If Planned Parenthood clinics in Little Rock and Fayetteville did nothing but provide medical abortions to women, theirs would be a valuable service. Abortion is legal; so far, the government does not force American women into motherhood, just as men are not forced into fatherhood. Yet options for this legal procedure are few: Among Arkansas cities, only Little Rock and Fayetteville have abortion providers. Meanwhile, politicians who believe they are sanctioned to declare what is moral and what is not are making exercising the right to an abortion harder. Planned Parenthood in particular is being punished financially by conservative politicians across the country.
But Planned Parenthood doesn't simply end unwanted pregnancies. Gov. Hutchinson's directive to the state Department of Human Services to terminate Medicaid reimbursement to Planned Parenthood suggests at best ignorance and at worst indifference toward what's at stake for the health of the women and men who use Planned Parenthood. By federal law, the Medicaid money sent to Planned Parenthood doesn't pay for abortions but for other forms of health care.
Fortunately, a federal district court in Arkansas has halted enforcement so far of recent onerous actions by the state. A suit filed by Planned Parenthood of the Heartland, with which Arkansas clinics are affiliated, stopped the state from refusing Medicaid reimbursement on behalf of several plaintiffs last year; the case is now being reheard as a class action.
U.S. District Judge Kristine Baker has also enjoined the state from enforcing a law passed in 2015 to make it more difficult to obtain a medical abortion. (A medical abortion, or medication abortion, entails the use of abortifacient drugs to terminate an early pregnancy, rather than a surgical procedure. A two-drug protocol is administered: mifepristone, which blocks the hormone progesterone, and misoprostol, which empties the uterus.) Part of the Arkansas law has been mooted by a change in U.S. Food and Drug Administration rules to acknowledge that a lower dose of mifepristone is effective and that it can be used up to 10 weeks; the legislature used the former protocol in its law to force doctors to administer the drug at a higher dose that caused more side effects. Planned Parenthood's suit also challenges the Arkansas law's requirement that doctors that provide abortions have admitting privileges at a nearby hospital. Opponents of abortion frame the admitting privileges requirement as an issue of women's health: It's necessary, they say, in case a procedure should go awry. This argument rings hollow when one considers how safe an abortion really is when performed by a medical professional. According to the U.S. Centers for Disease Control and Prevention, between 2008 and 2011 an average of 0.82 deaths occurred for every 100,000 legal abortions in the U.S. (There are about 17.8 deaths for every 100,000 childbirths, CDC data shows.) And in the rare case of complications resulting from an abortion, any hospital emergency room would, of course, treat a patient regardless of whether her physician had admitting privileges. The real reason for mandating admitting privileges is to shut down abortion providers, since bureaucratic requirements from hospitals (and the controversial nature of the issue) make it difficult for doctors to obtain such privileges. Meanwhile, in a sign of just how safe medical abortions have become, the new FDA protocol now allows nurse practitioners to administer the drugs.
On a recent evening in downtown Little Rock, protestors carrying signs gathered, as they always do, on the perimeter of Planned Parenthood's annual garden party. This year, a new sign appeared, with the slogan "Black Lives Matter." The protester holding it approached an African-American woman at the party.
"How could you support Planned Parenthood? What kind of mother are you?" the protester demanded to know.
"I am the kind of mother who has raised her children, both of whom are straight-A students ... and I know what I am doing," Nikki Strong responded.
As it happened, Strong was a speaker at the picnic. She talked about her experience with Planned Parenthood.
In January 2008, Strong found out she was pregnant and called an obstetrician/gynecologist for an appointment. She was told it would be four to six weeks before she could be seen. Strong didn't want to wait that long, so she went to Planned Parenthood instead.
"I called and said, 'Hey, can I come by?' and they said, 'Sure.' I filled out paperwork. It was pretty seamless."
About 10 minutes after she was taken back, she got the news: "They said it was a small positive, but it was a positive. I was excited."
And then she was asked, she told the Planned Parenthood gathering, " 'How do you feel?' Not come back in six weeks, but 'How do you feel?' "
"That was the part that stuck with me," Strong told a reporter. "They asked how I felt, and listened, and they were excited for me. 'Do you have any questions? Do you need services?' They went above and beyond and were very informative."
The staff told Strong she needed prenatal vitamins right away. There was no four-week wait for folic acid, which treats anemia and helps prevent neural tube defects.
