In 2013, Wicklund, facing significant health complications, was forced to close the Livingston clinic. Not long afterward, local activists created the Susan Wicklund Fund—a nonprofit that helps poor Montanans access abortion care—in her honor. In recent years, she has received fund-raising letters from Planned Parenthood featuring the “Care. No matter what” slogan. The first time she saw this, she told me, “I just came unglued—I was so livid.” She went on, “When I was a very young woman and would go to Planned Parenthood, it was a feminist organization. At some point, it changed into a business.”
Providing services to patients isn’t the only way that Planned Parenthood defends abortion rights. The group has arms devoted to advocacy and political organizing which push for pro-choice laws and policies; every election cycle, they perform an array of functions—including mobilizing and educating voters—that most abortion providers cannot undertake but from which they benefit. Last year, Planned Parenthood helped defeat anti-abortion ballot initiatives in numerous states, including Kansas and Kentucky. The organization’s national office, meanwhile, files lawsuits across the country to challenge restrictions. With Roe gone, the stakes of such battles have never been higher, which explains why so many people who care about abortion rights have donated to Planned Parenthood since the Dobbs decision—and why some providers I spoke to didn’t want to air their grievances about the group, saying that it was now more important than ever to band together.
Not everyone feels this way, however. In March, I had coffee with Katharine Morrison, the medical director of Buffalo Women Services, an abortion facility and birthing center in western New York. In October, 1998, a physician working there, Barnett Slepian, was murdered in his home, by an assassin who then fled. Afterward, Morrison told me, the police stopped by her house and advised her and her family to leave immediately. (The police also visited my parents’ house, because my father, Shalom Press, was working as an abortion provider in the area.) Morrison, who had three young children, quit her job, but she returned a few months later, intent on keeping a low profile. One day, a complication required her to transfer a woman to a local hospital, where a nurse who opposed abortion spotted her. A few weeks later, a bridge near Buffalo Women Services was spray-painted with the words “Morrison Murders Babies!” She relocated her family to Brooklyn and started flying to Buffalo once a week to keep the clinic open. Five years after Slepian’s killer, an anti-abortion zealot named James Charles Kopp, was arrested, she moved back to Buffalo with her family.
Until 2003, Planned Parenthood did not offer abortion care in Buffalo. That year, it began providing medication abortions in Buffalo and Niagara Falls, half an hour to the north. Today, medication abortions are available at Planned Parenthoods throughout western New York; surgical procedures are also done two days a week. Michelle Casey, the C.E.O. of Planned Parenthood of Central and Western New York, told me that this wasn’t enough to meet demand. “We need more access than we have in Buffalo,” she said, explaining that there was a two-week waiting list for surgical procedures now that patients were coming from Ohio and even Texas. Casey said that her organization viewed independent providers in the area as “collaborators with the same mission of having people have access to the care they need.”
Indeed, in some communities, Planned Parenthood affiliates have fostered solidarity with other providers. One independent clinic owner in Florida told me that two decades ago, after her facility suffered an arson attack, Planned Parenthood invited her counsellors to use the phones in its office to schedule appointments. But, she noted, the organization’s generosity did not last; it eventually started offering abortion services right down the road, imperilling her operation.
Morrison, the Buffalo provider, told me that her clinic, which now focusses on surgical procedures, may not remain open much longer, owing to a steady decline in the number of patients coming in. There were multiple reasons for this, including broader access to contraception, which has led to an over-all decline in the demand for abortion, including at Planned Parenthood centers. But the biggest factor, she told me, was Planned Parenthood. To illustrate the problem, she Googled “Buffalo abortion clinic” on her phone. The top two search results were for Planned Parenthood facilities. Google did not tell users, she noted with dismay, that those facilities did not offer comprehensive second-trimester care, and that Buffalo Women Services was the only local provider these patients could rely on. Morrison explained that although some second-trimester abortions were done in Buffalo hospitals, a medical board had to approve the procedures, and they required a justification, such as clear evidence of fetal anomalies. The vast majority of second-trimester patients went to Morrison’s clinic.
Michelle Casey had told me that Planned Parenthood did not offer care after the fourteenth week of pregnancy because “such a small number of people” needed it. Morrison disputes that the number is small. During our conversation, she randomly selected dates in her clinic’s log book: on February 28th, ten patients had come in for second-trimester procedures; on another recent day, six had done so. The real reason the local Planned Parenthood facilities don’t offer such care, Morrison told me, is that it is far more difficult and expensive, and involves potential complications. “You have to have staff, an ultrasound-sonographer, equipment, an R.N.,” she said. Medication abortion, by contrast, mainly involves dispensing pills. “It’s a great business model,” she said.
