Cecile Richards, the former president of Planned Parenthood and a staunch protector of women's rights, has died at age 67.

In January 2024, Richards shared that she'd been diagnosed with an aggressive form of brain cancer, for which she underwent treatment. On Monday, Jan. 20, Richards's family shared a statement paying tribute to "our beloved Cecile" following her death.

Cecile's husband, Kirk Adams, and their three children—Lily, Hannah, and Daniel—said in a statement via email that the Planned Parenthood pioneer had "passed away at home, surrounded by her family and her ever-loyal dog, Ollie." The statement explained, "Our hearts are broken today but no words can do justice to the joy she brought to our lives."

The family thanked "the doctors and health care workers who provided her excellent care and the friends, family, and well-wishers who have been by her side during this challenging time."

Richards's family also offered a suggestion for how the general public might celebrate one of America's most important activists in recent history. "[W]e invite you to put on some New Orleans jazz, gather with friends and family over a good meal, and remember something she said a lot over the last year: 'It's not hard to imagine future generations one day asking: 'When there was so much at stake for our country, what did you do?' The only acceptable answer is: 'Everything we could.'"

While details of Richards's memorial are not yet available, her family directed supporters to a number of important resources, all of which support causes crucial to her work.

"Gifts to Abortion in America to support her work lifting up personal stories around the impact of abortion bans can be made," the statement explained. "She was also inspired by the many local and grassroots organizations working to support people seeking reproductive health care, especially in the south, including Lift Louisiana, Midwest Access Project, Women’s Emergency Network, Tampa Bay Abortion Fund, Lilith Fund, and the M+A Hotline. And, of course, she was a lifelong supporter of Planned Parenthood."

The U.S. is the only wealthy nation that does not guarantee its citizens paid leave. This cold fact inspired organizations and founding director Dawn Huckelbridge—who previously worked at organizations like Supermajority, Planned Parenthood and People for the American Way—to launch Paid Leave for All Action in 2019. The action arm of Paid Leave for All unites organizations fighting for the 75 percent of Americans who do not have access to paid leave through an employer. Here, Huckelbridge outlines what we need to know about the state of paid leave and President Biden's plan to fund it.

Last week, President Biden unveiled his $6.8 trillion budget plan for the coming 2024 fiscal year, and in it, the strongest budget proposal for a federal paid family and medical leave program in history. 

To hearken back to one of Biden’s sayings, this is a "BFD."

The White House is calling it a “blueprint to invest in America, lower costs for families, protect and strengthen Medicare and Social Security, and reduce the deficit by making the wealthy and corporations pay their fair share.” It follows on the agenda that the President detailed in his State of the Union in February, where he also affirmed his commitment to paid leave. The proposal includes a $325 billion commitment to a comprehensive, permanent paid family and medical leave program. The program would provide up to 12 weeks of paid leave to cover you or a loved one’s serious health need and bonding with a new child, as well as leave for military deployment, safe leave from sexual or domestic violence, and leave for bereavement. 

This isn’t the first time the President has advocated for paid leave. It was in his previous budgets and a central part of his economic agenda, included in his original “Build Back Better” plan, the President’s core legislative framework in the first year of his administration. That legislation was later split off into separate bills and the family care components were lost in negotiations. There was overwhelming support for paid leave and an outcry when it was cut. We did in fact pass paid family and medical leave in the U.S. House of Representatives in 2021, and it was only one vote short had it moved to the Senate at that time. And now, as another election cycle begins, advocates and voters are confirming that paid leave is at the top of the agenda of must-pass legislation.

What’s so important about all this? 

Today the United States remains one of only six countries in the world that guarantees no form of paid leave for its workers. This means that:

• 3 in 4 working people do not have paid family leave through their jobs.
• 1 in 4 women have returned to work within two weeks of giving birth, while their bodies are not yet healed and their newborns are perhaps not even able to lift their heads yet. 
• 61 percent of people caring for an aging loved one, or a loved one with a disability or medical condition, are doing this while working and without support.

Under these conditions, the gender and racial inequities persist, and grow. On a personal level, in one of the wealthiest countries in the world, we are missing our parents’ last breaths, our babies’ first smiles, our own treatments and recovery. 

And it means that our public health suffers, our economy loses, and all of our families take the hit.

The budget, like all presidential budgets, is not expected to get through Congress intact. It’s on Congress and its budget committees to develop a budget resolution.  GOP lawmakers will likely reject the President’s blueprint for federal spending, as they have in the past. There has already been pushback on what some Congressional Republicans have called “woke” or “reckless spending.” Regardless of your political affiliation, there is near unanimous consent among voters that paid family and medical leave is not reckless, but necessary and urgent. In fact, working families lose over $22 billion every year because of our country’s failure to secure it. And passing paid leave with other care policies would actually yield millions of jobs, billions in wages, and trillions in GDP. It’s a boost to bottom lines and a boon to business, especially small business—and two-thirds of small business owners agree and want a national paid leave program to retain their workers and help them compete. 

Regardless of the final budget resolution, the President’s budget proposal remains an important document that reflects the administration’s policy priorities, values—and likely their campaign plan. 

Paid Leave for All Action did polling in midterm battleground states that found 81 percent of voters support paid leave—which was also a double-digit increase in the last year. Paid leave is popular with a majority of voters in all political parties, and especially popular with independent women voters. Paid leave is a hugely impactful policy, a proven tool for our health, our financial security, and our families’ wellbeing. And it’s key to electoral outcomes.

Why this can, and must, all change. 

The federal budget and the President’s proposal are just parts of how government programs are funded and work. We need legislation to move again for paid leave’s passage, and we need the votes in both chambers of Congress. But paid leave was right at the finish line and we believe this momentum and mandate will only grow. In just the first months of this year, we’ve already seen unprecedented energy and action. A historic bipartisan working group launched for the first time in the House of Representatives, as well as a Congressional Dads Caucus focused on passing paid leave. Paid leave legislation will be reintroduced again soon. The President and Vice President have taken executive actions and committed to a renewed push. We represent tens of millions of people and voters across the country, and every day more organizers, advocates, small business owners, and working families join us across the country. The movement is stronger than ever. And as a movement, alongside the President and the growing number of champions in Congress, we plan to finish the job.

President Biden signed an executive order today designed to protect access to medication abortion and contraception. The president has been under pressure from reproductive justice advocates and other Democrats who have criticized him for not taking more action after the Supreme Court overturned Roe v. Wade on June 24. 

White House Gender Policy Director Jen Klein tells Marie Claire that the Biden administration has had dozens of meetings with multiple stakeholders to talk about reproductive rights in the last few weeks. The administration has met with doctors, healthcare providers, privacy experts, advocates, government officials, Planned Parenthood, and independent clinics. When asked if Biden has met recently with people who have had abortions to hear their stories, Klein said he has not, but that people on his staff (including Klein herself) have.

“We are being incredibly careful and analyzing every option,” says Klein. “We run down every option. The fact is there literally has not been anything that has been proposed by an advocate or a member of Congress that we haven’t considered.” 

Before signing the executive order, Biden called the Supreme Court’s decision “terrible” and “extreme” and reiterated that people need to “vote, vote, vote, vote.” His order directs his secretary of health and human services (HHS), Xavier Becerra, to come back in 30 days with steps that can be taken to ensure access to medication abortion, contraception, and emergency medical care. The executive order touches on a need for additional HIPAA guidance and better patient protections, and seeks to convene volunteer lawyers to represent “patients, providers, and third parties lawfully seeking or offering reproductive health care services.” 

The president also called for an interagency Task Force on Reproductive Health Care Access. Biden’s order asks the chair of the Federal Trade Commission to consider how to protect consumers’ privacy when seeking reproductive health care services.

As reproductive justice advocates wait to see how this executive order will play out, specifically, frustration persists for some Democrats who argue more needs to be done—in particular for pregnant people seeking abortions who can’t travel and live in states where the procedure is banned or extremely restricted.

Responding to Marie Claire's questions about what support is being considered for people who can’t travel for financial reasons, Klein says: “That is mostly being considered by non-governmental organizations. The philanthropy and the private sector is really stepping up to fund travel and they will continue to do that." She adds, "We don’t, at the moment, have a plan in place to be able to fund transportation.”

After a follow-up about how the administration will address cases of people like incarcerated individuals, who won’t be able to travel even if they secure funding, Klein says that they are looking into "everything." As for undocumented immigrants who may be prevented from access due to the risk of border check points, the White House will remain “vigilant” about how people are being restricted from travel, Klein says. “I would say that really no, no, no option and no action is off the table.”

In the wake of Dobbs, there have been reports of people being denied access to mifeprostone, a pill used in medication abortion, either because a doctor or pharmacist is nervous or receiving legal counsel not to prescribe or fill the medication. “Women are being told to wait until they’re ‘really sick’ at which point the pill can be given,” says Klein. 

She points to Attorney General Merrick Garland’s recent comments about medication abortion: “The FDA has approved the use of the medication Mifepristone. States may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.”

Klein asserts that today’s executive order “takes the next step” toward figuring out what can be done to ensure that medication abortion is available and accessible. In the meantime, the battles continue to play out on the state-level as doctors, attorneys, and pregnant people attempt to navigate the new landscape of reproductive rights.

This story has been updated.

With the fall of Roe v. Wade, at least 26 states across the country are certain or very likely to ban abortion, to some degree. These bans include 6-week laws, which outlaw abortions that take place six weeks after conception (even though many women don't even know they're pregnant until after 6 weeks); 20-week bans, even though most abortions take place within 21 weeks, but for cases of lethal health risks and fetal deaths; and highly restrictive bans that lead to women being arrested for miscarriages. The overturning of Roe v. Wade could even spell the death of other American civil rights, such as same-sex marriage and basic access to contraception.

While it's easy to believe that all (or at least much) is lost, we can still mobilize to defend our rights as well as the rights of women around the country. Below, we've gathered some of the most impactful non-profits and grassroots organizations accepting donations that seek to protect the heath, safety, and reproductive freedom of all people with uteruses, regardless of background or socioeconomic status.

Planned Parenthood

You've almost certainly heard of Planned Parenthood, which often seems to sit at the crux of the fight for reproductive justice. The institution also provides a number of other services including cancer and COVID-19 screenings, contraception access, health, natal support, sexual dysfunction support, psychological services, STD screenings and treatment, sexual assault support, and counseling with regards to relationships, gender identity, and sexual orientation. This indispensable organization is a pillar of contemporary American medicine, especially for women and the LGBTQ+ community.

You can donate to Planned Parenthood at large, or you can donate directly to the Planned Parenthood Action Fund, which is set aside specifically to support all of Planned Parenthood's activities and to promote reproductive health across America.

National Black Women's Reproductive Agenda

This organization, founded in 2014, specifically assists Black women, who are disproportionately impacted by poverty in the United States and face a greater gender-based wage gap than their white counterparts, in accessing abortion and reproductive care. They work in tandem with eight state-based reproductive justice organizations in Ohio, California, Pennsylvania, Tennessee, Louisiana, Texas, and Georgia, and are active in lobbying, community outreach, and education for reproductive rights and women's health. You can donate to them. 

National Latina Institute for Reproductive Justice

People of color and immigrant communities are set to be disproportionately impacted by abortion restrictions, especially considering the state of access in border states like Texas. Thus, the National Latina Institute for Reproductive Justice strives to educate Latinx communities about abortion access and reproductive justice, as well as ensure all people have access to safe contraception and abortions regardless of socioeconomic status, immigration status, race, and linguistic ability. You can support them.

NARAL Pro-Choice America

Often referred to simply as NARAL, this non-profit fights not only for abortion rights but also for access to birth control and paid family leave, along with fighting pregnancy discrimination for female professionals. They also fight online disinformation and traps that could harm women looking for abortions, and they go undercover to unmask fake abortion clinics. Consider donating to them. 

National Abortion Federation

The National Abortion Federation connects abortion patients, providers, researchers, and advocates in order to directly provide safe, easily accessible, and affordable abortions to women across the nation. They also have a hotline for women who are urgently in need, require information, or are looking to connect with reproductive healthcare professionals. You can support them.

Center for Reproductive Rights

The Center for Reproductive Rights works closely with the United Nations across five countries to protect women's bodies. In addition to defending women's reproductive justice and access to safe abortions, they also support obstetrics care, maternal and natal care, contraception access, and they fight against forced sterilization and child marriage. Much of their work is also focused in the United States, including their work on policy change. You can donate to their efforts.

Rape, Abuse & Incest National Network (RAINN)

Many survivors of rape, incest, and domestic violence find themselves in need of abortion services after the attack(s). This can be especially challenging for survivors, on both psychological and physical levels, and RAINN is devoted to providing counseling, medical services, and psychosocial support in the wake of these attacks in addition to helping women navigate their options. They have a 24/7 confidential hotline, a chat service, and you can support them financially online.

Guttmacher Institute

A subsidiary of Planned Parenthood until it became its own organization in 2007, the Guttmacher Institute is based upon three pillars to support abortion access in the U.S.: (1) high-quality research, (2) evidence-based advocacy, and (3) strategic communications. A great deal of their work involves researching and providing education about reproductive health and the importance of widespread access to contraception and safe abortions. You can donate to them. 

National Women's Law Center

The National Women's Law Center, also known as the NWLC, works on a number of fronts to support access to abortion across America. Their efforts include co-authoring legislation regarding women's rights, working with media outlets and the entertainment industry to prevent misinformation regarding reproductive rights, and litigation in favor of reproductive freedom. You can support them.

National Network of Abortion Funds

The National Network of Abortion Funds works with over 80 organizations across the United States to provide abortion access and reproductive resources in spite of any financial and logistical obstacles. Highly intersectional, they specifically address disparities in healthcare access due to factors like race and socioeconomic status, and their website even provides a user-friendly "Find a Fund" function that can connect users with local clinics, help them navigate getting an abortion via Medicaid, find discounts at clinics, and learn about abortion safety. You can donate to their cause. 

Ipas

Ipas is an international organization that strives to create "a world where every person has bodily autonomy and can determine their own future." Their work includes outright and political action in the United States as well as in developing countries like Malawi, Bolivia, and India in order to ensure that women everywhere have access to safe, high-quality abortion care and after-care. They also educate women about reproductive self-care, fight against gender-based violence and inequity, and support climate justice initiatives. You can offer them your financial support.

Abortion Care Network

According to the Abortion Care Network, 2 in every 3 women who have an abortion get one from an independent clinics. However, in the last ten years, more independent clinics have been forced to shut down than ever before. The Abortion Care Network works to keep these clinics open and helps them mobilize on social media and within their communities so that they can continue providing much-needed care and education to those in need of contraception and/or abortions. The organization also works to end harassment at and outside abortion clinics in order to decrease the incidence of anti-choice violence and to ensure all women have access to dignified reproductive care. You can donate to these efforts.

American Civil Liberties Union (ACLU)

The ACLU is one of the most prominent and impactful civil rights organizations in the country, and fights for American liberties and safety across party lines. Currently, they are filling litigation in trigger states as well as states likely to ban abortions, and are lobbying on both the federal and state levels for measures to protect reproductive justice. You can donate. 

Advocates for Youth

We love Advocates for Youth, which advocates for access to safe contraceptives, racial justice, honest sexual education, LGBTQ+ rights, support for sexual assault survivor, abortion access, and much more, particularly as it pertains to adolescents and young adults. In addition to advocating for changes in policy, the organization's Abortion Out Loud campaign also works with schools and college campuses to provide education, financial support, and access to young people in need of contraception and/or an abortion. You can donate to them. 

National Council of Jewish Women

This organization is involved in a number of initiatives including expanding abortion access in the U.S., helping Ukrainian refugees, fighting human trafficking, and more. When it comes to reproductive access specifically, the organization has led protests, lobbied for reproductive equality (including supporting the Black Maternal Health Momnibus Act), and met with political leaders, including VP Kamala Harris, to ensure that women across the country have access to safe abortions, regardless of income, religion, and race. You can donate to their efforts. 

The overturning of Roe v. Wade last week has shaken people around the U.S. to their core, with protests breaking out across the country in response to the Supreme Court decision. Since the news broke, public figures have spoken out, loudly and with rage, and so have many celebrities.

Here's what people in the entertainment industry have had to say about the legal move that will make access to abortion so much more dangerous for millions of people with wombs.

Olivia Rodrigo and Lily Allen

During her Glastonbury festival set in England, Olivia Rodrigo brought out Lily Allen to sing "F*** You" to the Justices who struck down Roe. You can read more about the performance here.

Lizzo

Lizzo pledged a generous donation to organizations who help provide access to abortions. "I’m pledging $500k from my upcoming tour to Planned Parenthood and Abortion Rights. Live Nation agreed to match— to make it 1 MILLION dollars," she tweeted.

Sophie Turner

A visibly emotional Sophie Turner expressed exactly how she felt about the decision to overturn Roe via Instagram Stories. "Overturning Roe v. Wade is setting us back 50 years," she said.

"This isn't going to save any lives. It's going to kill and endanger millions of women who are gonna end up getting backstreet abortions, dangerous backstreet abortions, and end up dying from it.

"If this was actually about saving lives, if anyone cared about saving lives, then after any of the mass shooting that have happened here in the United States, we would have gun control. It's not about saving lives, it's about controlling a woman's body and controlling a woman's right to choose. And it's absolutely f***ing disgusting."

Taylor Swift

Taylor Swift quote-tweeted Michelle Obama's statement on the decision, adding, "I’m absolutely terrified that this is where we are - that after so many decades of people fighting for women’s rights to their own bodies, today’s decision has stripped us of that."

Harry Styles

Harry Styles wrote on Instagram Stories, "I'm absolutely devastated for the people of America today. Check on your friends. Look after each other. We're all in this together, and the fight is just beginning. A truly dark day for America."

The singer also held up a fan's sign during a recent performance that read, "My body, my choice."

Billie Eilish

At Glastonbury, Billie Eilish said, "Today is a really, really dark day for women in the U.S. and I'm just gonna say that, because I can't bear to think about it any longer in this moment."

Shonda Rhimes

Shonda Rhimes tweeted, "This is actually happening."

Jessica Biel

Jessica Biel tweeted, "I am enraged. What happened today is not only a disgusting step backward for women - undermining our ability to make decisions for our own bodies… but it’s also dangerous. You didn’t ban abortion, you banned access to SAFE abortion. #BansOffOurBodies."

Halle Berry

Halle Berry wrote, "I’m outraged! What the supreme court has done is BULLSHIT. Something has to be done! Guns have more rights than women.

"Stop this war on women & keep your laws off of our bodies. We have to ban together & NOT accept this! We can’t just post about it, we must DO SOMETHING about it"

Danny DeVito

Danny DeVito contributed simply, "Supreme Court my ass."

Viola Davis

Viola Davis commented, "And so it goes….Gutted. Now more than ever we have to use our voice and power! WE the people……

"The Supreme Court has overturned Roe v. Wade."

Padma Lakshmi

Padma Lakshmi wrote, "People will still get abortions. 

"These procedures won't stop just because Roe v. Wade is overturned.

"This will only prevent safe, legal abortions from taking place."

P!nk

"Let’s be clear: if you believe the government belongs in a woman’s uterus, a gay persons business or marriage, or that racism is okay- THEN PLEASE IN THE NAME OF YOUR LORD NEVER F***ING LISTEN TO MY MUSIC AGAIN. AND ALSO F*** RIGHT OFF. We good?" P!nk tweeted.

The battle for reproductive freedom continues today as the Supreme Court hears oral arguments in a case known as Dobbs v. Jackson Women's Health Organization that directly challenges Roe v. Wade. It's the first time the Supreme Court will rule on the constitutionality of a pre-viability (a.k.a. before the fetus can survive outside of the uterus) abortion ban since Roe became the law of the land nearly 50 years ago.

Reproductive justice advocates were surprised to learn in May that the Supreme Court would take up the case, which involves a Mississippi law passed in 2018 that bans abortion after 15 weeks. In 2019, the Mississippi abortion ban was struck down by lower courts and stopped from going into effect. Following this, Thomas Dobbs, state health officer of the Mississippi Department of Health, filed an appeal on behalf of the state requesting for the Court to uphold the 15-week ban and directly overturn Roe. The Court sat on the case for nearly a year before it decided to hear it.

"It's important to pay close attention to what happens in the oral arguments on Wednesday and how this gets spun by the states and by our opposition while we're waiting for the outcome," explains NARAL President Mini Timmaraju. "The anti-choice advocates are going to use the fact that the Court opened this window to hear this case and have let S.B.8, [the recent Texas law that bans abortions after six weeks], stand so long as more incentive to push further restrictions on abortion across the country."

The Center for Reproductive Rights will represent Jackson Women's Health Organization—the only licensed abortion clinic left in Mississippi—as the Supreme Court decides whether or not all pre-viability bans on elective abortions are unconstitutional. Jenny Ma, senior staff attorney at the Center for Reproductive Rights, tells Marie Claire that the simplest decision, and the option the Center is advocating for, would be that the Court recognizes Roe is the law of the land and reaffirms that decision like it did in Planned Parenthood v. Casey in 1992.

On the other end of the spectrum, in a devastating blow to abortion rights, the Court can accept Mississippi's arguments and overturn Roe v. Wade as well as Planned Parenthood v. Casey. In this scenario, the constitutional right to have an abortion would effectively be eliminated in about 26 states (12 of them have trigger laws that are waiting to go into effect if and when Roe is overturned). However, what it really comes down to is the details. The Court could decide not to explicitly uphold Mississippi's ban or overturn Roe. Instead, it could redefine provisions like the viability standard (fetal viability typically occurs around 24 weeks of pregnancy), which the state of Mississippi argues is arbitrary. 

"It's really important to understand that any decision that upholds Mississippi's ban is the same as overturning Roe," says Ma. "They might not say the words in the decision, but you cannot uphold this law without taking away the core holding of Roe, which is that the individual has the right to make the decision until viability."

Nearly six in 10 Americans support legal abortion and do not want Roe v. Wade overturned, yet 2021 has been the worst year on record for abortion access—with low income people of color, LGBTQ+ folks, and those who live in rural areas disproportionately impacted the most. At this critical time, pro-choice advocates are focused on electing pro-choice politicians in the 2022 midterm elections and passing the Women's Health Protection Act (WHPA). The bill would codify Roe and expand abortion access across the country by making it harder for states to pass medically unnecessary restrictions like waiting periods and telemedicine bans. It passed in the House and is currently sitting in the Senate.

As oral arguments commence, the Supreme Court's 6-3 conservative majority is a major concern for abortion rights advocates. Three of the justices—Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett—were appointed by former President Donald Trump who previously promised to appoint Supreme Court justices that would overturn Roe v. Wade. These justices, as well as Clarence Thomas and Samuel Alito, recently voted not to block Texas' six-week abortion ban from going into effect on September 1. This morning, hundreds are rallying in front of the Supreme Court in hopes that their reproductive freedom will be protected.

"Our generation has just not been through this, and so I think in some ways the [abortion] rights have been expected," says Ma. "For pregnant people and women, it's just devastating to see these arguments being made."

The Court is expected to issue a decision on Dobbs v. Jackson Women's Health Organization in summer 2022, though it could technically do so anytime beginning in January. You can listen to the oral arguments starting at 10 a.m. ET.

On September 1, 2021, Texas' near-total abortion ban, S.B. 8, went into effect. The most restrictive abortion law in the country bans abortion after six weeks of pregnancy (at six weeks, most people don't even know they are pregnant), does not make an exception for pregnancy that results from rape or incest, and allows private citizens to sue anybody who provides an abortion or assists someone in accessing an abortion after this time period. They will receive a $10,000 award if they are successful.

The law is the first of many that will likely be replicated in conservative states across the nation after the Supreme Court allowed the law to go into effect in a 5 to 4 vote. It also alludes to the Court's decision in the months ahead when it decides whether Roe v. Wade, the 1973 landmark decision that affirms access to a safe and legal abortion is a constitutional right, should be overturned.

As Nancy Northup, president and CEO of the Center for Reproductive Rights, wrote for Marie Claire on the 48th anniversary of Roe v. Wade this past January, "Roe has been a critical bulwark against the hundreds of state abortion bans and restrictions enacted in the past decade...But the Supreme Court has changed composition since the June Medical decision, following the death of Justice Ruth Bader Ginsburg and the confirmation of Justice Amy Coney Barrett in her place. This capped a seismic shift in the federal courts during the Trump administration, with incredibly troubling implications for abortion."

People of color will suffer the most from Texas' restrictive law, along with many young people, immigrants, LGBTQ+ people, and those who live in rural areas who already have barriers to quality health care and face other forms of discrimination. Traveling across state lines to receive the procedure is simply not an option for many people.

