Republicans did not always revile Planned Parenthood as a criminal enterprise. Nor did they always see its mission as a partisan one. For the early decades, in fact, they were some of the organization’s strongest champions.
The early seeds of Planned Parenthood were planted in 1898, when Margaret Sanger, a nineteen-year-old first-grade teacher, returned home to Corning, New York, to care for her ill mother, who was wasting away from tuberculosis. The sixth child born to Irish Catholic immigrants, Sanger saw her mother’s ability to fight the disease weakened by her eighteen pregnancies—eleven childbirths and seven miscarriages. When her mother died, Sanger lashed out at her father, who would live until age eighty.
“You caused this,” she said, standing over her mother’s coffin. “Mother is dead from having too many children.”
Sanger was determined not to die the same way. She dreamed of a magical pill that would prevent pregnancy. After nursing school, she worked as a visiting nurse on the Lower East Side, one of the poorest parts of New York City, where women begged her for contraception. She watched others die from abortions induced by drinking turpentine or infections after visits to illegal abortionists. Sanger came to believe that the only way to liberate women from poverty was to give them control over their reproduction. “Enforced motherhood,” she wrote in 1914, “is the most complete denial of a woman’s right to life and liberty.”
She opened her first clinic in Brooklyn three years before the passage of the Nineteenth Amendment, the constitutional amendment granting women the right to vote. Her clinic, where she provided women with items like diaphragms and information about what she started calling birth control, was the first of its kind in the country. A flyer, printed in English, Yiddish, and Italian, advertised her services. “MOTHERS! Can you afford to have a large family?” it read. “Do you want any more children? If not, why do you have them? DO NOT KILL. DO NOT TAKE LIFE, BUT PREVENT.”
Women pushing strollers and clasping the hands of their children lined the block on the day Sanger’s clinic opened. The first day, she saw one hundred women. The first week, four hundred women. And after nine days, authorities arrested her and shut down the clinic. Sanger had violated the Comstock Act, a law that criminalized the mailing of things deemed “obscene, lewd, or lascivious,” including information about contraception, as well as devices and medications. But her arrest turned her effort into national news. Sanger was convicted after the judge concluded that women did not have “the right to copulate with a feeling of security that there will be no resulting conception”—tantamount to arguing that women shouldn’t have sex unless they were willing to face all the possible consequences of childbirth, including death. Sanger was sentenced to thirty days in jail.
After two years of litigation, a judge ruled that doctors could prescribe contraception to married people for the prevention of disease. Sanger opened more clinics, and in 1921, she founded the American Birth Control League. The group’s mission focused on one cause: contraception. Abortion was illegal throughout Sanger’s lifetime. She didn’t condone the widespread use of the procedure. “It is an alternative that I cannot too strongly condemn,” she wrote in 1932. “Although abortion may be resorted to in order to save the life of the mother, the practice of it merely for limitation of offspring is dangerous and vicious.” Sanger believed that if contraception were widely available, abortion would become obsolete.
At the time, widely available birth control was a radical idea. Sanger courted anyone who would help make her vision a reality, including eugenicists. Sanger calculated she could give her cause greater legitimacy by allying with that movement. The theory of selective breeding—weeding out the “mentally and physically defective,” as Sanger put it—was a mainstream idea in the 1920s and 1930s, though it was later condemned as racist, classist, and ableist.
Yet Sanger’s strategy to expand political support for her cause may have worked too well. A year later, she was pushed out of her position as president by members who found her brand of socialist feminism too radical. And in 1942, over her objections, the American Birth Control League, which had become the Birth Control Federation of America, adopted a totally new name as part of an effort to move away from the more controversial phrase of “birth control”: Planned Parenthood Federation of America.
Prominent Republicans embraced the cause of birth control. These men were interested in contraception not to liberate women, as Sanger once dreamed, but because they worried about overpopulation. At the time, prominent political figures worried about how a higher birth rate could stress the world’s resources. Birth control like condoms or diaphragms, “family planning” as they called it, offered a solution. Prescott Bush, the father and grandfather of two future Republican presidents, was the treasurer for the group’s first major fundraising campaign, his name next to Sanger’s atop the organization’s letterhead in 1947. His son, George H. W. Bush, later took up the mantle of federal family planning, earning him the nickname “Rubbers.” Barry Goldwater backed the group, and President Eisenhower and President Truman served as cochairmen of a Planned Parenthood committee after their presidencies.