Strong introduced her daughter, Amanda, now 8 years old, to the Planned Parenthood gathering, and she looked above the crowd and directly at the protester with the "Black Lives Matter" sign. "Yes, black lives matters," she said. "Mine and hers."
Her life and her daughter's mattered to Planned Parenthood, too.
Here's a question for the protesters: What kind of mother teaches her son to point his finger like he's firing a gun at women going into a clinic where abortions are performed? You can see that behavior among some protesters at the Little Rock Family Planning Clinic, fingers pointed at women making tough decisions for their own good.
In fiscal year 2015, Planned Parenthood's Arkansas clinics in Little Rock and Fayetteville performed:
370 cervical cancer screenings.
236 breast exams.
5,242 tests for sexually transmitted infections.
services for 262 men (mostly STI testing).
Planned Parenthood provides a variety of birth control products, including by mail; Gardasil, a vaccine against the human papilloma virus; and medications for urinary tract infections. It refers patients to the University of Arkansas for Medical Sciences for mammograms and more complicated diagnoses. It also provides sex education to schools and other groups.
Planned Parenthood's patients include men and women who want to keep their reproductive organs healthy so they can have a family. Women who had unprotected sex and need emergency contraception (the "morning after pill," like Plan B). The homeless, like the woman the Little Rock clinic recently saw who had no money to buy sanitary supplies and was bleeding in the clinic. (The clinic gave her supplies, cleaning agents and a 12-year intrauterine device, or IUD, to prevent pregnancy ... as well as food, because she was hungry.) Women who because of a lack of insurance or for other reasons have put off mammograms, but find a lump in a breast — like a recent patient who learned she had Stage 3 breast cancer and was referred to an oncologist. Women who see their regular gynecologists for pap smears, but don't want them to know they are suffering symptoms of an STD.
Little Rock is a small town; despite HIPAA protections, privacy isn't always guaranteed. At Planned Parenthood, development director Suzanne Overgaard said, you'll never see a sign that says "STDs this way," as she's been told some health clinics have. No one going into Planned Parenthood is going to have to suffer the embarrassment of proclaiming his or her health status to the public, she said.
For pregnant women who do not want to terminate their pregnancies but also do not want to keep their babies, Little Rock's Planned Parenthood clinic provides information on area adoption agencies. Overgaard told the story of a pregnant 13-year-old in Des Moines, Iowa, who recently visited one of the organization's clinics. Her mother wanted her to have an abortion. But after counseling, the teen decided to carry the fetus to term. "We respect our patients and their privacy about their decisions," Overgaard said; clinics do not urge abortion on anyone.
(In Arkansas, girls 13 and up can receive family planning services without parental involvement. Girls under 18, however, need a parent's consent to have an abortion.)
Planned Parenthood also gives transgender people "a soft place to land," Overgaard said. Transgender men who have not transitioned, and so still have female sex organs, may not be comfortable undressing at the doctor's office, but they still can get cervical or breast cancer. They need pap smears and breast exams and even contraceptives, and they need to be provided them without judgment.
To build trust with the transgender community, Planned Parenthood partners with the Arkansas Transgender Equality Coalition, and Overgaard has worked with ARTEC to research barriers to health care in Arkansas. She hopes Planned Parenthood will one day be able to offer hormone therapy for female patients who are transitioning to male.
All are welcome to Planned Parenthood, she said.
Zack Baker, 25, who joined the Planned Parenthood staff last November after volunteering for the clinic, says his job is to make sure patients have "a good experience."
Baker, who is also director of Central Arkansas Pride, said gay men who come to Planned Parenthood won't be met with the same presumptions a friend experienced at his doctor's office. The friend had symptoms of an STI. His doctor said, well, you're gay, so it's probably HIV, the human immunodeficiency virus that can develop into AIDS. It was not.
Baker — who said the only reaction he's gotten from women who are checking in has been, "You're a guy!" — said discrimination against gay people is a societal ill that overlaps with discrimination against women who want an abortion; hence, his support for Planned Parenthood. "We all need basic rights," he said. He also learned how to engage in politics, thanks to Planned Parenthood, when as a college student he was asked to volunteer on lobby day at the state legislature and traveled to Washington, D.C., to meet with the state's congressional delegation.
Baker is thrilled with Planned Parenthood's desire to eventually offer Truvada for PrEP, a daily pre-exposure prophylaxis for healthy people who are at risk for contracting HIV from a sexual partner. "Most Little Rock doctors won't provide it," he said, for fear that it could encourage unprotected sex. (Truvada is meant to be taken in combination with a condom. Using both methods lowers the risk for HIV infection to 92 percent, according to the CDC.)
