"Women Can't Be Left Worse Off After Healthcare Reform Than They Were Before"

How do you insure access to birth control to millions of women? As president of Planned Parenthood, Cecile Richards deals with this question every day - and just because Obama's in the White House doesn't mean the fight is over.

Richards - the daughter of the late Texas governor Ann Richards, and the former deputy chief of staff to Nancy Pelosi - is also the head of the Planned Parenthood Action Fund, its advocacy and political arm. She spoke with Doree Shafrir about grassroots organizing, why it's important to have moderate Republicans in Congress, and how Planned Parenthood helps women worldwide.

You've had a lot of jobs. Why did you want to work for Planned Parenthood?
I went to Planned Parenthood in college as a patient. I had been on a board of Planned Parenthood. I have two daughters. In some ways it just was the right thing to do. I used to organize low-wage women in a lot of industries, and they're our clients in a lot of Planned Parenthoods and so it's a part of the big picture of my work for all my life. Planned Parenthood Federation of America is this incredible organization that is a legacy organization – it's 92 years old – and yet, as relevant today as it was when Margaret Sanger started it. And the potential to sort of put my energy into this is very exciting.

So what are some of the things that you wanted to do when you started?
Well, I knew that there was a real interest by the organization in trying to kind of leap forward, and think about how do we look and feel and who do we work with and who are our patients today and who our patients were. I didn't come in with some preconceived notion of what that looked like, it's just that I knew there was some work we needed to do. And I think the other side of it was, we'd been kind of taking a beating for a long time from the extreme right. And I think they had been, to some extent, in the driver's seat about defining who we were and what we do, and it was time for us to really go back on the offense and talk about the important healthcare we provide, the education we provide, and sort of what we are as a movement. So I just finished three years, and now we're in this moment in the country where there really is an opportunity to both expand what we do as a service provider but also rebuild a movement. So it's turned out to be a good time.

You started in February of '06. So, obviously George Bush was still in office. What were some of the things that Planned Parenthood did to help Obama get elected?
When I first came in, in sort of preparation for '08, the Action Fund worked a lot of governor's races. For women, and for women's healthcare and for young people, actually, a lot of the decisions that get made happen in the state legislatures and the governors' [offices]. I thought it was really important to be able to demonstrate that you can be pro-choice and pro-Planned Parenthood and get elected governor in the heartland of the country. The Action Fund worked with governors' races in Iowa and Ohio, Michigan, Wisconsin – to really say, these are states where it's about as middle-of-the-country as you can get. And in fact we were successful in electing folks and really, I think, the folks that were elected ran on the fact they were for women's health and for women's life.

So that kind of led into the '08 election, which was the Action Fund's opportunity to focus particularly on women voters, because there's a lot of independent women voters who very much support Planned Parenthood for a whole host of reasons – not very political reasons, just that's where they went for healthcare. It was called the Million Strong Campaign, and the idea was to try to target one million women voters, and make sure that they were registered and informed about the presidential election and that they voted. So in addition to that, the Action Fund focused on these voters, and we did a lot of mobilization on the ground level in our states. Because the incredible thing about Planned Parenthood is we're in every state. We're not just in blue states or just red states or just in in-between states. We're everywhere. And our folks really rose to the occasion.

What does grass roots mobilization entail?
There's definitely a lot of door-to-door, I knocked doors in a lot of states, and a lot of Action Fund folks did. Many of them had never really taken part in that kind of electoral activity. The most important work you can do as a grassroots organizer or advocate is have a face-to-face conversation. Like, phoning is fine, mail is fine, internet is fine, but it's literally those conversations that really influence whether people vote and how they vote. And the great thing is since New York wasn't a contested state, a lot of folks bused in from New York to Pennsylvania, a lot of folks from Massachusetts who went to New Hampshire. So it was really an opportunity for everybody to literally be on the ground. We did a lot of volunteer phone-banking, because the technology now is amazing. You can really focus on the folks that you need to talk to. Obviously, it was an incredibly exciting election both in the Action Fund and across the country because in the amount of just volunteerism and people feeling like they had some stake in the outcome. It's been a long time.

