Dr. Leana Wen had just lost her baby.
It was a hard blow during a difficult season of her life. As then-president of Planned Parenthood Federation of America, Dr. Wen was struggling with bureaucrats who didn’t share her vision for the organization. They’d criticized her, undermined her, and finally given her an ultimatum: Change her approach to leading PPFA, or lose her job. In the midst of the turmoil, the conception of her second child was a momentary bright spot. It didn’t last.
“My pregnancy loss was devastating in a way that I couldn’t have anticipated,” Dr. Wen says in her new memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health. “I cried for many hours and could not be consoled.” Although she’d cared for many women with the same sad diagnosis, her medical training didn’t prepare her for the feelings of anxiety and grief that accompany such an experience. Seeking a breather to recover, she took a vacation with her family over the Independence Day holiday.
“Then a bombshell went off,” she writes. “I’d confided in someone at Planned Parenthood about my miscarriage, who told others without my consent. People began suggesting that I should use it as a reason to explain my departure. This was offensive and hurtful on so many levels that I began writing an op-ed about my miscarriage so as not to have this deeply personal experience stolen from me.”
The editorial appeared on July 6, 2019, in the Washington Post, earning a tsunami of accolades. But the response to the piece from Wen’s pro-choice allies was brutally mixed. “I could tune out the anti-choice extremists who said that I deserved what happened to me,” she says of the reviews. “It was harder to ignore the criticism from people who accused me of stigmatizing abortion by talking about miscarriage.” Days later, PPFA unceremoniously fired her. She’d been on the job for eight months.
Dr. Wen’s experience as a woman working at the very heart of Planned Parenthood is just one prominent example of how the non-profit has squandered opportunities to serve the patients who are meant to be at the heart of its mission. About a million women suffer pregnancy loss every year, yet PPFA’s approach to Wen matched that of the most regressive, patriarchal corporation imaginable. Instead of seeing her openness about her loss as a chance to speak into the lives of women, Planned Parenthood dumped her.
Indeed, the organization’s leaders have opted for a narrow, inflexible focus on abortion, a procedure that most women will never seek out. Meanwhile, patients and their families continue to drown in a pool of unmet needs, even as the self-described “leading provider and advocate of high-quality, affordable healthcare for women, men, and children” looks away.
The first place to find this disconnect is in Planned Parenthood’s name. Despite the attention paid to the child-free movement, and the supposed environmental and mental health benefits of not reproducing, most Americans still want to be parents. Pew Research Center recently found that even among the minority of young people who don’t see kids in their future, more than one in three say it’s because of (potentially treatable) medical problems or the lack of a (potentially en route) partner.
In particular, motherhood is having a bit of a surge recently. In 2018, about 86 percent of U.S. women age 40 to 44 had given birth at some point in their lives. That’s boosted from 80 percent a decade earlier. For comparison, in the 1970s, the share of women who’d had a baby by 44 was 90 percent, which, if trends continue, isn’t far off. Although the United States and other Western countries continue to struggle with low overall birth rates, most individual women do eventually get around to having kids—they’re just waiting longer to do it. It’s hard to overstate the implications childbearing has for a woman’s social, physical, and mental well-being. So, you’d expect the self-proclaimed “leader in the fight for reproductive health” to provide significant support to those who are reproducing.
Unfortunately, it’s just not so.
Consider infertility, for example. It’s one of the world’s most common health problems, affecting 10 to 15 percent of couples. Millions of American women are dealing with this medical challenge, which research shows is about as emotionally distressing as a cancer diagnosis. It’s a condition that health insurance companies notoriously don’t cover: Only 19 states have laws requiring that simple procedures (like unclogging a woman’s Fallopian tubes) be paid for. Women of color are at higher risk of suffering from infertility, even after taking into account variables like education, economic status, smoking, obesity, and age.
But PPFA’s outreach to these patients is virtually nonexistent. Its website briefly describes high-risk in vitro fertilization, cheerfully adding that it “tends to be pretty expensive”—and that it’s not provided by Planned Parenthood.