With abortion top of mind for both citizens and lawmakers (2021 is the worst legislative year for abortion rights since Roe), misinformation continues to circulate about the procedure itself and related laws across the country, like whether taking Plan B is the same thing as getting an abortion (it's not) and whether or not abortion is still technically legal in all 50 states (it is). To clarify these questions, Marie Claire enlisted the expertise of Dr. Meera Shah, a family medicine physician who currently serves as the chief medical officer of Planned Parenthood Hudson Peconic, to debunk common abortion myths by creating a comprehensive guide on abortion, below.

Is abortion still legal in all 50 states?

Texas' law banning abortion after six weeks makes it pretty close to being illegal in the state, but, yes, abortion is technically still legal in all 50 states and in D.C. "It's unfortunate, but a lot of the headlines make that very simple question pretty confusing," says Dr. Shah. "I have to let my patients know that abortion is legal everywhere, despite what the headlines say and the attacks on abortion care at the moment."

The Guttmacher Institute, a pro-choice research organization founded in 1968, has a frequently updated legislative tracker where you can check to see what type of restrictions and bans your state has introduced. You can access it here.

Is it still legal to get an abortion past the six-week mark?

Not in Texas due to the passage of S.B. 8, which went into effect on September 1. It's the most restrictive abortion law in the country.

"The reason why [lawmakers] picked six weeks is because this is usually the time at which there is some cardiac activity detected on ultrasound, but most people aren't even aware that they are pregnant at this time," explains Dr. Shah. "Often people discover that they're pregnant around seven to eight weeks. Essentially this bans the vast majority of abortions [in Texas]."

I want an abortion. How does the process work?

"It depends on where you live. In New York, if somebody discovers that they're pregnant and they decide that they don't want to continue with the pregnancy, they can call one of the many providers that are available who provide abortion care and make an appointment. Oftentimes, they're able to get an appointment that same day," says Dr. Shah. "Where I work at Planned Parenthood Hudson Peconic, we have 10 health centers that provide abortion care six days of the week. The pregnancy is dated and then either a medication abortion is provided or a procedural abortion is scheduled. There's no waiting period, no mandatory script that has to be read. In some states, a script has to be read that's filled with lies that say things like 'abortion can cause breast cancer, abortion can cause depression.' It's not true."

Though the cost of an abortion widely varies, you can learn more about the potential cost here and here.

What are some barriers to accessing abortion?

"In some states, like Texas, there's a 24-hour waiting period where the patient has to go home [after getting the ultrasound] and return at least 24 hours later to get the abortion. In Indiana, it's 18 hours. In Missouri, it's 72 hours. In North Carolina, it's 72 hours as well," says Dr. Shah, noting this disproportionately affects people of color the most. "There are these arbitrary amounts of time where patients have to go home and return, which means that they have to take time off work, find transportation, and arrange childcare all to fulfill the requirements that are in place to restrict abortion access."

Dr. Shah continues, "These rules do nothing to 'change people's minds' as they're intended to. What they really end up doing is cause harm and distress. They cause people to have to pay more out of pocket to try and access care. In some states they don't even allow commercial insurances to pay for abortion care. So people are paying out of pocket essentially. Because of the Hyde Amendment, Medicaid can't be used to pay for abortion care."

The Biden administration recently announced it will remove the Hyde amendment from the proposed budget for the 2022 fiscal year.

How do I decide whether to receive a medication abortion or a procedural abortion?

"The vast majority of abortions occur early in pregnancy in the first trimester. We know that medication abortion is safe and effective up to 11 weeks. So if somebody is less than 11 weeks [pregnant], they can choose to have a medication abortion or they can choose to have a procedural abortion," explains Dr. Shah. "But because of all of these bans, what [lawmakers] do is they oftentimes push people into a later gestational age, thus forcing them to only have the option of a procedural abortion. It's a great and safe method, but some people would rather take a pill as opposed to having a procedure. We want to ensure that people are still able to make those choices."

If I choose to receive a medication abortion, can my abortion provider mail me pills or do I have to pick them up in person?

"Historically, the [abortion] provider has to dispense the pills from the health center, meaning a patient has to come to the health center to get the pill. Now, what is allowed is that a provider can mail the pill or send the prescription to a mail-order pharmacy to have it shipped to the patient if they qualify based on their gestational age that they report," says Dr. Shah. This is based on Food and Drug Administration (FDA) rules.

"The FDA has restrictions on the pill mifepristone. [At the beginning of] COVID-19, patients were being told that they should stay at home, shelter in place, and socially distance, yet they were also being told they can have telehealth for any health care needs, but for abortion you have to come in to get the pills," explains Dr. Shah. "There was this pause in the rule where patients were mandated to come in. Now it's back in place. Still, it's not an option for everyone everywhere because of state rules. So the FDA can say one thing, but then each state has the right to implement unnecessary barriers."

Will an IUD cause me to have an abortion if I get pregnant?

"No. An IUD is one of the most effective methods of contraception that we have. It prevents pregnancy before it even occurs," says Dr. Shah. "We see this a lot where politicians will say that IUDs or emergency contraception cause abortion, and that's just not how it works. It's not even medically possible."

Is Plan B the same as medication abortion?

"No. There are two different emergency contraceptive pills: One is Ella. One is Plan B. One is progesterone, one is a progesterone blocker," says Dr. Shah. "They prevent pregnancy by delaying ovulation. It does not cause an abortion. It's two totally different pharmacological mechanisms."

If you're already pregnant, Plan B won't affect the pregnancy either in the event that you were pregnant and didn't know.

How old do I have to be to get an abortion?

"That depends on the state you live in. In many states, minors have to have parental or guardian consent in order to get an abortion and if this isn't possible, then some states will allow judicial bypass, where the young person can go to court and have the court grant them the ability to get an abortion without parental or guardian consent," says Dr. Shah. "Interestingly, in these same states, if the individual wanted to continue the pregnancy, they do not have to have parental or guardian consent. They can continue a pregnancy and become a parent."

FIND MY STATE'S ABORTION AGE REQUIREMENTS

Can I go by myself to get an abortion or does someone have to come with me?

"That depends on your age. If you live in a state where you have to have consent from a parent or guardian, then you would need to bring somebody with you who can sign the paperwork," explains Dr. Shah. "If you're getting a procedural abortion and want sedation to help make the procedure more comfortable, you may be asked to bring someone with you who [can provide support] and drive you home afterward as well."

How do I find the closest abortion clinic near me?

You can utilize Power to Decide's abortion finder tool, which includes more than 750 verified abortion service clinics across the country and a list of state laws that might limit a person's access to abortion care.

FIND AN ABORTION CLINIC NEAR ME

Do transgender folks need to disclose that they are trans before getting an abortion?

"No. The only thing that we ask when seeing patients for abortion care are things that are medically relevant," says Dr. Shah. "At Planned Parenthood, we ask patients their pronouns because we want them to feel seen. It's a way for us to honor them and honor their identity and let them know that it's a safe place to get care. If they're pregnant and they don't want to be, the care is the same. The fact that they're trans or non-binary doesn't need to be disclosed if it's not medically relevant."

How can I fight against abortion restrictions both at the federal and state level?

You can learn more about federal and state restrictions on abortion here. The best way to fight against these restrictions are to take the following actions:

• Vote for pro-choice politicians up and down the ballot.
• Sign the petition against S.B. 8: Text SB8 to 22422 or click here.
• Follow organizations who are actively fighting for abortion rights like the ACLU, Planned Parenthood Action, NARAL, Whole Woman's Health Alliance, Power to Decide, the National Abortion Federation, and the Center for Reproductive Rights.
• Donate to abortion funds like the National Network of Abortion Funds, Indigenous Women Rising, and the Lilith Fund that provide assistance to people who want to receive an abortion but may not be able to afford it.

In April, Kristina Tocce was video chatting with a woman who wanted to end her pregnancy. Tocce, an obstetrician-gynecologist, was used to providing this kind of care; she’d been virtually prescribing abortion pills from her Colorado office to patients there and in New Mexico for more than a year. A virtual procedure means women don’t have to travel to an abortion clinic to get care, which is convenient in normal times and potentially lifesaving when a deadly respiratory virus is surging.

But this patient wasn’t sitting on her couch or at her kitchen table. This patient had just crossed the Texas–New Mexico border and was alone, parked in her car. She had driven four hours from her home in Texas for the consult, the required first step to receive an abortion. After the appointment, she turned right back around; she hadn’t been able to find overnight childcare, so staying in a hotel wasn’t an option. She would make the same trip again the next day to retrieve the package of abortion pills the clinic had mailed to her friend’s New Mexico address. Legally, she had to receive them in the state even though she wouldn’t set foot inside a doctor’s office.

Weeks earlier, Texas had deemed abortion nonessential health care under the guise of preserving PPE and hospital beds. While a virtual appointment wouldn’t require these resources, telehealth abortion (a.k.a. teleabortion) is banned in Texas, pandemic or not. To even video chat with a provider who could help her, the patient had to physically be in one of the 30 states where this service is legal. In total, she drove 16 hours over two days simply to access a constitutionally protected procedure.

Tocce, vice president and medical director of Planned Parenthood of the Rocky Mountains, was stunned. She recalls another Texas patient who made a 10-hour trip with a disabled family member and their health aide; the trio had stayed in a hotel until a package of pills arrived in the mail the next day. “It’s really frustrating as a provider to see patients have to go through that,” says Tocce. “There is no medical reason for that barrier and that hassle for the patient.”

Telemedicine has transformed the way Americans receive medical care during the pandemic, and the model will no doubt continue to grow even after COVID-19 vaccines are widely distributed—one analysis suggests sevenfold by 2025. But as medical care continues to shift online, people seeking abortions could be left behind.

In 2017 (the most recent year with data available), nearly 40 percent of all abortions in the U.S. were done via pills. Patients take two: mifepristone, which blocks the hormone progesterone, preventing the pregnancy from progressing; then misoprostol, which induces cramping and bleeding to empty the uterus. The regimen is FDA-approved up to 10 weeks into pregnancy and legal in all 50 states, but 20 states, including Texas, ban prescribing abortion drugs through a phone or video appointment. The first pill, mifepristone, is also subject to a Risk Evaluation and Mitigation Strategy (REMS), an FDA drug-safety program. Under normal circumstances, this means that mifepristone can be dispensed only in clinics, medical offices, and hospitals by or under the supervision of a certified health-care provider, and doctors have to stock the drug in their office or clinic; neither brick-and-mortar nor mail-order pharmacies can carry it. Though the FDA guidelines are unclear, most doctors interpret the language to mean they must give pills to patients in their clinic, forcing them to act as both physicians and pharmacists, says Kirsten Moore, director of the Expanding Medication Abortion Access (EMAA) Project.

Prior to the pandemic, abortion providers generally did not mail pills to patients unless they were a part of the small FDA-authorized research study in which Tocce’s clinic participates. (The TelAbortion project operated in 14 states and Washington, D.C., in 2020. Elizabeth Raymond, a senior medical associate at Gynuity Health Projects, which runs the TelAbortion project, says participating clinics had mailed just over 1,500 packages of pills as of December 2020.) In desperation, some women turned to the deep corners of the Internet, including a legally murky telemedicine site founded in 2018 by a Dutch doctor who ships pills to the U.S.

But as telemedicine abortion proved indisputably safer than in-clinic care during the pandemic, the American College of Obstetricians and Gynecologists (ACOG)—which had called for the REMS to be overturned in 2018—filed suit (along with reproductive justice group SisterSong Women of Color Reproductive Justice Collective) in federal court in May 2020 for providers to be able to mail the drugs for the duration of the crisis, citing the regimen’s extensive safety record. (Evidence shows the process is effective in 95 percent of abortions and that serious complications occur in fewer than 0.4 percent of patients.) The lawsuit, brought by the American Civil Liberties Union (ACLU), notes that, of the 20,000 drugs the FDA regulates, mifepristone is the only one that must be dispensed in a medical office but can be taken at home with no clinical supervision.

“The whole reason for the REMS is a political way to restrict access to the pills,” says Elisa Wells, the cofounder and codirector of Plan C, a site that provides information on medication abortion. “And [politicians, lobbyists, and regulators] have been successful because providers don’t want to jump through all those hoops in order to provide the care.” There’s no medical reason to block mailing the pills, adds Daniel Grossman, a professor of obstetrics and gynecology whose 2017 study on a pilot program in Iowa found that the telemedicine model is just as safe as providing abortion care in person. (Fun fact: Mifepristone is actually much safer than Viagra. Viagra, however, is not subject to REMS—no surprise there.)

On July 13, 2020, a federal court in Maryland ruled that the FDA must allow providers to mail mifepristone during the pandemic—but they would still have to adhere to state laws. The Trump administration appealed to the Supreme Court, and on January 12, 2021, in the first abortion decision with Amy Coney Barrett on the bench, SCOTUS reversed the lower court’s ruling, reinstating the FDA’s restriction on mailing. In the time between the two rulings, a number of U.S. doctors had opened virtual services; it is unclear if they can continue operating in the same way without action from the Biden administration. But as Wells put it: “The genie’s out of the bottle. And once the genie is out of the bottle, it’s really hard to get it back in.”

One of the biggest benefits of receiving abortion pills in the mail is not having to travel to a clinic—possibly twice if your state has a mandated waiting period after “informed consent” counseling. Five hostile states have just one abortion clinic within their borders. The majority of people seeking abortions are living on low incomes, and travel and childcare can be costly. Teleabortion offers flexibility; Tocce is able to see patients outside traditional clinic hours if that’s better for the patient’s work or childcare schedule. She’s even treated patients who couldn’t visit a clinic because they were quarantining for COVID-19 and, if forced to wait for an in-person appointment, would have been too far along in their pregnancy to use pills. New asynchronous models (like texting services and an AI chatbot program that Planned Parenthood is piloting) also streamline the unnecessarily arduous process.

Telemedicine is also helpful for people who are largely homebound, including some people using wheelchairs and others with chronic illnesses, says Laurie Bertram Roberts, executive director of the Yellowhammer Fund in Alabama, a state with a ban. It can also be a relief for those who are anxious going to clinics based on past negative medical experiences, such as people who are Black or Indigenous, gender-nonconforming, undocumented, or even overweight, Roberts says.

But just because teleabortion might be easier than getting in-clinic care, that doesn’t mean it’s easy. Between remote schooling and working from home, some families might be battling for Wi-Fi, making it difficult for a pregnant person to video chat with an abortion provider on the same network, says Amy Hagstrom Miller, the president and CEO of Whole Woman’s Health, which runs eight clinics in five states. Whole Woman’s Health has done audio-only consults for people with bandwidth issues and for those who don’t have smartphones. Some patients drive to coffee-shop parking lots or reserve private rooms at their local library to do the consult, either because they can’t speak in their home or because they’re out of data for the month, says Melissa Grant, the chief operating officer of Carafem, a network of reproductive-health clinics that has participated in Gynuity’s TelAbortion project since 2018.

For some patients—like those with abusive partners, religious family members, or controlling parents—it wouldn’t be safe to talk about getting an abortion on a video call at home. Telemedicine providers are devising solutions, including informing people that they can do the consult in their car and that, for some, pill packages can be shipped to any address in the state; Carafem has even sent pills to a FedEx customer center. During consults with Just the Pill, a Minnesota service that launched in October 2020, clinicians ask patients if they feel safe at home, then devise a care plan if they don’t. In Just the Pill’s first three months, many of its 40 patients did the consults in their cars.

Though communicating from cars might give patients much-needed refuge, it could also create a feeling of isolation. The empathy that abortion necessitates is hard to replicate in a virtual model. “A lot of the stigma surrounding abortion in this country has taught people to believe that they’re the only person they know who’s had an abortion,” says Hagstrom Miller. She hopes to translate the compassion Whole Woman’s Health provides to in-person patients to those taking abortion pills at home to “be sure that we don’t slide backwards into this sort of secret abortion that you’re hiding.” To help humanize the experience, Carafem is shipping abortion pills with care-package items, like a maxi pad, antinausea medications, a single-use heating pad, and herbal tea. “Those kinds of little differences can make the experience just a little bit easier,” Grant says.

Real change will depend partly on the Biden-Harris administration directing federal agencies to reevaluate current restrictions. Advocates hope that, on day one, Biden will instruct the FDA to allow providers to mail pills for the duration of the pandemic and, within the first 90 days of taking office, Biden will direct the FDA to review the scientific data and determine the necessity of the mifepristone REMS. Moore believes getting restrictions removed entirely is a heavy political lift; a more viable middle pathway is for the FDA to keep most of the restrictions but permanently allow mailing. Biden has already pledged to reverse the Hyde Amendment, a federal budget rider that bans Medicaid from covering abortion in 34 states and D.C., increasing accessibility overall.

Even if the FDA restrictions change, Moore and others recognize that access issues will still exist. Lifting the REMS would be “really meaningful in states that do not ban telemedicine for abortion. It will not be meaningful for places that do,” says Bertram Roberts. Until states overturn their bans, they could pass other laws eliminating waiting periods, like Virginia did in early 2020. They could also pass laws permitting advanced-practice clinicians like nurse practitioners, nurse midwives, or physician assistants to administer medication abortion, which 32 states currently do not allow. Hagstrom Miller says moves like these would help improve access in Texas, where, thanks to the political climate, there are so few doctors willing to provide an abortion in person that Whole Woman’s Health flies physicians in from Brooklyn, Seattle, and San Francisco.

But the telemedicine boom could upend the business model of abortion clinics in ways good and bad. The average cost of an in-clinic medication abortion is around $535, whereas some new teleservices have offered treatment for much lower: Carafem offers telemedicine abortions for as low as $325. Just the Pill costs $350, though it’s a pay-what-you-can model supported by the Minnesota abortion fund Our Justice. Choix serves California for $199 and Hey Jane is available in New York and Washington state for the same cost. Patients at Choix and Hey Jane can get financial support through Reprocare, a new digital abortion fund that’s integrated into the checkout, according to its founders Morgan Love, a software engineer, and Phoebe Abramowitz, a healthcare organizer. “It’s important that these platforms are financially accessible from the beginning,” Abramowitz says.

These prices are beneficial for many women, but possibly with unintended consequences for traditional clinics. “In theory, a single telemedicine service in a state can serve all the patients in the state,” Raymond says. “If the telemedicine people are skimming off all of the early abortions, then the in-person clinics aren’t going to be able to continue to function.” Hagstrom Miller says that while this problem isn’t specific to abortion—any medical practice needs a certain amount of in-person patients in order to pay for rent, electricity, and staff—“if half of our patients were not in the clinic, the majority of clinics that I manage would not be able to stay open.” That would be harmful to people who need abortions later in pregnancy or prefer an abortion method other than pills. To stay in business, clinics will have to diversify the kinds of health services they offer—better for patients who need more access to trans-affirming health care, HIV PrEP, prenatal care, and midwifery. It’s also good for clinics in the long run, Bertram Roberts says; they need to be financially prepared for the possibility of Supreme Court rulings blocking abortion access in their state completely. She notes that dozens of Texas clinics closed after HB2 went into effect in 2013, and even after the Supreme Court overturned the law in 2016, some never reopened. Buildings had to be sold and providers moved away.

Increased abortion-pill access also requires grassroots activism and political will. Grossman’s ideal future includes getting a mifepristone prescription from your regular doctor and picking it up at a pharmacy or from your mailbox. Eventually, he hopes trained pharmacists will be able to prescribe medication abortion the way they can prescribe birth control in 13 states. Better still, pills would be available over the counter like Plan B, though that could take 10 years or longer.

A future with accessible teleabortion care means that those seeking to terminate their pregnancy can do it with an ounce of peace—away from the sign-wielding protestors who crowd clinic parking lots. Telehealth denies these protestors their most offensive political weapon: harassing women seeking care. “It changes everything,” Bertram Roberts says. “All of their scare tactics don’t work against medication abortion. They can’t stand outside with big, bloody signs, because how are they going to track down everybody’s house? What are they going to do, just find someone’s miscarriage photos? Because that’s all it is.”

A version of this story will appear in the Spring 2021 print issue of Marie Claire.

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Illustrations by Carla Indipendente

UPDATE, April 21, 2020: Yesterday, the 5th U.S. Circuit Court of Appeals announced in a 2-1 opinion that Texas officials could legally restrict access to medication abortions during the coronavirus pandemic, claiming “the constitutional right to abortion does not include the right to the abortion method of the woman’s (or the physician’s) choice.” The decision comes less than a week after the courts first decided that Texas had not “made a strong enough case for banning medication abortion,” per Politico. The courts had eased the temporary ban on April 14, saying that a medication abortion was not a “procedure” and did not interfere with hospitals treating COVID-19 patients. Monday's decision revoked that ruling, meaning the issue will likely be taken to higher courts in the weeks to come.

ORIGINAL STORY, April 8, 2020: Heather* is a 30-year-old single mom living in Texas. She was just laid off from her full-time job as a result of Covid-19. She has no health insurance, no additional source of income, and she has no idea how she’s going to continue to pay her bills or provide for her two sons.

She’s also six weeks pregnant and unable to get the abortion she wants and needs.

“A pregnancy, for me, has the potential of being high-risk,” Heather tells Marie Claire. “I have a prolapsed uterus, cervix, and bladder. I would not be able to work full-time, and could be bedridden for a majority of my pregnancy. And I just do not want to have a child right now. Beyond all of the logical reasoning against continuing a pregnancy, I just don’t want to be pregnant.”

Despite her best efforts, Heather cannot access abortion care where she lives. On March 23, the state’s governor deemed the procedure medically unnecessary during the coronavirus pandemic, claiming a need to preserve personal protective equipment and hospital beds. A lawsuit filed on March 25 by Planned Parenthood and the Center for Reproductive Rights led to a temporary stay, allowing abortion services to continue. But just 24 hours after the ban was lifted, it was reinstated by the Fifth Circuit Court of Appeals.

“I have been a nervous wreck,” Heather continues. “On top of having severe anxiety, hormonal difficulties from this pregnancy, and constant fear from the encroaching pandemic, the back and forth litigation has been overwhelming. I've had two appointments cancelled, only to be rescheduled days later. I'm going from extreme elation to extreme lows. I'm physically sick from it and unable to parent my sons the way they deserve during this crisis.”

Texas is not alone in its efforts to thwart a woman's right to choose. So far, the GOP governors and acting attorneys general of Ohio, Mississippi, Iowa, Alabama, Kentucky, and Oklahoma have also called for the cancellation of abortion services.

Meanwhile Republicans have tried to include anti-choice language in a Coronavirus relief bill, the Hyde Amendment was expanded in the recently passed Covid-19 emergency spending bill, and anti-choice groups have urged the Department of Health and Human Services to use its authority to ban abortion outright—a blatantly unconstitutional request.

“Anti-abortion policy makers have a long history of trying to attach draconian abortion restrictions to federal legislation,” says Megan Donovan, senior policy manager at the Guttmacher Institute. “And the threat remains as they move on to new Covid-19 responses. Members of Congress and this administration will seek to use these moments to negotiate and sort of force in anti-abortion policies in order to try and score political points instead of focusing on mitigating the public health crisis.”

While some lawmakers claim banning abortion would free up medical personnel and equipment, Dr. Dan Grossman, director of Advancing New Standards in Reproductive Health, an abortion research group at the University of California, proved via Twitter that it won’t. Studies have also shown that people who are refused wanted abortions are more likely to experience pregnancy complications—which would require a large amount of personal protective equipment to adequately treat. Those people are also more likely to experience depression and other mental health issues. They are more likely to live in poverty. And the children they already have are more likely to suffer in the long term.

And now that nearly 10 million Americans have filed for unemployment as a result of the coronavirus, these outcomes are likely to be exacerbated by a pandemic that is making it increasingly harder for people to provide for their families.

“We know in times like this people aren’t going to stop getting pregnant,” Dr. Ghazaleh Moayedi, a board member for Physicians for Reproductive Health and an OB-GYN and abortion provider in Texas, tells Marie Claire. “We’re probably going to see more pregnancies as a result of this pandemic than we would normally expect during the summer months. So our services are going to continue to be needed.”

She continues, “All the things that this whole country is going through right now? That’s what people seeking abortions go through every day: How am I going to pay for my care? How am I going to make money? How am I going to miss work? How am I going to get childcare? That’s what people seeking abortion care think all year, every year.”

Of course, barriers to abortion access are nothing new; the anti-choice movement has worked tirelessly since the passage of Roe v Wade to limit access to these medical services, especially for Black people, poor people, young people, people who live in rural communities, and people in the LGBTQ community. Even prior to the pandemic, 89 percent of counties nationwide did not have an abortion provider, while one-third of all abortion patients had to travel an average of 25 miles, both ways, to seek care.

So how could the state and federal government ease the burden on both patients and providers and eliminate unnecessary barriers to abortion access? For one, utilize telemedicine and telehealth services—as the federal government is already calling on general physicians to do—and lift the ban 18 states have on using telemedication for medication abortions. This would allow people to have abortion medication mailed to them, providing safe, legal abortions in the comfort of their homes. States also could wave mandatory waiting periods—which require the people who are seeking abortions to undergo multiple in-person visits, putting themselves at further risk of contracting the novel coronavirus. Medicaid and medicare policies could be adjusted to cover abortion costs and states could forbid anti-choice protestors from gathering outside of clinics. (Despite warnings from public health officials to remain indoors, protestors continue to demonstrate outside abortion clinics, yelling obscenities or spreading lies about contracting Covid-19 inside.)

