How Planned Parenthood Works

While the Planned Parenthood Federation of America has national headquarters in New York City and Washington, D.C., the local health centers are actually governed and operated by regional affiliates. As of January 2009, there are approximately 860 health centers.

The services provided at local Planned Parenthoods may differ slightly. For example, Planned Parenthood of Western Washington's Take Charge program offers residents below the poverty line free annual exams and birth control pills for a year. Planned Parenthood of Delaware offers free wellness coaching that helps clients navigate everything from Medicaid forms to the vitamin aisle. Some Planned Parenthood chapters offer abortion training to medical students who don't learn the procedure in medical school or hospital residencies.

Although different programs are available in different regions, there are, of course, some very common reasons that people go to Planned Parenthood. In 2006, Planned Parenthood's local health centers saw 3.1 million patients. The vast majority of those patients were seeking some form of contraceptive service; contraception makes up 38 percent of Planned Parenthood's services. Planned Parenthood's contraceptive options include reversible contraception, such as condoms or the birth control pill, as well as more permanent options, such as tubal sterilization and vasectomy. Additionally, Planned Parenthood provides emergency contraception, commonly known as the morning-after pill.

Testing and treating sexually transmitted diseases and infections, including HIV, made up 29 percent of Planned Parenthood's services in 2006. Cancer screening and prevention, which consists of Pap tests, breast exams, colposcopies (tests for abnormal growths in the cervix), LEEP procedures and cyrotherapy (those last two treat cancerous cells and growths), made up 19 percent of Planned Parenthood's docket.

Ten percent of Planned Parenthood's services in 2006 were devoted to health services that included pregnancy tests, prenatal care and infertility treatment. Three percent of Planned Parenthood's services include abortion procedures. Though that is a small percentage of Planned Parenthood's work, that 3 percent totaled 289,750 abortions in 2006, making Planned Parenthood the largest provider of abortions in the United States. According to the U.S. Conference of Catholic Bishops, Planned Parenthood is responsible for 1 in 5 abortions in this country [source: USCCB]. Referrals to adoption agencies made up less than 1 percent of Planned Parenthood's services.

In addition to seeing patients on-site, Planned Parenthood provides sexual health information online to 1.25 million visitors a month; that number includes visitors to a site geared specifically to teenagers, teenwire.com. The Planned Parenthood Federation of America also works with international partners to ensure that women worldwide have the same access to information and health care as women in the United States. In 2006, Planned Parenthood provided $2.6 million in grants to partner organizations, so that women from Nicaragua to Nepal can receive health care.

In addition to patient healthcare here and worldwide, Planned Parenthood acts as an advocate and lobbyist for reproductive health issues on the local, state and national level. Here are a few of Planned Parenthood's stances:

As you might imagine, much of Planned Parenthood's agenda for advocacy depends on the political climate in the country. Of course, that's not anything new -- all of Planned Parenthood's history has been shaped by the politics of the time. Go to the next page for more on Planned Parenthood's history.

Abortion has always been a controversial issue, but at the time of Planned Parenthood's founding, there was more of a concern about birth control. At the turn of the 20th century, the country was governed by the Comstock laws, which held that it was illegal to send obscene materials through the mail. Included on the list of obscene materials was any information regarding contraceptives or preventing conception.

In the early 1900s, Margaret Sanger, who had seen her own mother give birth to 18 children, saw the misery created by unwanted pregnancies in poor families who couldn't support the children. Additionally, women were seeking back-alley abortions that often ended in serious injury or death. Thinking that wider availability of contraceptives would prevent abortions as well as these large families of unwanted children, Sanger opened the country's first birth control clinic in Brooklyn in 1916. That clinic and Sanger's American Birth Control League would eventually become Planned Parenthood.

Sanger and Planned Parenthood played major roles in defying and changing the laws so that more women had access to reproductive health care. Planned Parenthood even provided the grant that financed the testing of the birth control pill. When the FDA approved its use in 1960, Planned Parenthood campaigned for its distribution to women, regardless of their income level. At the time, Planned Parenthood had the presidential administration's support. President Lyndon Johnson identified a lack of family planning as one of the four most pressing health issues facing the country, and his successor, Richard Nixon, established Title X of the Public Health Services Act, which made contraceptives available even to those without the ability to pay. Title X was later expanded to include sex education programs for teenagers.

As more women accepted the idea that they had the right to choose when to become pregnant via the use of birth control, more people started to believe that true reproductive choice also included the ability to terminate an unwanted pregnancy. Planned Parenthood, which had always been opposed to unsafe abortions, joined the fight to legalize abortion, which was realized in the court case Roe v. Wade in 1973. Since the case's ruling, Planned Parenthood has always fought against any legal encroachment upon the rights provided by the Roe decision. However, that task became difficult three years later, when abortion and reproductive rights became a party issue. For the first time, the Republican Party and the Democratic Party established their first anti-abortion and abortion rights platforms, respectively.

