When Heidi Heitkamp finally rose from her desk in the Senate chamber to cast her vote on the Kavanaugh nomination, she felt a deep sense of history. So much of what the Senate did was routine, passing the federal budget or statements of support for one cause or another. But for Heitkamp, this was a vote that could change the country for generations to come. Above her, in the gallery, female protesters screamed and chanted “Shame on you” at her Republican colleagues. Mike Pence, who was presiding from the dais, banged his gavel again and again, repeatedly asking the sergeant at arms to restore order. Heitkamp voted no, knowing the decision would cost her reelection. Susan Collins believed Brett Kavanaugh’s promises of precedent and voted to put him on the court, along with one Democrat, Joe Manchin, who crossed party lines.
Kavanaugh was confirmed. He was the most unpopular nominee in thirty years, put on the court by a 50–48 vote, one of the slimmest margins in American history.
With Kavanaugh on the bench, the court was now more conservative than at any other point in modern history—by one scholar’s estimate, since before World War II. Antiabortion activists had moved a pivotal piece of their strategy into place. There was a distinct conservative majority of five justices, and a liberal minority of four, without the confusion of a swing justice like Anthony Kennedy.
Still, only 39 percent of Americans believed Kavanaugh would vote to overturn Roe. An even smaller number of Republicans—a little more than a quarter—believed he would, according to polling.
Ilyse Hogue and Marjorie Dannenfelser and their allies on both sides had been preparing for this battle for years, starting before Donald Trump was inaugurated. They spent millions of dollars on Kavanaugh’s confirmation, releasing a deluge of ads and protests, calls to Congress, and knocks on doors trying to sway public opinion to their side. Roe was mentioned more than 280 times in the hearings and in the testimonies and letters submitted to the committee from both sides.
But the drama over Christine Blasey Ford’s explosive accusations pushed the issue to the back burner of the public conversation. Sexual assault became the dominant conversation, one that lingered into the elections. “I don’t want to call it a distraction, because that sounds like it wasn’t equally important,” Hogue told The New Yorker days before voters headed to the polls. “But I think that, because of the power of that story, it eclipsed the other concerns.”
Many antiabortion activists believed that Ford was persuaded to testify by Democrats who were afraid of losing Roe. But Ford didn’t see herself as protecting Roe, according to Ricki Seidman, one of her advisers. She believed the Senate would confirm a conservative and simply wanted one without a history of sexual assault allegations. “I never had a conversation with her about Roe,” said Seidman. Just as with Wendy Davis and her Texas filibuster, liberal America had grabbed headlines for protesting Kavanaugh’s nomination. But now, Hogue saw how little that mattered. “People rose up in record numbers, and Republicans didn’t even pretend to care,” she said.
Kavanaugh was a capstone to female rage during Trump’s first two years in office, and Americans responded weeks later in the midterm election with a Year of the Woman reminiscent of 1992. Democrats took power in the House, which soon had a female speaker when Nancy Pelosi reclaimed the gavel. A record total of thirty-six new women won House seats—all but one were Democrats. Their ranks included a litany of historic female firsts, including the first Muslim women in Congress and the first Native American women in Congress. There were four female military veterans. There were old political hands—like Donna Shalala, a member of Bill Clinton’s cabinet—and new faces, like Alexandria Ocasio-Cortez, the twenty-nine-year-old who won an upset victory in New York City against a longtime party leader. Some, like Ocasio-Cortez’s new “squad,” were progressives. Others were moderates. But they all supported abortion rights.
It wasn’t all good news for Democrats: Republicans expanded control over state governorships and rode a conservative backlash to the outcry over the charges of sexual assault to strengthen their control in the Senate, flipping four seats, including Heitkamp’s in North Dakota. She might have lost even if she voted to confirm Kavanaugh, she realized. But there was little question that, politically, it would have been better for her to trust his promises of precedent, like Collins had, and vote to confirm him. Though it was hard to see at the time, with their wins in the Senate and governors’ mansions, Republicans had increased the power of their antiabortion majorities in the places that mattered most in their longer-term fight against abortion rights.