Donovan adds that states also could allow more healthcare workers, rather than just certified OB-GYNs, to provide abortions. She notes that physician assistants, nurse practitioners, and certified nurse midwives could “be assisting in making abortion care available at any time, including a time of crisis like this.”

While the fate of abortion access in Texas during this pandemic plays out in court, Heather is continuing to try to access the care she needs. “I spent all of Wednesday cold calling women's health clinics and Planned Parenthoods in New Mexico, Colorado, Kansas, Illinois, and Missouri,” she explains. “I found a clinic that will see me—it is about nine hours away, in New Mexico, on the border of Texas. This kind of road trip entails spending more money, working out somewhere safe for my children to be, trying to find someone who will drive with me, and risking coronavirus exposure from making multiple unnecessary stops to use restrooms and get gas.”

Still, she plans to leave as soon as she can—despite the added risk.

“My life matters. My sons' lives matter. Forced birthing does not sound like freedom. It does not sound like America. It is dystopian, devastating, and unconstitutional."

If you are in Texas and are seeking abortion you should continue to reach out to your local clinics. Other resources include: Clinic Access Support Network, The Yellowhammer Fund, The Lillith Fund, Fund Texas Choice, West Fund, Naral Pro-Choice Texas, the National Network of Abortion Funds, La Frontera Fund, and Jane’s Due Process.

*Heather’s last name has been withheld to protect her identity and safety. 

For more stories like this, including celebrity news, beauty and fashion advice, savvy political commentary, and fascinating features, sign up for the Marie Claire newsletter.

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During this unprecedented moment in history, the conversation around our public health care system is more crucial (and politically charged) than ever. COVID-19 is impacting the way we work, eat, communicate, and, for many, it's disrupting how we receive necessary medical care. The consequences of the virus are wide-reaching, but vulnerable communities—women, people of color, immigrants, the elderly or sick, and those of a lower socioeconomic status—are at a much higher risk.

For more than 100 years, Planned Parenthood has been a mainstay in providing care for these groups and its commitment remains steadfast in the wake of the present-day global pandemic. Marie Claire spoke with Jacqueline Ayers, vice president of government relations & public policy at the Planned Parenthood Action Fund, to learn more about the current collision of politics and healthcare. Via email, we also checked-in with Dr. Krishna Upadhya, M.D., M.P.H., senior medical advisor at Planned Parenthood Federation of America, who leads the group’s efforts related to the virus, to find out the health impacts of COVID-19 on reproductive care and what Planned Parenthood is doing to keep patients safe.

Marie Claire: How is Planned Parenthood responding to COVID-19?

Krishna Upadhya: Just like all healthcare providers, we are taking all things into consideration to keep our patients, staff, and communities safe at this time—including the availability of personal protective equipment (PPE), the additional safety protocols needed to minimize the spread of the virus, the capacity of other local healthcare providers, and the need to conserve resources. It’s important to keep in mind that the impact of COVID-19 is evolving and varies based on location, which is why we’re encouraging all patients to reach out to their local Planned Parenthood health center to get the most up-to-date and accurate information about services.

MC: Have you seen an influx of people coming to clinics who are panicked or sick with no other options?

Jacqueline Ayers: We continue to see a lot of different responses. We have focused on monitoring the COVID-19 outbreak and making sure patients get what they need. We’re seeing that patients are continuing to come to Planned Parenthood. Even in a pandemic, access to reproductive healthcare is critical.

KU: Planned Parenthood health centers across the country are encouraging patients who think they may have COVID-19 symptoms (such as fever, cough, or shortness of breath) to call their provider before visiting a health center to help determine where to go for care—and when—in order to protect their health and the health and safety of other patients and health center staff.

MC: At this time, do any Planned Parenthood clinics have access to COVID-19 tests?

KU: Planned Parenthood health centers’ access to COVID-19 tests depends on the services they typically provide and the availability of tests in their communities. The limited access to tests across the country, as well as [shortages of] protective supplies such as masks and gloves, has impacted our health centers’ ability to conduct COVID-19 screenings.

At nearly 600 health centers across the country, we’re working in real-time to adapt to our patients’ needs. Some Planned Parenthood affiliates offer sexual and reproductive healthcare services, such as birth control, STI testing, and gender-affirming hormone therapy, to patients remotely through telehealth. We’re working as quickly as possible to expand our telehealth services so that more patients will be able to access critical healthcare services via technology.

MC: Texas and Ohio [and, since this interview was conducted, Mississippi] have included abortions among nonessential surgical procedures that must be delayed in order to conserve resources. Do you think this is valid?

JA: We have to look at the broad picture. The public health infrastructure in this country has been undermined by the current administration and hostile state governments, both of which have continued to attack public healthcare, whether it’s by sabotaging the Affordable Care Act [ACA], not expanding Medicaid, or restricting abortion access.

In this moment, we should remember that abortion is healthcare. Abortion is essential. It’s a time-sensitive medical service. Planned Parenthood facilities across the country are doing our part. We're thinking about how we can conserve resources, but also make sure patients don’t go without care. In Ohio, our clinics are following all state and federal guidelines in order to provide care.

Editor's note: Planned Parenthood, which deems abortions essential, is still providing surgical abortions in Ohio while adhering to the Department of Health's order. Additionally, Planned Parenthood, other abortion providers, and advocates filed suit in Texas to protect access to abortion in the state. For additional info, click here.

MC: Dr. Upadhya mentioned telehealth services. Telemedicine abortion [taking medication abortion pills over a video appointment with a provider] is banned in 18 states. Is that something you see as a potential solution?

JA: What I will say is: These are really unprecedented times. Many of the 600 health centers that Planned Parenthood affiliates with across this country are working around the clock, in real time, to make sure they can meet their patients’ needs. That’s going to vary state to state. We know that they are continuing to provide sexual and reproductive healthcare services, following all state and federal guidelines, and they’re thinking about innovative solutions. Expanding telehealth services for sexual reproductive healthcare is something that we are continuing to look to.

This is a moment and opportunity to think about how, overall, we need to strengthen our healthcare infrastructure. Any pushback from state governors is moving us in the wrong direction at a time when people are relying on us to make sure they have more access to care, not less.

MC: Activists have accused state leaders of using the COVID-19 crisis to advance their personal political agendas. Do you find this to be true?

JA: I think here have been deliberate attacks on healthcare. We have seen that on a federal and state level. Particularly this administration has left healthcare leadership roles unfilled. We’ve seen inadequate response from this administration. It has a history of sabotaging the ACA and refusing to expand Medicaid. The subtotal of what we see when we add all of these actions together is that vulnerable communities, particularly folks who rely on Planned Parenthood, have more barriers to getting care in this moment. This is definitely not the time to devise attacks; we have to think about the ways that we can expand and strengthen the entire healthcare safety net.

MC: On March 18, Trump signed The Families First Coronavirus Response Act (FFCRA), which gives some Americans, but not all, paid sick leave. What would you say is the weakest point in that emergency plan?

JA: The Planned Parenthood Action Fund did support FFCRA as a first step. Think about paid sick leave—everybody should have access to that. We want folks to be able to prioritize taking care of themselves, but not to be at risk of losing income. We need everybody who feels sick to get financial security, stay home, and follow expert guidance.

MC: How can we better protect vulnerable groups that rely on Planned Parenthood during this time?

JA: [This crisis] underscores why we have to strengthen the entire public health safety net. The infrastructure has to be stronger because our vulnerable communities, like immigrants and communities of color, are going to continue to go to the providers they trust. Unfortunately, the Trump administration has worked to try to undermine [this], whether it’s sabotaging the ACA or blocking patients in their access to Planned Parenthood.

They also have put forth the very cruel “public charge” rule. It's designed to keep immigrant families from getting access to basic healthcare and other services, like screenings for routine illnesses or [the ability] to get a birth control prescription. If you make certain communities fearful to access healthcare, we’re not going to be able to slow the curve of COVID-19. [Editors note: The Department of U.S. Citizenship and Immigration Services is encouraging immigrants to get tested for COVID-19, though many still may be afraid to do so.] Things like the public charge rule are really weakening our ability as a country to respond to this crisis.

MC: How do budget cuts and policies like Title X gag rule (which prohibits healthcare providers from talking to patients about abortion), make it harder for organizations like Planned Parenthood to get basic medical supplies, including face masks?

JA: This is something we will continue to hear across the country from our affiliates. We want to make sure we are continuing to provide care, but it’s important to remember Planned Parenthood health centers are just like every other health center. We need medical supplies. We need to make sure the workers feel safe and comfortable coming to work. We need to make sure that people get the care that they need. Any past policies that have targeted Planned Parenthood further weaken that response. We know that there are going to be time-sensitive services that people need in this moment, whether it be abortion services, STI testing and treatment, or birth control access, so we are continuing to help patients get the care they need. We need every healthcare provider to be strong, so we can’t have opposition from the administration and others who are using this moment to try to cut Planned Parenthood out of the response plan.

MC: Are there any findings regarding how COVID-19 affects sexual and reproductive health?

KU: Right now, the data (including [the virus’] impact on pregnancy), is extremely limited. What we do know is that pregnant people are often among the most vulnerable when it comes to infectious diseases. That’s why we encourage all people to take the necessary precautions to reduce their chances of contracting COVID-19.

MC: On a macro level, how might this pandemic impact access to birth control?

JA: Our partners at the Guttmacher Institute put out a good piece on this topic. We probably don’t know the full picture yet, but the virus is certainly going to impact the birth control supply chain and access. As we continue to monitor and think about the short- and long-term impacts, what’s going to continue to become apparent is just how much this administration’s dismantling of the public health infrastructure and inadequate response to healthcare has set us up [to be underprepared].

[This month] marks the tenth anniversary of the ACA. Any administration that has tried to weaken the Affordable Care Act [is leading us in the wrong direction]. We at Planned Parenthood Action Fund want to continue to emphasize that we need leadership that is really focused on strengthening our overall healthcare system.

KU: We know that people’s sexual and reproductive healthcare can’t wait—even during a pandemic. People across the country are practicing social distancing and staying in their homes (though many are having sex), which is why access to sexual and reproductive health services—including birth control, emergency contraception, and abortion—continues to be critically important.

Planned Parenthood is moving to quickly expand our telehealth services, including leveraging a private and secure video conferencing platform that connects patients with Planned Parenthood’s trusted providers so that more patients will be able to get birth control and the other health care services they need. We also know that for some patients, their preferred method of birth control requires an in-person visit, which is why Planned Parenthood is working hard to keep all options available to those in need.

Interviews were conducted separately but combined and condensed for length and clarity.

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As of August 19, 2019, the Trump administration has effectively forced Planned Parenthood to remove itself from receiving Title X funding, which allows nearly 4 million people access to affordable birth control and additional reproductive health care resources, including abortions. Of that 4 million, nearly 1.5 million are low-income women, according to U.S. News and World Report.

Due to the courts' inability to block the Trump administration's "gag rule," which makes it illegal for Planned Parenthood—and any of the other organizations receiving Title X funding—to advise patients on how they can safely receive an abortion, Planned Parenthood is unable to continue to receive funding. The organization refuses to comply with the administration's unethical and dangerous goal for women to have zero control over their bodies.

"Today, the Trump admin is forcing us out of the Title X program—our nation's program focused on family planning, of which we serve 40% of patients," Planned Parenthood tweeted. "This is a *direct attack* on Planned Parenthood and on our health and rights, and we will not stand for it."

As put in a New York Times report on the news, the restriction would force Planned Parenthood to withhold medical information from patients, interferes with the doctor-patient relationship, and could deny pregnant women the range of options available to them.

For the past 50 years, Title X has ensured every person has access to basic reproductive healthcare, regardless of where they live or how much money they make. Planned Parenthood health centers make up just 13 percent of Title X centers, according to its website, but they serve 41 percent of all Title X patients.

This is a huge blow for our country, but Planned Parenthood believes it has no other choice but to remove itself from Title X funding after the 9th Circuit Court of Appeals allowed Trump's gag rule to go into effect. The United States Department of Health and Human Services warned PP that if they did not comply by today, they would be forced out of the program.

Planned Parenthood Federation of America's Acting President and CEO Alexis McGill Johnson released the following statement assuring patients that PP will not stop fighting for us:

“I want our patients to know: while the Trump administration may have given up on you, Planned Parenthood never will. Our doors are open today, and our doors will be open tomorrow. The Trump administration’s gag rule will reverberate across the country. This reality will hit hardest people struggling to make ends meet—including those people in rural areas and communities of color.

We believe that the Trump administration is doing this as an attack on reproductive health care and to keep providers like Planned Parenthood from serving our patients. Health care shouldn’t come down to how much you earn, where you live, or who you are. Congress must act now. It’s time for the U.S. Senate to act to pass a spending bill that will reverse the harmful rule and restore access to birth control, STD testing, and other critical services to people with low-incomes. People’s lives depend on it.”

As McGill mentions above, there's still hope for the Senate to pass a spending bill (more on that here), which repeals the Title X gag rule, but it's up to us to urge our Senators to make this a priority. Still, funding is a worry. Planned Parenthood acknowledged that, without money from Title X, clinics will feel the impact. It's already been announced that at least one clinic in Ohio will close. Personal donations will become more important than ever before.

Consider donating to Planned Parenthood, below, if you have the means. Donations will help keep these clinics open, providing a safe and supportive environment for people in all communities across the country. American citizens shouldn't have to take this issue into their own hands, but it seems to be the only way we can remain in control of our own bodies.

DONATE TO PLANNED PARENTHOOD

I don’t think I’ve ever heard a man, let alone a man who’s running for president, use the word “doula” as much as Senator and presidential candidate Cory Booker does. In fact, I don’t know if I’ve ever heard a man use the word “doula,” unless it’s preceded by “what the hell is a.” But Booker, who on a recent weekend trip to Iowa pledged again to make reproductive rights “a central part” of his administration, throws it around like it’s second nature.

In the cozy living room of a Democratic Party county co-chair in Burlington, in the south-east corner of the state just across the Mississippi from Illinois, Booker spent a Saturday morning meeting with local reproductive rights activists who have watched their nearby Planned Parenthood clinics close in the last several years.

Booker kicked off the morning by saying a few words about recent draconian restrictions on abortion access in places like Alabama, Missouri, and Georgia. He reiterated his commitment to restoring and expanding abortion access, and said that he wants to challenge men to play a leadership role in that fight. “You don’t have to say, ‘oh, I have a wife or a daughter’ to care about this and to step up,” he said.

Booker also noted that the very states that are restricting abortion have refused to make health care more affordable for parents and children by refusing to expand Medicaid. One result is that the U.S. has the highest maternal mortality rate of any industrialized nation. And while our peer countries are solving the problem of women and babies dying preventable deaths, our rates are going up. The numbers are particularly dire for for Black women, who are three times more likely than white women to die during pregnancy or childbirth. Beyond expanding Medicaid, Booker listed a suite of policies that could help alleviate the crisis: paid parental leave, paid sick leave, and more affordable holistic post-partum care. “Why don’t low income women have access to doulas?” he asked.

Alexandra Rucinski, 29, sat across from Booker and told him her story. She grew up in a conservative family and was taught all about abstinence and nothing about contraception. When she became sexually active in her early twenties, she got pregnant “really quick.” When she walked into a Planned Parenthood clinic for the first time, she was terrified. She’d always been told that Planned Parenthood was an evil organization.

Rucinski started crying as she told Booker about what she’d actually found there: kindness and compassion. “There was no agenda, it was about what I wanted,” she said.

Phoebe McNeece, 33, told Booker about learning that she was pregnant shortly after attempting suicide for the second time. Like Rucinski, she went to Planned Parenthood for care, and like Rucinski, she decided to stay pregnant.

Until the nearby clinic closed, both women had been going there for contraception and other health care. “I kept going back,” Rucinski said, “because I wanted to take care of myself and my son.” Her son and Phoebe’s are about the same age, and when the roundtable was over, Booker recorded videos for both boys on their mothers’ phones. In one, he said, “we have something in common: We both think your mom’s amazing.” In the other, he described the boy’s mother as “the original Wonder Woman.”

Later, as Booker and his team travelled north from Burlington to Muscatine in a rented RV, I asked him how he came to learn about doula care. He said his awareness about maternal mortality, and the importance of pre- and post-partum care, dates to his time as Mayor of Newark, New Jersey. “I used to say back in Newark, ‘in God we trust, but everyone else, bring me data, ” he explained, leaning across the tiny table to emphasize the point.

In Newark, the data on maternal mortality, and on the effectiveness of doulas and programs like the Nurse-Family Partnership, are undeniable. Booker served as Mayor from 2006 to 2013, when maternal mortality was already on the rise nationwide, especially for Black women. Newark’s population is 50 percent Black, and 28 percent of residents live below the poverty line. Black women in New Jersey are three-and-a-half times more likely to die from pregnancy or birth complications than their white counterparts, and their babies are at a much higher risk of being born underweight or dying before their first birthday.

Doula care—in which a trained birth professional attends to the needs of a pregnant person during and immediately after they give birth—is one effective intervention into this public health crisis. Doula care can cut rates of low birth weights and premature births in half, and according to a study published in The Journal of Perinatal Education, people who have a doula present when they give birth are “two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.”

Then there’s the Nurse-Family Partnership, which Booker spoke about in glowing terms as the RV trundled along a two-lane highway past soybean and corn fields. The Partnership matches a low-income first-time mother with a registered nurse who visits her in her home throughout her pregnancy and beyond, until her child’s second birthday. It has been stunningly effective. The program reduces the risk of hypertensive disorders like preeclampsia, lowers maternal mortality, reduces child abuse and neglect, makes it easier for mothers to recover from opioid addiction, and reduces the risk of childhood obesity.

In 2002, when he first ran for mayor, Booker campaigned on expanding access to prenatal care for low-income women, and on preventing unwanted teen pregnancies. By 2013, when he was running for the Senate, he was talking up the value of visiting nurse programs for health, education, and crime prevention outcomes.

Once he got to the Senate, Booker—who said he sometimes has to explain to his male colleagues in Washington what a doula even is—took his advocacy for holistic women’s health care with him. In 2018, he was one of several Senators to introduce the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act, also known as the MOMMIES Act (Booker’s rivals for the Democratic nomination Sen. Kirsten Gillibrand and Sen. Kamala Harris were co-sponsors). Medicaid covers about half of all births in the U.S.; the bill would extend its coverage period from 60 days to a year after birth, and make sure that women on pregnancy-related Medicaid could use the program to cover all health care. Also in the bill: stipulations that would make it easier for low-income women to afford doula care, which is inconsistently and inadequately covered by insurance of all kinds. The bill died, but Booker re-introduced it this year, just before Mother’s Day.

Even though he doesn’t usually use the words, what Booker’s talking about—what’s he’s calling for when he links abortion access and contraception to doula care and children’s health—is reproductive justice. The reproductive justice framework, which was envisioned and evangelized by Black women, insists on “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

Reproductive justice, its proponents stress, is about more than abortion and more than any individual woman’s personal choice: It’s about building systems that work for everyone, regardless of if, how, or when they want to make a family.

Booker’s question in that Burlington living room—“why don’t low income women have access to doulas?”—was a rhetorical one. In a world remade by reproductive justice, they would.

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Like many teenagers, when Dr. Leana Wen was 16, she was curious about birth control but wasn’t exactly getting top-notch sex education at home. “It’s not something my parents ever talked to me about,” she says. “I think the closest my mother came was when she told me: ‘You need to finish school.’” She intended to graduate but had no idea what getting her diploma had to do with sex; she needed real information.

Wen, now 36, remembers feeling terrified when she walked into a health center run by Planned Parenthood in Pasadena, California, near where her family was living at the time. “If you were to ask me the color of the wallpaper or number of chairs, I would have no way of knowing that,” she says, “but I remember the emotion of sitting in that waiting room feeling so scared and anxious.” Wen found some pamphlets with information on contraceptives and was just about to take them and run when her name was called by the receptionist. She doesn’t recall the specifics of the care she received at that appointment, but she left Planned Parenthood knowing she had found her people. “The nurse was so kind and so normal and talked to me in the way I needed, which is as a person, as a peer, without judgment,” Wen says. “I remember the relief that I felt after I talked to somebody who I thought really got me.”

Twenty years later, on a sunny morning in late January, a banner reading “Welcome home, Dr. Wen,” greets her as she walks into that very same health center as the newly named president of the Planned Parenthood Federation of America (PPFA). Wen is the first doctor to lead PPFA in nearly 50 years, and today’s visit is the third stop on her national listening tour to 20 of the organization’s 53 regional affiliate offices that run Planned Parenthood’s more than 650 health centers, which provide care for some 2.5 million people nationwide.

As part of the tour, Wen is learning about local initiatives that could be rolled out at clinics across the country. In the suburbs of Cleveland, Wen learned about an outreach program targeting African Americans, whose infant-mortality rate is twice that of the general population; in Miami, she heard about how employees went door-to-door with prevention kits during the Zika epidemic. Here, Wen seems particularly interested in how Planned Parenthood of Pasadena and the San Gabriel Valley has expanded so quickly (it had one health center in 2004 and will have seven by 2021), a flow plan that gets patients in and out of most appointments in an hour or less, and recently added services including HIV prevention, hormone treatments, and mammograms.

Hiring Wen, an emergency room physician who most recently served as the public health commissioner in Baltimore, seems to be a targeted effort by Planned Parenthood to remind pundits and the public that while the organization remains committed to providing abortions, they also offer a plethora of high-quality, potentially life-saving healthcare services that have nothing to do with the politics of terminating pregnancies. Her tone-setting first campaign, “This Is Healthcare,” rolled out just three weeks into her tenure (which began November 12), affirmed that notion. “For so many patients who come to us, we are their only source of care,” Wen says. “I wanted people to know what they can count on us for.” Planned Parenthood could even begin offering services not typically associated with reproductive care like treatment for diabetes, mental health, and opioid addiction, an issue she tackled in Baltimore by issuing a city-wide prescription for the overdose-reversing drug, Naloxone. (The program is credited with saving nearly 3,000 lives in three years.)

Listening may be the stated purpose for the national whirlwind, but the tour is clearly also about introducing Planned Parenthood’s employees to their new leader to assure them that the organization is in good hands following the departure of Cecile Richards, the political powerhouse who led PPFA for 12 years. There are so many speeches, handshakes, and requests for selfies that spending a day with Wen feels like being with a politician on the stump. She begins talks by highlighting her personal history as an immigrant.

Wen was born in Shanghai to a family of political dissidents who rebelled against the communist regime’s crackdown on free speech. Her dad spent much of her childhood in jail, and when he wasn’t imprisoned, her parents focused on leaving the country for a better life elsewhere. “My parents tried for years to leave China, but it was very difficult,” she says. In 1990, when Wen was seven, her mother received a student visa to study at Utah State University in the city of Logan. Several months later, just before Wen’s eighth birthday, she and her father left to join her mother.

Her dad was sick at the time—he had a perforated ulcer and had been in intensive care—but he didn’t want to miss his chance to go to the U.S. Neither he or Wen spoke English, but her grandfather did, and he tucked little pieces of paper reading: “Help, my father fainted. He has an ulcer. He needs help immediately,” and “I don’t speak English. My mother is waiting in Utah. Here is how to reach her,” in her pockets just in case anything went wrong. “When I said goodbye to my family in China, I thought it was really goodbye—we did not expect to see them again,” Wen says. “I thought that was the last time I would hug or even speak to them.” (She eventually reunited with her aunts and uncles on a trip to China some 15 years later.)

By the time she and her father made it to Utah, they had just $40. They also had the misfortune of arriving in December. “I had never seen snow,” Wen says. “I remember my parents said, ‘We have to save in every way,’ so we went without heating. We were just really cold all the time.” She had no winter coat or boots either. “The only thing we could do was layer on clothes,” Wen says. “I would wear five pairs of pants and six sweaters or something.” One day, a week or so after they arrived, they heard a knock on the door and found a large bag of clothes sitting outside. A neighbor had collected items for them from her church. “They must have seen us really struggling,” Wen says. “There were clothes, blankets, snow boots, and other things we needed to survive.” She says she’ll never forget the act of kindness. “I don’t even know who to thank, but I feel very grateful to the people there,” she says. “They really embraced us as a family and helped me to learn English. I was that kid in school—the only one who didn’t speak English. There was no English as a second language instruction, it was just me. The other kids were so tolerant and friendly. I wouldn’t be where I am now without the teachers and students there.”