Baker has seen women who are elated by the results of their pregnancy tests and women who are distraught. For the latter, "It's moments like that when you realize how important" Planned Parenthood is. "You just need to be there and listen to them," Baker said. They know Planned Parenthood will support whatever decision they make.
Veronica Tess Myers has used Planned Parenthood for more than two decades. Her first trip to a Planned Parenthood clinic was when she was 19 and was suffering from severe pain. "I was married at the time and my husband was not faithful," she said; she learned her pain was the result of an STI. Planned Parenthood treated her with antibiotics, and she eventually had surgery. Doctors told her there was a "high possibility" she would not have children. "Hence, my son," Myers said, laughing.
The disease was caught early enough, and "through the grace of God and Planned Parenthood," she said, Myers was able to conceive.
Myers' son, Alexander, is autistic; he was diagnosed at age 2, and doctors told her he'd have to be institutionalized. She decided she did not want to risk having a second child with autism, and went to Planned Parenthood for contraceptives.
Myers chose not to institutionalize Alexander, now 22, but to raise him at home. She has been his advocate, even attending school with him. Now, she wants to be prepared for the day he becomes interested in sex. Though he is developmentally delayed, he's already showing interest in women. And though his brain is continuing to develop, he will not understand things like STIs.
The staff at Planned Parenthood knows Alexander, and they "embrace him without hesitation," Myers said. When the time comes, they'll be there to advise her.
"I do feel like as an individual, we do have the right to make decisions about our own bodies," Myers said. Legislators who want to defund Planned Parenthood ought to realize that what the health care provider does "is bigger than abortion," she said. "This is about evidence-based sexual health education that should be provided to our teens in schools before they even reach adulthood ... . [It works in] a broader realm than just abortion." She added that legislators should remember "they're being paid with tax dollars, too."
Planned Parenthood's Little Rock clinic is open four days a week. Medical abortions are available on only one of those days.
Planned Parenthood's educational outreach is tailored to the needs of the group requesting it, Overgaard said. The organization provides sex education to public schools, usually in health classes, and the curriculum includes a discussion of abstinence as a method of birth control. (Overgaard did not name which schools Planned Parenthood works with.) Its outreach also may address issues of diversity, including sensitivity towards trans people.
Sometimes sex education — minus the birds and bees — can even be tailored to meet the needs of 9-year-olds.
Erin Finzer, 38, who describes herself as a lifelong feminist, is the mother of two young girls. She is also a professor at the University of Arkansas at Little Rock, and concerned about issues of sexual assault on campus and elsewhere.
Finzer saw a need for age-appropriate sex education for her older daughter, Sarah Blanche, who is 9. Finzer got the mothers of the girls in her daughter's Brownie Scout troop on board and sought advice from Crystal Johnson, the health educator for Planned Parenthood. Johnson modified the Family Life and Sexual Health Curriculum (FLASH) for sixth-graders for use with third-graders and has been meeting with the girls in their homes since last year.
In their FLASH meetings, the girls discuss sex stereotypes, physical boundaries, and what to do when someone makes them uncomfortable. They've watched the animated Indian video "Komal," about an uncle who uses sweets and gifts and secrets to get too close to a 7-year-old and what she does about it. They've learned to "explode on" someone — to raise a ruckus to get people's attention when they feel threatened.
Finzer calls what the girls are learning "survival skills."
Erin Finzer said Sarah Blanche has already learned to recognize inappropriate behavior. She told her mother on an outing that a person with them wanted "to help a whole lot and that's suspicious." Finzer had picked up on the suspicious behavior as well.
Finzer said one of the funniest — and also empowering — classes involved asking the girls to answer: What are boys like? What are girls like?
"Most people think girls should like pink" and be quiet, Sarah Blanche told a reporter, "and, really, girls can pretty much like or do anything that boys like or do."
Sarah Blanche also said she's learned that bad things can happen anywhere: at home, or at a friend's house, or even at church.
Planned Parenthood has decided to pay for a new, broader curriculum next year for the girls.
Planned Parenthood "is my favorite organization," Finzer said, because of its motto: "Care. No matter what."
You would think that educating little girls to be aware that there are sexual predators in this world would be something all can agree is a good thing. But such is the animus toward the health care provider that Finzer, who has volunteered with Planned Parenthood since she was a graduate student, felt the need to ask that when the Times took pictures of her at her house, no street address would be shown.
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