I was reading a profile of you in the Washington Post from probably two or three years ago, and one thing that struck me about it was, you had spoken to a group of women, and they were saying that they never really thought about choice as the pivotal issue for them when they were voting. They were like, "Well, we always end up voting for the pro-choice candidate, but it's not my issue." It struck me that that is an issue that that's a pivotal issue for the anti-choice people.
Right. It's kind of like all they talk about.

So how do you then turn that into a pivotal issue for women?
Well, it's funny. Usually if a candidate's anti-choice, there's a whole lot of other things that they are as well. So for example with John McCain, it wasn't simply that he was anti-choice, but that he had never supported family planning, he wasn't supportive of comprehensive sex education for young people, a whole lot of other things we worked on. In some instances, it's sort of the whole package. Being anti-choice just tells you a lot about a candidate, even if that isn't the only issue you vote. So I think it's kind of filling in the whole picture. If someone is that out of touch about women's health and women's rights, then they're probably not gonna be that good on other issues you care about.

But what about anti-choice Democrats?
Obviously they've always existed. But I'd say that, actually, if you look at the last election, that the vast majority of new members of Congress that were elected in the Democratic Party, were pro-choice. And the only thing that's sort of an unfortunate outcome about all this, and I think particularly in that way in an election that was such a sweep, is that pro-choice Republicans in Congress largely have been defeated now. If they were in a swing district, a more moderate district, and they were moderates, then the Democratic sweep kind of took them out of office. So I think if there were a place where there's a real opportunity to rebuild is with Republicans who are what I think of as old-style Republicans.

Like the Maine senators.
Exactly. Certainly, Olympia Snowe and Susan Collins. Mark Kirk in Illinois. There are some Republican Congress people from Connecticut who were pro-choice. And I think it's, you can see, I think there's a real struggle within the Republican party now. You look at these town hall meetings and you think, "Oh my god, is that how you want to be defined? This is your party?" I'm very hopeful that there's this kind of emergent, moderate Republican strain. You see it written about all the time—folks are saying, "We don't want to be a party of only one hard-right point of view on women's rights."

Would you say that that's one of the major challenges the organization is facing now that Obama is in the White House?
It's definitely an opportunity. To me, it's an opportunity to say, women's health shouldn't be a political issue. It should be everybody's issue. So I think there's a way to try to take it out of that intense political realm and say actually if you care about women's health, women's well being, there's a whole host of things you can work on with Planned Parenthood. I'm actually excited because some ex-members of Congress, Republican members of Congress who are pro-choice, are now working with the Action Fund on trying to re-establish a pro-Choice Republican base in America. I think there's a real appetite for that. And particularly, look: women who are elected to office, they in particular understand, this is a women's health issue, it shouldn't be a partisan issue. I think the party is gonna have to do some sorting out here about whether they want to be a big tent again.

"Women Can't Be Left Worse Off After Healthcare Reform Than They Were Before"

You just wrote on the Huffington Post about Bob McDonnell. And that he's a really viable candidate.
He is. But you know, it's so interesting. Obviously he's running for governor of Virginia, and has kind of made his entire career out of fighting against women's rights. Certainly against choice. And yet, now that he's running in this big high-stakes, high-profile election, he's trying to completely distance himself from that, and say, "This election shouldn't be about social issues, it should be about economic issues." Meanwhile, he hasn't done anything on economic issues his entire career. It's all been about trying to restrict access to abortion. You know, he doesn't even support family planning. So it's a question of whether or not women and other folks in Virginia are actually going to learn enough about Bob McDonnell to understand how far off to the right he is on some pretty basic issues.


What a danger.
Yeah. But you know, that's why these governors' races are really important, because that's where so many decisions get made about access to health care, about what's taught at schools, about family planning.

What do you think some of the misconceptions people have about Planned Parenthood are?
Well, the biggest misunderstanding about Planned Parenthood is literally who we are and what we do. We are the largest reproductive healthcare provider in the country, we see about three million patients through our clinics every year, and the vast majority of them are low-income, and mainly young. We're kind of the entry point for a lot of women in this country, where they first go to get counseling about family planning and those kinds of things. Ninety-seven percent of our work is preventive care—contraception, STI testing and treatment. We do cervical cancer screenings, we do breast exams. Last year we did 1.3 million cervical cancer screenings as an example. The thing that's great about a Planned Parenthood clinic is that a woman may come in because she really needs birth control, she knows she needs to take care of her birth control, but she may not have the money or just the inclination to get the rest of the preventive care she needs. So the great thing is, once you go to Planned Parenthood, she can go ahead and get her cervical cancer screening, her breast cancer screening. And that's actually how we catch a lot of sort of pre-cancerous situations for women who might otherwise say, "Well, I can't afford that," or "I'm not gonna do that now."