Her parents worked multiple jobs to get by. Her dad washed dishes in restaurants; for a while, he worked in a cheese factory (“To this day, he can’t eat cheese,” Wen says). Her mother, a full-time student, worked as a cleaner at the university and at a hotel. When Wen was 10, her family moved to California, living for a short time in Compton before settling in East L.A. “There were multiple times when we couldn’t make the rent and we had to pack up everything because we were being evicted,” Wen says. “We stayed with my father’s friends. A few times we had to find a motel room. A couple of times we lived in homeless shelters.” They didn’t have health insurance, and Wen remembers her mom, who received care at Planned Parenthood, talking about the clinic as “the place that she could go when she couldn’t afford to get care anywhere else,” Wen says. “That’s why I always associate Planned Parenthood with being a place that gives people refuge.”

During those early years, Wen remembers, her mom once came home crying from her job at a video store and told her dad she’d been sexually harassed by her employer (they lived in a studio apartment, so Wen overheard a lot). “I don’t know the extent of it,” Wen says. “I know she was being verbally and maybe even physically abused by the employer, but we needed the money.” Her mother was also worried because of the family’s immigrant status; they had applied for asylum but hadn’t yet been granted it. (They eventually became citizens in 2003.) “She felt like her employer had all the power—that if she complained in any way, or if she even fought back, she would be putting our entire family at risk,” Wen says. “I remember hearing the shame in her voice as she was telling my father all of this. I think about it a lot now that I am an employer and a manager. I think about my responsibility to prevent anybody else from experiencing that same fear and intimidation that my mother felt.”

In 1996, when she was 13, Wen began attending California State University via its early entrance program, graduating summa cum laude in 2001 at age 18 with a degree in biochemistry. She then attended medical school at Washington University in St. Louis and also completed two master’s degrees, one in modern Chinese studies and another in economic and social history at the University of Oxford, where she was a Rhodes Scholar; she also met her now husband, Sebastian, an information-technology project manager, in the U.K. After a clinical fellowship at Harvard Medical School and residency training at Brigham and Women’s Hospital and Massachusetts General Hospital, she went to work as an attending physician in the ER at George Washington University before becoming the public-health commissioner in Baltimore (or the city’s “top doctor” as the position is often called). As commissioner, Wen successfully sued the Trump administration for cutting funds from the Teen Pregnancy Prevention program.

Her years as a physician made her an especially good fit for her new role. When she shares anecdotes of patients being denied care, it’s not theoretical—they’re real stories from her life experience, like one she often recounts of caring for a woman who was denied an abortion and died after trying to give herself one at home (by the time Wen treated her in the E.R. it was too late). When she talks about the Trump administration’s domestic gag rule (forthcoming at press time), which is expected to prevent any organization that accepts Title X funds—which Planned Parenthood uses to offset the cost of exams, cancer screenings, and birth control for-low income patients—from providing information on abortion, her passion is palpable. “I find it unconscionable and unethical that I am being told by the Trump Administration, or any politician, what I’m able to say to my patients,” she says during a luncheon speech at a country club to donors and local board members. “The oath I took is to provide them the best information that I can and empower them to make the best decisions for themselves, not to censor what I can say based on what a politician believes.”

(Editor's note: On February 22, 2019, the Trump Administration formally banned federal family planning funds from going to providers who offer or refer patients to abortion services.)

That conviction should serve her well for the fight ahead. Not only is Planned Parenthood preparing for the possibility that Roe v. Wade will be dramatically altered or overturned now that the Supreme Court has five conservative-leaning justices, she was also dealt her first internal crisis a month in, when Planned Parenthood employees alleged in The New York Times that they were sidelined or ousted because they were pregnant. Wen says the organization is investigating the claims and taking swift action to ensure “we truly live the values that we espouse.” The organization is also looking into instituting paid parental leave nationwide (currently some affiliates have it, others don’t). “We have to do better,” Wen adds.

When she was first approached last spring about the opportunity at Planned Parenthood, Wen says she almost didn’t return the call. She had just returned to work seven weeks after giving birth to her son, Eli, and was figuring out how to pump every three hours and the other difficulties that come with being a working mom. “I could not even imagine even thinking about another job,” she says. But then two things happened: Someone randomly gave her a copy of Richards’ book Make Trouble, and she gave a commencement speech the Johns Hopkins Bloomberg School of Public Health during which she called on students take action. “I told them we all have to step up, because as frustrated as we are, things are not going to change unless we do everything we can,” Wen says.

She quickly realized she had to take her own advice. Wen took the first meeting at Planned Parenthood mostly to offer insight. Regardless of who got the job, she wanted to present helpful ideas to the organization that had touched her life and that of her mother, who died from breast cancer in 2010. She says she urged them “to look at their work from a health-care lens because that’s what Planned Parenthood means to the patients who come. They’re not trying to make a political statement—they are trying to get care,” Wen says. “That’s what it meant to my mother. That’s what it meant to me as a patient.” Several months and meetings later, “Here I am!” she says. And as long as she’s in charge, she’ll work to keep open the doors that once welcomed her.

A version of this article appeared in the April 2019 issue of Marie Claire.

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The CEO of Planned Parenthood, Cecile Richards, has written a new memoir, and it details the meeting she had with Ivanka Trump and Jared Kushner regarding the future of the organization.

It was previously reported that Trump had suggested that "Planned Parenthood split up, creating a small operation that ran abortion clinics and a larger one whose health clinics didn’t perform abortions" (via The New York Times). And now, we finally have details of what was actually said during the exchange.

People reports that, according to the author, Richards was wary about meeting with Trump and Kushner in January 2017, but that she was seeking political allies after Hillary Clinton's defeat.

When Speaker of the House Paul Ryan announced that he wanted to completely defund Planned Parenthood, Richards reached out to Ivanka Trump, at the behest of a contact in the fashion industry. She explained, "Even if there was only a sliver of a chance of changing anyone's mind, I owed it to Planned Parenthood patients to at least take the meeting."

Richards reveals in her new book, "Everyone at Planned Parenthood was hoping for the best but preparing for the worst. We brainstormed, planned, and made lists of anyone who might be a potential ally in the administration."

Trump brought husband Kushner to the meeting, and he apparently wasn't shy with his opinions. Richards reveals:

"The main issue, he explained, was abortion. If Planned Parenthood wanted to keep our federal funding, we would have to stop providing abortions. He described his ideal outcome: a national headline reading 'Planned Parenthood Discontinues Abortion Services.'"

And that's not all. Kushner apparently urged Richards to make the change to Planned Parenthood's services quickly, and then he could influence their funding.

Of course, Richards saw through the offer, but she couldn't help feeling that it was a bribe of sorts:

"Jared and Ivanka were there for one reason: to deliver a political win. In their eyes, if they could stop Planned Parenthood from providing abortions, it would confirm their reputation as savvy dealmakers. It was surreal, essentially being asked to barter away women's rights for more money."

In Make Trouble: Standing Up, Speaking Out, and Finding the Courage to Lead, Richards is speaking out about Trump's and Kushner's questionable, and unsuccessful, attempts to influence politics.

Cecile Richards has had quite a year. Lawmakers have been trying to “defund” Planned Parenthood for at least a decade, but with Donald Trump in the White House and the Republican-led Congress working to overhaul our nation’s health-care system, it seemed legislators might finally get their wish. Both houses included a provision in their health-care plans that would have pulled $500 million from the nonprofit—about 40 percent of its budget—for one year. Congress may have failed to pass its proposals this time around, but Richards has been on the front lines too long to rest easy. Marie Claire visited Richards at her office in Manhattan to talk abortion, Ivanka, and whether she’ll ever run for office.

Marie Claire: You’ve been the head of Planned Parenthood for 11 years. How does this year stack up?

Cecile Richards: It has certainly been a year of challenges because so many things we were able to achieve over the last decade in terms of healthcare outcomes for women—we now have a record low for teenage pregnancy, a 30-year low for unintended pregnancy, the lowest rate of abortion since Roe v Wade was decided—are now at risk. But I’ve also never seen the outpouring of engagement, particularly among women, standing up and fighting for what they believe is rightly theirs, and fighting not only for themselves, but a whole generation. So, if there was any silver lining to this year, it’s that!

MC: Senator Elizabeth Warren said on the Senate floor recently that she’s tired of having to explain what Planned Parenthood does (and doesn’t do), and I thought, “Well, gosh, how must Cecile Richards feel.”

CR: Look, some people say, “What could ever change their minds?” I think the one thing that would change anyone’s mind is coming to a Planned Parenthood Health Center. Visit with our patients, speak with our staff, our doctors, our clinicians, and see the vital healthcare that we provide every single day. I was just in Speaker Paul Ryan’s district. We have three health centers there that provide only preventative services like family planning and pap smears—they don’t provide abortion. And now the women there are at-risk of losing access to care if our centers close. They’re panicked because if you’re in Racine, Wisconsin, and Planned Parenthood isn’t available to you, there’s isn’t anyone else providing birth control there. So I just wish, even Paul Ryan, I would just love it if he would come see our center and visit with these women, and then tell us: What is it that you object to? And what do you want to tell your constituents about where they’re supposed to go if their local Planned Parenthood closes?

I think, look, until we have more people in Congress who have had to deal with a lump in their breast and are worried about, “Can I find an affordable provider that can see me now?” things are not going to change.

MC: How does it feel to constantly be under attack?

CR: I have always worked in some area where it wasn’t easy for organizations that I think move us forward—whether it’s for voting rights or women’s rights or environmental rights. So, if I wasn’t in the midst of controversy, I probably would be in the wrong job. But, also, one of the things that is so important to me about Planned Parenthood is that we have the vast majority of the country supporting us. When you have one in five women in this country who’ve been to you for healthcare, that is a very deep well to draw from. So, it’s an interesting organization—you may feel like you’re on the front lines, but you never feel alone.

MC: What goes through your mind when you hear male legislators saying things like, “Well, I don’t understand why men should have to pay for birth control or maternity care.”

CR: It’s extraordinary. Everyone had a mother at some point, right? That is something that seems to be completely lost. And not just our mothers—there are members of Congress who have wives, daughters, some of them have granddaughters. Can you imagine? Basically, what, of course, concerns me is that probably their relatives—because they have Congressional health insurance— they’ll always be able to get coverage. But what about other women? I heard a young woman speaking at a town hall meeting, who said, “I’ll be the first person in my family to graduate from high school and college, and so why are you taking my access to family planning that can help me actually be part of the American Dream that we all desire?” It’s very hard to see the double standard, and I don’t see anybody trying to take away men’s access to healthcare. That seems to be pretty well intact.

MC: Yeah, men can still get their Viagra covered.

CR: Exactly! The whole reason we ever got family planning covered in insurance plans is because they started covering Viagra, and it became so embarrassing to say, “We’ll cover one and not the other.” But now we see this boulder is rolling back downhill.

MC: Can you tell us a bit about what you did behind the scenes to stop the healthcare bill? Do you actually pick up the phone and call members of Congress yourself?

CR: Oh, definitely! Oh my gosh, I talk to senators all the time. And I go to their states. But it’s also important that senators not just hear from me—they need to be hearing from folks back in their hometowns. I used to work on Capitol Hill and I know that, at the end of the day, no matter how smart lobbyists are or whatever argument you could make, what legislators really want to know is, what are the women back home saying? So I spend a lot of time on the road making sure those folks are being heard.

MC: Let’s talk about the attacks on birth control specifically. If the GOP wants to reduce abortion, then why make it harder or more expensive for women to access contraception?

CR: The U.S. Health and Human Services department is now chock full of people who don’t believe in birth control. And so we’re seeing the unraveling of the birth control benefit that 55 million women in the country fought for and earned under the Affordable Care Act. Now they are basically saying to employers, ‘You don’t have to cover birth control in your insurance plans,’ and that doesn't make any sense! This is one of the most commonly used prescription medicines in the country. And every medical report and research study shows when women are denied access to birth control, you can guarantee two results: One is more unintended pregnancy, and two is more abortion. The policies that this Congress and this administration are pursuing are going to have those exact results.

MC: I wanted to give you the chance to address one of the biggest arguments people make against Planned Parenthood: The idea that money is fungible, and so even though the federal funding Planned Parenthood receives doesn’t pay for abortion, it helps the organization keep the lights on. What do you say to that?

CR: We operate just like every other hospital or healthcare provider—we get reimbursed for services directly, the money is not fungible. The federal government reimburses us for birth control, pap smears, breast exams, STI testing and treatment, and one of the cruel ironies is we actually have to raise money to supplement Medicaid payments because they’re so low. So the thought that any of that money is going to go anywhere else other than to the non-abortion services we provide is just not accurate. And I feel like there’s a double standard that Planned Parenthood is being held to because hospitals that provide abortion services get billions of dollars in Medicaid funding, so why is it that Congress is targeting the one healthcare provider that is primarily focused on women’s health?

MC: Given that abortion represents just three percent of the overall services Planned Parenthood provides, do you ever wish the procedure was less associated with the brand?

CR: No. It might be a small portion of what we do, but it’s incredibly important that women have access to safe, legal abortion. Now, do I think as a country we could be doing a lot more to reduce unintended pregnancy and the need for abortion? Absolutely. That’s what we do every day. But putting politics in-between women and healthcare, or making it more impossible isn’t going to get rid of abortion. It’s just going to make it unsafe, and we see that in states already.

MC: Shortly after the inauguration, you met with Ivanka Trump at her request. What can you tell us about the meeting?

CR: The important thing to say upfront is, I’ll meet with anyone about Planned Parenthood if there’s an opportunity to educate them about what we do and the healthcare that we provide, and that’s why I met with Ivanka. She expressed interest and even support for Planned Parenthood. And that was really the tenor of the conversation. She said, “My father is against abortion.” And, look, I believe that’s his right, but it’s not his right to make that decision for every woman in America. That’s simply not what he was elected to do. And that’s what I said to her.

I also talked to her a lot about the work that we’re doing that’s really amazing. We just did clinical research for a self-injectable birth control shot that lasts for three months. Just think how that could change options for women in rural America. To me, that’s what we should be talking about: How do we make medical advances that help women’s health? So I don’t know what I hope for, but I will say, I have never seen a White House that is less responsive and, frankly, more aggressively on the attack on women’s healthcare. So, if Ivanka Trump has influence in this administration, this is the time to make it shine.

MC: Given Ivanka’s support of Planned Parenthood in the past, do you wish she was doing more to protect women’s healthcare now?

CR: As a special advisor in charge of women’s issues in the White House, that is her job. We hold everyone in government accountable not by how nice and well-meaning they are, but by what they are doing. Women are backsliding in so many areas under this administration and that’s her responsibility. It’s a mystery to me what the agenda is in this White House around women, unless it is to try to put us back 50 years.

MC: Let’s talk about the worst-case scenario. Federal funding is 40% of Planned Parenthood’s budget, or about $500 million. So, let’s say Congress is actually able to defund Planned Parenthood, what happens the next day?

CR: We’ve completely put in place plans for what we would do in that scenario. To me, the most important thing is that we maintain our footprint across this country and that we continue to see women in need. Because frankly, if Congress succeeds, it’s not going to be just Planned Parenthood that suffers—there are going to be millions of people who are going to lose their healthcare coverage. And so our plan isn’t just about us as an organization—it’s about the millions of folks who are going to lose access to care. I hope we don’t get to that day, but we plan for any eventuality.

But look, Planned Parenthood has been around 100 years and we’re going to be around 100 more. We’re scrappy, we’re inventive, and we will survive. The real fundamental thing that keeps me up at night is, what happens to the women that can’t see us anymore? Because I’ve seen too much of that already in states like Texas where we’ve seen a doubling of the maternal mortality rate because women don’t have access to basic preventive healthcare service. That’s what should be on the conscience of every member of Congress as they vote to take away women’s access to care.

MC: You’ve said previously that you don’t have any plans to run for office because you love your job, but is there any scenario in which you see yourself running? And if you were to run, what would your campaign slogan be?

CR: I think it would be, “Why not a woman?” Like, men, why don’t you take a break for a minute? Let women actually see if we can work on some of these issues. Look, never say never, but I don’t really think that’s my path. I will say, it’s really exciting so many Planned Parenthood activists, patients, and even staff are now filing to run for office because I think that’s why we’re in the fix we’re in. If more members of Congress could get pregnant, we wouldn’t be fighting about Planned Parenthood.

After lord-knows-how-many failed attempts to repeal and replace Obamacare, Senate Republicans are back at it again. This time they're trying to crash in the Graham-Cassidy bill before next week's budget reconciliation deadline—a health care bill numerous experts are calling the worst one yet. MarieClaire.com spoke with Cecile Richards, president of Planned Parenthood, about the latest legislation. Her take: "It's terrifying for women."

The reason? Well, there are multiple—"there are so many problematic and dangerous aspects of this bill," laments Richards—but at the heart of nearly all of them is this: The plan isn't much of a plan at all. It simply passes the power to regulate health care from the federal government to the states. In doing so, it gives those governments the ability to waive the insurance mandates that came with the Affordable Care Act (ACA). So, for example, your state could decide to let insurance companies charge more for pre-existing conditions.

"If you're a woman who has given birth, it's estimated that insurers could charge you up to $17,000 more a year for coverage," explains Richards. "This bill will allow insurers to charge breast cancer survivors more for their coverage—some estimate $30,000 more. These numbers are prohibitive."

The bill also abolishes the ACA's requirement that all plans cover maternity care and preventative care and institutes a nationwide ban on abortion coverage—even for private plans. And what are republicans offering as a solve? Women could pay extra for a rider, as women in Texas already have to. It amounts to "rape insurance," says Richards. "Women would have to somehow anticipate that they would need an abortion and buy a rider to cover that."

So the bill is obviously terrible for all women, but if you're a woman who gets her health care at Planned Parenthood, it's even worse. Graham-Cassidy would prevent any person on Medicaid from getting care at Planned Parenthood.

"I can't say it enough: Planned Parenthood is not in the federal budget. We do not get a check from the federal government. We get reimbursed—not for abortion services—we get reimbursed for cancer screenings, for STI screenings and treatment, for birth control. All that will not longer be available for patients to get at Planned Parenthood if they're on Medicaid," explains Richards.

"The people who are going to be punished by this bill the most are the women who have relied on Planned Parenthood for affordable health care," she says.

Regardless of whether they patronize Planned Parenthood, this bill is likely to negatively affect all Medicaid patients, because "the bill completely goes after Medicaid," Richards says, noting that there's no Congressional Budget Office (CBO) score yet, but that experts are "concerned millions of people will lose insurance because of the radical restructuring of Medicaid." Women and children disproportionally access their care through the program.

"The irony of it all is that Paul Ryan started this crusade because he said that the wanted people to have choice in their healthcare provider," Richards points out. "Women should be able to do the same. For about 2.5 million women, they choose Planned Parenthood."

We know that you have health care fatigue. You are exhausted by all the frenzied talk of the last 8 months. But that's exactly what these republican lawmakers want: to pass a bill that's been denounced by all major health organizations while American women are distracted by something else.

"The reason the previous bills have been blocked is because people have spoken up," says Richards. "Go to istandwithpp.org to find a resistance event near you. Call your senator, call your representative. Now is the time to tell them how you feel."

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I vividly remember a time when whispers of HIV filled people with fear. I will never forget the devastation, the scorched earth that AIDS left in its wake: To have a friend with you one day and taken the next. To visit friends in the hospital and see them waste away week by week, becoming shells of the vibrant and beautiful people they once were.

During the initial epidemic in the early 1980s, a dear friend and mentor of mine was diagnosed and, like many, was whisked away to succumb to the disease in secret. I remember my heart wanting to be with him, to be his supporter and friend. But this disease pushed people into the shadows. His boyfriend, uncertain of how HIV was spread and wanting to protect me, allowed only glimpses through a doorway.

But I also remember seeing this deadly disease galvanize communities to fight for treatment, and to fight for dignity and respect for those who had been diagnosed. As new drugs entered the market, HIV was no longer a guaranteed death sentence. For those who could afford these treatments, living with HIV was not only a possibility but a reality.

There has been incredible progress in the United States in the fight against HIV/AIDS, and our nation saw even further gains when Obamacare expanded Medicaid coverage, increased subsidies for private plans, and mandated that insurers cover essential prevention, testing, and treatment services. And yet, now Trumpcare is callously threatening to block people with Medicaid from accessing care at Planned Parenthood—one of the nation's leading HIV testing providers. The bill would derail the progress we've made and send us back to a time when it was nearly impossible for people living with HIV to get the care they needed.

As time marches on, the fear, the sadness, and the pain from the early years of the HIV epidemic has slowly faded from many Americans' memories, but the threat is still there. According to the CDC, more than 1.1 million American men and women are living with HIV, and 1 in 7 of them don't even know it. We are still actively fighting the HIV epidemic, and Planned Parenthood is instrumental in that effort. In 2015 alone, the organization provided more than 650,000 HIV tests. All of Planned Parenthood's more than 600 health centers offer HIV testing and education, and more than one-third also offer HIV prevention, including PrEP, a daily pill that can help prevent HIV.

Planned Parenthood is there for all people because HIV does not discriminate. I remember the shock of a dear friend's diagnosis in 1984. The misperception at the time was that this was a "gay man's disease." My friend "Dee"—the first woman I knew that had been diagnosed—was a young, funny, vibrant woman of color. She got sick so quickly…and then she was gone.

Even now, decades later, women of color are among the groups of people disproportionately affected by HIV in the U.S. In many communities—like some communities of color, immigrant communities, LGBTQ communities, and rural areas—Planned Parenthood is the only health care option. This is especially true in areas with provider shortages, where it can be difficult to access non-discriminatory and non-judgmental care that also accepts Medicaid.

This dangerous bill highlights the startling reality of how men in Washington—almost all white—are willing to play politics with people's lives. The Senate shrouded its efforts to replace and repeal Obamacare in secrecy, and now that Americans have finally seen the bill, our worst fears have been confirmed: The bill would have a devastating effect on the fight against HIV/AIDS, which has been showing signs of promise in the past decade (the CDC observed a decline of 19 percent in the annual rate of HIV diagnoses in the U.S. from 2005 to 2014). Trumpcare would curb access to HIV testing and treatment to anyone covered by Medicaid, and would allow states the option of waiving essential health benefits, including services people living with HIV rely on, such as prescription drug coverage and chronic disease management.

Republican's previous attempt to pass this cold-hearted bill was stalled because it was estimated to cut coverage for 22 million people, hampering the ability of Americans with low incomes to access HIV testing and cutting off those who are diagnosed with HIV from accessing treatment options. HIV treatments have significantly lengthened the life expectancy for people living with the disease, but the majority of people living with HIV do not have it under control—often because they don't have access to care. Without coverage, HIV medications can cost between $19,000 to $20,000 a year.

So many of us have worked to bring HIV out of the shadows and now it's time for our elected officials to join us. As a country, we cannot afford to play with the lives of millions of our most vulnerable people. If you believe, as I do, that we shouldn't cut off care to our family, friends, and neighbors living with HIV, contact your senators (202-224-3121)and tell them to vote 'No' on Trumpcare.

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Elizabeth* is a 29-year-old stay-at-home mother of four. From a young age, her conservative evangelical parents and pastors impressed upon her the values of the religious right: that a woman's virginity is a gift to her husband, that sex outside of marriage is a sin, that abortion is murder.

Planned Parenthood was the enemy. "My dad instilled in me that we were against that group," Elizabeth says. "He was the kind of guy that would honk in support when people were outside protesting."

At 18, Elizabeth married her high school sweetheart in the same conservative California church she had attended every Sunday since childhood. But the marital bliss she'd been taught would follow didn't—within just a few years, Elizabeth discovered that her husband was having an affair, and she divorced him soon after. Suddenly she was uninsured.

Before long, Elizabeth started experiencing severe cramping and heavy periods—symptoms she would later learn were the result of an ovarian cyst. "That's when the whole Planned Parenthood thing started," she recalls.

Voices from the religious right have long been some of the loudest and most vitriolic critics of Planned Parenthood, an organization that provides reproductive health services to an estimated 2.5 million women and men in the United States each year. They've called Planned Parenthood a baby-killing factory and a bastion of evil. Evangelical Christians are the most visible aggressor in the fight to overturn Roe v Wade. And this is a social group with hefty political sway: 25 percent of Americans identify as evangelical according to the Pew Research Center, and 82 percent of those evangelicals identify as politically conservative or moderate.

"When I walked in there, I was so embarrassed," Elizabeth says of her first reluctant visit to a Planned Parenthood clinic. "These were all people getting free services to possibly kill their child. They were a stereotype, to me. But I was out of resources." The only place Elizabeth could think to turn was the one place she'd been taught forever to avoid.

There are many more women like her, all around the country. Women who grew up in conservative Christian environments that push abstinence-only education, unwavering anti-abortion attitudes, and adherence to the Republican party line—and who, out of necessity, are secretly visiting Planned Parenthood clinics for pap smears, birth control, STD tests, and other reproductive health services, including abortions.

