In the wake of the Supreme Court’s decision to overturn Roe v. Wade, the news has been full of stories about patients crossing state lines in order to access reproductive care. What often gets left out is the accompanying confusion created by abortion restrictions.
“I had a patient travel all the way from Mississippi,” said Sarah Traxler, an OB-GYN in Minnesota, “only for me to have to say, ‘It’s not safe for me to see you here in this clinic. You need to be seen in a hospital.”
The patient’s condition was complicated enough that an outpatient office wasn’t equipped if something went wrong; she might need a transfusion. “It was devastating,” said Traxler, the chief medical officer for Planned Parenthood North Central States. “And it’s going to happen more and more.”
Those are the kinds of challenges facing Planned Parenthood as it deals with an ever-shifting landscape of legal restrictions on reproductive care. State laws have exceptions that different people interpret in different ways. Bills get passed and then temporarily blocked by judges. Patients hear about an abortion ban in their state and think it applies to contraception as well. Others worry about seeking care for a miscarriage, fearing prosecution.
To Alexis McGill Johnson, president and CEO of the Planned Parenthood Federation of America, the task of informing and caring for patients today is tied up with trying to prevent the erosion of democracy itself. STAT caught up with her soon after she was selected as a member of the 2023 STATUS List.
This interview has been edited and condensed for clarity.
There are two lawsuits in federal court regarding abortion pills. One, filed in Amarillo, Texas, by anti-abortion groups, is seeking to revoke the Food and Drug Administration 23-year-old approval of mifepristone. The other, filed in Seattle by 12 state governments, is asking the FDA to immediately remove the restrictions on its use, given that this drug is safer than Tylenol. How do you see these cases?
The case in Amarillo is a wake-up call to everyone who thought that they didn’t have a stake in this or that they lived in a state where they weren’t going to lose access to abortion. We’re not aware of any medication where a court has revoked an evidence-based FDA approval. So we’re clearly very concerned, as the entire medical community should be. It’s a very dangerous precedent. For them to have forum-shopped to a federal court where they were guaranteed to get a judge who has demonstrated a hostile viewpoint on reproductive rights — we have concerns about how our judiciary is being used.
The other case is important, raising questions about why we have restrictions on a medication that is proven to be incredibly safe and effective. I’m grateful for that engagement from governors and attorneys general.
Do you think that borrowing from the toolkit of the anti-abortion movement — i.e. challenging FDA’s authority — might end up giving some sort of unintended credence to those tools?
I wouldn’t say borrowing tools so much as being incredibly patient-centric about what this fight needs to look like to ensure that people get access to care.
Setting aside that mifepristone lawsuit, what are the biggest concerns for you right now?
These restrictions are sowing chaos and confusion into people’s lives. The thing that keeps me up at night is ensuring that we have the infrastructure — from a care perspective, from a resource perspective, from a legal perspective — to protect our patients and providers, to get people access to the care that they need.
“We are seeing politicians using the same playbook that they used to dismantle abortion to attack gender-affirming care.”
Alexis McGill Johnson, Planned Parenthood president & CEO
Last year, in the midst of this crisis, we also set aside resources for our Black health equity initiative, which is a forward-looking opportunity to say, “As we are remaking our organization to meet a new moment, how could we rethink the patient voices at the center of our work?” By putting the Black patient experience at the center, we can leverage our infrastructure and lay the groundwork for making Planned Parenthood among the best, if not the best, places for Black Americans to get their care.
We’ve been having conversations around things like: what would it take for us to make a dent in cervical cancer rates for Black women, knowing that provision of pap smears and HPV vaccines are critical?
Are you seeing changes in the gender-affirming care Planned Parenthood is able to provide at some of its centers?
Planned Parenthood is proud to provide sexual and reproductive health care to transgender communities across the country. We have gender-affirming hormone therapy at 41 affiliates [of 49]. We are proud about supporting people’s ability to be their free, full, authentic selves. We know that providing gender-affirming care is important for health and well-being, particularly for trans and non-binary teens. I’m sure you’ve seen the studies about how access to gender-affirming care can help youth experience less depression, less anxiety.
We’re also fighting back, because we are seeing politicians using the same playbook that they used to dismantle abortion to attack gender-affirming care. So we’re kind of familiar with this playbook, which is anti-freedom. And we’re really proud of providing care that helps people live free lives.
Can you tell me about some of the staffing issues you’re seeing?
Planned Parenthood got hit doubly hard. Our providers and frontline staff are incredibly passionate, but they’re also — reasonably — getting worn out. At some affiliates, it’s from the surge from other states; at others, from not being able to provide care. That is impacting their mental health and well-being. But also, we’re three years into Covid; there’s been that wear and tear on our health care workers, too, who were still showing up every day, trying to help people navigate complex Covid restrictions.
With the Dobbs ruling, in some states where abortion is banned, or access is severely limited, we’re also losing the ability of medical students and residents to learn the procedure, which for many people could be life-saving. So we are investing in a service corps for providers, to support their development and ensure that people can also come to affiliates where they’re still able to practice that care, and intern and get residencies.
What role will alliances with Republicans play in protecting reproductive rights?
The majority of people in virtually every state support access to reproductive freedom. There’s no public opinion poll that suggests that that is not the case. So the question we have to ask is: How can it be that the majority of people believe in bodily autonomy, and these laws are still being pushed? What you see is a pattern of gerrymandering, locking in control of state houses.
“The Republican Party has been captured by an anti-abortion-rights minority, and that is pushing them to very extreme positions.”
Alexis McGill Johnson, Planned Parenthood president & CEO
The question I have for people who identify as Republican, who are benefiting from other policies, but are clearly not being fully represented, is: How are they going to continue to show up in this fight? There’s no way we could have gotten to the kind of ballot measure results that you saw in 2022 without Republican and independent support. We are trying to demonstrate this disconnect between having majority support for reproductive freedom and having laws, systems, structures that deny our ability to hold these lawmakers accountable.
That means engaging in questions around democracy reform, but also talking to folks on both sides about getting stronger protections. This is totally a nonpartisan issue. The Republican Party has been captured by an anti-abortion-rights minority, and that is pushing them to very extreme positions that are impacting the health and life of many people who could become pregnant.
What haven’t I asked you about that I should be asking about?
We need to identify and bring more stakeholders into the conversation. We’ve been doing a lot of corporate engagement: Companies have expanded their benefit policies, which is incredibly important, but we need them to engage further with the communities that they’re operating in and the consumers who support them. Those will continue to be conversations we push over the next few years, because no one can stay neutral in this fight. We need everybody engaged.