Still, for the first time in the House, a majority of the representatives supported abortion rights. The last time Democrats controlled the House—before the 2010 Tea Party wave—there were still dozens of largely male antiabortion Democrats in their ranks, who along with antiabortion Republicans made it impossible to advance legislation protecting Roe. The effort pushed by Nancy Northup in 2013, titled the Women’s Health Protection Act to be as broadly appealing as possible, never even reached a vote.
Representative Diana DeGette, a Democrat from Colorado who led the House Pro-Choice Caucus, saw new opportunities. Their best chance to codify Roe, to write it into national law instead of just relying on the 1973 court ruling, could come in as soon as two years—if Democrats held the House and gained control of the Senate and the White House. It was hardly impossible, she thought; Trump was so polarizing that Democrats just might be able to beat him in 2020. Still, a bill would be a heavy political lift, and there was no guarantee that any legislation wouldn’t eventually be undercut by the court. But they could start getting ready now.
They needed to rally their troops, take advantage of the protests swelling on the outside to mobilize inside Congress. But their strongest ally, Planned Parenthood, was losing political traction. The brief, troubled tenure of Cecile Richards’s successor, Dr. Leana Wen, would illustrate a central problem of the abortion-rights movement in the final years of Roe. At the height of the onslaught of the Trump administration, Planned Parenthood was at war with itself, arguing over tactics, strategy, and even the simple question of how to talk about abortion. While the antiabortion movement executed a multipronged attack to take down Roe, abortion-rights advocates couldn’t seem to agree on the basics.
Wen, an emergency room physician, was the first doctor to run Planned Parenthood since the 1960s, and unlike Richards, she had limited political experience. She was an immigrant who worked her way from poverty to medical school—starting when she was just eighteen—then to a Rhodes Scholarship and, eventually, a position leading Baltimore’s public health department.
Where Richards saw a political army in Planned Parenthood, Wen saw a medical powerhouse. “I want Planned Parenthood to be the doctor for American women,” she told the board when she interviewed to replace Richards, according to a participant in the meeting. Planned Parenthood, under her leadership, could become an innovative health care system equal to Mayo Clinic. Its affiliates would be one-stop shops for health care, staffed with clinic workers prepared to address a range of problems from mental health disorders to substance abuse. It was a significant shift in vision, and Planned Parenthood’s leadership was all in. She got the job with the board’s unanimous support.
Not long after the 2018 “pink wave,” Wen came in her hot pink blazer when Pelosi, the most powerful female politician in the country, invited her to be part of the resistance at Trump’s State of the Union address. The Democratic women below her in the House chamber looked like beacons in their suffragist white blazers, standing out amid the seat of dark suits. And yet as Republicans thundered applause for Trump, Wen couldn’t help but hear a very different message. One not of defiance, but of defeat. “Lawmakers in New York cheered with delight upon the passage of legislation that would allow a baby to be ripped from the mother’s womb moments before birth,” Trump said, devoting a section in one of his biggest speeches to target abortion rights. “These are living, feeling, beautiful babies who will never get the chance to share their love and dreams with the world. And then, we had the case of the governor of Virginia, where he basically stated he would execute a baby after birth.”
“Execute a baby.” The remark was a new twist on the graphic terms Trump used in the third presidential debate, this time drawing from a political controversy that had consumed Virginia and the nation in recent days. Democratic governor Ralph Northam, a pediatric neurologist, had stumbled into a political firestorm when he defended legislation that would lift some of the restrictions on third-trimester abortions in the state. Asked in a radio interview if the bill would allow an abortion even as a woman was in labor, he said no. Abortions late in pregnancy were rare and only done when the fetus faced “severe deformities.” In cases where a woman goes into labor with a nonviable fetus in the third trimester, he continued, “the infant would be delivered, the infant would be kept comfortable, the infant would be resuscitated if that’s what the mother and the family desired. And then a discussion would ensue between the physicians and the mother.”
