood are now under threat, and from all three branches of the federal government. In March, Trump withheld Title X grants, which fund contraceptive, reproductive and sexual health services for poor people, from at least nine Planned Parenthood affiliates while the administration investigates their compliance with its policies on D.E.I. In June, the Supreme Court ruled that patients do not have the right to sue states for denying state Medicaid funding to Planned Parenthood clinics, making it easier for more states to withdraw funding. And earlier this month, Congress passed Trump’s megabill, which effectively ends federal Medicaid funding for Planned Parent--hood for the next year. (Trump has pledged not to cut off what he sees as deserving Medicaid recipients but to focus on waste, fraud and abuse.)

“We are in a fight for survival,” said Rebecca Gibron, CEO of Planned Parenthood of the Greater Northwest, which includes Hawaii, Alaska, Washington, Kentucky, Indiana and Idaho, and is the country’s largest affiliate. She said the organization may face a deficit as high as $800 million. “This is a catastrophic situation. So we are doing an analysis of the impact, looking at where we may need to consolidate. It’s a moving target.”

As it faces this potentially dire future, Planned Parenthood is also contending with an identity crisis that has been brewing for decades. The trouble stems from its dual and often dueling roles as both a national advocacy organization and a local healthcare provider, one inherently political and the other necessarily nonpartisan. While its roughly 600 clinics offer patient care, the national organization operates as an advocacy group, raising money to support positions that place it firmly on the progressive left in America’s culture wars.

On July 3, Alexis McGill Johnson, the CEO and president of Planned Parent--hood and its political-action committee, Planned Parenthood Action Fund, since 2020, announced that it would sue the Trump administration over the withdrawal of Medicaid funding. “They know we fight for freedom, and they hate us for it,” McGill Johnson declared in a video posted on social media. “But that has never stopped us before, and it won’t stop us now. President Trump,

we’ll see you in court.”

Trouble From Conception

It’s a bold approach for an organization that has suffered a recent series of legal and political setbacks, most notably the Supreme Court’s 2022 Dobbs decision overturning Roe v. Wade. Planned Parenthood has been in financial trouble for years. According to one former executive, a little over a decade ago, it hired McKinsey to assess its healthcare operations; McKinsey concluded they were unsustainable. Many of its clinics are poorly maintained, understaffed and short on funding.

Though the Dobbs ruling led to a surge in fundraising, donations have dropped 15% from a decade high of $428 million in 2022, and most of those funds go toward advocacy rather than patient care. Despite receiving a record $792.2 million in government reimbursements and grants in 2023-24, Planned Parenthood has closed several clinics, including its Manhattan clinic, which was losing more than $30 million a year.

Trump’s policies will only intensify these problems. According to the Guttmacher Institute, a healthcare policy and advocacy organization, the administration’s cuts mean that 834,000 people will lose access to Title X-funded care, a large por-

Planned Parent--hood wants to be the head of the anti-Trump resistance in all its forms, a former executive said.

tion of which would have been delivered by Planned Parenthood clinics. Planned Parenthood estimates that 200 clinics could close.

Planned Parenthood has frequently had to evolve in response to political, medical and legal changes: the arrival of the birth-control pill in 1962, the legalization of abortion in 1973, the passage of the Hyde amendment in 1976 (which restricted the use of federal money for abortions), the murders and bombings of abortion providers in the ‘90s, the passage of the Affordable Care Act (which gave many patients alternatives to Planned Parenthood), the development of medical abortion alternatives and now the overturning of Roe v. Wade.

In 1993, when Pamela Maraldo, a nurse with a Ph.D., succeeded Faye Wattleton, a legendary figure and the first Black woman to lead the organization, Bill Clinton had just been elected president. With abortion rights considered safe, donations to Planned Parenthood plummeted. Maraldo saw a public health opportunity—the chance to provide more primary healthcare services and treat patients holistically.

At the time, less than half of the organization’s clinics performed abortions. “Like Clinton, I wanted abortion to be safe, legal and rare,” Maraldo said. “But people at Planned Parenthood didn’t like that—they felt it was apologetic. I used to say, ‘Why wave red flags in front of a bull? Let’s try to raise prevention.’” She says her efforts to adapt and bring more people along were met with strong internal resistance. Only two years into the job, Maraldo resigned after a vote of no confidence from the board.

Planned Parenthood, which declined requests for an interview, responded by email to Maraldo’s comments with the following statement: “Planned Parenthood is proud to be the nation’s leading provider of high-quality, affordable sexual and reproductive healthcare for all people, including abortion, as well as the nation’s largest provider of sex education.”

Maraldo’s struggles reflect the challenge of managing Planned Parenthood’s federated structure, with 48 independently incorporated affiliates operating under the national organization’s umbrella.

Gloria Feldt was president of Planned Parenthood from 1996 to 2005 during a time of intense violence against clinics, including murders and firebombings, and the organization was deep in red ink. But Feldt says she left because she was “exhausted” by managing an organization in which affiliates were often deeply resentful of the national organization’s financial advantage and control.

“I could have fought the external politics all day,” she said. “But the internal politics were very difficult. The structure makes it very hard to lead a movement, especially in times of political turmoil.”

