President and CEO of Planned Parenthood League of Massachusetts
Planned Parenthood Advocacy Fund of Massachusetts
"It doesn't make sense. Maybe what they're really against is any kind of sexuality for women, any kind of choices for women because if you are really only anti-abortion then you would really want to support those other things like public education and birth control. It sends a message that they're really anti-women, anti-sexuality, anti-science, and anti-education."
Quick learning from this interview:
· Less than 10% of the Massachusetts Planned Parenthood budget goes to abortions
· Less than 3% of the national Planned Parenthood budget goes to pay for abortions
· In other words: 97% of the money spent by Planned Parenthood is not for abortions but on women’s health services, sexual reproduction education, and birth control
· In America we have the Hyde Law that ensures not one federal dollar goes to pay for abortions, one of the only developed nations to have this law.
By Heidi Legg
Margaret Sullivan, a leading media columnist for The Washington Post and former public editor for The New York Times, recently encouraged journalists in her column to continue to seek the truth while also admitting any bias. It gave me pause as a I prepared for this interview with Planned Parenthood around a woman’s right to choose. I think it's important you know that I grew up in Canada and went to college and graduate journalism school north of the 49th parallel. My views on women's rights and women's health were cemented before I left Canada, at the age of 25. And what drew me to this interview with Planned Parenthood was my incredulity over the past 20 years living in America watching the political debate and use of women's health as a political inferno. This week with another attempt at repeal in health care that would cut back access to women’s health, we see the debate roar again.
With this interview I hope to debunk some of the myths that are being propagated in this country while all other developed nations and allies such as the UK, Canada, Sweden, France, Spain, Germany, Belgium, Finland, and (even Russia!) fund abortions using taxpayer dollars and see women's right to choose as a private matter between a woman and her doctor.
Doctor Childs-Roshak, thanks for joining me as I try to understand this.
Thanks so much for having me.
Let's talk repeal first. Is it true with this current Graham-Cassidy repeal and earlier ones, that they are trying to block people with Medicaid coverage from accessing preventive care at Planned Parenthood Health Centers?
Yes, I would add that the Graham-Cassidy bill is the worst Trumpcare bill yet. The Graham-Cassidy bill makes it harder to prevent unintended pregnancy, harder to have a healthy pregnancy, and harder to raise a family.
Like every other version of Trumpcare, the Graham-Cassidy bill targets Planned Parenthood patients by blocking people who rely on Medicaid from receiving preventive care at Planned Parenthood health centers. This means limiting people’s access to birth control, cancer screenings, and STD testing and treatment, making it harder for the most vulnerable members of our communities to stay healthy and take care of themselves. In fact, Fifty-four percent of Planned Parenthood health centers nationwide are in health professional shortage areas, rural or medically underserved areas. Experts have repeatedly said that other providers cannot absorb Planned Parenthood’s patients.
This bill slashes Medicaid, cutting millions off from insurance, and rolling back access to basic care for millions more. With the latest version of Trumpcare, Americans will pay more and get less, but women will pay the biggest price of all. This irresponsible and dangerous bill raises premiums for middle class families; gives insurers the green light to classify pregnancy as a pre-existing condition and deny coverage for maternity care; and forces new mothers with Medicaid coverage back to work shortly after giving birth.
Massachusetts has invested in each and every resident by expanding access to health care and Governor Baker has vowed to protect Planned Parenthood patients’ access to care, but this bill’s impact is so far reaching it will make it harder for everyone to receive the care they need.
Women’s health care policy should not be concocted by a small group of male politicians behind closed doors. Congress should listen to the American people and focus on bipartisan fixes to expand access to care instead of trying to ram through this terrible bill that will take America backwards.
The irony with this ACA repeal and attempt to defund Planned Parenthood: there is no federal funding that goes to abortion, and there's no check that gets written to Planned Parenthood. We deliver health services, bill for health services.
We see the patients. We deliver the care. We send the bill to the insurance companies.
Let's go back to some of the basics. What is Planned Parenthood Health Center? And what happens inside of one?
Planned Parenthood Health Centers are health centers that provide expert service in sexual and reproductive health. We care for women, men, transgender folks, and youth with compassion and a non-judgmental approach. We provide a lot of the basic preventive health care services like pap smears, well-woman exams, STI testing and treatment, birth control, as well as abortion. All of us at Planned Parenthood see access to abortion care as an important part of normal health care delivery for the reproductive and sexual health of women.