And payment is on a sliding scale.
Yes. It really varies state to state, because each state is a little bit different in terms of even how states fund family planning services. We're always looking to expand more into areas where there's the most unmet need. The other thing, when you say, what are the most common misconceptions, or maybe things that people don't know, is we're the largest sex-educator in America. So we work with thousands of young people who are trained at Planned Parenthood to work with their peers and teach them about safe sex, and prevention, about getting tested for STDs. And for me, that's some of the most exciting work we're doing. We're really trying to change healthcare for this next generation of young people in America.

Were there laws or regulations passed during the Bush administration that you are actively trying to overturn?
There were a lot of things done during those eight years. It wasn't a high point for women's healthcare, that's for sure.

Or sex ed.
Or sex ed, no. One of the things most representative of this shift and why it was so important to elect a new president is the Global Gag Rule, which had prevented funding for a number of family planning providers around the world. It was overturned, I think, the third day in office by President Obama. And that has implications internationally, for obviously just millions of women. Then we've been really pleased that this president has taken a totally different approach to sex education, which is that we should teach abstinence, absolutely, but you've also got to teach comprehensive sex education. During the last few years, we've seen this country with the highest teen pregnancy rate in the Western industrialized world, and we have now one in four teenage girls in America has a sexually transmitted infection. So this is like, it's not just a theoretical problem, it's a healthcare problem. I'm excited that this president, he doesn't just talk the talk, he actually is making things happen.

And how are you guys involved in the current healthcare reform debate?
Like 24/7. I mean, this is the biggest opportunity for the women that not only that we see, but that we would like to see or that we'd like to be able to get affordable health insurance, to finally get covered in this country. So we've been focused on two things. One is just to make sure that reproductive healthcare is part of the healthcare package – and the second is that women's healthcare providers are part of whatever exchange is developed. If a woman gets an insurance card, she can take it to any family planning clinic, she can take it to any community health provider, and she can get contraception.

What states right now are sort of turning back the clock, in terms of family planning…? The ones that are not progressive, that are becoming less progressive, that you're working on.
Well, there's a couple of states that we're just constantly suing, where there's just always litigation, and you'd have to say the top of the list are South Dakota and Kansas. So we just won a really important case in South Dakota actually, about the South Dakota law that had been passed about instructing doctors what they had to tell women who came to them seeking an abortion, and like 90 percent of this was struck down. That was a really important case within the state of South Dakota, but it was also important in principle—you can't have state legislatures getting in between doctors and their patients, and telling doctors what they have to say to their patients.

And then Kansas as you know has just been a really difficult place for women and for women's health. I mean, most people know of it because of Dr. Tiller's assassination, but it for many years, has just been a place where it's been really tough for women to access all kind of reproductive healthcare.

Is there a legacy of your mom you carry with you?
It's interesting, it was her birthday September 1st, so I've been thinking about her this week. I just dropped my daughter off at college, and I was thinking, God, I wish mom had been here, because she was really many things, and I'm sure people have their own feeling about Ann Richards as they have certain memories about her. But women's rights—for her, that's it. That was the most fundamental issue, and even though she worked with a million things, she cared so much about women individually taking care of themselves, whether it was taking care of their health or taking care of their finances, or going to school. Right before she died, she opened The Ann Richards School for Young Women Leaders, a public junior high and high school in Austin, Texas. ‘Cause for her, she just wanted women to keep moving forward. And honestly, she got more radical, the older she got. I just think she became – and maybe because, you know, you keep doing this work, and at some point, you think, "God, are things are going to change?" – I think that was probably a radical thing for her. I think after she got out of office, everyone wanted her to come and campaign for them. I don't care if you lived in Montana, Nebraska, or Oregon or whatever, and she only had one requirement of the folks she would go and campaign for, and that is you had to be 100 percent pro-choice. And if you weren't, that was it, she was moving on. So she really lived her beliefs. So it's wonderful to be at Planned Parenthood doing the work that she did all her life and felt so strongly about.