­­Since that time, Planned Parenthood's work has been shaped largely by the political leanings of the president. Title X has been restricted during Republican administrations and expanded during Democratic administrations. In 1984, the Reagan administration created the global gag rule, which pulled U.S. family planning funds from any international organization that provided information on abortion to its clients, even if that information was paid for by different funds. This move in effect defunded the International Planned Parenthood Federation (in 1952, the Planned Parenthood Federation of America joined with seven other family planning organizations to create the international organization), which refused to comply with the requirements. Three years later, Reagan introduced a domestic version of the gag rule, leading a Planned Parenthood medical director to sue on the grounds that a doctor's right to free speech was violated by the policy. The Supreme Court upheld the gag rule. Since then, the global and domestic gag rules have been alternately revoked by Democratic administrations and reinstated by Republican administrations.

Regardless of leadership, however, grassroots efforts support Planned Parenthood's mission. For example, when abortion clinics endured violent picketers and when abortion providers received death threats (or in tragic cases, actual bullets), then volunteers have responded to escort patients into Planned Parenthood's clinics. When an elected official says or does something particularly offensive to those who support the right to an abortion, then Planned Parenthood is flooded with donations. It's safe to say that you will see Planned Parenthood's citizen activists on the site whenever there is a threat to the reproductive issues the organization stands for.

Critics claim that Planned Parenthood is too jumpy about some of these issues and works to block rulings that the majority of people in an area may support, such as mandatory 24-hour waiting periods before an abortion. On the next page, we'll take a look at the other criticism that has been leveled at Planned Parenthood.

You don't become the country's leading abortion provider without facing criticism­ along the way. Some critics claim that "freedom of choice" applies only as long as Pla­nned Parenthood agrees with your choice. The U.S. Conference of Catholic Bishops is just one group that points to the extremely low numbers of adoption referrals that Planned Parenthood makes in comparison to the abortions it performs. Many anti-abortion groups would prefer that Planned Parenthood provide more counseling prior to an abortion, including showing the patient a 3-D sonogram, the belief being that it's harder for a woman to go through with an abortion when she sees what is growing inside her.

Additionally, critics claim that Planned Parenthood doesn't support the choice that medical professionals have to exercise a right of conscience, or the right to refuse to do something on the job that violates their moral beliefs. This includes everyone from nurses who won't assist abortions to pharmacists that won't dispense emergency contraception. This right of conscience is legally protected, which Planned Parenthood has claimed is an unfair claim on a woman's body by the government.

Critics, however, would say that even though Planned Parenthood refuses even the slightest governmental interference in terms of a woman's body, the organization certainly doesn't have a problem taking the government's money. One-third of Planned Parenthood's revenues come from government grants (the rest is mainly from fees for services rendered at the health centers and from private donations). Planned Parenthood has made a profit for many years and also maintains status as a tax-exempt organization.

­Many conservatives are troubled by their tax dollars funding Planned Parenthood, but also b­y the fact that Planned Parenthood's success and future tax-exempt profits are dependent, essentially, on young people having sex and then seeking birth control or an abortion. Some detractors have even made the argument that Planned Parenthood encourages teens to have sex without understanding the consequences, if only because they make the consequences erasable by abortion. Planned Parenthood also has created sex education curriculums that have made their way into the hands of organizations like the Girl Scouts and the Boys and Girls Club; when some parents get a whiff of a child being told about condoms and birth control instead of about abstinence, they pull their children out of the programs.

Many anti-abortion groups have also conducted undercover stings to see how Planned Parenthood works from the inside. For example, in Indiana in 2008, a university student posed as a 13-year-old girl worried about a possible pregnancy with her 31-year-old boyfriend. A secret videotape of the encounter showed a Planned Parenthood nurse asking the girl to stop telling her the ages of those involved so that she wouldn't have to report the couple to Child Protective Services for statutory rape [source: Morton]. The same year, in Idaho, another anti-abortion group made taped phone calls to a Planned Parenthood office asking if donations could be earmarked to fund black women's abortions, because, as the caller put it, "the less black kids out there the better" [source: Forester]. According to the recording, Planned Parenthood's response was nervous laughter, followed by "Understandable, understandable" [source: Forester].

The issue of eugenics has long been an issue for Planned Parenthood. When Margaret Sanger was campaigning for the use of birth control in the early 1900s, she made many statements about how crowded populations would be better off without adding unwanted and unfit babies into the mix (babies, that, it should be noted, mainly came from lower class families). Planned Parenthood has never repudiated Margaret Sanger or her support of eugenics, and the idea of some babies being unfit for this world is abhorrent to many. Also abhorrent to some was Planned Parenthood's offer of free birth control and abortions in the aftermath of the events of Sept. 11 and Hurricane Katrina, on the basis that families may not be ready for the addition of a new baby after losing a loved one or all their belongings [source: Braun].

Still, while some people find Planned Parenthood distasteful, there are millions worldwide who rely on Planned Parenthood as a means for getting birth control and preventing unintended births. For more on family planning and other women’s health issues, see the links on the next page. ­