"We have many people from evangelical or born-again traditions who come to our health centers all across the United States," says Reverend Vincent Lachina, regional chaplain for Planned Parenthood of the Great Northwest and Hawaii. "Some evangelical and fundamentalist church staffers have even been patients."

Like Elizabeth, Megan's* childhood in the deep South was steeped in evangelical moral and social codes. She went to church every Sunday and attended a private Christian school from the fifth grade on. "It was a part of every aspect of my life. All the people I associated with were evangelical," Megan, now 34, recounts. At the time, she took their teachings to heart. "I'm a people pleaser and I wanted to do what was right. I got straight As. I played sports. I went along with it."

Then Megan went away to college and, after a year of dating her first boyfriend, decided she was ready for sex. She knew she needed birth control, but she was worried that if she used her health insurance to pay for it, her mother would find out she was sexually active. So Megan went to a nearby Planned Parenthood instead—easy enough to hide if she paid in cash. "Nothing with any sort of paper trail," she says.

To go to Planned Parenthood—a place many evangelicals associate only with abortions—was an uncomfortable step. But Megan had come to grips with the fact that she was already crossing a red line by engaging in premarital sex; she decided she might as well be responsible about it.

By senior year, Megan and her boyfriend had broken up. She was dating around for the first time and had stopped taking birth control. That's when a guy "took advantage" of her. She hesitates as she relates the incident, drawing in a sharp breath. Then: "There was a situation where I felt pressured to go beyond the point that I wanted to go."

After the assault, Megan discovered that she was pregnant. The news devastated her. Which explains why, despite her upbringing, she made an extreme decision: to return to Planned Parenthood and get an abortion.

Megan had done the moral math. It was worse to endure the disgrace of being an unmarried mother than it was to live with the secret—and the guilt—of terminating the pregnancy. "There was just so much shame in being pregnant and unmarried," she explains. "I thought, There is no way I can face my mother and my community back home with this." Again she paid for everything in cash. To this day, her family doesn't know.

It's largely due to the Christian right's vehement opposition that Planned Parenthood faces the very real possibility that it may have to shut down. Clinics around the country continue to close, one by one, state by state, due to lack of funding—just two weeks ago, Planned Parenthood announced that it would have to shutter four locations in Iowa and leave nearly 15,000 women without a primary healthcare provider after the state's mostly Republican congress voted to block funding to any medical facilities that provide abortions, despite the fact that a majority of Iowans support Planned Parenthood.

In fact, since the 1970s, taxpayer money has not paid for abortion services except in cases of rape, incest, or danger to the life of the mother. By law, public funding—which amounts to roughly $550 million per year, or 43 percent of Planned Parenthood's total operating budget—specifically goes to health services like birth control, STD testing, and cancer screenings instead.

That hasn't stopped the Trump administration from kindling the debate over whether welfare and Title X funding should go to the organization at all—an argument so heated that it threatened government shutdown last month.

Vice President Mike Pence, a self-proclaimed evangelical Catholic, made good on the promise he delivered at January's anti-abortion March for Life in Washington D.C. ("We will not rest until we restore a culture of life in America for ourselves and our posterity," he said that day) when, in March, he cast the tie-breaking Senate vote to allow states to stop federal grants for facilities that provide abortions. That legislation is why Iowa politicians were able to reduce their Planned Parenthood population by four.

The move was lauded by Christian organizations with a political bent, like Focus on the Family, the Family Research Council, and the Heritage Foundation, which have consistently lobbied for Planned Parenthood to be defunded. Focus on the Family founder James Dobson, a saintly figure in many evangelical homes, has said that "if you scratch around anywhere near the Planned Parenthood message and the function of Planned Parenthood, you see wickedness; you see evil." Franklin Graham, son of renowned evangelist Billy Graham and president of the Christian organization Samaritan's Purse, recently compared Planned Parenthood clinics to World War II concentration camps: "Raising funds for this organization is like raising money to fund a Nazi death camp—like Auschwitz, except for innocent babies in their mother's wombs." The Planned-Parenthood-as-modern-day-equivalent-of-a-concentration-camp trope has been picked up by Republican lawmakers as well. "This is as bad—or worse—as having one's name associated with Dachau," Kansas state senator Steve Fitzgerald wrote in a letter to Planned Parenthood after someone donated to the organization in his name. The Family Research Council published a 2016 report entitled "The Real Planned Parenthood: Leading the Culture of Death."

Data doesn't exist on just how many women who were raised in this faith actually patronize Planned Parenthood in private, which is a result of the very reason many of them go there: It provides anonymity. We do know that 13 percent of abortions conducted in this country are for women who identify as evangelical protestants, in addition to the 17 percent for more mainline protestants like Lutherans or Methodists, according to a 2014 study by the Guttmacher Institute. When you add in Catholics, that number rises to more than half.

I was raised in an evangelical culture myself and, while doing research for this story, I was taken aback by how often one Christian woman's experience with Planned Parenthood led me to another's, and another's, and another's. What I once believed was simply a handful of anecdotal instances became an undeniable trend, one that reached into many different backgrounds and beliefs. Some of the women in this article have left the faith in which they were raised, either altogether or adopted more progressive forms of it; others, like Elizabeth, still identify as evangelical Christian, a broad label that often indicates a born-again protestant who adheres to a fundamentalist interpretation of the Bible. Some of the women are from cities, others small towns. The common thread that runs through all their stories: Visiting Planned Parenthood was a risk—but one worth taking.

"It's a very difficult thing for them," says Lachina, the Planned Parenthood chaplain, who echoes the fact that secrecy is critical for the young Christian women who visit clinics. "They certainly don't want their parents to know that they're going to a Planned Parenthood facility," he says. "They want to be anonymous."

More valuable than even anonymity, Planned Parenthood provides religious women with honest medical information they likely aren't getting anywhere else: Research published in 2012 in the Journal of Women's Health found that weekly church attendance made women half as likely to be receiving any sexual or reproductive health services.

"They gave me an exam and birth control to help with my menstrual cycles, because they said my cycle might be causing problems with my cyst," Elizabeth says of her first Planned Parenthood appointment. "It was an education."

Still, the pressure of the community is hard to shake. Evangelical culture tends to be intentionally exclusionary, creating a sense of us-versus-them, and these women had engaged with what they were taught was the very worst of "them."

Rachel*, a pastor's wife, felt that pressure fiercely. "I grew up in a strict religious community. Planned Parenthood was the devil," Rachel says. "Our church talked about Planned Parenthood as a gas chamber and part of the new Holocaust."

But when she and her husband, whose job didn't provide health insurance, needed birth control, Planned Parenthood was the only option they could afford.

"During my exam, the doctor talked with me about all the different birth control options and referred me to a really detailed chart that showed the advantages and disadvantages of each. It was the most education I'd ever received on the subject," Rachel explains. "And she was the first doctor who didn't flinch or act judgmental when I told her I was a virgin until I got married."

"I felt really guilty afterward—both for using Planned Parenthood and for finding it so much more pleasant than I expected," she continues. "I was in ministry at the time, and that added another level of guilt because it felt so hypocritical. They put me on their mailing list, but I called and asked to be removed because I was so terrified someone would see the envelope and know. I lived in a liberal New England city, but I didn't even want the mail carrier to see it."

Julie Davis, a Christian marriage and family therapist in California, explains that trauma is often wrapped up in how young Christians are taught about sex, an act that's equated with lust and sinful desire. Young single women aren't supposed to want sex, let alone have it. And they're certainly not supposed to go to Planned Parenthood to enable it—or deal with the fallout. Despite the doctrine, 80 percent of unmarried evangelical young adults are, in fact, having sex, according to a widely-cited 2009 study from the National Campaign to Prevent Teen and Unplanned Pregnancy—not much lower than the 88 percent national average. Davis says that for young women caught in this trap, shame can multiply and lead to destructive behavior like substance abuse, depression, or eating disorders later in life. "Culture and religion together set up a difficult situation for young women," she says.

Part of the issue is simply about openness. "If a young woman doesn't have a female mentor and she's experiencing something difficult or needs something regarding sexual health, where does she turn?" Davis asks. "Often it is Planned Parenthood, a place she knows she can go and they will help her."

Planned Parenthood was that kind of place for Heather*. She was 16 when she first became sexually active and needed birth control. An older classmate at her private Christian high school in Maryland told her that she could get a prescription at Planned Parenthood. Like Megan, she was worried that it would show up on her insurance and that her parents would find out she was having sex. But at Planned Parenthood, she was able to pay $10 cash for the Pill.

"We were all going there," Heather, now 27, says of her schoolmates, who used Planned Parenthood as teens. "I can think of six, seven, ten girls off the top of my head who were going there for birth control or pregnancy tests."

There was no sex ed at Heather's high school. "We weren't getting sex ed at home, either," she says. "Parents would be outraged if you talked about having sex. Girls would be starting their periods and they didn't know what was happening." Everything Heather and her friends learned about reproductive health was hearsay.

"You'd go to Planned Parenthood and they'd give you real information," she recalls. "They'd ask, 'Are you sexually active?' and tell you that you need to have a pap smear and should be tested for STDs. They would give us brown paper bags of condoms that we would giggle about. It was a vital resource."

Some young women aren't so fortunate. For Kristen Irving-Jordan, director and producer of Pro-Lifetime, a forthcoming documentary that examines the history of the pro-life movement, the stigma of Planned Parenthood was at first insurmountable.

At 22, she realized she had irregular hormonal issues. But her conservative background caused her to worry that if anyone found out she was on birth control to fix it, they would assume she was having pre-marital sex, a judgement she wanted badly to avoid. She had health insurance, but it wasn't extensive, and she would have to pay out of pocket to see a gynecologist. Kristen was busy building her career in the film industry and had little money to spare, so she considered going to Planned Parenthood since it was affordable and would provide her anonymity. Still, the idea was hard to stomach. "I remember calling the clinic and getting an automated recording asking me questions. Even with that, there was this sense of, I am engaging the devil right now," she says.

The morning of her appointment, Kristen awoke sick with shame. "Seeing it on my calendar, I thought, Can I do this? Ultimately I decided I couldn't."

Kristen didn't show up for her appointment, a pattern she'd repeat a few years later when she was without insurance and needed a physical due to chronic immune system deficiencies. Now, at 35, her experience has led her to explore the right-wing politics that dictated her guilt—and her health—in her 20s. The documentary has taken Kristen a long way, even to a Planned Parenthood anniversary gala in 2015. At the event, she was pleasantly surprised to witness a standing ovation at the announcement that abortions in their clinics were down 15 percent.

"I spent so many years motivated by fear and shame, and it wasn't just limited to sexuality. It defined my relationships and my life choices. My mental, emotional, and physical health were affected, and I suffered from severe depression and anxiety," she tells me. "It's sad, and I know I'm not alone. It's a big motivator for my film. I want to help expose the false narrative that has created an inconsistent pro-life ethic—one that demands birth but often doesn't care for that child once it gets here—and caused so many of us to be crushed by shame."

Like Kristen, Megan views her experience with Planned Parenthood as a formative one. "Of course it makes me sad," Megan says of having to terminate a pregnancy in college, "but what really makes me sad is that I feel like my upbringing put me in a position where being sexually assaulted was more likely to happen. I couldn't talk about sex in a healthy way."

Megan has come to the decision that Christian condemnation of Planned Parenthood is tainted by hypocrisy. "I think it's really silly. They characterize Planned Parenthood by one service, when really, what I think is most important is that the group provides preventive women's health services that are affordable," she says. "If you're really pro-life, then you should help people prevent unwanted pregnancies in the first place."

She's now married and has a young daughter, whom she's determined to give the chance she wasn't—to be a confident, strong woman with a mind of her own.

*Names have been changed.

When it comes to defunding Planned Parenthood, it seems a Republican's work is never done. The GOP's latest effort in their years-long crusade? The Senate passed a bill last month (thanks to Vice President Mike Pence's tie-breaking vote) allowing states to withhold federal money from organizations that provide abortion services, including Planned Parenthood. President Trump signed it, privately, on Thursday.

But here's the real rub: Because of the Hyde Amendment, no federal taxpayer dollars ever go toward abortions anyway. That means that if the states choose to stop giving Medicaid reimbursements or family planning grants to Planned Parenthood—which, thanks to the new bill, they can—they will be taking money away from preventive health care, birth control, pregnancy tests, and other women's health services. Things like the 360,000 breast exams and 270,000 Pap tests Planned Parenthood provides to American women every year.

Courtney is one of them. The Wisconsin native juggles multiple part-time jobs and can't get insurance through an employer, so she relies on Planned Parenthood for everything from basic medical care to life-saving screenings for ovarian cancer, which runs in her family.

Watch her exclusive video for MarieClaire.com, created by the Cancer Survivors Network for Planned Parenthood, here:

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The Senate passed a measure today that will allow states to block federal grants for family planning centers, like Planned Parenthood, with Mike Pence casting the tiebreaker vote. The vice president rushed to the Senate to push the bill through after two female Republicans, Alaska Senator Lisa Murkowski and Maine's Susan Collins, defected and voted against it.

The bill overrides an Obama-era protection that stopped states from defunding family planning centers for purely political reasons. Under the new measure, states will be able to cut funding from facilities that perform abortions—funding that pays for birth control, pregnancy care, cancer screenings, and fertility services.

Democrats were furious, with many taking to Twitter to criticize the vote and Pence's part in it.

Planned Parenthood has already responded: "Mike Pence went from yesterday's forum on empowering women to today leading a group of male politicians in a vote to take away access to birth control and cancer screenings. People are sick and tired of politicians making it even harder for them to access health care," said the center's vice president, Dawn Laguens, according to the New York Daily News.

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We're torn: We can't wait to watch Elisabeth Moss's performance in The Handmaid's Tale, Hulu's buzzy new series based on Margaret Atwood's dystopian novel of the same name that drops on April 26th. But then, just seeing the trailer (the final one was released yesterday, appropriately on "A Day Without A Woman") is a bit unnerving. Given the current political climate, its themes seem less and less like speculative fiction and more like real life.

If you haven't read The Handmaid's Tale since college (guilty), the book tells the story of Offred (played by Moss), a woman forced into sexual slavery after a group of ultra conservative, extremely religious white men take over the U.S. government and disenfranchise women, non-Protestants, gay people, and people of color. Offred is now a so-called handmaid required to sleep with Fred (the man who owns her), a married military commander whose wife is infertile. Her sole purpose is to produce a child. Abortion is illegal, and women are controlled by male leaders whose M.O. is to block women's autonomy over their own bodies.

Atwood wrote the novel in the 1980s, as the New Right—conservatives against abortion, the Equal Rights Amendment, and LGBTQ equality, to name a few things—became increasingly influential. Ronald Reagan gladly accepted the New Right's support to help him win the presidency, and in return, gave more political power to evangelicals, which helped energize the anti-abortion movement.

Perhaps prescient execs at Hulu decided 2017 was the year to adapt the modern classic after spotting similarities between the GOP of the 80s and today: President Trump campaigned on a largely pro-white, pro-male platform. He has surrounded himself mostly with like-minded white male conservatives, including Vice President Mike Pence, who while governor of Indiana, approved some of the most extreme abortion regulations in the country (which he signed into law "with a prayer"). And let's not forget Trump's chief strategist Steve Bannon, who as the head of Breitbart News published such articles as "Lesbian Bridezillas Bully Bridal Shop Owner Over Religious Beliefs." Here, a few other scary similarities:

1. Women are forced to have children whether they want them or not.

Although abortion is still legal in the U.S., (mostly white, mostly male) elected officials are making it ever harder for many women to obtain one. More than 300 restrictions on the procedure have been enacted at the state level since 2010, including mandatory waiting periods and in-person counseling sessions that can delay a woman's ability to have an abortion, potentially making the procedure more $$$.

Then, in January, House Republicans voted to make permanent the Hyde Amendment, which prohibits taxpayer money from being used for abortion services. This hurts low-income women specifically. Not to mention that if Planned Parenthood is defunded, as Trumpcare stipulates, the government would cease to reimburse the organization for all services needed by all Medicaid patients, including STI testing, cancer screening, and family planning services.

It certainly doesn't help that the Trump administration has positioned itself squarely in the anti-abortion corner, with Pence speaking at the March for Life rally in January and Trump tweeting his support. "The message from the White House is that they are on a mission to overturn Roe v. Wade," said Andrea Miller, president of the National Institute for Reproductive Health, before Trump took office.

2. Abortion providers are targeted and killed.

Atwood imagines a society where abortion providers are hanged for crimes against the state. In real life, it was less than a year and a half ago that three people were shot and killed at a Planned Parenthood clinic in Colorado. Six years prior, anti-abortion extremist Scott Roeder killed George Tiller, MD, an abortion provider in Kansas. In total, there have been 84 incidents of extreme violence, including murders, bombings, and arson attacks, targeting providers and clinics in the last 20 years. Then there's the harassment. As David Cohen, co-author of Living in the Crosshairs: The Untold Stories of Anti-Abortion Terrorism, told ProPublica, "A lot of [abortion providers] deal with home picketing… It sends a not-so-subtle message: We know where you live, we know where to find your family, and maybe we'll do something more."

"I am very concerned about the impact that [Trump's opposition to abortion] could have on both healthcare providers that are already under attack for providing these services and women who are frequently punished and shamed for doing so," Miller said.

3. Men dictate what happens to women's bodies.

In The Handmaid's Tale, Offred is forced to have sex with her owner in order to produce a child. The idea that men are in control of women's wombs isn't so far-fetched: All those state bills limiting reproductive rights go through state legislatures (roughly 75 percent male, on average). Then the bills are signed into law by state governors—of which 46 are currently men.

Here are two recent examples: In late January, Arkansas's Asa Hutchinson signed a bill criminalizing dilation and evacuation (aka "D&E"), a low risk procedure used to safely terminate a pregnancy after the first trimester. Not only does the bill effectively make it impossible for women to get an abortion after about 14-weeks, but it also states that a spouse, parent, or legal guardian of a woman who receives or attempts to receive a D&E can sue the provider. Then, in February, the Oklahoma House advanced a bill requiring a woman seeking an abortion to get written consent from the man who impregnated her. Rep Justin Humphrey defended the proposed legislation by saying that once a woman is pregnant, she's a "host."

4. Women are purposefully kept uninformed.

Women are forbidden to read in The Handmaid's Tale. And so, by stripping women of their right to information, the men in Atwood's novel are able to maintain authority—if they can control women's minds, they can control their bodies. Currently in the U.S., 17 states require that women seeking an abortion undergo counseling that includes inaccurate and unsubstantiated information about a link between abortion and breast cancer, fetal pain, and/or negative psychological effects. Likewise, several states require that medically inaccurate handbooks be given or made available. In short: If women don't have reliable information about their reproductive health, it hurts their ability to choose their best course of action.

5. Women are stripped of economic independence.

Another way to control women: Limit their ability to earn. It's taken to the extreme in this story, with women denied jobs, education, and access to credit cards. Today, the discrimination is softer but not insubstantial. As of last year, the median income of women working full-time, year-round in the U.S. was just 79 percent of what men earned, according to the White House archives. That gap is even wider for women of color.

Here, there is some hope, though: In his speech to Congress last week, President Trump said his administration "wants to work...to make childcare accessible and affordable" and "to help ensure new parents have paid family leave." Both policy items are crucial to women's economic advancement. To really move the needle, POTUS will have to do better than the plan proposed during his campaign—one which benefits higher-earning families and leaves out adoptive parents and fathers.

6. Women's health is negatively impacted by pollution and STIs.

Many women in The Handmaid's Tale are left infertile after exposure to environmental toxins, as well as untreated STIs. While we may not be suffering from the aftermath of nuclear and biological warfare (and thank goodness for that), the Trump administration continues to deny climate change and STIs are on the rise.

On Trump's first day in office he eliminated any mention of global warming from the White House website. Then he announced Oklahoma attorney general Scott Pruitt as his pick to lead the Environmental Protection Agency. Pruitt, who has close ties with the fossil fuel industry, has already made moves to place climate skeptics at the top of the agency and roll back water regulations. Ignoring the environment can have serious consequences for people's health—asthma, cancer, heart disease, neurological disorders, and other conditions could all potentially become more prevalent as a result of climate change.

If that's not worrisome enough, the U.S. is already in the middle of a spike in STIs, partially as a result of budget cuts that caused clinic closures, according to the latest report by the Centers for Disease Control and Prevention (CDC). Women experienced a 27 percent hike in reported syphilis cases from 2014 to 2015, as well as increases in gonorrhea and chlamydia. Undiagnosed or untreated case can lead to infertility. Defunding Planned Parenthood, which provides STD testing to women and men would only leave more people without care.

It's no wonder that in an interview with Marie Claire, Moss pointed out that the cast of The Handmaid Tale has been noticing similarities between what they're acting out and what's happening in real life. "We occasionally will send articles to each other from that day's paper that exactly mirror what's happening in the show—whether it is reproductive rights, whether it's an environment issue, some new random crazy strain of virus," she said. "We are fascinated and horrified by the parallels." Us too.

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On Monday, Republicans in Congress introduced their Affordable Care Act replacement bill, which includes a provision that will block patients who get their health insurance through Medicaid from receiving care—any care, including preventative care—from Planned Parenthood. Earlier that day, the White House tried to pressure us to stop providing abortions in exchange for access for those patients.

Our response is short and simple: No way. Providing safe and legal abortion is central to our mission of giving all people the care and information they need to make their own decisions. Abortion is a legal right and a health care service that should not be shamed or stigmatized by politicians, especially since 1 in 3 women in this country will have one at some point in her life.

The health of our patients is never up for negotiation. The health of millions of women and men is not a political game.

Yet opponents of women's health in Congress continue to play politics with women's health. They call their provision "defunding" Planned Parenthood in an attempt to cover up what they're really proposing: This bill doesn't strike a line in the federal budget for Planned Parenthood, because there is no such line. Just like every other health care provider, federal dollars come to Planned Parenthood for the services we provide to patients who rely on Medicaid and other federal health programs.

Because of the discriminatory Hyde Amendment, federal dollars did not go towards abortion services before this bill, and they won't after. But if Congress passes it, millions of Americans who rely on Medicaid and other federal health programs will no longer be able to go Planned Parenthood for birth control, cancer screenings, STI testing and treatment, and well-woman exams.

This would cause a national health disaster.

Planned Parenthood provides care to 2.5 million people each year. Last week, hundreds of these patients traveled to Washington D.C. from all over the country to tell members of Congress how Planned Parenthood changed—and sometimes saved—their lives. They are moms who wouldn't be moms today if Planned Parenthood hadn't caught their ovarian cysts in time, or treated their endometriosis. They are LGBTQ people who found in Planned Parenthood the first or only health care provider to treat them with compassion and without judgment. They are women in rural America who felt lumps in their breasts, and Planned Parenthood was the only place they could get quick, affordable, urgently needed care.

They are just a fraction of the 1 in 5 women in this country who have relied on Planned Parenthood for preventative services, treatment, and, yes, abortion.

Politicians are renewing their attacks on reproductive health care at a time when we've made historic progress. Right now our country is experiencing the lowest unintended pregnancy rate in 30 years, all-time lows in teen pregnancy, and thanks to access to effective contraception, the lowest abortion rate since Roe v. Wade was decided in 1973.

Anyone who wants women to be healthy and have children only when they're ready should be horrified at the idea of a world without Planned Parenthood. Anyone who believes that birth control, cancer screenings, and STI testing and treatment should be affordable and accessible should make it known to their representatives in Washington.

It is clear that Republicans in Congress and the White House are worried about the political fallout of attacking Planned Parenthood. That's why they proposed this ridiculous exchange. Taking away access to life-saving preventive care at Planned Parenthood is deeply unpopular. Nineteen national polls since 2015 show the majority of Americans support Planned Parenthood—including 50 percent of those who voted for President Donald Trump.

Planned Parenthood was founded 100 years ago to promote what was then a radical idea—that a woman's body is her own. Our founder and her colleagues went to jail defending that idea. That idea is apparently still radical to some—and we'll still do whatever it takes to defend it.

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Donald Trump is willing to preserve federal funds to Planned Parenthood, on the condition that it stops providing abortions. The New York Times reports that the Trump administration, concerned about political blowback from defunding Planned Parenthood, is considering this horrifying offer as a kind of compromise, though the proposal has not been made formally.

Planned Parenthood currently receives about $500 million in federal funding each year, but that money goes towards women's health services, not abortion services. The organization has made it clear that it has no interest in such a deal.

"Let's be clear, federal funds already do not pay for abortions," Dawn Laguens, the executive vice president of the Planned Parenthood Federation of America, told the Times. "Offering money to Planned Parenthood to abandon our patients and our values is not a deal that we will ever accept. Providing critical health care services for millions of American women is nonnegotiable."