And why would people go to a Planned Parenthood Health Center instead of their GP or a nearby hospital?
There are lots of reasons. I can tell you as a primary care physician and as a family doctor for over twenty years, I would recommend Planned Parenthood to a number of my patients. I've used Planned Parenthood myself for primary care when I couldn't get in to see my own primary care doctor – even as a primary care doctor – as ironic as that is. Patients come to see us because they can't get in to see their own primary care doctor or an OBGYN, to deal with either an urgent issue like a bladder infection or an STI concern.
We have problems within the American health care system in terms of waiting and access and barriers. So, people come to see us for access reasons. We have weekend and evening appointments. We have walk-in appointments, same-day appointments, appointments online.
It’s funny; I think that if you're not a woman, you don't understand how many things happen quickly to our bodies where you need a doctor pronto for a prescription. So here goes: If you have a serious yeast or urine infection, or you’ve run out of contraception, you need to go to see the doctor to access solutions. Sometimes you can't solve that over the counter. I wonder what percentage of the work that's happening inside Planned Parenthood Health Centers is around this type of women's health care, outside of abortion?
The majority of the work that we do across the country, 97% of the health care delivered by Planned Parenthood Health Centers, is everything but abortion. And the same is true in Massachusetts. Here in MA, 90% of the services we provide are about everything but abortion. So, it's not just the majority of what we do is unrelated to abortion, it's the super majority of the health services that we provide are preventive care, STI treatment and testing, and then birth control access.
So again, to debunk myths, what percentage of the services offered at Planned Parenthood centers is for abortion?
Less than 10% in Massachusetts [and less than 3% nationwide.]
And abortion is not funded by tax dollars in the US? Is that correct?
That is correct and that is one of the myths out there and falsely perpetuated by people who are anti-choice and anti-abortion access. The truth is NO federal tax dollars go to support abortion in America.
There are some states, like Massachusetts, that have decided that access to abortion care should not just be the purview of women who have commercial insurance and that all women should have access to the same suite of health care services. For example, here in Massachusetts, state Medicaid programs will fund abortion, but there are no federal dollars that go to pay for abortion in the United States.
What happens if you live in a state that is politically and religiously very sensitive to this topic and may not be offering state dollars for abortion? Who's paying for those abortions?
Women in those states pay for abortions themselves or with the help of their families. They raise money for themselves like any other cash medical service that's not covered. Before the Affordable Care Act, many general health services were not covered either, and patients would have to raise their own money.
How would people find the resources?
There are some ‘justice funds’ where donors will specifically donate money to Planned Parenthood to cover the cost of patients who can't pay. Planned Parenthoods in those states will either fundraise for those dollars or provide patients with a sliding scale. What we see in those states is that women don't have access; they don't have all the choices that they should be empowered to make for their own health.
So there are big differences on what a woman in one state receives for health care and what a woman in another state may have?
Exactly. Or they may delay care because it may take time to raise that money. The other thing that we see is people traveling to states where maybe the access is a little bit better, the prices are a little bit different, the waiting periods are a little bit shorter.
Do they have to travel for birth control and health services as well, or only for abortion?
There are places in the country where there is a huge lack of access. In fact, more than half of Planned Parenthoods across the country are in those geographically isolated, underserved communities. Without access to Planned Parenthood, a lot of people would be traveling a lot further even for birth control.
Are there states that don't fund birth control?
Under the Affordable Care Act now, especially the states that have taken the Medicaid expansion money, birth control is typically funded. That has been an improvement and a change.
However, we've learned recently that there's a leak around this. Can you explain that to us?
Yes, there are exceptions to the rule. There are companies – think Hobby Lobby – that have religious exemptions to say they do not want to cover birth control or abortion care under their insurance plan. What we are seeing from the Trump administration is a leaked rule around expanding that ability for employers to refuse to offer birth control under their typical health insurance plans by citing a "moral exemption." There's no specific definition of what having a “moral exemption” means. I think that it's specifically targeting birth control but it certainly sets up an interesting slippery slope for employers or companies being able to choose…
To opt out?
Yes, and choose what's morally okay to be covered under a health insurance or not.
Would Viagra fall under a moral exemption?