One of the few affiliates to attempt to treat infertility, Planned Parenthood South Texas, focuses its efforts on intrauterine insemination, also known as IUI. Sometimes crudely called the “turkey baster method,” it has abysmal success rates, with around 85 percent of patients left childless.
What about women who are already pregnant? A quiet crisis is unfolding for them, and their babies. Maternal mortality in the United States has been steadily creeping upward since the turn of the millennium, taking the lives of 861 women in 2020. This disturbing trend has no equivalent elsewhere in the developed world. And in this case, too, black women are at highest risk, with a death rate three times worse than for white women. Traditionally positive factors like education actually amplify the inequality: A college-degreed black mother is more likely to die than a white mother who didn’t finish high school. How does Planned Parenthood address this women’s health crisis? Feebly. Despite a network of more than 600 clinics positioned to interface with needy communities, PPFA has no national program aimed at saving mothers’ lives. That’s despite the fact that simple interventions can make a big difference. Doulas, for example, have been shown to be effective advocates for pregnant women, overriding the built-in biases of healthcare institutions that are not set up to listen to patients—especially female patients of color. Bizarrely, Planned Parenthood affiliates responded to the concept by appropriating it and starting “Abortion Doula” programs. But these “doulas” aren’t centered on helping women question and push back on their abortion provider; instead, their work involves comforting clients who are frightened and distressed.
Even when local PPFA affiliates attempt to engage with the crisis, the bottom line remains abortion. In Northeast Ohio, Planned Parenthood’s “Healthy Moms, Healthy Babies” initiative sought to save moms’ and babies’ lives by encouraging prenatal care, working with high-risk women in their own neighborhoods. The program was shuttered at the beginning of the coronavirus pandemic, even as the state’s PPFA affiliates fought to keep using scarce Personal Protective Equipment for abortions. It has not reopened. Some services, it would seem, are more “essential” than others.
PPFA’s abandonment of mothers’ health is capped by its complete absence of support for perinatal mental wellness. About 15 to 20 percent of women develop postpartum mood disorders and anxiety, illnesses that can have a cascading effect on their physical health, their relationships, and their careers. Despite the stigma that continues to surround PMAD (Perinatal Mood and Anxiety Disorders), it’s one of the most common reproductive-associated health conditions women (and their partners) can encounter. And, once again, women of color are at higher risk and have less chance of accessing care. “Planned Parenthood health centers don’t provide treatment for postpartum depression,” PPFA’s website explains, offering no excuse.
PPFA’s advocates would likely object that the organization does work to reduce maternal mortality—by prescribing massive amounts of female contraceptives. After all, one of the risk factors for maternal death is pregnancies that follow one after the other, with little gap left for the mother’s body to rest and recover.
But Planned Parenthood’s most commonly offered methods of family planning come with a host of harms for women. The birth control pill’s status as a carcinogen has been re-confirmed by a Danish study on nearly 2 million women that found it caused a 20 percent increased risk of breast cancer. The non-hormonal IUD, Paragard, has been linked to bleeding, copper toxicity, and infection. And in 2015, Planned Parenthood lined up at an FDA hearing with Bayer Pharmaceuticals and much of the U.S. medical establishment against a tidal wave of women complaining about Essure, a sterilization device that repeatedly perforated patients’ uteruses and left them in crippling pain (Bayer eventually removed the product from the market, and in 2020, settled with patients for $1.6 billion).
Women’s desire for effective family planning that doesn’t cause depression, stroke, cancer, weight gain, blood loss, and general misery, has led to an explosion of interest in Fertility Awareness Based Methods, or FABMs. Planned Parenthood acknowledges the existence of FABMs on its website. But its explanation mixes in misleading statements, such as that the methods can’t be used if a woman has an irregular cycle (they can, and they can be used to help make her cycles healthier). That suggests clinic staff aren’t prepared at all to guide women in how FABMs work.