Trump confirmed discussions about the proposal in a statement. "As I said throughout the campaign, I am pro-life and I am deeply committed to investing in women's health and plan to significantly increase federal funding in support of non-abortion services such as cancer screenings," he said. "Polling shows the majority of Americans oppose public funding for abortion, even those who identify as pro-choice. There is an opportunity for organizations to continue the important work they do in support of women's health, while not providing abortion services."

So there's that.

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Think of it not as shopping to make yourself feel better (though that might be the case); think of it as throwing your buying power behind organizations like Planned Parenthood that the Trump administration has already promised to savage—and getting a thoughtfully designed Pantsuit Nation sweatshirt in the process.

Founded by Rebecca Correa Funk and Claire Schlemme, feminist marketplace The Outrage has pledged to donate 100 percents of profits from its Pantsuit Nation range to Planned Parenthood in light of Tuesday's outcome.

"To have such a qualified, intelligent and inspiring woman come so close and lose like this is absolutely devastating," Funk said. "But it's also a signal that we have a lot of work to do. Hillary has championed women's rights for decades, and donating to Planned Parenthood is the best way we can think of to carry her work forward. So far, we've surpassed $15K in sales for our 'Pantsuit Nation' collection."

Get to it. Support groups that give women autonomy over their bodies. Support one another. And may all the New Balance you burn light the way.

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Oh, Colleen, you're here to butcher the babies again, aren't you?" That's how an antiabortion protester greets Dr. Colleen McNicholas as she maneuvers her silver SUV into the parking lot of the Planned Parenthood clinic in St. Louis' Central West End on an unseasonably warm day in mid-February. McNicholas pulls into a spot—she likes to park in front of the fence nearest the protesters so patients don't have to—and heads to the entrance, carrying two dozen bagels she brought for the clinic's staff.

Once inside, an armed guard waves her through the metal detector and a set of auto-lock doors (the second won't open until the first one shuts). She has just enough time to change into scrubs, shove a few bites of a bagel into her mouth (she'll munch on this one bagel all day in lieu of a lunch break), and wash her hands for the required three minutes before it's time for the first abortion.

By the end of her eight-hour workday, she will have terminated 31 pregnancies.

McNicholas is one of a dwindling group of doctors performing abortions in the Midwest, which, along with the South, is known to pro-choice advocates as the abortion desert. According to the Guttmacher Institute, as of 2011, the most recent year for which data are available, 94 percent of counties in the Midwest had no abortion clinic to serve the 13.2 million women of reproductive age who live there. She works two days every three weeks at the Planned Parenthood in St. Louis—the only remaining abortion clinic in Missouri—flies once a month to the Wichita, Kansas–based clinic where Dr. George Tiller practiced until he was shot dead in 2009 by an antiabortion zealot, and in June will begin traveling to Oklahoma City to work at a newly opened clinic. "Part of the problem with being so committed and feeling so passionate about an issue is that it's hard to say no," McNicholas, 35, says. "It's hard to say, 'I can't do that,' because that means somebody is going without care, and what that means is, they're probably going to have a baby they don't want. So ultimately, I end up saying, 'I can do one more day' or 'I can go one more place.'"

When she's not crisscrossing the Midwest, she's treating patients at her obstetrics and gynecology practice at St. Louis' Washington University School of Medicine, where she is an attending physician and assistant professor. She also drives two hours to Jefferson City, Missouri, a few times a year to testify before the state Legislature in opposition to bills restricting access to abortions. Once a year, she goes to Washington, D.C., with other doctors to lobby legislators that science ought to trump politics when it comes to providing a procedure that, according to Guttmacher, one-third of all American women will have before age 45. Some nights, she meets with the board members of the abortion-access fund she founded to help Missourian women afford the procedure. (At Planned Parenthood in St. Louis, patients pay from $545 to $1,470, most often out of pocket, as state law prohibits Missouri-based insurance companies from covering the cost, except when the woman's life is at risk.) Whatever precious hours she has left are spent at home with her 5-year-old son (a basketball star in the making) and her partner, an anesthesiologist, who didn't want her name used out of concern for her safety.

It's an exhausting schedule ("Good thing you learn how to not sleep in med school, huh?" McNicholas says, laughing), but one she feels she has to maintain. Soon, however, and to her dismay, her workload may get a whole lot lighter. In June, the U.S. Supreme Court may issue a decision in Whole Woman's Health v. Hellerstedt, the most significant reproductive-rights case to come before the high court in more than two decades—the outcome of which will determine the state of abortion access nationwide for years to come.

At issue is HB2, a law passed by Texas in 2013 that requires abortion clinics to maintain the standards of ambulatory surgical centers, and doctors performing abortions to have admitting privileges at a hospital within a 30-mile radius. Twenty-two states, including Missouri, Kansas, and Oklahoma, have passed similar surgical-center-requirement laws, while 14 states require abortion providers to have some affiliation with a local hospital. Such legislation is known to advocates for abortion access as Targeted Regulation of Abortion Providers, or TRAP laws. In the past five years, states have enacted 288 laws restricting abortion—the most in any five-year period since abortion was legalized in 1973, according to Guttmacher. Since 2011, at least 162 abortion providers of the estimated 553 clinics nationwide have shuttered or stopped offering the procedure, according to Bloomberg Businessweek. Texas saw at least 30 clinics close, and, as a result, women there have had to wait as much as three weeks longer for an appointment and drive an average of four times as far to get to a clinic, according to a survey by the Texas Policy Evaluation Project, a University of Texas–based project to determine the impact of the state's reproductive policies. The survey also found that between 100,000 and 240,000 Texas women between the ages of 18 and 49 have tried to end a pregnancy themselves. "When abortion is illegal, it becomes unsafe and women die—it doesn't go away," McNicholas says. "People think we say that because it sounds scary, but we say it because it is true."

In order to determine the legality of the Texas law, the justices will have to revisit a 1992 Supreme Court decision in Planned Parenthood v. Casey that said states are permitted to pass measures regulating abortion care so long as such laws do not impose an "undue burden" on a woman's right to terminate a pregnancy. Proponents of TRAP laws say the requirements are necessary to protect women. "Abortion, whether accomplished by an invasive surgery or potent drugs, has significant risks to women," says Anna Paprocki, a staff attorney with Americans United for Life. "Health and safety standards are not a prohibition on abortion ... [they] are common-sense standards that aim to provide maximum patient safety."

Yet the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Osteopathic Association filed a brief with the Supreme Court in October saying such requirements are "contrary to accepted medical practice and are not based on scientific evidence" and "fail to enhance the quality or safety of abortion-related medical care and, in fact, impede women's access to such care by imposing unjustified and medically unnecessary burdens on abortion providers."

All three states where McNicholas performs abortions have admitting-privileges laws on the books. Texas may have put such laws on the map, but Missouri pioneered the legislation, passing the nation's first admitting-privileges law in 1986. Kansas and Oklahoma have also passed privileges laws, but both are currently on hold pending legal challenges. McNicholas has admitting privileges only in St. Louis, which means if HB2 is upheld and Kansas' and Oklahoma's pending laws are enacted as a result, she will no longer be able to perform abortions anywhere outside St. Louis. The clinics in Wichita and Oklahoma City may be left scrambling to find a doctor with privileges, and in the meantime, the women they currently serve— who come from as far away as Texas and Arkansas—will have to drive farther, wait longer, and spend more money in order to get an abortion. "If that happens, it will feel like a whole lot of steps backward," McNicholas says. "I think the word for how I would feel is deflated—disappointed, frustrated, and deflated."

At 7:25 a.m. the next day, McNicholas takes a call from a patient while she brews coffee in the kitchen of her ranch-style home on a tree-lined street on the west side of St. Louis. When McNicholas and her partner moved in about a year ago, they installed an alarm system and security cameras, and met with the local police chief to let him know what McNicholas does. Last September, an antiabortion blogger threatened to protest at McNicholas' home in order to "expose the hidden works of darkness," prompting her to send a letter warning neighbors and asking them to report any suspicious people to the police. And in March, when McNicholas and her partner hosted a Hillary Clinton campaign event at their home with Planned Parenthood president Cecile Richards, protesters picketed on the street out front.

McNicholas was raised on the South Side of Chicago in a family that was "supportive of me being whatever I wanted," she says. In high school, most of her friends were on birth control and some had abortions, and none of them thought of it as an "Oh, my God, crisis," she says. It wasn't until McNicholas went to medical school in rural Kirksville, Missouri, that she realized how different her experience was. "There wasn't anywhere within miles and miles and miles of Kirksville where someone could get an abortion if they needed one," she says. Once McNicholas decided to pursue obstetrics and gynecology (she liked the idea of treating "overall healthy people in a mostly preventive way"), performing abortions wasn't even a question. "As a doctor, my job is not to have an opinion on abortion," she says. "My job is to care for patients."

She didn't get involved with advocacy at first. "I thought doing the procedure was advocacy enough," McNicholas says. But during her family-planning fellowship in 2013, she testified before the Missouri Legislature on a bill restricting access to medical abortions. "It was so eye-opening," she says. "The folks testifying for the bill were all men. I felt like if you're going to make decisions that affect half the population, you should have input from them." But finding other women to testify alongside her was difficult. "When I first started doing advocacy, I would think, Where are all the women who have abortions? Why aren't they standing here with me?" she says. "But as time went on, I was like, Well, we don't expect the people who have colonoscopies to come and talk to the legislature about it." She often ends her testimony with an invitation for legislators to come spend a day with her. "I say, 'Do you want to meet any of these women? Do you want to see what it's like? Do you want to see what kind of impact you're having?'" she says. "Of course, nobody ever does."

Just before 8 a.m., a smattering of protesters stands on the sidewalk near the parking lot entrance. An intern with Coalition for Life St. Louis, who declined to be interviewed, wears a hot-pink vest (Planned Parenthood's unofficial color) and is holding a clipboard next to a sign reading, "Check in here"—a seemingly deliberate attempt to confuse arriving patients. Even though Planned Parenthood warns women about the protesters when they schedule their appointments, many patients stop or pause when greeted by a protester's friendly wave. Others drive in as the intern yells after them, "You have options!" or "Just give us the opportunity to comfort you!" She then scribbles down the car's license plate number and a description of the passengers (she won't say what the information is used for). If any patients stop, the protesters direct them to Thrive St. Louis' mobile unit parked across the street. They tell women they can get a free pregnancy test and ultrasound on the bus, but don't mention that such centers typically counsel women against having an abortion.

Once patients are safely in the parking lot, they're greeted by a volunteer from the advocacy group NARAL Pro-Choice America, who escorts them inside. There are 22 abortions on the schedule today. The majority of patients in McNicholas' care fit the profile of women seeking abortions in the U.S. Nationally, more than half (58 percent) are in their 20s, 61 percent already have one or more children, and nearly 70 percent are economically disadvantaged.

Of the patients McNicholas will see today, one is a 24-year-old mother of three from St. Louis whose IUD—the most effective form of contraception available—failed. "This is a situation I tried to prevent," she says, adding that she just started nursing school. She's fired up about her right to make her own decisions about having more children. "I mean, how would you feel if someone came to you, telling you, 'You shouldn't do this because I believe in God'?" she asks. "That's like saying, 'I'm a vegetarian, so you can't eat meat.'" Another patient is a 24-year-old who drove from a small town about three hours away. She says she was drugged and raped at her own housewarming party. "I never in my mind thought I would be here—this is a nightmare," she says. "But this is a decision I had to make because, yeah, I could do adoption, but when that kid hunts me down one day, they're going to say, 'Why?' And I'd have to say, 'Well, you're a product of rape.' That's nothing to put on a kid."

Whether McNicholas is performing a medical abortion, where the patient takes one pill at the clinic and a single dose of four others within the next 48 hours at home, or a surgical abortion, where the pregnancy is suctioned out of the uterus, she only needs about 10 minutes with each patient. She enters the room with a big smile and a cheerful hello, immediately trying to put patients at ease. The first question from surgical patients is usually, "Will it hurt?" McNicholas tells them she can't promise it will be painless—most patients experience varying levels of cramping—but she can say it will be over quickly. The actual procedure only lasts three to five minutes. "You can handle anything for three minutes," she tells patients.

The 40-person staff at the Planned Parenthood in St. Louis constantly worry that the state Legislature will find a way to shut them down. "Anytime there's some new restriction, we have to step back and say, 'What is our current work flow, and how does that need to change? What's our current paperwork, and how does that have to change? What's our current training, and how does that have to change?'" says Mary Kogut, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri. The clinic's medical director, David Eisenberg, adds, "We have spent so much time, energy, and money defending ourselves against these attacks. If they can't stop us from taking care of women, they're hoping they can bleed us dry in the process."

Feeling like they have a target on their backs is not without cause. The state Legislature is currently trying to pass a measure to defund Planned Parenthood, pulling nearly $380,000 in financial support. Legislators successfully stopped the state's only other abortion provider—a Planned Parenthood clinic in Columbia, home to the University of Missouri—from performing abortions last winter. The Columbia clinic had been unable to provide abortions since 2012, when its doctor left for a military deployment. In 2014, when Laura McQuade took over as president and CEO of Planned Parenthood of Kansas and mid-Missouri, one of her primary goals was to get abortion care up and running again. She started looking for a doctor and eventually connected with McNicholas. After a lengthy licensing, inspection, and credentialing process, the clinic was approved to start providing abortions on July 14, 2015. "Within one week," McQuade says, "our schedule was full."

The very same day, however, the Center for Medical Progress (CMP), an antiabortion organization, began releasing undercover videos purporting to show Planned Parenthood officials discussing donating fetal tissue from abortions to research. CMP used the heavily edited videos to make the case that Planned Parenthood was illegally selling fetal tissue for profit, which Planned Parenthood denies. (CMP's director, David Daleiden, has since been indicted on a felony charge of tampering with a governmental record and on a misdemeanor charge related to intent to purchase human organs, and faces up to 20 years in prison; he has petitioned the court to have the charges dismissed. Twelve state investigations have cleared Planned Parenthood of any wrongdoing.)

Within days, Missouri's Senate formed an ad hoc committee, called Sanctity of Life, to investigate the state's Planned Parenthood clinics, though neither participates in a fetal-tissue-donation program. The committee applied pressure on the University of Missouri, where McNicholas had obtained admitting privileges, and in December, the college revoked the category of privileges McNicholas had been granted, making it so the Columbia clinic could no longer provide abortion care. "I'm horrified that Missouri has gone back to being a one-provider state," McQuade says. "We remain deeply frustrated that we are unable to provide women the health care that they deserve and that we have the ability to provide, but [we] are being blocked by a hostile legislature."

They aren't alone: Admitting privileges are often incredibly difficult, if not impossible, to secure. Many hospitals refuse to grant privileges on religious grounds (nearly one out of nine hospital beds in the country is in a Catholic-run facility), or because they receive a large portion of their funding from a state legislature (as is the case for state- and university-run hospitals) and don't want to risk losing their financial support by becoming embroiled in the politics of abortion. Other hospitals may have requirements that all physicians with privileges admit a certain number of patients a year, which is an impossible quota for abortion providers to meet because the procedures are extremely safe (Guttmacher estimates that the risk of major complications requiring hospitalization is less than 0.05 percent). The result is few doctors with privileges—often none in the same town or city as a clinic—so doctors like McNicholas rack up frequent-flier miles, jetting from state to state to provide care.

On Friday, McNicholas' alarm rings at 4 a.m. She's on one of the first flights of the day to Wichita, where she will spend the next two days at the South Wind Women's Center, one of three clinics in Kansas. It's run by the Trust Women Foundation, which opens abortion clinics in underserved communities (its second is slated to open in June in Oklahoma City; McNicholas will fly in to work there once a month). Named in honor of Dr. George Tiller, who often wore a button reading, "Trust Women," the foundation reopened the clinic in the same facility four years after Tiller was assassinated in 2009 in his church by antiabortion extremist Scott Roeder. (Roeder was convicted of murder and is serving a life sentence.)

Founder and CEO Julie Burkhart heads both the foundation and the clinic. She worked for Tiller for seven years and has six photos of him framed in her office. Burkhart says she "felt a calling" to reopen the clinic after his death. When she approached McNicholas to work at the facility, McNicholas carefully considered the decision. "I certainly don't make light of security," she says. "But one of the things that drove me was that I felt it was a really important stance from the abortion community to say, 'You're not scaring us—we're not going to stop doing what we're doing just because you walked into somebody's place of worship and murdered them.'"

Today, like most days, protesters have set up a dozen small wooden crosses and a handful of gruesomely graphic signs outside the center's entrance. One protester screams, "Children do not deserve the death penalty—they don't want to be torn limb from limb! Repent before the hand of God comes against you!" as patients make their way inside. The woman has also knitted a baby blanket to show to arriving patients. "It helps women realize it is a baby and if they let it live, they will enjoy it," she says.

McNicholas is ushered inside by an armed security guard who worked as Tiller's personal bodyguard for 17 years. (He wasn't with Tiller that day in the church; "He felt pretty safe there," says the security guard, who didn't want to be identified.) Within 10 minutes, she's inside an exam room with the first patient. She will perform 24 abortions today and 17 tomorrow before heading home. "Lots of people assume the hardest part of my job is the work—abortion after abortion, how sad that is," she says. "But the truth is, the hardest part of my job is when I have to say no to somebody." Most often, McNicholas says, she has to say no not for a medical concern, but a legal restriction—increasing numbers of women are getting abortions later because it takes time for them to scrape together enough money to drive hours away, stay in a hotel, and afford the procedure. By the time they arrive, they've passed the legal limit on the number of weeks pregnant they can be and still have an abortion. (In Kansas, the law permits abortions at or after 20 weeks if the woman's life is endangered.) "It's so devastating to me to see a woman's face when they don't want to be pregnant and you're the last person who can help them, and you can't," she says. "They are forced to continue with their pregnancy by law."

With the Supreme Court decision looming, McNicholas can't help but think of the many more women she may have to say no to in the coming months as a result. "I don't know what is going to happen, or what changes or requirements we will have to take on," she says. "But those of us who provide abortion care are an innovative, creative, and determined bunch—we will continue to find ways to make sure women have access." For now, she remains focused on her current patients. "The best part is when somebody gets off the table and gives me a hug because they feel like, I just got my life back. I'm going to walk out of here and have a new start—whatever my goals are, I'm going to reach them," she says. One of her hopes for telling her story, she says, is that other doctors will say, "If she can perform abortions in three places, then I can do it in one."

"It does feel overwhelming and daunting to take this on," McNicholas admits. "But it's doable—you really just need that first hug from a patient and then you're hooked."

Back in Wichita, she completes the last abortion of the day just before 3 p.m. She checks on her patients in the recovery room, and then she's out the door, with 30 minutes until her flight takes off. She makes it through airport security just in time to board the plane. She'll have one day at home with her family tomorrow before it all begins again.

This article appears in the June issue of Marie Claire, on newsstands now. (An earlier version of this article inaccurately stated that the results of the survey of Texas women were those who have tried to end their pregnancy after HB2 was enacted, when in fact the study did not focus on post-HB2 attempts. The error has been fixed.)

On Sunday, Republican presidential candidate and Ohio Governor John Kasich signed a bill that blocks his state from securing health services from organizations that perform or promote abortions, according to CNN. 

Though Planned Parenthood isn't specifically named in the bill, the outlet reports that the effects of this law will defund the organization by more than $1 million, because Planned Parenthood does perform abortions along with its more common health and contraceptive services for women. 

"This legislation will have devastating consequences for women across Ohio," Planned Parenthood President Cecile Richards said in a statement. "John Kasich is proudly eliminating care for expectant mothers and newborns; he is leaving thousands without vital STD and HIV testing, slashing a program to fight domestic violence, and cutting access to essential, basic health care."

Kasich, who has positioned himself as the moderate candidate among the Republicans, just finished fifth in the South Carolina primary, but has racked up important endorsements, including one from the New York Times. 

A spokesperson for Kasich's office said this bill will move funds to other providers for pregnant women and newborns.

"The Ohio Department of Health has at least 150 other sub-grantees and contractors for the affected grants and projects addressing such issues as new born babies, infant mortality, expectant mothers, violence against women, and minority HIV/AIDS," a statement from his office said. "ODH will reallocate funding from ineligible providers under the new law to other currently eligible providers, ranging from local health departments and community organizations to hospitals and universities. These organizations will be required to submit proposals in order to receive funding."

Despite the continuing action against Planned Parenthood, most Americans oppose defunding the organization, according to a USA Today/Suffolk University poll released in December.

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Planned Parenthood and its California affiliates have filed a civil lawsuit against the Center for Medical Progress, a group that filmed undercover videos of executives and claimed the company profited from sales of fetal tissue to a bank called StemExpress.

The Hill reports that the suit accuses the Center for Medical Progress of violating state and federal law, including "secret taping with an unlawful purpose." The group posed as executives from a medical tissue firm in the videos, and Planned Parenthood says the clips are deceptively edited, though they led to many governmental hearings and a campaign to defund their clinics.

"We're holding anti-abortion extremists accountable for their three-year conspiracy to attempt to shut our doors," Planned Parenthood president Cecile Richards said on Twitter. "As we have every day, we will continue to protect access to quality, compassionate care, [including] safe and legal abortion. These doors stay open."

The Center for Medical Progress isn't backing down, either. "Game on," CMP's project lead, David Daleiden, told BuzzFeed. "I look forward to taking the depositions of all the Planned Parenthood CEOs who profited off of their business relationship with StemExpress." 

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Planned Parenthood has filed a federal lawsuit to protect access to abortions in Ohio. The lawsuit was filed on Sunday after state officials accused them of illegally disposing of aborted fetuses.

On Friday, Ohio Attorney General Mike DeWine said a four-month investigation of three Planned Parenthood facilities showed they had contracted with a medical waste company that was disposing of medical tissue in a Kentucky landfill. According to Ohio law, the only rule about disposal is that "the fetus shall be disposed of in a humane manner."

DeWine argued last week that "disposing of them in a landfill is not humane," and said that he and Rick Hodges, director of the Ohio Department of Health, were filing a court injunction "to restrict Planned Parenthood activities where violations of law have occurred," Hodges said in a statement.

Planned Parenthood argues that they have, in fact, been acting in accordance of the law and that the state officials never confronted them with concerns and, instead, went straight to the press and threatened to take legal action. 

"Planned Parenthood handles medical tissue just like other health care providers do," Jerry Lawson, CEO of Planned Parenthood Southwest Ohio, said in a statement. "We work with licensed medical removal companies to handle fetal tissue respectfully and safely. It's clear from the Attorney General's press conference that we've acted properly and legally, and this is just part of his longstanding political agenda to ban abortion in all cases. We won't let that happen."

The number of abortion providers in Ohio has been cut in half in the last four years, the second highest number of closures nationally behind Texas. 

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The debate surrounding Planned Parenthood is still raging, but one supporter has figured out the key to talking some sense into them: Get into the nitty-gritty about women's health and start talking about yeast infections. (That's right.)

Mary Numair, 29, works at Purringtons Cat Lounge in Portland, Oregon, and noticed that protesters had been gathering outside the Planned Parenthood nearby. She told BuzzFeed that she tried to reason with them, but could never get through to them. 

And for Numair, this is personal. When she was in her early 20s, she had chronic yeast infections but no health insurance because she had a pre-existing condition. (This was the pre-Obamacare years.) So she relied on Planned Parenthood to help with birth control and care for her stubborn infections. 

She got a piece of cardboard form the dumpster, and wrote "Dear P.P, thanks for helping with my yeast infections" on it with market. She then added a vulva drawing, complete with smiling clitoris, and a stick figure of a woman with big boobs. She then got a co-worker to cover the rest of her shift, went outside to the protest, and stood next to some families with kids.

She started yelling and chanting "yeast infections," and naturally, it did not end well. "In my first 30 seconds of walking out there, I did get called a whore," she told Slate. "One woman was shaking her head. I knelt down to her kid and said, 'Do you know about yeast infections?'" 

But some people passing by the protest gave her props, and the tactic eventually worked. After 20 minutes of screaming and doing high kicks, they left, even ending the prayer circle they started in an effort to pray for her.

Numair said she'll continue her counter-protests, and wants someone to help her make a giant wooden labia. She hopes that the trend will spread, and has good advice for people who get confronted: Ask about their own personal health.

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Republicans really, really don't like Planned Parenthood. If thepresidential candidates haven't made that clear, conservatives in Congress did last week when they threatened to shut down the government—yet again—over Planned Parenthood's federal funding.

But the reason Planned Parenthood exists and even receives federal dollars in the first place is largely because Republicans got it off the ground. 

When birth control was legalized, Republicans helped expand access to contraception for low-income people because they recognized its economic value to women, families, and taxpayers. Even when abortion was legalized through Roe v. Wade, a women's right to choose wasn't immediately a partisan issue—or much of an issue at all.

Over the past few decades, the Republican Party has shifted further right—and the politics behind this evolution explain why the GOP is trying to stop the very thing that they started 45 years ago. 