And it must have been challenging for her in Texas.
Yeah, you know, it was funny about Texas, she was always too liberal for Texas. There was no way to get around it. I always feel like her election was this one progressive moment in Texas where the stars and the moon and everything aligned. A day earlier or a day later, it might not have happened. But they still continued to like her, even after George Bush beat her. It's just that she was too progressive, which I hate to say. I think the state's kind of moving in the right direction. But she was always just a little bit out in front of where the electorate was.

Who are some of the women in the next generation that, you know, you see as kind of coming up?
Well, I guess I'd say rather than specific names, I would say I spend a lot of my time here working with teens and young people that are the next generation. So we're reaching pretty much down into the folks that are, to me, the future of Planned Parenthood, not only patients but leadership, volunteers, employees. And I see at least in the area we work in, I'm just blown away by the young people I meet, who even at a very young age, are asserting their responsibilities for their peers. I was just in New Mexico, which has a very high teen pregnancy rate. It's a wonderful state, but you know, there's a lot of poverty. And at the dinner I went to, we were awarding this group of really young women in their high school who had taken it upon themselves to become sort of peer educators, because they were really worried about the teen pregnancy rate in their high school. And that year there was not a single teen pregnancy in that high school. And these young women, they didn't wait to ask for permission. They saw this problem, and they took ownership, and I see that all over the place. We just brought two underage teenagers to Capitol Hill to lobby on healthcare needs and getting sex education. We got meetings with members of Congress we've never seen before, because you bring a young person from their district, folks are gonna make time in the schedule. And many of these kids had never been out of their home city, much less gone to Washington, and to see them in three days go from getting off the plane to lobbying a member of Congress, it was pretty intense.

Who are some of your mentors? You talked about your mom, but who were some of your mentors as you were coming up in the movement?
Well, I guess definitely Mom had the most influence on me, and largely because she just believed you just had to get out there and do stuff. I think that folks, though, who influenced me the most were the women I worked with when I started as a union organizer back when I got out of college. I worked with garment workers around the border and I worked with hotel workers in New Orleans, and these were women who – despite enormous odds, lack of income, many of them juggling being a single parent – they just got out there, and at that point we were organizing for healthcare coverage and better wages, and they risked everything, and they were just incredible. And many of those women I remember from every town I ever worked at, so I guess that's who I would say were my mentors. If there was one sort of people that I think of when I think about doing this work every day, it's about those women that I worked with in the early years, and seeing their courage, their belief that they were doing this even if never benefited them but for their kids or for their community.

Who are the female politicians you've been following?
The great thing is now there's a whole bunch, though I will say I was just with Barbara Mikulski, who's now the dean of women in the Senate. So she's seen it all, right? She was back there in the days when she was it. And she just did a really important thing for women—women all across America should be thanking Mikulski, because she got a women's healthcare amendment into the healthcare reform bill. So I'm particularly fond of Barbara. But there's also a lot of up-and-comers. One colleague, Donna Edwards, who's a new Congresswoman from Maryland, who everyone should watch. She came to Congress for a purpose. She's wonderful. Chellie Pingree, from Maine, also a new member of Congress who's really great. These are women who have already lived a life and done a lot of great progressive organizing and advocacy and now have chosen to go to Congress to sort of continue that work. So they're really grounded. Jan Schakowsky, who I just have enormous respect for, who started out as a mom who was fighting for food safety in Chicago, now is one of the leading members of the United States Congress. And I can't close without mentioning m old boss, Speaker Pelosi, who unbelievably sort of leads what is very much the ultimate sort of old boys' network. And I have enormous respect for her, and you know I think you see with Nancy, much like I think you saw with now-Secretary of State Clinton, the unbelievable bias of the media against women in politics. And the fact that she continues to hold her own, and I think really forward progressive values and hold that Caucus together – amazes me.