Well, under the current rule, it's specifically focused on birth control but it certainly could.
I'm trying to get my head around it, because I'm trying to debunk these myths and understand this hot button issue. So for clarity, are there women in America who can't easily get abortions if they don't have a Planned Parenthood Health Care near them?
And is it difficult for some women in some states to access birth control? Or has this been cleared up with the Affordable Care Act (ACA)/Obamacare?
It’s certainly better. I do not want to sound like an expert on every other state in the nation, but I think with the coverage expansion under the ACA (or Obamacare) has improved the access to birth control, but I do know that there are still barriers to accessing birth control. It's better than it was but there still are barriers and we see that even here in Massachusetts.
What would be a barrier? What would be an example?
The barriers can be related to the expense; they could be related to the distance one has to go, a geographic barrier. There's a lot of stigma attached to birth control. Think about a young person who might not be able to be forthcoming with a parent about their sexual activity, and then not being able to get the right care whether it's birth control access or STI testing or even some counseling. The stigma that's connected to sexual and reproductive health is a barrier as well.
We know even here in Massachusetts, where we have some of the lowest teen pregnancy rates in the country, the lowest teen birth rate in the country, there still remain disparities in care between communities of color and the LGBTQ community. Whether it’s cultural, economic, or education-related – all of those things create barriers.
How is Planned Parenthood trying to solve this?
We have health centers here in Massachusetts in five communities: Springfield, Worcester, Boston, Fitchburg, and Marlborough. We really try to meet patient's needs by improving access. I mentioned earlier, same day access, walk-in access, and how we make getting to the Planned Parenthood office as easy as possible in terms of appointments. That's one way.
I think a second way is that we work very, very hard on sexual and reproductive health education. We have an award-winning curriculum; we’re in schools across the country where we're reaching twenty-nine states and a quarter of a million students. We do a lot of parent education as well through outreach efforts. We are really trying to improve education about sexual and reproductive health and healthy relationships. We work very closely in coalitions related to family planning across Massachusetts; our Coalition for Choice includes the ACLU, NARAL, and the Massachusetts Association of Family Planning Organization. So it's not only Planned Parenthood. We're working in coalitions to really advocate for sexual and reproductive health, for women's health, for LGBTQ health, for access for all.
Since I have set out to debunk myths in this interview, are the doctors inside Planned Parenthood trained and qualified the same way the doctor is in the hospital or the medical clinic?
Absolutely credentialed, trained exactly the same. In fact, a lot of our clinicians work in other places, as well.
One of the other arguments for defunding Planned Parenthood is that health care providers in other places could absorb the 2.4 million Planned Parenthood patients if the Trump administration stops funding Planned Parenthood. Is that true?
No. It's not true.
Planned Parenthoods are in more of those rural underserved areas than a lot of the community health centers but I think the most important thing here is the community health centers themselves have said there is no way they could absorb all of these patients.
I've worked at a community health center. I think they are fabulous. I think it's a terrific model. They should be funded more than they are, but what happens at community health centers is they're typically delivering full primary care and sometimes some specialty care. They don't have the ability to absorb a lot of new patients. In some ways, we have been helpful to them and patients in terms of expanding those access points and providing that level of expertise around birth control management, access to IUDs, and the long-acting reversible contraceptives, which are so effective.
Is Planned Parenthood unpopular with all lawmakers in the GOP? Are there any stats? Is it more male? Is it more female? Is it by state?
I don't know that off the top of my head, but what I would tell you is that there have been at least two Republican champions: Senator Murkowski from Alaska and Senator Collins from Maine with the last repeal attempt. I don't think it's an accident that they're both women.
It's not an accident that they both come from rural, underserved, poor states. I've lived in Maine. I've practiced in Maine. Maine is a beautiful state but it has some real needs that would not be served if Planned Parenthood were defunded.
In the political debate, where it kinda gets crazy in America – from my vantage point as a Canadian-born woman – is that the Republican party seems quite vehemently opposed to Planned Parenthood. They appear to have a very different narrative and experience with it. What is their argument? Why do you think they are the so opposed to Planned Parenthood and so much so that they went to the trouble to call for a one-year freeze on it for repeal. Was that bait for their base?