I asked Morrison if, given her clinic’s role in the abortion fight and the ordeals she’d been through, anybody at Planned Parenthood had ever reached out to discuss how its operations might affect the broader ecosystem of abortion care in Buffalo. “Nope,” she said. We were sitting in a café in Brooklyn, and Morrison, who is sixty-six, with short brown hair flecked with gray and a wry sense of humor, told me that, to keep Buffalo Women Services afloat, she’d started working at a clinic in New York City. She was now commuting every week to the city from Buffalo—the opposite of her old trek. “I’m doing it in reverse,” she said, with a smile. When I asked her if she could imagine a time when the patients she served would also have to travel to New York City, because her Buffalo clinic had closed, the smile vanished. “Definitely,” she said. She noted that some second-trimester patients wouldn’t be able to make the trip—a six-hour drive—because most of her clients were poor. “The younger you are and the poorer you are, the greater your gestational stage,” she said. “Because you were afraid to tell your mom, or because you were hoping you weren’t pregnant, or because you thought you were pregnant but if you don’t show up at work you’re gonna lose your job, and if you lose your job you’re gonna get evicted.” Such patients were also disproportionately people of color, Morrison added. She’d recently treated an undocumented immigrant with no medical insurance, and a thirteen-year-old Black girl who she suspected had been raped. Although various funds now exist to help patients in need cover travel and lodging, “people are living a paycheck away from disaster,” she went on. “Even if you say it will be covered, they can’t take off a day to travel, spend two or three days in New York, then take another day to come back.”
Since the Dobbs decision, the media has taken note of a dramatic increase in the number of medication abortions, which now constitute a little more than half of all pregnancy terminations. It stands to reason that this figure will continue to rise, because pills make it easier to evade barriers to care. But, as these barriers proliferate, causing more patients to encounter delays, the demand for procedural abortions later in gestation is also likely to grow. Buffalo is hardly the only place where independent clinics provide such care. According to the Abortion Care Network, sixty-two per cent of the clinics in the U.S. that perform abortions after thirteen weeks are independent. For procedures after twenty-two weeks, the figure is seventy-nine per cent. Nikki Madsen, the network’s co-executive director, told me, “When people need abortion care after the first trimester, they rely on independent clinics. This is the most expensive abortion care to provide, and it’s done at clinics that lack the institutional support, visibility, name recognition, and fund-raising capacity of national health centers and hospitals, making it especially difficult to secure the resources to keep the doors open.” Independent providers, she added, also deliver a disproportionate amount of care “in the most hostile states.”
In March, I drove to Casper, Wyoming, with Julie Burkhart, the founder of an abortion-care nonprofit named Wellspring Health Access, to visit a clinic that she was planning to open there. Burkhart lives in Colorado and co-owns a clinic in southern Illinois, but in 2021 two abortion-rights advocates from Wyoming had urged her to expand her operation, and she’d agreed to take on the challenge. Originally, the facility was scheduled to begin seeing patients last June, but shortly before opening day an assailant broke in, poured gasoline onto the newly refinished floors, and torched the place. After the Dobbs decision, the Wyoming legislature banned abortion in virtually all cases. The law has been temporarily suspended, because Wellspring Health Access filed an injunction claiming that it violated the state constitution’s protections for matters of bodily integrity.
These developments could have led Burkhart to rethink her plans. She told me why she’d decided to persist on the way to Casper—a nearly four-hour drive from the town in Colorado where she picked me up. Burkhart, who is plainspoken and was wearing bluejeans and leather boots, said that she was still motivated by what had happened to George Tiller, an abortion provider in Wichita whose clinic she had joined in 2001. She’d worked for him until 2009, when an anti-abortion extremist murdered him in the foyer of his church. When a friend called Burkhart to deliver the news, she thought that he was joking. After the reality sank in, she started to think about who could provide care to the women who’d relied on Tiller’s clinic. There was a Planned Parenthood in Wichita, but it didn’t offer abortion services. Burkhart decided to reopen Tiller’s clinic herself, even though pro-choice allies warned her that it would only bring more violence to the community. Abortion opponents waged a fierce campaign to stop her. She received death threats. More than once, Burkhart told me, she contemplated abandoning the project, but on April 3, 2013—nearly four years after Tiller’s murder—the new clinic began seeing patients. In the first week, just three women showed up. Eventually, the facility was seeing nearly two thousand patients a year. Burkhart had formed a nonprofit, Trust Women Foundation, that aimed to improve access to abortion in underserved communities. Its next project was in Oklahoma City, where it took two and a half years to open a clinic.
The Problem with Planned Parenthood
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