Obviously giving money is always welcome, but what are some of the other ways that women can get involved in Planned Parenthood?
Well, I think that absolutely getting involved politically is critical. And the great thing again is that even if you live in a state that's relatively progressive, there are so many ways now to get involved in affecting elections in other places, even if it's doing volunteer phone-banking, traveling to help, you know, talk to voters, so I would really encourage folks to sign up for the Action Fund, on the Action Fund site, and become a volunteer that way. And I think right now, because we're sort of in this moment, it is so important that every woman in America lets their member of Congress and their Senator know that women can't be left worse off after healthcare reform than they were before. And that means we need to have our full reproductive rights and healthcare covered, and we need women's healthcare providers as part of the healthcare network in America. Literally, if every single woman who read this did that, that would be an enormous thing. And I know I sometimes think people think it doesn't really matter, and you look at all the stuff that's going on, but folks pay attention. And they really pay attention when people personally take time. Sending an e-mail is fine, but when you actually make a phone call to an office and say, "This is what I'm calling about," believe me, I go to those offices all the time, they absolutely are keeping track.

I saw that you're on Twitter.
Yeah. We're doing the Twitter, we're doing the Facebook. We partnered with MTV this last spring on helping young people get tested and treated for STI's, and the great thing is when we can kind of co-brand with other sites where young people are coming, and MTV was thrilled because they were saying, "Look, we got all these kids coming, and the thing they want to know about is they don't want to get pregnant, and they want to know about STD's, and so you all have the information, we've got the traffic, let's get together."

How involved are you internationally?
We are actually really involved. We fund programs in 11 countries – in Africa, Asia, and in Latin America. Our providers in this country do a lot of sort of exchange of information and ideas and capacity between the states and other countries. And again, it's sort of not just a North-South, it's a South-North thing too. I was down in Ecuador visiting this program there that we've supported and have partnered with for many years, and I met with their teens, like our peer educators here. In Ecuador, because a lot of them out in the rural areas, they really have a list of clients for whom they help them get birth control, they help them get testing if they need it, other kinds of healthcare. So they've taken it like another step further than we have in this country, so I think there's just things we can learn from each other when we talk about, how do we improve healthcare outcomes for women and for young people?

Where in the world are women most at risk now
It's hard to say. It's hard to pinpoint one place. Obviously, some of the worst healthcare outcomes are now in some of the countries of Africa, where we're dealing with issues of maternal mortality, related to unsafe abortion, and certainly, the rise of not only HIV-AIDS, but other STD's. That's why policies in this country are so important, because there's this enormous ripple effect. I don't know if you saw the article by Nick Kristof in the Times Magazine, about this thought, which is just so right, which is if you invest in women, it has all kinds of residual great benefits for society. And in fact, Secretary of State Clinton, who came and spoke to Planned Parenthood in the spring, really made the same point, which is, if you look at the countries where women have the best access to health care, access to family planning, and rights, they're the countries with the least amount of economic instability, the least amount of terrorism, a whole host of issues. There is just a very strong case to be made if you can help women with planning the number of kids that they want and allowing them to voluntarily have the family of their choosing, and access to work and the other things that they need, all of society benefits. And where you don't, you have the very worst outcome.

Is there anything else that we haven't covered that you think you want to mention?
Well, the only other thing that I've been really interested in and that we've invested a lot of time and energy in is making sure that the internet is providing all the ways for young people and women to get the healthcare information they need. Young people come to us online and ask the very same questions that kids were asking when I was in high school. Like, "My boyfriend and I had sex but I heard you couldn't get pregnant the first time," or, you know, whatever, just make up the myth. So I think that I'm really excited about Planned Parenthood online because to me, it's a place where, even if you're a kid sitting in East Texas, where you can't talk to your parents and you don't want to talk to anybody at school, you could at least go online and get the information you need, and if you need it, find out how to get birth control, how to get tested if you might have an STD. That's the most hopeful thing about the future—both the young people that I think are now infusing this movement with new energy and the fact that technology is just going to help us leap forward.

Planned Parenthood Federation of America [Official Site]
Planned Parenthood Action Fund [Official Site]
Cecile Richards' Twitter [Twitter]

Related: Virginia Women: Get Back in That Chastity Belt! [Huffington Post]