It Didn’t Have To Be This Way
Planned Parenthood’s erstwhile president, Dr. Leana Wen, took over in 2018. She was only the second doctor to ever run PPFA, and the first in about 50 years, which is as good a sign as any that medicine has been subordinate to abortion advocacy. Wen arrived with experience in public health as the Baltimore City health commissioner, where she tackled issues as diverse as the opioid crisis and helping the pharmaceutical supply chain recover from the community’s 2015 race-related riots.
As befitted her role as a doctor, Wen knew that women are whole people with far greater challenges than just undesired pregnancy. She envisioned a Planned Parenthood that responded to more of their needs. In a New York Times editorial, she explained she wanted PPFA to “increase care for women before, during, and after pregnancies,” and described visiting one such affiliate where newborns could receive vaccinations under the same roof where their mothers could get treatment for postpartum depression, addiction, and other disorders. Wen wanted Planned Parenthood’s reality to match its marketing as a healthcare dynamo.
She even harbored hopes of working with groups that didn’t have gung-ho pro-choice views. By growing connections with people who didn’t like abortion, but who did appreciate PPFA’s work on other aspects of healthcare, she aspired to move the organization into the mainstream. A broader coalition of supporters, she reasoned, would also provide protective cover for abortion services. Planned Parenthood’s headquarters staff wouldn’t go for it. In her memoir, Wen describes every woman’s nightmare, overhearing a derogatory conversation while in the ladies’ room at work. “I thought we’d get a rock star rabble-rouser, a congresswoman or a senator. Instead, we got a doctor,” she heard one colleague snipe. Another critic at the bathroom counter chimed in to complain that Dr. Wen was still seeing patients, when she could be spending that time banging the drum at donor events. For these detractors, healthcare was quite literally a distraction from the political work they thought was most important.
Wen also recalls an extremist culture where colleagues celebrated the label “pro-abortion” and considered it a positive moral good. As a physician, she’d encountered many women who experienced their abortions as painful and heart-wrenching, and she continued to hear such stories every day in her new role. But PPFA’s stakeholders resisted being honest about patients’ real lives. “Not all women who go through abortions think the decision was difficult . . . You can’t make it sound so dramatic,” Wen quotes them as telling her. It’s no surprise that some members of the same empathy-challenged group reacted heartlessly to Wen’s miscarriage.
It turns out that Dr. Wen wasn’t the first woman to try to make Planned Parenthood live up to its promise, and its hype. Pam Maraldo, an advanced practice nurse, served as president of PPFA for two short years, starting in 1993. She, too, had begun her brief tenure wanting to remake the organization into a full-service women’s healthcare provider, with media headlines at the time trumpeting the need to move “Beyond Abortion.” And, she, too, had been quickly drummed out of her position by abortion enthusiasts. “Pam drove to Baltimore to see me,” Wen writes. “Over lengthy conversations, I came to see that our experiences, separated by more than two decades, had much in common.”
Meanwhile, Wen’s replacement at PPFA, Alexis McGill Johnson, couldn’t be more devoted to abortion as the organization’s reason for being. In an interview with the Washington Post, she dropped one of Planned Parenthood’s recent popular talking points—that abortion is only 3 percent of its activities—like a hot potato. “I think when we say, ‘It’s a small part of what we do,’ what we’re doing is actually stigmatizing it,” she said. “We are a proud abortion provider . . . So I don’t like to marginalize it in that way.” PPFA has sprinted so quickly away from Wen’s centrist message around public health that its new leader has been forced to denigrate and discard its own marketing. That no doubt pleases the national-level Planned Parenthood activists who have made abortion activism the center of their own identities. But it doesn’t help affiliate staff in clinics across the country, who are tasked with convincing their communities that their work is pro-woman, not pro-abortion. And it does nothing to help women with a host of unmet needs, most of which have nothing to do with ending a pregnancy.
It begs the question: Were women ever the mission of Planned Parenthood? If they ever were, the organization has long since abandoned them. Abortion is PPFA’s true passion now.
Margaret Brady, an associate editor at Verily Magazine, is a graduate of the E.W. Scripps School of Journalism at Ohio University. She writes from the Cleveland, Ohio area.