Northam thought he was describing a mother facing an impossible, unthinkable choice in a pregnancy gone terribly wrong. But to antiabortion activists, it was infanticide. Republicans from the Virginia statehouse to Capitol Hill pounced on the remarks, depicting Democrats as monsters who would condone the murder of an infant.
The line had been a late addition to Trump’s speech after Dannenfelser and a small set of conservative leaders came to the White House for a private preview of his remarks. Trump burst into the room, where they were meeting with Vice President Mike Pence and Kellyanne Conway. “Can you believe that crazy governor of Virginia?” he said, talking about the issue for five minutes, before switching to talk about expanding his wall across the southern border.
Over the weeks that followed, Trump embraced the infanticide message at rally after rally, turning the phrase execute the baby into a staple of his reelection events. During his first two years in office, Trump had rarely mentioned abortion in his public remarks. Now, in 2019, he mentioned the issue regularly, in inflammatory and inaccurate ways. “The baby is born,” Trump said at a rally in Wisconsin. “The mother meets with the doctor. They take care of the baby. They wrap the baby beautifully, and then the doctor and the mother determine whether or not they will execute the baby.”
Republican candidates across the country started following Trump’s lead, making claims that Democrats promote “birth-day abortions” and were “the party of death.” Coordinated campaigns by Dannenfelser and her allies targeted swing voters in battleground states with digital advertising repeating the claims. Again, it was an old message made new: the Willkes’ 1971 handbook taught that abortion and infanticide were no different; both were forms of euthanasia, one prenatal, one postnatal. It was a core belief of the antiabortion movement, grounded in its fervently held belief that a single-cell zygote is a full human person deserving of civil rights.
The political conflation of murdering babies with abortion later in pregnancy was a misrepresentation of complicated medical procedures, a way to undercut all abortions by highlighting the small number of cases that surveys showed made Americans the most uncomfortable. Only about 1 percent of abortions happened after twenty-one weeks, just short of the viability line. Very limited data existed on the number after twenty-six weeks, though one older study estimated it was about 0.02 percent—a few hundred abortions. Providers who conducted these procedures described the devastating choices and circumstances that led to them. There were girls who were sexually abused before getting a period so they didn’t realize they were pregnant. There were women who wanted a child but discovered late in their pregnancy that delivering could risk their life or future fertility. And then there were the women carrying fetuses with severe conditions who, if born, would suffer before dying shortly after birth. In those rare cases, the parents and doctors would have a discussion about end-of-life care after birth—not executions or infanticide.
Wen knew those medical realities didn’t matter, at least not politically. As with the Daleiden videos, the antiabortion movement had defined the terms of this new debate, and abortion-rights advocates were struggling to catch up. A majority of Americans were aware of the “infanticide” claims, surveys by progressive groups found, showing that the message had reached into the political mainstream even if it was not true. Some Democrats argued against responding at all, saying that reacting to what they saw as clear misinformation would only amplify Trump’s and the Republicans’ claims. Wen disagreed. “Sometimes there is a temptation to let the absurdity stand on its own, but we have to recognize that this is a different time,” Wen told The New York Times. “He’s deliberately conflating infanticide with abortion late in pregnancy. And it’s important that we as doctors and health care providers explain the extremely rare and devastating circumstances of abortion later in pregnancy.”
For much of the Trump administration, Planned Parenthood had leaned into an unabashedly pro–abortion rights message, linking its mission to an array of liberal causes, including immigrant rights, racial justice, and even net neutrality. The night of Trump’s 2018 State of the Union, Richards had cohosted an alternative event—the State of Our Union—organized to celebrate the power of women with a coalition of labor organizers, sexual assault survivors, and immigrants’ rights advocates. Planned Parenthood was still a health care organization, with dozens of independent affiliates running hundreds of health care centers across the country. But now, it was also a leader of the Trump resistance, a potent, hot-pink symbol of liberal power in a country where all their values were under siege.