From Nixon using abortion legislation to strategically woo Catholics to lobbyists deliberately linking family planning to abortion in the '90s, the Republican long game to court a new voter base was nothing if not effective. Today, it's almost impossible to be a pro-choice Republican running for any major political office. And across the country, state-level efforts to restrict abortion access are powering forward: in Texas, the number of abortion providers dropped from 40 to eight in a little over a year.

Though reproductive rights seem to be disappearing before our eyes, the secret Republican history of Planned Parenthood tells a different story—namely that it doesn't have to be this way, because it hasn't always been.

The organization was an affiliate of the American Birth Control League, which would eventually become Planned Parenthood.

He helped launch their first national fundraising campaign.

The same year, former Republican President Eisenhower (who said just six years earlier that it's not the government's "business" to support birth control) serves as co-chairman of a Planned Parenthood committee with Harry Truman. In a 1968 address to Congress, then-Congressman George H.W. Bush advocates for government support of family planning programs, citing statistics from a Planned Parenthood clinic.

The federal grant program, which provides planning services to low-income families, was championed by President Nixon and George H.W. Bush (who was such a vocal supporter of birth control that he was supposedly nicknamed "Rubbers"). The funds have never been used to provide abortions because of provisions written into the law.

Only a year after the Supreme Court struck down Massachusetts' prohibition of birth control for unmarried women through Eisenstadt v. Baird. 

As they adopt an anti-choice stance, the Democrats adopt their first pro-choice platform.

A Human Life Amendment, which would have overturned the Supreme Court's decision, comes to vote for the first and only time after several attempts. The Senate defeats it, with Goldwater reversing his previous position to vote against it (Planned Parenthood still issues an achievement award named for him.)

Their strategy centers on the idea that government funding for family planning providers "frees up" money that is used for abortions. In 1992, polls show that as many as 71% of Republican Party members are pro-choice. But by 1996, public opinion changes sharply as the number of people believing that abortion should be legal "under certain circumstances" overtakes the number of people who believed abortion should always be legal.

Only six Republicans vote against it.

She's grilled by GOP members who would rather the government shut down than Planned Parenthood continue to receive federal funding—even though that funding has never been used to provide abortions.

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Last Saturday morning, I woke up at my in-laws' house in California at 6:30am. I paced the quiet, chinoiserie-studded rooms before settling in for my first pee of the morning—and like many of us, I used that time to check Facebook. I scrolled through posts from well-meaning people regarding the proposed defunding of Planned Parenthood, friend after friend defending the organization by talking about the various healthcare services they had obtained there that had nothing to do with sex or pregnancy, much less abortion. Deeply sick of not only the GOP's mercenary attacks on my rights but the mealymouthed, apologetic tone of my allies, I tapped out the following status:

I was increasingly pissed at the compromised rhetoric my friends were using to defend the organization. Of course Planned Parenthood provides a wide spectrum of women's (and men's) wellness services. Of course we have all gone to Planned Parenthood for pap smears and cancer screenings and STI tests and all manner of non-abortion health services. Of course the Hyde Amendment prevents abortions from being federally funded. 

But they were making Planned Parenthood sound like any other health clinic, which it is not. It very importantly provides sexual health-related services, including abortion, to women—especially low-income and uninsured women. Who have sex. And don't want to be pregnant. And this is a good thing.

Hillary Clinton is the first example I can recall of a well-meaning person muddying the waters of this conversation, when she said that abortion should be "safe, legal, and rare" back in 1992. We don't say that any other medical procedure should be rare; we say that it should happen as often as is needed to keep people healthy. In 2012, Sandra Fluke's speech—to Democrats—regarding insurance coverage of contraceptives was heavy on the arguments about how they help ovarian cysts and endometriosis, and light on the sex talk. She was still, of course, called a slut and a prostitute by Rush Limbaugh, because he is wonderful. 

Yes, these medications have many uses—hell, I'm sure the Pill could be used as an earring back in a pinch, and an IUD could replace a lost zipper pull—but their main purpose is to prevent pregnancy in women. Who have sex. And don't want to be pregnant. And this is a good thing. 

Meanwhile the GOP is taking that "rare" and running with it, making sure it's not just a concessionary political talking point, but the rule. Laws are being passed in several states restricting not only if and how a woman obtains an abortion, but *why*. We are on a very slippery slope sliding right into the hands of people who treat The Handmaid's Tale like an instruction manual. And this is not a good thing.

So anyway, after I posted my "rant," my family and I headed out for a wedding up in the redwood forest of northern California. I looked at my phone right before we left, and saw that it had a few likes and shares and some heartening comments. I stopped looking, and tried to focus on analog life. We stayed for hours, dancing to great jazz and inhaling canapés. When we emerged and rejoined the grid, I checked my phone.

Holy shit.

I thought it was broken. I thought there was some kind of glitch.  My phone glowed hot in my hand. I had hundreds of friend requests. I had in fact hit the limit for friend requests, which I now know is one thousand. The post itself? Over 20,000 likes. I was suddenly the focus of the vast and terrifying panoply of human digital behavior. 

Again, I thought this must be some kind of mistake, some weird algorithmic shart. Then I started reading the comments and messages, which were overwhelming.

The word "preach" was thrown around, along with those praising emoji hands. People said "finally!" and called me their "shero." I felt pretty damn good.

But mixed in with the encouraging responses were people calling me a whore, a murderer. There was a holy trinity of the c-word: stupid c-nt, f-cking c-nt, insane c-nt. Many people cordially invited me to end my own life. A group called Chicks on the Right called me a godless monster—right underneath a post celebrating the recent deaths of hundreds of Muslims in the stampede at Mecca. Pro-lifers!

A lot of people sent me violent and graphic messages telling me to abort myself (the logic here mystifies me), then immediately blocked me so that I couldn't respond or access their profiles. I guess that's a popular tactic. I would never have thought of it, because I never send hateful, violent messages to people simply because I disagree with them, and then so fear their response that I scurry away and hide. The other thing I learned is that some people will send you a hateful message, hover over their screen until the moment they get a read receipt, and then quickly delete it, so that you cannot report it to Facebook or the police. 

(Sidenote: I do find it ironic that all these time-consuming hate-mail strategies, not to mention the constant screaming at women outside clinics, are practiced so heavily by the anti-abortion crowd in particular, considering that they are so purportedly concerned with preventing the waste of lives.)

"How dare you use the word Nazi—you are the real Nazi, abortion is the American Holicaust! [sic]" Okay, random hateful person, you have a fair point. I do regret using the word Nazi, if only because it's uncreative. I'd love to go back and change it to "stormtroopers" or "hatebarons." But, as I now know, there are no takesies backsies on the internet. 

Also, if you're so concerned about genocide, surely you are appalled by the very real threat of genocide happening right this second in Syria and Iraq, and have appealed to our president to provide harbor for even more refugees than the 10,000 he has promised? No?  

I have one other regret, by the way. There were women who said that they agreed with the post, but that their abortions had been painful, tragic, or both, and that they found my statement to be insensitive to them. I could have been a bit clearer about this. I meant that the fact of abortion, the existence of it, is not itself tragic or painful—it just is. I certainly did not mean to invalidate anyone's personal experience ; I was simply trying to refute the theatrical hand-wringing that so many liberal politicians engage in when it comes to discussing abortion as a fact.

Abortion is the only medical procedure in which the circumstances and behavior of the patient are used as excuses to stigmatize and deny their treatment. A lot of the pain and tragedy abortion patients feel is owing to that stigma, and the guilt they share as a result. And I'm sick of it.  So I posted about it. And now it's out there.

So here I am now, a and a half week later. I have a couple thousand new followers, a bunch of new friends, and many new enemies. My post has been shared by politicians and women's rights groups, has been seen by hundreds of thousands of people, and has been made into a meme. It's on Facebook and Twitter and Instagram and probably some other social media apps I'm too old to even know about. 

To those who continue to harass me, at least it keeps your hands busy. To those who held me up with those rows and rows of emoji hands, thanks. I'm going to keep preaching about abortion, about all women's rights, and about every other damn thing I am passionate about. I just hope my posts about people clipping their nails on the subway, or not covering their mouths when they sneeze, get this many eyeballs. If we're gonna control what other people do with their bodies, can we please start there?

My senior year of college, I worked at a Planned Parenthood clinic. At my orientation, I said, "I'll take whichever part is hardest," so they assigned me to the recovery room. Every Friday morning for a year, I woke up early to escort girls and women from their procedures to one of eight black leather chairs, where I took their vitals, counseled them on birth control, and held their hair while they vomited. 

On my first day, one of the nurses said, "Are you pre-med or social work?"

"English," I said. "I'm a writer?"

She placed her hand on her hip and cocked her head. "Why the hell are you here if you don't have to be?"

I tried to utter a philosophical answer about women and their reproductive rights and my responsibility to be on the "front lines" of the fight, but she stopped me.

"Whatever you do, just get them to someone who can drive them home safe," she said. "Oh, and wear gloves when you clean up the vomit."

It was going to be much less glamorous than I'd thought. In my head, I was a hero volunteer. In reality, I was a desperately needed extra set of hands.

I'd grown up as a strict Catholic. When a close high-school friend had confided in me about her abortion years earlier, I had gone silent. In truth, I didn't know how to feel about abortion then. All I knew was what I was told—that it was wrong. It was normal for girls in my school to disappear for a year, then return the next a little weary, a grade behind, and never quite the same. People said they were being sent on missions somewhere, but we all knew where they really were. If abortion was evil, I thought, then giving up the child for adoption was banishment to a life of sleepwalking. Abstinence, our teachers told us. But as I grew older, I couldn't reconcile the disconnect between reality and religion.

At Planned Parenthood, reality ruled. There was no sugarcoating.

The girls and women who showed up for their procedures couldn't have been more diverse. They were mothers of three from regular middle-class families who couldn't handle the financial, emotional, or physical obligations of another child. They were college students who'd used condoms and birth control and still gotten pregnant. And they were out-of-towners who'd made a six-hour drive to cross the state line so they could secure safe healthcare.

I befriended a frantic lesbian who pleaded with me to believe her that she'd only had sex with a man once and didn't even think pregnancy could be possible. There was a sorority girl who couldn't stop crying and screaming, wondering why she was crying and screaming when she knew she'd made the right choice. And there were the many women dizzy from the anesthesia, drooling and exhausted, who tried to leave on their own so they could make their shift at work. These were the patients the nurse had warned me about: Make sure someone is there to take them home.

Every girl and woman who entered my room got a cup of animal crackers and a juice box and however many refills they needed. I'd direct them to the notebooks sitting beside every leather chair, scrawled over by previous patients who needed to put their thoughts on paper. On my breaks, when the room was empty, I'd shove animal crackers into my own mouth and read their notes and cry. These people weren't selfish. They weren't bad. They were people with jobs to go to and families to care for. They were just like me, only a little less lucky.

I used to imagine myself in those leather chairs, on the other side. I would probably be like the lesbian patient, pleading my case, assuming my own guilt—I promise I was careful! I made one mistake!—but I vowed never to make another woman explain herself to me. And while Planned Parenthood itself is responsible for preventing thousands of unwanted pregnancies in the first place by giving out free or affordable birth control, sometimes that birth control fails. 

I quickly saw that those who worked on the surgical side at Planned Parenthood were overworked and emotionally taxed. Just to get in the door, they would have to physically push through protestors who hurled insults and spit at them, even shouting out their home addresses to intimidate. While I worked there, a new bill was being proposed that would allow protestors inside the gates, all the way up to the front doors. I huddled with the nurses, all of us wondering, What will we do?

We were lucky. It didn't go through then. But they could still lie down on the hood of a patient's car, posting photos of fetuses between your windshield and wiper while you tried to drive away. That part was legal. That was protected.

When I watched that "gotcha" video with pro-life actors, I think I was supposed to see how laissez-faire Planned Parenthood's attitudes toward abortion and human life were. I didn't. I thought of the veteran Planned Parenthood workers I had met who lived under constant stress. They had families and kids of their own, and when a girl would come in terrified by the protestors, the nurses tried their best not to lose their patience. There are only so many times you can say, This is your choice, not theirs.

Sometimes the nurses would see a "regular." You see, many of the women who seek abortions have already had at least one, and where I used to be on the moral fence about this, I have no qualms about repeat abortions now. You either want to have a child, or you don't, and that can apply every time. Some of the regulars are sex workers, and others simply poor. Sometimes when their husbands wanted sex, they complied, but couldn't get them to give them a ride to the clinic 30 miles away to pick up their next birth-control prescription. I heard variations of that story a lot. The further away a woman lived from a Planned Parenthood, the more likely she was to come in for an abortion.

In my time at Planned Parenthood, I saw people who dealt with the world with pragmatism, practicality, and great empathy. They needed those giant cups of coffee. Their resolve took a hit every time a 12-year-old came in pregnant, crying, and scared. Still, everyone showed up for work, ready for the protestors, ready for the graphic photos plastered to their cars, ready for the attacks on their character for doing what they think desperately needs to be done. But most importantly, ready for the crying girls who had no one but you that day.

Sen. Elizabeth Warren pulled no punches on the Senate floor Monday when she harangued Republican lawmakers for calling a vote to defund Planned Parenthood.

"Did you fall down, hit your head and think you woke up in the 1950s, or the 1890s?" said Warren, a Democrat from Massachusetts. "Should we call for a doctor? Because I simply cannot believe that in the year 2015, the United States Senate would be spending its time trying to defund women's health care centers."

Republican senators needed 60 votes to proceed to the Senator floor with a debate of a bill to defund Planned Parenthood, but they ultimately garnered 53 in support. That means Planned Parenthood is safe, for now.

Monday's vote came as Republicans have seized upon recent undercover videos that show Planned Parenthood executives discussing fetal tissue donations to medical research companies. The activist group that captured the films say they're evidence Planned Parenthood profits from selling the tissue, which is illegal. Planned Parenthood has emphatically denied that claim.

Warren addressed the video and the GOP response directly in her speech Monday.

"Let's be really clear about something," she said. "The Republican scheme to defund Planned Parenthood is not some sort of surprised response to a highly edited video. Nope. The Republican vote to defund Planned Parenthood is just one more piece of a deliberate, methodical, orchestrated right-wing attack on women's rights. And I'm sick and tired of it. Women everywhere are sick and tired of it. The American people are sick and tired of it."

"The year is 2015, not 1955 and not 1895," she added.

A Dallas, TX area crisis pregnancy center featured in Misconception.

Hit play on Vice News's documentary Misconception, and you'll immediately be greeted by a haunting image of people lined up on the edges of a sidewalk leading to the door of a Washington, D.C. area Planned Parenthood. A man reads off a list of female names, each punctured by a uniform cry of "may God have mercy on her soul." The chants more resemble the sounds of church service than they do a scene outside of medical office. But these are the drastic tactics that anti-abortion advocates use to propel women away from the doors of places like Planned Parenthood, and into the walls of a crisis pregnancy center.

As of this year, crisis pregnancy centers (CPC) outnumber abortion clinics five to one throughout the United States, Vice News reports. They claim to offer emotional support and a free pregnancy test and sonogram. But really, it is a chance for pro-life supporters to mislead women and capitalize on their vulnerable state. "You go in asking for help, but they're not giving you the kind of help that you're asking for," Donna, who ignorantly went to a CPC seeking termination and instead was given an unwanted sonogram and a lecture about faith, says. "I feel like I was lied to, I feel like I was tricked." The revealing film exposes the lies that they fed their so-called patients. The 20-minute film reveals the jaw-dropping misconceptions that are fed to women who are seeking abortions but end up in CPCs.

1. They trick Google into showing the link to these centers when a woman searches for phrases such as "pregnancy symptoms." To get your attention, they need you to believe that they are offering you what you're looking for. "If they were up front about what their purpose was and what they did, no one would go," Bethany Herrera, who has worked for an abortion provider for over 20 years, says.

2. When a woman mistakenly calls a CPC and asks for abortion pricing information, she is told she must come into the center to receive the details. This is how the centers mislead women who mistakenly think that CPCs offer the procedure.

3. Visitors are warned about the "physical and mental consequences" of abortions. According to counselors, these include substance abuse, a perforated uterus, a higher risk of suicide, toxic shock, and possible death. In actuality, less than .05 percent of those who undergo first-trimester terminations result in complications serious enough to require a hospital visit.

4. Some of the cautions doled out aren't just exaggerated, but are simply wrong. In the video, a counselor states that there is a correlation between her risk of breast cancer and the number of abortions she's undergone. Multiple studies have disproved this claim.

5. They call into question the ethics of providers. One CPC counselor can be heard saying that termination is an "all-cash business." It's not just their ethics that are attacked, but the safety practices, as well. Another one quipped: "It could never be safe, it's so totally unnatural."

6. The centers are often located next to or across the street from operating clinics. This strategic placement enables them to misdirect women attempting to keep their appointments at the nearby facility, giving them the opportunity to dispense their gospel.

7. During one woman's visit, the counselor inaccurately relayed the age of her fetus. The further along you are, the more difficult it is to procure an abortion. The desire is that she will be deterred from following through if she believes she is deeper into her pregnancy than originally anticipated.

8. They try to make your appointment personal. In one instance, a CPC employee pulls out a model of a 12-week-old fetus, and even offers to let her keep it—because everyone needs one of those lying around the house, right? On top of that, they make their space welcoming. In one instance, the consultation was staged in a comfortable room, complete with plush couches, artwork of blossoming flowers, and soothing, pale green-hued walls.

Watch the full documentary to learn more, below.

Related:

Tennessee Republicans Want To Put Pro-Life Language In Their Constitution

This Act Could Put an End to Anti-Abortion Legislation

These States Are Trying to Eliminate a Woman's Right to Choose

UPDATE: The Iowa Medical Board tried to ban the video chat appointment system Planned Parenthood introduced (details below) and an Iowa state supreme court judge immediately blocked their ban. While the court has yet to make a final decision on whether or not the IMB has the authority to introduce such a restriction, if the ruling is upheld, then Iowa will be the third state to use this prescription-giving system.

If the fear of being accosted by pro-life protesters had kept you from paying a visit to Planned Parenthood, things are looking up. The women's health giant just debuted online video visits so allowing women seeking reproductive healthcare access to contraceptives without ever leaving the comfort of their own home. Yep, you can get your birth control the same way you order a killer pair of heels or new bedding—online. The service is dubbed Planned Parenthood Care, and is accessible through a website or the Planned Parenthood smart phone app.

During the 15 minute 'appointment', patients video chat with a clinician where they discuss what form of birth control is best for her. Once decided, said birth control is shipped directly to her doorstep. The service is priced pretty well, too—just $45 per appointment. The low price tag is essential at this point, as the appointment can't be covered by insurance.

The program is Planned Parenthood's way of trying to connect with the tech-obsessed millennial demographic, as well as ensuring that anyone who wants to access Planned Parenthood's services is able to. As of now, the program only exists in Minnesota and Washington, but in search of a younger generation of patients, we expect that Planned Parenthood in other states will follow suit.

Related:

Primary Protection: The History of the Pill

The Contraceptive Cheat Sheet

Photo via Getty Images

Who: Cecile Richards, President, Planned Parenthood Federation of America and Planned Parenthood Action Fund

Rapid Response: Seconds after the Supreme Court's June 30 decision to allow some private corporations, like Hobby Lobby, to not cover contraceptives in employee health plans for religious reasons, Cecile Richards, 57, took to Twitter, tweeting both rebuttals ("No coincidence: all 3 women on #SCOTUS dissented. For women, only controversy about birth control is that we're still fighting for it") and messages of hope ("Worried your employer might cut your birth control coverage? Text 'birthcontrol' to 69866 and we'll help you find a solution").

Driving Force: "A lot of my drive involves wanting my daughters—and my son—to have opportunities," Richards says. "Any movement to drive women's issues and women's rights backward simply cannot happen on our watch."

The Numbers: Twenty percent of women in the U.S. have visited Planned Parenthood. Collectively, these centers prevent an estimated 515,000 unintended pregnancies annually and provide more than a million women with services like breast exams and Pap smears.

Backstory: Richards herself visited Planned Parenthood for the first time as a college student and calls the experience an awakening. It "was the one place where you could ask questions—and folks would talk to you—without guilt," she told The Nation. "No matter how much things change, some things are immutable: The need for basic sexual education will never go away."

Get Involved: plannedparenthood.org or donate here: ppaction.org

Related: 19 Other Women Who Are Changing the World

Photo via Peter Hapak

Planned Parenthood Votes released an ad on Wednesday as part of the organization's $1 million TV and radio ad buy in Virginia, a state currently involved in a heated gubernatorial race.

The ad attacks Republican candidate Ken Cuccinelli, whose record on women's rights issues has come under harsh scrutiny throughout the campaign. In addition to his opposition to abortion, Cuccinelli co-sponsored a bill while in the Virginia Senate that would have defined life as beginning at fertilization, thereby granting full legal rights to embryos. The "personhood" bill, which eventually did not pass, could have rendered certain forms of contraception illegal.

The ad attacks Cuccinelli, who has been trying to court female voters, for interfering with access to birth control, opposing emergency contraception, and attempting to ban abortion. The ad asks women voters, "Ken Cuccinelli doesn't trust women, so how can we trust Ken Cuccinelli?"

In recent weeks, Cuccinelli has tried to redefine his record on women's rights as he lags in the polls behind Democratic candidate Terry McAuliffe. In addition to denying that he had previously tried to interefere with access to contraception, Cuccinelli told a crowd at an August campaign event that he was "not going to touch contraception as governor." Check out the Planned Parenthood Votes ad below.

Who'd have guessed that women's health would be the hot issue of 2012? First the Susan G. Komen Foundation ignited a firestorm by saying it would withdraw funds from Planned Parenthood for breast cancer screenings. After a backlash, Komen backed down. But that only kicked off more fierce battles.

On February 16, three priests, a rabbi, and a doctor walked into a Capitol Hill hearing room. Sounds like a bad joke, but when those five men testified about denying insurance coverage for birth control, women weren't laughing. The controversy continued when Sandra Fluke, a Georgetown University student who had planned to speak in favor of contraceptive coverage but was turned away, became the symbol of the debate when she was subjected to character attacks. Among other nasty things, Rush Limbaugh called her a slut. Suddenly, it was personal, and the simple fact of using contraception, as 98 percent of American women have, was called into question.

How is it possible that we're debating the morality of birth control? Some social conservatives have resurrected the old argument that having sex without wanting to get pregnant is bad for society. As former GOP presidential candidate Rick Santorum put it: "[Birth control] is ... a license to do things in the sexual realm that is counter to how things are supposed to be." Many abortion rights opponents have also sounded the alarm against contraception, in part because they erroneously claim that some forms, including the Pill, end pregnancy.

But that all-guy panel opposed all birth control. Catholic bishops (and many Republicans) were outraged that President Obama's health-care law mandated that full contraceptive coverage be provided by religiously affiliated institutions. That meant that female employees of Catholic organizations (not including churches) would no longer be denied coverage because of the Vatican's opposition to birth control. (The Church has no such concerns about Viagra.)

Those were the women Fluke was trying to represent. For that, Limbaugh said she was a prostitute and having so much sex that she couldn't walk. "When he talked about me, he could have been talking about any woman who uses contraception," Fluke says. In the ensuing outrage, dozens of Limbaugh's advertisers fled.

Covering birth control is not only popular —63 percent of Americans support the policy —it makes business sense. Data show that every dollar spent on family-planning saves the public almost $4, and that access to birth control helps reduce teen pregnancies. But funding for those services is in constant danger; last year, Republicans almost shut down the U.S. government trying to deny funding for Planned Parenthood because it provides abortions (even though no federal funds pay for abortion).

Though the Great Birth Control Debate is in some ways a nightmarish blast from the past, some see reasons for optimism. Says Cecile Richards, president of Planned Parenthood, "We've seen people across the country who are saying, 'Keep politics out of women's health.'" But much depends on the election: Every Republican candidate supported a failed measure that would have let employers deny workers coverage for anything that violated their conscience, and they've campaigned to overturn the entire health-care law, which is also about to be examined by the Supreme Court. Republicans wouldn't be able to make birth control illegal —but they could make it difficult to get. And that should be enough to get any woman to the polls in November.

President Barack Obama: His Affordable Care Act mandates birth control coverage. Supports Planned Parenthood. His administration rejected an FDA request to make emergency contraception available over-the-counter to girls under 17.

Former Governor Mitt Romney: Supported a Senate measure that would have allowed employers to deny contraceptive coverage to employees on the basis of conscience, and vowed to defund a federally funded family-planning program.

Former Senator and former presidential candidate Rick Santorum: Finds contraception "not OK." Voted to renew funding for women's health, including contraception, to Planned Parenthood and other providers, but has since distanced himself from the vote.

Q: Will all contraception be covered by insurance?

A: As of August 2012, all FDA-approved contraception will be covered without copay.

Q: Will there be a religious exception?

A: After an Obama compromise, religious-affiliated institutions are exempt; insurers must offer complete coverage free of charge.