I've been trying to figure that one out myself, because to be honest with you and, again, as you shared your perspective and your bias, I'm from a religious family. I understand where people are coming from if they have a personal objection – whether it's abortion, whether it's sexuality. This is a free country where people are able to have their own opinions about things. When I listen carefully to what the anti-abortion people are saying, the thing that would make sense to me is, ‘well, if you're really anti-abortion, then you should be really pro-birth control.’ And really pro-education and really pro-supporting women and anti-sexual violence…
You're right. That's where the confusion comes in. Thank you for pointing that out. What’s with that?
When you peel the onion, it doesn't make sense. Maybe what they're really against is any kind of sexuality for women, any kind of choices for women. Because if you are really only anti-abortion then you would really want to support those other things. The fact that they're not supporting any of those other things sends a message that they're really anti-women, anti-sexuality, anti-science, and anti-education.
I've thought about feminism in America and written about it a great deal in my fiction and I'm trying very hard to understand why American feminism is limited around this subject. It seems to me that women in America are very empowered with ‘you can do it; you can be this and that,' but they’re not yet liberated. Why is this?
Internationally, we watch them conquer masculine goals whether it's in Hollywood movies or in companies running things as founders and CEOs, but then there's this pullback. They don’t have ultimate control of their sexuality, their freedom to choose for their body, and they have a very distinct place in the domestic breeding family.
There's this lack of liberation that I didn’t notice when living in Canada or briefly in the UK. I see the freedom women have in Canada, in European countries, and I don’t understand what the holdback is here in America. I can't figure it out. If you're religiously opposed to abortion, I appreciate and relate and understand; that's the freedom of choice in this country. And as you say, ‘then you should want to have birth control or you should want to have public education.’ Where is the disconnect? Why is it such a political issue in America?
I think that's a really interesting way of thinking about feminism in general – empowerment versus liberation. Maybe it's talking the talk versus walking the walk. This is a tough one, and I'm the oldest of five kids in six years. It was very apparent to me, early on, that having personal agency over my own reproductive system was the key to finishing school, success in life, financial independence.
I do think about this a lot, and I think it's something that we really have to grapple with and solve in this country. When you expand and think beyond sexual and reproductive health and rights and justice – it's not only about women. There are all of these communities that, on paper, have equal rights but in practice do not. I think it's something we have to come to terms with.
How does abstinence education work in stopping pregnancy compared to birth control? Under the Affordable Care Act, also known as Obamacare, is contraception free?
Yes. There's a great deal of science behind the fact that abstinence-only education doesn't work. It does not affect any improvement in teen pregnancy or STI rates. The majority of people involved with sex education will point to a number of studies and science and research. Kids who have been in those abstinence programs have been speaking out about how ineffective those programs are and how unprepared they are to handle things.
A real problem with the 'abstinence-only until marriage' type of approach is it also completely alienates a portion of the population that's super vulnerable: LGBTQ youth. They are at a higher risk of sexual violence, of unintended pregnancy, of STIs, and poor health outcomes. So, having access to age-appropriate, evidence-based, inclusive sexual health and education is really, really important.
Which is the bigger vehicle for you: going into schools to educate on health and reproduction, or educating at your centers?
We have always believed – as a parent of two young adults myself –that parents should be the primary sexual educator of their children. Not every child has that privilege – not in a socioeconomic sense but not every child has someone who can do that. Schools then need to provide that backup. The most important thing is trying to empower and enable and help parents and trusted adults have those conversations, as well as the schools. We also believe that kids can be good educators of their peers. It’s a multi-faceted approach, and I think our approach is probably similar to other Planned Parenthoods across the country, but we have very strong education programs for sex educators or people who work in schools. We have the curriculum that schools can purchase that then their own teachers are trained to use.
How many schools have purchased or use your curriculum?
In Massachusetts, unfortunately, sex education is an elective, not a mandated part of the curriculum. One of our legislative agenda items, a priority now going on seven years, is to say that at least if a school elects to teach sex ed in Massachusetts, it should be age-appropriate, evidence-based, medically accurate, and inclusive. That bill is called the Healthy Youth bill and it's currently being debated in our state legislature.
What's the holdup?
I think the holdup is that schools don’t like to have anything mandated, but the mandating is a myth too! The Healthy Youth bill would not mandate sex education be taught in schools or mandate a particular curriculum. Rather, it would ensure that if a community chose to offer sex education in schools, then it would have to use a curriculum that is age-appropriate and medically accurate. Despite that, those who oppose teaching sex education claim the bill is a state mandate in order to bolster opposition.