Sanger was frustrated by the conservative shift of her organization. “If I told or wrote you that the name Planned Parenthood would be the end of the movement, it was,” she wrote to a former national director, after she was no longer president. “The movement was then a fighting, forward, no fooling movement, battling for the freedom of the poorest parents and for women’s biological freedom and development. The P.P.F. has left all this behind.”
Still, Sanger kept pushing. In 1953, she convinced a little-known scientist, Gregory Pincus, to develop a new form of contraception—a birth control pill. In the years that followed, the final hurdles to Sanger’s vision were overcome. The U.S. Food and Drug Administration approved the pill in 1960. Five years later, the Supreme Court ruled that married couples had a right to contraception in Griswold v. Connecticut. The case grew out of the arrest of Estelle Griswold, the executive director of Planned Parenthood League of Connecticut, who was violating state law by distributing contraception to married women. And in 1970, legislation creating Title X, the program that contributed millions of federal dollars to Planned Parenthood to help fund contraception, cancer screenings, and other types of women’s health services, passed with bipartisan support. It was championed by then representative George H. W. Bush and signed into law by President Nixon. In 1972, the decision in Eisenstadt v. Baird created a right for single people to access contraception.
And in 1973, Roe made abortion legal. At first, only a handful of Planned Parenthood’s affiliated health centers, like its clinic in New York, offered abortion services. But slowly, those who were uncomfortable with the procedure left the organization and Planned Parenthood embraced abortion care as central to its mission.
By the time Faye Wattleton, the organization’s first Black president, took over in 1978, the political environment had grown more hostile to abortion rights. Wattleton, a nurse and the only child of a Pentecostal female preacher, came from a local Planned Parenthood in Dayton that didn’t provide abortions; it faced attacks from the Catholic Church nonetheless. She believed Planned Parenthood would have to adopt a more aggressive defense of abortion rights. “It was prophetic that I felt this was the direction we would have to go, without knowing we were nearing the Reagan years,” she later said. “But I saw the growing political opposition on the local level.”
At her first press conference as president, Wattleton announced that she was “putting the world on notice” that Planned Parenthood would fight for abortion rights. Its legal victories in the 1960s and 1970s had made many in the movement “complacent,” Wattleton said. But efforts like those of Henry Hyde to severely limit access to abortions for women on Medicaid showed that the battle was far from won. “What has happened is that we’ve allowed them to have center stage,” she said of the new “right to life” movement. “I’d like to say those days are over.”
Like Cecile Richards, Wattleton expanded Planned Parenthood’s political profile, setting up a Washington office to lobby Congress and launching a political action committee to endorse candidates. She hired pollsters and media experts and created a team to streamline national policymaking. Under her leadership, Planned Parenthood grew fast, adding clinics and expanding services. Income and operating budgets skyrocketed. The organization grew from serving 1.1 million patients in 1978, when she became president, to about 5 million by the time she left in 1992 to become the host of a daytime television show.
As Planned Parenthood grew, the conservative attacks on the organization escalated. The Reagan administration targeted Planned Parenthood for funding cuts. The antiabortion movement dubbed Planned Parenthood public enemy number one. It was “the single largest child killer in the United States,” said Randall Terry, the head of Operation Rescue, the group Troy Newman would eventually lead.
As antiabortion activists pushed Republicans to make opposition to abortion a central plank of their party, a right-wing fringe grew more powerful within their movement. Operation Rescue became known for blockading clinics and screaming at patients through bullhorns, organizing thousands of antiabortion activists in chaotic protests that sometimes resulted in criminal charges. “Rescue as often as you can,” Terry instructed his supporters from a jail cell in 1989. “Go to jail as often as you can.” Violent actions spread throughout the 1990s, as antiabortion extremists firebombed clinics and gunned down doctors.
By the time Richards took over Planned Parenthood in 2006, almost all Republican support for the group had vanished. A year later, a staunchly antiabortion little-known Republican congressman debuted a new way to undercut its operations. Representative Mike Pence sponsored the first bill in Congress to strip Planned Parenthood of its federal funding. “If Planned Parenthood wants to be involved in providing counseling services and HIV testing, they ought not be in the business of providing abortions,” he said. “As long as they aspire to do that, I’ll be after them.”