To Wen, the success of the campaign to rebrand abortion late in pregnancy as infanticide illustrated how deeply Planned Parenthood’s strategy had failed. The hurricane had already struck, she thought; Roe was barely hanging on after the shift on the Supreme Court with Kavanaugh’s confirmation. Their mission now was not only political advocacy but emergency management: how could resources be sent from places with trigger laws to places where abortion remained legal? Could they transport patients across state lines?
Planned Parenthood remained the top provider of abortions in America. But that was only one part of its medical practice, far smaller than services like testing for sexually transmitted infections and providing contraception. Some of its clinics offered family medicine, like treatment for rashes or gastroenteritis or conjunctivitis, pediatric care for low-income women, infertility services, or prenatal care. In thirty-one states, clinics offered transgender hormone therapy.
The only way to save Planned Parenthood’s mission was to depoliticize it, Wen believed. If they could make clear that abortion was a part of health care, and only a small piece of Planned Parenthood’s work, the attacks wouldn’t carry as much power. “People aren’t coming to Planned Parenthood to make a political statement,” she told BuzzFeed News. “They’re coming because they need their vaccinations. They need their well-woman exams. They’re getting HIV tests.”
The strategy marked a dramatic break from Richards, who required that all the organization’s affiliates provide onsite abortions, a rule that prompted a few health centers to leave Planned Parenthood entirely. Instead of Richards’s campaigns like “#Fight4BirthControl” or “I Stand with PP,” one of Wen’s first efforts was called “This Is Health Care.” She posted new sections on the group’s website about chronic health conditions like diabetes, asthma, and the common cold—over objections from aides who worried it could expose the organization to attack, since they didn’t provide care for those illnesses.
At a basic level, Wen believed she could do what would prove to be impossible: simply talk about abortion as a medical procedure. The new approach was a tactic Richards would have never considered and a line of thinking Ilyse Hogue at NARAL was actively trying to change among Democrats. And it would end shortly after it began. Just eight months after she started the job, Wen would be pushed out in an ugly public spat.
To many on her staff, Wen’s vision of depoliticization seemed ridiculously naive, even dangerous. Wen, they thought, believed in a fantasy, a myth that abortion could be discussed solely as a clinical procedure. The antiabortion movement saw Planned Parenthood as a symbol of everything wrong with America. If it didn’t defend itself, Planned Parenthood could lose what little ground it still had.
Tensions within the organization grew as the antiabortion forces in the White House advanced. Every month brought another blow. At the National Institutes of Health, the administration banned researchers from using fetal tissue in their work—the same kind of material Planned Parenthood officials discussed in the Daleiden videos. A new Health and Human Services rule required some insurers to issue a separate invoice for the amount of premium attributed to abortion services, a mandate insurers warned could result in the elimination of abortion coverage.
And at the United Nations, the antiabortion movement expanded its efforts to encompass not only the nation but the world. US negotiators pushed to remove references to “universal access to sexual and reproductive health and rights” from an annual document about empowering women. In his address before the annual UN meeting later that year, Trump stressed his country’s commitment to protecting “innocent life,” as his administration unveiled a letter signed by the United States that there “is no international right to an abortion.” The letter’s other nineteen signatories were largely autocratic nations and those with poor records on women’s rights, including Saudi Arabia, Yemen, Sudan, Libya, Russia, and Bahrain.
But the existential blow to Planned Parenthood came just weeks after Wen went to Trump’s State of the Union address. The Trump administration announced it would ban any organization that performed or referred patients for abortions from receiving money through Title X—the federal program that pays for contraception and other reproductive health care for millions of low-income Americans. The policy change would eliminate as much as $60 million in annual funding from the program for Planned Parenthood clinics.
The change made antiabortion pregnancy centers, which were largely not medical facilities, and other community health organizations eligible to receive the grants, so long as they did not mention abortion as an option for their patients. In practice, the rule redirected tens of millions of dollars from Planned Parenthood to these centers. The Trump administration soon awarded $5.1 million in Title X funds to the Obria Group, an antiabortion organization that ran centers in six states. The group encouraged abstinence, marriage, and “natural family planning,” and didn’t offer hormonal birth control, including pills. At the time, Dannenfelser sat on its board.