Q: What if the health-care law is nixed by Congress or the Supreme Court?

A: Twenty-eight states already mandate contraceptive coverage. Women who work for institutions that object to birth control or who are uninsured will have to pay out of pocket, go to increasingly strapped publicly funded clinics, or go without.

There's just one year to go before the major elections of 2012 and the Planned Parenthood Action Fund is not going to let its mission go unnoticed by politicians across the country on both a federal and a state level. And that's why today they've launched the "Women Are Watching" political action campaign.

In speaking about the campaign yesterday Cecile Richards, President of the Planned Parenthood Action Fund, pointed out that there was a 13 point gender gap in the 2008 election and that number will indeed be very significant if not larger in 2012. With women's health under attack on many levels across America, Women Are Watching will give readers correct information about exactly what the candidates are saying, what legislation is in motion to take away women's health rights and give you ways to get involved. The site also gives women easy ways to share this information on their own social networks and add their own stories to the discussion. As Richards said yesterday, "Women's health doesn't come with a party label...it trancends it all."

Women have the power to truly make our voices heard in this election. But we need to be informed and I'm so glad to see a site like Women Are Watching available to all. I, for one, have already taken the pledge

and hope you'll consider it too. Women's reproductive health and access to family planning are way too important to the future of our country to stand idly by and let others make the decisions. The basic tenets of the pledge kind of say it all: Watch. Think. Act. Vote. If we do that, I have faith that good things will result.

For more information on Women Are Watching and the Planned Parenthood Action Fund, check out the site here

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This week the Institute of Medicine recommended that prescription birth control be included as a women's preventative health service which would make it covered without co-pays by new insurance plans under the Affordable Care Act. The U.S. Department of Health and Human Services is now reviewing the report with a ruling expected in August. And that means that now is the time to make our voices heard on the matter.

Of course Cecile Richards, president of Planned Parenthood Federation of America was one of the first to speak out: "Millions of women, especially young women, struggle every day to afford prescription birth control. [This] recommendation brings us a step closer to ensuring that all newly insured women under the health care reform law will have access to prescription birth control without out-of-pocket expenses. This would be a tremendous stride forward for women's health in this country."

I couldn't agree more. And before you start to think this isn't a big issue you should take note of a 2010 survey by Hart Research that found that over one-third of female voters struggled with the cost of birth control at some point in their lives which led them to be inconsistent with its use. The obvious result here is a whole lot of unplanned pregnancies. And this certainly should not be a partisan issue—it's about the health of all women. In the very same survey, 77% of Catholics and 72% of Republicans surveyed believed that birth control should be covered without out-of-pocket expense. See? We can agree on things from time to time..

What do you think? Vote in our poll below.

Do you think prescription birth control should be fully covered by insurance?

In case you missed it, Republicans in the House of Representatives pushed through a budget bill this past spring that included cutting off federal funds for Planned Parenthood. The move was a war on women, fueled by misinformation about federal funding and abortion. Under current law, federal funds for Planned Parenthood go to cancer screenings, STD tests, birth control, and other preventive services for women — not abortion. Thankfully, the bill did not make it past the Senate. Who exactly are the congresswomen who voted to defund Planned Parenthood? Marie Claire found out. If you, like us, have no desire to take a giant leap backward in reproductive health, then tell these women what you think:

House:

Rep. Sandy Adams (R — FL)

Rep. Michele Bachmann (R — MN)

Rep. Diane Black (R — TN)

Rep. Marsha Blackburn (R — TN)

Rep. Ann Marie Buerkle (R — NY)

Rep. Renee Ellmers (R — NC)

Rep. Jo Ann Emerson (R — MO)

Rep. Virginia Foxx (R — NC)

Rep. Kay Granger (R — TX)

Rep. Vicky Hartzler (R — MO)

Rep. Nan Hayworth (R — NY)

Rep. Jaime Herrera Beutler (R — WA)

Rep. Lynn Jenkins (R — KS)

Rep. Cynthia Lummis (R — WY)

Rep. Cathy McMorris Rodgers (R — WA)

Rep. Candice Miller (R — MI)

Rep. Shelley Moore Capito (R — WV)

Rep. Sue Myrick (R — NC)

Rep. Kristi Noem (R — SD)

Rep. Martha Roby (R — AL)

Rep. Ileana Ros-Lehtinen (R — FL)

Rep. Jean Schmidt (R — OH)

Senate:

Sen. Kelly Ayotte (R — NH)

Sen. Kay Bailey Hutchison (R — TX)

You can contact the congresswomen through their websites, or just send an e-mail to action@marieclaire.com, and we'll forward your note to them..

In late February, the House of Representatives voted to defund Planned Parenthood — the most aggressive assault on your organization since you assumed the top job in 2006. Were you surprised?

I think what I didn't realize until then was how fiercely under attack all of women's health care would be, way beyond Planned Parenthood. I have been stunned by how much this new Congress is so focused on rolling back access to women's health care at a time when women are more in need than any other moment in my lifetime.

It's no secret that Planned Parenthood's abortion providers face death threats. Do you ever feel in danger?

I've never lived in any way afraid of what comes next. You just have to do what you think is right. We spend a lot of time making sure that our 11,000 employees around the country are safe. That does weigh on me. Particularly at times like this, when the political tension seems to be at a boiling point.

You must get loads of hate mail.

Let's just say there are a lot of people praying for me.

What's it like running an institution that has to routinely fend off attacks that threaten its survival?

I try to keep it in perspective. When Margaret Sanger first opened her birth-control information center 95 years ago, she was hauled off to jail. Women have had to fight every step of the way for reproductive care.

How do you get things done when you're constantly dealing with crises?

Yes, we're dealing with this battle in Congress. But we're also making so much progress where it really matters. We see 3 million patients a year, and in the last 30 days, we will have seen 2.2 million visitors to plannedparenthood.org; 10 percent come from other countries, where they have no information about birth control. We are testing a program where young people can text their questions to Planned Parenthood. And, as a result of health-care reform, there is going to be an explosion of health-care access for women. Planned Parenthood will happily be at the forefront.

You were the deputy chief of staff to Democratic leader Nancy Pelosi. So you've spent a lot of time on Capitol Hill. Do you think the mostly male Congress treats women differently?

I was in a couple of meetings with senators yesterday, and they were lecturing me on what we should be doing. And I thought, God, if I were a male CEO, head of a large national health-care organization, I don't think they'd be lecturing me. Sometimes you just have to nod, say thank you, and move on.

Your mother was Ann Richards, the legendary Democratic governor of Texas. Did she give you any good job advice?

She believed that women are always waiting for someone to give us permission. We think we don't have the right clothes, don't know the right people, don't have the right degrees. She told me to never turn down a new opportunity because I might think I'm not qualified — the only regrets you have are for those things you didn't do.

What comes next for you — political office?

Could be. I don't know. I haven't ever planned ahead.

Today is World AIDS Day, a day to take stock of how well organizations are doing to combat the disease. And according to the United Nations' AIDS program, the overall HIV infection rate has declined almost 20 percent in 10 years, which is great news.

But despite that and because I'm a paranoid hypochondriac alarmist, I was shocked to see a new CDC report, announced yesterday, that found that only 45 percent of Americans have been tested for HIV at least once in their lives. This is up from only 40 percent in 2006, but, if you ask me, the number is still dismayingly low — especially when you consider that the CDC urges everyone to get routine testing.

So, who should get routine testing? Anyone who is sexually active — because the more quickly you discover it, the better able you are to treat it.

I also always ask anyone I'm dating about his sexual history and if he's been tested. Because: If I don't feel comfortable enough with a guy to ask him all this stuff ... well, then, maybe I shouldn't be having sex (or doing much else with him) in the first place, right?

Still, I try not to make it into a medical exam, complete with clipboard and nurse's outfit (though I'm sure there are some guys who wouldn't mind that kind of thing). Usually, I'll initiate the conversation on a night when we seem to be progressing from kissing to something more physical. And I'll say, "Hey, because I'm interested in my health — and yours — can you tell me if you've had an STD test recently?" If he hasn't ... I'll insist he get one.

I guess this is all a long way of encouraging all of you to get tested more — and to be firm about asking that your partners do, too. If you're not sure where to go to get it done, ask your primary care doctor, or your gyno, or check out Planned Parenthood's find-a-location page. And if you just want more info on getting tested, check out AIDS.org.

The Planned Parenthood where she works looks like a typical 21st-century American abortion clinic. The bulky brick exterior defends the edifice against bombs. Deliberately high windows protect those inside from snipers. A rear parking lot hides patients from protestors who might hurl slogans, spit, or Molotov cocktails. On Monday mornings, the patients-many of whom wear hats and all of whom study the ground-enter the locked, bulletproof doors pregnant. Since no South Dakota doctor will work at the clinic, 71-year-old gynecologist McCreary, grandmother of 10 and daughter of Lutheran missionaries, hops her early flight to Sioux Falls, population 141,000. Her husband, a retired businessman, kisses her good-bye, then tries to get through the day and get past his worries-foreign terrorists who hijack airplanes, domestic terrorists who murder doctors-with military-history magazines. The Minneapolis flight is often delayed; Midwest weather is iffy. So a Planned Parenthood staff member regularly watches the sun rise over a tall-grass field from the curb in front of the regional airport, where she waits for the doctor to arrive. Week after week, she comes to understand how frontier women periodically went crazy from the prairie wind's whisper-whistle, while back in the clinic's waiting room, a more complex tension thickens despite the generous supply of People magazines.

To begin a surgical abortion, Dr. McCreary injects a patient's cervix with an anesthetic. She'd like to offer general anesthesia, but there aren't enough nurses at the clinic to watch IV lines. So Dr. McCreary gives the women what she calls "verbal anesthesia." "I talk to them," she says. "Most have the same favorite topic: their kids." Sixty percent of abortion patients in the U.S. are already mothers. Next, Dr. McCreary dilates her patient's cervix to about the width of a pen. Then, taking something that looks like a mini vacuum-cleaner hose, she sucks out the contents of the uterus. Sixty days after conception, a fetus is about the size of a kidney bean. It has a head, a rump, and tiny webbed fingers, but limited brain function. Along with the placenta, Dr. McCreary pulls the fetus, in pieces, into a glass jar. Like amputated limbs, abortion material is considered regulated medical waste and is cremated or incinerated. About three hours after entering the clinic, most patients leave with their wombs empty- though about twice a month, a woman is so distraught that Dr. McCreary sends her home still pregnant to reconsider her options. "I tell her, 'Think about what you really want to do,'" says Dr. McCreary. "I say, 'We'll be here if you need us.'"

On the sidewalk in front of the brick fortress, two other grandmas, from Brookings County, SD, recite the rosary. Each carries a poster of a baby that reads, "Look it in the face." "This clinic protects rapists," one informs me. "If a woman has been raped by a family member, the law says you're supposed to report it. But if you come here and get an abortion, it doesn't get reported. The man gets a free ride." Then she confides, "And the clinic sells baby parts to manufacture cosmetics." It would be an abortion clinic like any other, except that the Sioux Falls is the last facility in all of South Dakota, a state of 775,000 people scattered across some 77,000 square miles. It is also the most imperiled clinic in the country-endangered not from the kaboom of violence, but from a silent smash of law.

Last winter, the state legislature passed House Bill 1215, The Women's Health and Human Life Protection Act, which bans virtually all abortions, even in cases of rape, incest, and threat to a woman's health. "If you have high blood pressure or heart disease and a pregnancy will make the condition much worse, too bad," says Sarah Stoesz, president and CEO of Planned Parenthood in Minnesota, North Dakota and South Dakota. "Even if you already have small children. Same if you're carrying a severely damaged fetus." For now though, the Act cannot be enforced. The South Dakota Campaign for Healthy Families gathered enough signatures to put it to a statewide vote on November 7. On that day, if South Dakotans choose to rescind the Act, pro-life advocates will likely introduce a slightly less-stringent ban in the State Legislature. If South Dakotans vote to uphold the Act, Planned Parenthood will file a federal lawsuit against the state. Either way, both sides agree, the battle will rise up through appeals courts, and sooner rather than later, the U.S. Supreme Court will decide-based on HB 1215 or similar measures introduced in Ohio, Indiana, Kentucky, Georgia, and Tennessee-whether abortion remains legal in America.

Politics normally don't interest Nancy, 26, a cherubic-looking hairstylist from Aberdeen, SD. But when she discovered she was pregnant in late May 2006, Nancy (not her real name) wound up thinking a lot about the political intricacies of the controversial procedure, especially how much "people hate abortion in South Dakota." She finds the hostility toward abortion confusing. "I already have a 6-year-old," she says, looking around the Sioux Falls clinic waiting room. "I know what parenting is like." Her boyfriend of two-and-a-half-years, Jim, 24, a Spartacus-looking construction foreman, seems more understanding of the pro-life position. He's clearly conflicted about Nancy's decision. "It's hard not having a say in the matter," he says. "This week hasn't been easy."

Like many unintended pregnancies, Nancy's is not the result of carelessness but of statistical odds. "She was using birth control," Jim tells me. "Really. She was on the Pill." Regardless, the South Dakota Task Force on Abortion finds that the procedure Nancy wants to get "exploits the mother . . . damages her health . . . and portrays [her] as valueless." Nancy searches the corners of the clinic room for a way to defend herself against the notion she's doing anything but what's best for herself and the child she already has. Finding no answers in the drywall, she gestures toward her boyfriend. He's younger than me," she says. "Only 24. Just starting his life. I'm trying to hold mine together. Really, people should mind their own business." She gets up to go have her abortion. That Nancy and Jim were having sex is undeniably what caused her unintended pregnancy. Leslee Unruh, founder of the abstinence clearinghouse, thinks sex creates many other ills, too-cervical cancer, bad grades, and poor female self-esteem. That's why she was one of the main lobbying forces last year behind both South Dakota's abortion ban and a law to teach school children "that it is the expected standard to abstain from sexual activity until they are married." The abstinence law passed in the South Dakota house of representatives but was never voted on in the state senate. Since 2003, Unruh's organization has received grants from the Bush administration's $113 million budget for community-based abstinence programs.

Unruh, 51, a descendent of Laura Ingalls Wilder, describes herself as "an all-natural type" who raised goats in order to give her five children organic milk. In her youth, Unruh was pro-choice. At age 19, she met her husband, who was pro-life. The couple had many "hot" discussions about the issues, but Unruh didn't change her position until, between her third and fourth child, she had an abortion because her doctor said her life was jeopardized by the pregnancy. "I was given information, but not all the information," Unruh says. "I made a choice-the wrong choice. I'm into taking personal responsibility." The procedure left Unruh deeply bereaved. She turned her regret into action and in 1984 opened the Alpha Center, a pregnancy "counseling" service. Three years later, the center paid a $500 fine after Unruh was accused of offering pregnant women money in exchange for not aborting.

Working with so many pregnant women led Unruh to see what she calls "feminism's new lie"-the myth that women can be as sexually rapacious as men, and as happily promiscuous as Sex and the City's Samantha."When a man has sex, it's just physical," she says. "It's scientifically proven that women get attached. And he who cares the least has the most power." Ergo, virginity, in Unruth's view, is the key to feminine clout.

"I slept around," I tell Unruh. "I don't feel any worse for the wear." (For the record, I'm now a faithfully married 40-year-old with a 6-year-old daughter.)

"You're rare," she says. "Most women who use their bodies have damage, emotionally and physically. But I don't want you to think I think badly of you."

Unruh doesn't think badly of Planned Parenthood, either. She "likes" the Sioux Falls clinic director, Kate Looby, but feels that Planned Parenthood deceives its patients by giving them birth control and abortions. An unintentionally pregnant woman, especially, "needs the truth," says Unruh.

"What's the truth?" I ask.

"That there's a little life there from the moment of conception. But the abortion industry is big business, so they won't tell you that."

I disagree, my uncle Bart Slepian, was an OB/GYN who also performed abortions in Buffalo, NY. I used to write the rare speech he gave. In his last one, he said, "abortion is undeniably the taking of potential life. It is not pretty. It is not easy. And in a perfect world, it would not be necessary."

It's true he made a lot of money doing abortions. Though a relatively cheap surgery (between $275 and $700), abortions don't generate heavy billing costs because they're not covered by some insurance plans. Also, the procedure often takes less than five minutes; in an eight-hour day, a doctor can perform dozens of them. Still, the majority of my uncle's income came from routine gynecology and obstetrics.

On October 23, 1998, my uncle and his wife returned home from Friday-night synagogue services. They were in their kitchen, chatting with three of their four children (ages 7 to 15), when an anti-abortion activist hiding in the woods behind their house fired a rifle into the domestic scene. The bullet hit Bart in the back, shattered his spine, and tore through his aorta before exiting his body through his left armpit-barely missing his 15-year-old son's head. My aunt began CPR, and one of my cousins ran for paper towels to stanch his father's wounds. But Bart was already dead.

A few years before he was killed, my uncle opened his front door and invited the people singing "Jesus loves the little children" on his stoop inside for breakfast. He said if they would stop harassing him and his family (he particularly didn't like them following his kids to school and asking them not to grow up to be "killers like daddy"), they could set up a table inside the clinic where he worked two days a week and pass out pro-life information. He suggested that the real way to stop abortion-which he was all for; no one was more critical of repeat abortion customers than Bart-was to make birth control free and easy to get.

The minister in charge of the "Jesus Loves" choir didn't want to discuss birth control. "They're not interested in solutions," Looby, the Sioux Falls clinic director, tells me. "They only want to talk about abstinence."

Looby, a mother of four, thought she'd seen the anti-abortion movement's most virulent moment when she worked at a clinic during operation Rescue's 1991 "Summer of Mercy." That August, in Wichita, KS, whole families crawled across parking lots, winding up as heaps of "babies" at clinic doors. Children laid down in front of doctors' cars to stop them from driving to work. Protestors closed down every clinic in town. In Omaha, NE, other protestors showed up at a shower Looby's clinic staff threw for her shortly before she gave birth to her first child. "My husband and I decided we had to get out of there," Looby says. She laughs, briefly. "We came here."

I can't even smile with her. After Operation Rescue's "Summer of Mercy" success, anti-abortion leaders began planning a "Spring of Life" in Buffalo. "They'll never drive me out," my uncle Bart told his local paper when he learned of the upcoming event. "I'm not sure what they can do to me that hasn't been done-short of physical violence."

A year later, abortion doctors started getting shot. During the five years between the first murder and my uncle's, I became increasingly aware of the tension surrounding the issue. But for whatever reason, not once did I say to my uncle, who was becoming so depressed he began planning his own funeral, "Gee, Bart, doing abortions seems to be getting to you, and it's definitely getting very dangerous, so why not just quit?" Or just, "Bart, love you." Instead, assiduously marched in pro-choice rallies and considered anyone who opposed abortion a backward woman-hater-not that ever spoke to anyone who was pro-life.Since my uncle died, I've gotten to know a lot of people who are pro-life. Some are decent; others are backward. But, as Yitshak Rabin said, you make peace with enemies, not friends.

Now, in search of some peacemaking, I climb into my rented Pontiac and take off for South Dakota's capital, Pierre-which locals pronounce "peer"-the epicenter of the abortion debate. At 70 miles an hour on surgical-scar-straight roads, it's a nearly four-hour drive populated with more cows and buffalo than people. Over and over, wavy grassland turns into neat rows of corn and back again. The scene's serenity is marred only by billboards: among the most common are those for a place called wall drug, a pharmacy that sells things like mounted jackalopes (a dead rabbit with deer antlers); and those that herald the evils of abortion ("The gift of life, God's special gift!"), often accompanied by a portrait of what appears to be a smiling fetus, not a born baby, but I'm never sure.

Upon arriving in Pierre, I'm surprised to find state Rep. Roger Hunt, 68, prime sponsor of the abortion-ban bill, in a capitol room chock-full of massage therapists. It seems the state legislature recently passed a law requiring insurance for masseurs, and many don't think that's fair. Hunt gently admonishes them not to cast aspersions so wantonly.

By trade, Hunt is a business and contracts lawyer; serving in South Dakota's legislature is a part-time gig and only pays $6000 a year. He entered politics after retiring from the Navy with no agenda beyond "doing a little good." He got involved in fighting abortion when "some ladies" came to talk to him about abstinence in the early 1990s. Over the past 16 years, Hunt has introduced and supported legislation that, as he puts it, "chips away at Roe v. Wade"-with waiting periods and parental/spousal notification-and launched full-frontal assaults on the right to choose.

Because it's true, tell him that I understand his pro-life position. But I can't fathom why anyone-even people who think virginity until marriage is a worthwhile goal-would support a law that says sex education "may not [discuss] contraceptive drugs or methods" and requires telling students that "engaging in unlawful sexual activity may be a crime punishable by law." In a country where about 80 percent of people have sex before age 20-while the average marital age is 26-such legislation seems downright idiotic. But Hunt thinks teaching teens about birth control is society's way of saying "yes" to fornication, and that if we just stopped talking about sex to kids, a lot of them would quit having it. "When I was a teen," I tell Hunt, "I remember thinking, if I could just stop daydreaming about sex, I'd get so much done. Don't you remember that feeling? "No," he says. Hunt also believes the self-discipline of not having sex translates into the self-discipline of not doing drugs, not becoming involved in crime, and not dropping out of school. He is not alone.

Between 1994 and 2001, the federally funded National Longitudinal Study of Adolescent Health tracked over 14,000 American teens. The survey found that 21 percent of sexually active teens dropped out of high school, compared to just 8 percent of virgins. Outside America, however, these stats don't hold up: As many teenage Danes have intercourse as teenage Americans, yet their high-school graduation rate is 13 percent higher. And since 1975, Denmark has reduced its abortion rate by 40 percent; ours has increased more than 20 percent. What's the difference? Mainly, that sex education has been compulsory in Danish schools for 36 years, and birth control and emergency contraception (EC) are cheap and easy to get without a prescription: You walk into a drugstore, pay a nominal fee, and don't become pregnant.

It makes me wonder: does accessible contraception function like a seat belt, which protects me but doesn't make me drive crazily - or is it more like the overdraft protection on my checking account, which also protects me while occasionally enticing me to spend recklessly? What i decide is that something is seriously messed up about a country in which sex is as much a predictor of life derailment as drug use or poverty.

Hunt believes one of the reasons his abortion ban finally became law is due to the "scientific findings" from a state-funded task force that studied the issue. the science in the 71-page report, needless to say, is not universally accepted-particularly its controversial argument against abortion in the case of familial rape because incest may create "the brightest person in the family . . . sometimes in the genius range of intellect."

Whether a child comes out smart or stupid, tell hunt, it seems outrageously cruel to make a girl sexually abused by a family member have the baby. The practical issues alone are overwhelming: can she sue him for child support? he stop her from putting the child up for adoption? Hunt is silent for a minute. "From where I stand, there should be no exception. Because what is the greater offense? Taking a life is worse than rape."

Of course, most unintended pregnancies are not caused by vicious attacks. They're the result of kisses that get carried away-and, as Nancy and Jim found out, birth control that breaks.

By the time Nancy returns to Jim in the waiting room later that day, Dr. McCreary has performed 15 other abortions. Kristen Peterson, 28, a South Dakota native and teacher at a local middle school, cleans up after her. Married and super-careful with birth control, Peterson has never had an abortion and probably will never need one. But she's still willing to spend her summer vacation holding the hands of women in the clinic in an effort to stop her state from morphing into a place where she no longer feels at home. A few weeks back, Peterson attended a Planned Parenthood rally. The next day, her photo wound up in the local paper. "That wasn't smart," a school colleague told her.

Why? She wondered. Because I'm pro-choice? Because I'm any kind of political? Because I don't think women should be punished for being sexual beings? "Gosh," Peterson says, "it's getting bad here in South Dakota."

Outside, the late afternoon sun is painfully bright. In the clinic, Nancy looks pale but relieved. Jim just looks pale. They don't seem to notice the protesting grandmas, and the grandmas don't look up from their rosary beads to consider them.

I try to imagine if the world were just a little different-say, one U.S. Supreme Court justice different. What would Nancy and Jim be doing instead of leaving an abortion clinic? .Would they be preparing to give the baby up for adoption? Or would they, like the one time I thought I was unintentionally pregnant, find the notion of someone else raising their child less bearable than aborting it? Would Nancy be on the Internet figuring out how to end the pregnancy herself? Would she and Jim already be arguing over child support and custody? Or would they be down the street, at the state's only Wal-Mart, buying a crib? The last scenario is the one Leslee Unruh and Roger Hunt imagine, and it's one, I suspect, Jim sorely wanted to create. But it wasn't for Nancy. The clinic staff doesn't allow me to probe the depths of why, but I'm guessing Nancy already found out the hard way that a gurgling baby won't fix a troubled relationship, turn a hot-headed boy into a responsible man, or transform a woman into a joyful mother. "I just want to get on with my life," Nancy tells me. And that, for now, is her choice.