What benefits the national organization doesn’t always translate into improvements for affiliates. According to a former senior executive at the national office, outrage tends to fuel donations; the more restrictions on abortion, the more it benefits the national office. (In its emailed response, Planned Parent--hood called this “a gross mischaracterization.”) Some former staff members describe the national office as bloated, with too many employees making too much money in undefined roles. (Planned Parent--hood did not respond to a request for comment.) McGill Johnson received more than $900,000 in compensation, according to the organization’s most recent publicly available tax returns.

Meanwhile, many clinics are underfunded and operate at a deficit. Some former executives said the national office’s outspoken progressive agenda can make it harder for affiliates to gain the support of local and state governments.

Under Cecile Richards, president between 2006 and 2018, abortion rights moved front and center; new bylaws established that any clinic that did not want to provide abortions had to leave the net --work. When Leana Wen, the former health commissioner of Baltimore, was briefly president following Richards’s departure, her efforts to focus less on the political battles around abortion and to broaden services into primary- care issues affecting poor women, such as asthma, were characterized by her critics as “mission creep.”

In the years since Wen was forced out, a different kind of mission creep set in, with the organization tethering itself to causes like democracy reform and gun control—actions that have alienated some donors, according to former employees. These moves reflect the political motivations of its workforce, increasingly populated by young people who come to the organization for its progressive values more than for its provision of healthcare.

A self-described “champion for social and racial justice,” McGill Johnson shares this vision. In a 2021 op-ed, she accused Planned Parenthood of focusing too much on “women’s health” and “privileging whiteness.” As she wrote, “What we don’t want to be, as an organization, is a Karen. You know Karen: She escalates small confrontations because of her own racial anxiety. She calls the manager. She calls the police. She stands with other white parents to maintain school segregation.”

Planned Parenthood wants to be the head of the anti-Trump resistance in all its forms, according to one former senior executive at the national office. The question, she said, is who are they alienating in the process?

A Matter of Sex

Today, Planned Parenthood no longer positions itself as the leading healthcare provider for women and has largely stopped referring to women on its website and in policy statements. In testimony before Congress, Dr. Bhavik Kumar, then a Planned Parenthood medical director and now chief medical officer at the Greater Ohio affiliate, said that “men can have pregnancies, especially transmen.”

The organization’s pervasive language around “pregnant people” is intended to be inclusive of transgender people, a cause that the organization connects to abortion rights under the umbrella of “bodily autonomy.” As Planned Parenthood put it on Threads, “trans and nonbinary people are essential to the movement for sexual and reproductive health and rights—the fight for trans rights is our fight.”

Not everyone agrees this is the best approach for a movement founded to empower women. “I don’t understand the national office’s thinking in not allowing anyone to talk about women’s health anymore,” said Maraldo. “These really, really left-wing ideological postures are to me just as off-putting as they are on the right when they’re counter to basic Americans’ common sense.”

Planned Parenthood has also rapidly expanded its services into one of the most contested and politicized areas of healthcare, gender transitions. Its national office does not reveal numbers on these services, instead grouping them into an “other services” category in its annual report. In 2019, that category included 17,791 cases. It rose to 77,858 in 2023. With trans-identified minors, Planned Parenthood follows an “informed consent” model, which, according to its patient guidelines, enables patients to get a same-day prescription for cross-sex hormones after a 30-minute in-person or remote consultation with a staff member. No professional diagnosis is required.

More moderate voices on gender medicine like Laura Edwards-Leeper, who co-founded the nation’s first gender clinic and helped develop the transgender advocacy group WPATH’s standards of care, believes that Planned Parenthood is operating “beyond their scope of practice.” “It really seems that their protocol is substandard and lacks the rigor necessary for a life-altering intervention,” Edwards-Leeper said.

According to an analysis of insurance claim information by the Manhattan Institute, a conservative think tank, at least 40,000 patients went to Planned Parenthood for gender medicine in 2023. About 40% of them were 18- to 22-year-olds. Between 2017 and 2023, it also treated 12,000 kids aged 12 to 17 for gender dysphoria. (These figures do not include patients who paid out of pocket, patients at VA facilities or those covered by Kaiser.)

In response to emailed questions about the specifics of its gender protocols, a spokesperson wrote, “Many Planned Parenthood health centers are proud to provide genderaffirming care to eligible patients, as part of Planned Parenthood’s mission to ensure all people have access to the care they need to exercise their right to control their own bodies and lives.”

Though its commitment to these principles remains strong, Planned Parenthood itself is in a kind of existential limbo. On July 8, U.S. District Judge Indira Talwani issued a temporary restraining order on Trump’s Medicaid measure. The administration challenged the order, but Talwani issued a new temporary restraining order on July 11. Arguments on the case will begin on July 18.

Like any independent healthcare provider, Planned Parenthood is plagued by the same pressures facing all of American medicine: a shortage of primary care, industry consolidation, hospital closures and a relentlessly profit-driven system. According to several public health experts who specialize in reproductive health, in many parts of the country, especially rural areas, Planned Parenthood is the sole provider of primary and family-planning care for poor people, which they may not be able to access elsewhere.

“This is where you get that ripple effect,” said Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute. “It not only affects Planned Parenthood, it affects all people in a given community. Healthcare is a complicated ecosystem. In theory, these actions by the federal government are targeted, but in reality, they affect many, many more people. It’s hard to overstate how devastating this will be.”

Alexis McGill Johnson, head of Planned Parenthood, speaks outside the Supreme Court, April 2.

Trans flag stickers at an event sponsored by Planned Parenthood Keystone in Doylestown, Pa., March 2023.