It was a defunding, not by Congress, as Republicans had tried to do since Pence introduced the first bill more than a decade earlier, but by executive action. And this time, no senator could save them, like John McCain had in the early months of the administration.
Wen cast her opposition in clinical terms, accusing the Trump administration of violating medical ethics. “Imagine if the Trump administration prevented doctors from talking to our patients with diabetes about insulin. It would never happen. Reproductive health care should be no different,” she told The New York Times. Planned Parenthood’s lawyers prepared to sue the administration to block the policy as its policy experts contemplated whether the organization would need to withdraw from the program entirely—a once nearly unimaginable step.
Yet as she pushed back against the flood of outside attacks, Wen was fighting an internal uprising. Meetings with Planned Parenthood’s state affiliates and national staffers exploded in recriminations after she publicly described abortions later in pregnancy as “extremely rare and devastating circumstances.” To many of her staff, it felt like Wen was casting their movement back to Clinton’s old language of “safe, legal, and rare.” Wen wasn’t just wrong, they thought, she was complicit in the stigma and shame that surrounded abortion in America.
Tensions between Wen and the liberal politics of many of her staffers consumed the organization. High-profile political aides quit. Damaging details about her brusque management style began seeping into the press, including a handbook that detailed best practices for working with her. Her rules included maxims like, “Make sure to frequently look up [from Twitter] and make eye contact with Dr. Wen to see if she is trying to communicate urgent information” and “Try not to look at emails more than once. Take care of it then.”
Wen and her staff didn’t just disagree. They didn’t even speak the same language. Wen refused to use “trans-inclusive” language, reported BuzzFeed News, like pregnant “people” instead of pregnant “women.” She argued that such terms would “isolate people in the Midwest,” while her more progressive staff said the terms were more encompassing of all of Planned Parenthood’s patients.
Wen was standing in a restroom stall when she overheard two people airing their frustrations: “I thought we’d get a rock star rabble-rouser, a congresswoman, or a senator,” one said. “Instead, we got a doctor.” Ten days later, Wen was fired in another unanimous board vote. She learned of her official ousting by reading about the news in The New York Times.
THE WAR OVER Wen laid bare a central tension of Planned Parenthood. The organization was both a health care provider and a political juggernaut. Amid the frenzied politics of the Trump era and the ever-growing restrictions in the states, balancing those two functions had become increasingly difficult. Planned Parenthood was a sprawling operation, a federation of fifty-three affiliated but separate state operations, with a nearly unmanageable financial structure, according to some board members. Each affiliate operated independently, with its own leaders and board, and fundraising apparatus to pay for staff, medical equipment, and services for uninsured patients. They paid dues to the national office, which focused more on campaigns, politics, and lobbying. And now, three years after they thought they would live in Hillary Clinton’s America, every part of the operation was under attack.
A divided mission wasn’t a challenge faced by Planned Parenthood’s opponents, who had purely political groups, like the Susan B. Anthony List, and largely separate networks of crisis pregnancy centers. Planned Parenthood offered health care, with services that included breast cancer screening and vasectomies. The pregnancy crisis centers largely offered non-medical-grade sonograms, classes on baby care, free diapers, and other kinds of social support. They were not, nor did they aspire to become, the kind of world-class medical system that Wen had dreamed of making Planned Parenthood into.