The senate has already passed the Healthy Youth bill and it's waiting to be taken up by the House. We have done some polling and we know that 80% of voters in Massachusetts support sex education in middle school and 90% support sex education in high school. I’m not 100% sure why the blockage or why things aren't moving forward.
Massachusetts seems like one of the most progressive states. Is it a price issue? Is there certain content in there that feels too controversial?
I think, frankly, people are still really nervous about sex education.
I think there are people that are worried that if we talk about sex and reproductive health, that kids will be more sexually active when the evidence points to the alternative. I think there is a lot of stigma and nervousness and shame about sexuality, and that's the core of what we're talking about today.
When you really peel that onion back, the stigma that is attached to sexual health in general, sexuality, reproductive health and all of those things, that stigma permeates and then it impacts everything.
Earlier when we talked about it also being around the lack of supporting women’s health. I’m not convinced it's only stigma in America. People are squeamish up north, as well as European countries: People blush and giggle but is there something else going on here in the US?
You raised this and I agree. I think it's complicated. I think there's still some blatant inequality in our society and we need to keep fighting against that. Look at what happened in Charlottesville, right? I think about things like the Equal Rights Amendment. That was many years ago and it still hasn't passed. It needs to be resurfaced.
[The Equal Rights Amendment (ERA) is a proposed amendment to the United States Constitution designed to guarantee equal rights for all citizens regardless of sex; it seeks to end the legal distinctions between men and women in terms of divorce, property, employment, and other matters.]
In America, we have the Hyde Amendment that was signed forty years ago to ensure that the federal government never pays for abortions, even though most developed nations do. While unbelievable that we are still discussing choice, does it seem surprising that we're the one developed nation that doesn't pay for abortion with tax dollars?
Unfortunately, it is not super surprising given where we are at this point in time and the conversations that have gone on for years and years and years about abortion access, about women's rights. I think it's unforgivable. I think it's unconscionable.
Am I missing something? Is there something else about this whole Planned Parenthood versus the GOP that I don't understand?
To be honest, I don't completely get it either but what I try to do is understand where people are coming from.
I understand the religious issue with abortion and I think that is a personal decision for a woman to make on her own with her doctor or her God. What I don’t understand is how Planned Parenthood has become this huge negative force for one party in our politics?
I think the person who's the best spokesperson for this is Cecile Richards, and she often points out how Planned Parenthood is rated in terms of public sentiment: the overall public sentiment is actually very positive.
Then why is it this amazing political tool that we don't see in other developed nations? I was hoping you could help me understand that.
What I would say, and this is my opinion, part of what we're seeing is that over the years with Planned Parenthood we have two organizations: we have the health care delivery and education organization and then we have an advocacy and electoral group as well, which in Massachusetts is the Planned Parenthood Advocacy Fund, and nationally is the Planned Parenthood Action Fund.
The Action Fund and The Advocacy Fund of Massachusetts and all advocacy and electoral groups related to Planned Parenthood around the country focus on what I think is driving the negativity on the GOP side. We really focus on advocacy, grass roots organizing, and getting the right people elected into office. That is the threat. My guess is that using the same old red flag about abortion is not quite as provocative as it used to be.
When we look at the opinion polls, more and more people recognize that choosing to have an abortion is a personal decision. It should not be a political decision; it should not be up to state or local government to decide what health services you should choose for yourself, whether it's an abortion or anything else for that matter.
If that then has a little bit less momentum, then I suspect that the political power: the coalition-building, the advocacy work has created some attention for Trump-type voters and I suspect it’s that electoral work that we have done supporting candidates is what’s making people not only nervous, but angry.
But this has been going on for a long time in America, long before Trump. When the GOP said they were going to defund it for one year in the repeal, that time limit reads as politically motivated and an olive branch to certain voters who don’t like Planned Parenthood. What is that?
It's totally political and, frankly, I think that's why it wasn't passed. I think the American people are smarter than people give them credit for, and I think women are stronger and more activated and more vocal than they've ever been before. I think that that groundswell of support for health insurance in general, and for the Affordable Care Act, and women's health in particular, has defeated the political agenda for now.