His effort marked a new strategy for antiabortion lawmakers. Previous fights over abortion focused on procedures—like so-called partial-birth abortion—or direct federal funding of abortion as with Hyde. They didn’t attack Planned Parenthood, which provided health services to millions of American women annually. “There was some unwritten agreement that we had arrived at, an unstated truce between pro-abortion and pro-life legislators that the debate would happen within certain parameters,” Pence later told Politico. “When we introduced this, it was a completely different element in the equation.”
Pence reintroduced his legislation three times before the new Republican majority, fueled by Tea Party conservatives, passed the bill in 2011. The defund rallying cry was embraced across the party, championed from the presidential primary debate stage to the halls of Congress. The new attack amounted to a striking twist of history: Republicans were now actively working to dismantle the same family-planning programs their party founded three decades earlier.
From the invention of Sanger’s pill to its support for abortion rights, Planned Parenthood led and championed the changes that reshaped women’s reproductive and sexual lives. Yet, where abortion-rights advocates saw themselves as driving the country toward greater equality and freedom, conservatives like Pence saw national decline, a chipping away of what they believed were the core values of American life: traditional marriage, religious faith, and family.
The story of Planned Parenthood was intertwined with the broader cultural transformation of women’s rights and sexual freedom. When Planned Parenthood was founded in 1921, as the American Birth Control League, birth control was criminalized, abortion was banned, and gay sex was illegal. By 2015, when Daleiden unveiled the results of his sting, contraception was not only no longer controversial but covered by insurance. Abortion had been a federal right for more than four decades. And two weeks before the videos exploded into public view, the Supreme Court legalized same-sex marriage.
To social conservatives, Planned Parenthood had come to represent the diminished power of traditional religion, gender roles, and families in American life. The fight was about abortion, of course, but also taking down an entire liberal social agenda and the threat of Hillary Clinton as president. In more than two decades in Washington, Clinton had proven to be not only a champion of women’s reproductive rights, but also liberal feminist ideals. “I think Cecile Richards has now become the puppetmaster for Democrats in Congress,” said Carol Tobias, president of the National Right to Life Committee. “There is no doubt that Cecile Richards wants to influence a President Clinton and control the Supreme Court.”
Over time, the symbolism of Planned Parenthood had far outpaced the reality of its services. Planned Parenthood was the country’s largest abortion provider. But the vast majority of its work involved far less controversial health care like testing for sexually transmitted disease, screening for cancer, and providing contraception. Only about 12 percent of patients came to its clinics for abortions in 2013, according to PolitiFact. In 2015, when the videos were released, Planned Parenthood operated 661 health care centers across the country and saw 2.5 million patients. Its clinics performed 324,000 abortions—nearly half of the total recorded by the federal Centers for Disease Control and Prevention—but those were a fraction of the nearly 9.5 million services it provided that year.
Despite Republican claims, taxpayers funded a very small number of those procedures. Hyde blocked most federal money from being spent on abortions. In total, the federal government contributed funds to pay for just 160 abortions in 2015, spending a total of $490,000 out of a more than $1 trillion federal budget.
Still, Republican efforts to defund Planned Parenthood posed an existential threat to the organization. About 43 percent of its total annual revenue—approximately $550 million—came from federal funding. Losing that money would make it difficult, if not impossible, for many clinics already operating with tight margins to remain open.
An irony of the Republican defunding efforts was that they could end up costing taxpayers more. An analysis by the Congressional Budget Office in 2015 found that defunding Planned Parenthood would increase federal spending by $130 million over a decade. Nearly 2.5 million low-income women got their contraceptives at Planned Parenthood centers. If those centers closed, some of those women would go to other providers. But others—the Congressional Budget Office estimated several thousand annually—would have children. Those pregnancies would cost the federal government more than contraception, given that the prenatal care, labor, and delivery would likely be paid for by Medicaid. And then, potentially, those children could qualify for Medicaid and other federal programs—costing even more taxpayer dollars.
That cost was well worth it to abortion opponents, who saw an opportunity to shut down the biggest abortion provider across America and strike a blow at the liberal worldview the group represented. Targeting Planned Parenthood had become a proxy for conservative America to project its anxieties about gender dynamics and families in a changing and increasingly secular country.
And Richards, preparing to testify to Congress, was about to experience the full force of their fears.