As Planned Parenthood scrambled, longtime board member Alexis McGill Johnson took the reins as interim president. Almost immediately, she renounced Wen’s efforts to minimize the organization’s work providing abortions. “I think when we say, ‘It’s a small part of what we do,’ what we’re doing is actually stigmatizing it,” she told The Washington Post. We are a proud abortion provider.” One of McGill Johnson’s first acts was to announce that Planned Parenthood was withdrawing from the Title X program due to Trump’s new rule. That action only underscored the risks abortion rights faced in this changed national landscape. Republican governors were signing an unprecedented wave of abortion bans into law. And now, Kavanaugh was on the court, replacing Kennedy, who ruled in favor of federal abortion rights, with a justice who posed a potential threat to those rights. “A lot of us are awakening to the fact that if you are wealthy, if you live in the New York ZIP code or California ZIP code or Illinois ZIP code, your ability to access reproductive health care is not in jeopardy in the same way that it is in other states,” McGill Johnson said.
Her early months were spent working to stabilize Planned Parenthood and rebuild trust within the organization after the infighting of Wen’s tenure. Then McGill Johnson began to reimagine the organization entirely. Richards, a daughter of the Democratic Party, had focused on building political power. Wen, a public health expert, had emphasized its health care services. McGill Johnson, who built a career combating bias and discrimination, decided to prioritize racial equity.
Lori Alexis McGill was a self-described “movement baby,” born five months before Roe, sandwiched between second-wave feminism and Black Power. Her mother worked her way up from a secretary at AT&T Bell Laboratories to the company’s vice president of human resources, while paying her father’s way through medical school. Her parents, she told The Root, were “race folks”—in dashikis and Afros, marching and organizing.
She went from Princeton to Yale, where she began going by her middle name, Alexis. After earning a graduate degree in political science, she taught courses on Black politics, race, and poverty at Yale and Wesleyan. She helped hip-hop icons like Russell Simmons and Sean “Puff Daddy” Combs form organizations, like the 2004 Vote or Die campaign, to turn out younger Black voters.
Her work with Planned Parenthood began in 2011, after a billboard in SoHo caught her eye. There, about a half mile from the Planned Parenthood clinic in Lower Manhattan, was a photo of an adorable Black girl in a pink sundress. The words printed above her read: “The Most Dangerous Place for an African American Is in the Womb.” The ad was purchased by Life Always, a Texas antiabortion group, and part of a series of billboards posted by antiabortion organizations in urban areas that used photos of Black children to level charges of racism and genocide against abortion providers. It was a racist demonization of Black women’s reproductive choices, McGill Johnson thought, something she associated with conservative states, not New York City. “I just was shocked, like, ‘What is going on here?’” she remembered thinking.
A few weeks later, she found herself at a dinner party with Richards. At the time, she was leading the Perception Institute, the anti-discrimination think tank that she helped found to tackle racism and bias in school systems, police departments, health care providers, and corporations. She brought up the billboard. “This is horrible. You’re the head of Planned Parenthood. You need to do something about this,” McGill Johnson said. Richards shot back: “No, you need to do something about this.” McGill Johnson joined the board soon after.
Now, with McGill Johnson as president, racial equity would become Planned Parenthood’s new “North Star,” she promised. In her Planned Parenthood, the staff would wake up every day and think about the experience of Black women, as patients and employees. She started programs to eradicate implicit bias in Planned Parenthood’s care, from interactions with office staff to medical treatment to billing.
She wasn’t Planned Parenthood’s first Black president, a distinction that belonged to Faye Wattleton more than forty years earlier. But McGill Johnson believed that this was the time for her expertise to help correct historical wrongs and build an abortion-rights movement that better represented people who looked like her. “What does it mean to show up unapologetically for your staff? To be able to say, ‘We’re going to talk about race, about intersectionality, about Margaret Sanger?’” she asked in an interview with Elle. “We are going to make a big bet on equity. It’s our moonshot.”
It was yet another vision for Planned Parenthood, a third shift in direction for the organization in as many years. Just three years earlier, in 2016, it had the power of the Obama White House and the protection of the Supreme Court. Hillary Clinton seemed ascendant, and they were preparing to expand abortion rights. Now, the organization was weakened, riven by infighting and boxed into refusing tens of millions in federal funds. It was perhaps the most vulnerable time in Planned Parenthood’s more than one-hundred-year history, exactly as its opponents had hoped.