Planned Parenthood CEO Discusses The Post-Roe Fight For Abortion Access–And The “Opportunity To Reimagine… Something Better”

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When the Supreme Court released its decision overturning Roe v. Wade on June 24, Alexis McGill Johnson was ready. As president and CEO of Planned Parenthood, she had been warning of this outcome long before a leaked draft of the Court’s opinion was published in May. The reproductive rights movement had been working to prevent this moment for years. And yet, McGill Johnson still found it devastating.

Access to abortion quickly changed in about half the country, as providers, patients, lawyers, activists, and state officials scrambled to interpret confusing, overlapping laws–some of which hadn’t been in effect for decades or were written a century ago. In the weeks since, advocates have filed suit in a number of states, aiming to block laws that restrict abortion. The Biden administration has taken some steps to protect access to medication abortion and to abortions in life-saving situations, but the federal government is limited in what it can do.

The new fight over abortion is largely at the state and local levels. And that’s where much of McGill Johnson’s focus is trained. Planned Parenthood is working to help people travel across state lines to access abortion and moving resources to places where the procedure is still legal. The organization, along with groups like the American Civil Liberties Union and the Center for Reproductive Rights, is waging battles in state courts to delay or strike down as many anti-abortion laws as it can. It is also trying to convince voters to pay close attention to state and local elections, where abortion policy will be decided for the foreseeable future.

But ultimately, this is a “generational fight,” and winning back a national right to abortion will be a long-term project, McGill Johnson says. Born just months before the Supreme Court issued its decision in Roe, McGill Johnson, 49, has lived most of her life with the national right to abortion. She spent years as a social justice activist and political scientist, served on the Planned Parenthood board, and was running the Perception Institute, a research group she co-founded to study racial bias and discrimination, when Planned Parenthood tapped her to take over after it ousted its former leader in 2019. The organization made her permanent head of both Planned Parenthood Federation of America, the nonprofit that is the nation’s largest abortion provider, and Planned Parenthood Action Fund, its political arm, in 2020, just in time for a fresh round of high stakes political fights.

TIME recently spoke with her about how a broad patchwork of anti-abortion laws are playing out around the country, what she would like to see President Biden do to protect abortion access, and the economic impact of overturning Roe.

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The interview has been condensed and edited for clarity.

It’s been three weeks since the Supreme Court overturned Roe. Now each state has different laws and policies on abortion, and it seems like every day things are changing. What does this rapidly shifting landscape mean for Planned Parenthood’s clinics and staff around the country?

The moment has been devastating. It is confusing. It is complicated. Just in the last three weeks, 12 states have moved to ban abortion or banned abortion. And we expect more to do so in the coming days, weeks, and months as states rush to open up their legislative seasons. So what that looks like on the ground is people who are waking up who are pregnant who no longer wish to be, calling health centers trying to figure out whether or not they can get the abortion care that they need in state and what the additional restrictions are, because even in some of the states where abortion is still legal, there are other restrictions on top that complicate the provision of care.

I’ve traveled to North Carolina, South Carolina and Michigan. I’m headed to Indiana in a little bit. It’s been heartbreaking to be on the ground and talking to providers at our affiliates, who are either overwhelmed with the increased volume in their health centers because they are doing everything they can to meet the patient needs. And particularly for those who are traveling out of state knowing that they have such a finite time to be seen before they need to get back. And it’s also overwhelming for the providers who have the ability to provide care–but no longer legally–who are just being denied the opportunity to treat their patients. And it is no question the beginning of what will overwhelmingly be a public health care crisis.

In some places, abortion clinics closed. But in other places, they’ve changed their operations out of fear of violating these laws. For example, Planned Parenthood of Montana stopped providing abortion pills to some out-of-state patients because it said it was worried about neighboring states’ abortion bans. How do you think about risk when evaluating what services you can provide under the new laws?

Each affiliate is independently affiliated with Planned Parenthood and so they make their own decisions with respect to their risk tolerance. But I think what you are seeing is, in addition to the abortion bans, additional restrictions being introduced around things like the right to travel, the criminalization of medication abortion over state lines, or the kind of civil suits that are consistent with the Texas bounty hunter provisions in SB 8. And so, each affiliate, each health center is trying to identify ways to protect their patients and their providers and the workforce so that they can continue providing the care they can in state.

And when you have the AG in Texas suing the HHS Secretary for forcing them to provide abortion care in the instance of protecting the life of the mother, it makes it very challenging to consider what the risk ultimately will be. And I think that’s the hardest part about this period, is the unknowable risks, and making sure that providers and our affiliates get the clearest guidance not only from us as an organization, but also from the Administration about where they will put the weight of and power of the Department of Justice and HHS and enforcing the right to access care up where they can.

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You brought up the Texas suit. The state recently sued the Biden administration’s Health and Human Services Department over guidance it issued telling hospitals they must provide abortions in emergency situations. What was your reaction to seeing Texas’ suit?

There was a patient in Texas who had an intended pregnancy that was no longer viable and the hospital administrators, the insurance providers did not want to give her the abortion care that she needed, until she essentially started showing signs of sepsis. And so I think what the Secretary is doing here and saying here is underscoring the impact on health care broadly and on the lives of patients in Texas now. And I think what the [Texas] AG is doing is putting their agenda to ban abortion at the expense of the lives of women and others in the state.

In addition to the Supreme Court’s conservative majority, there’s been an influx of conservative justices onto the federal courts over the last several years. Does the Texas suit make you concerned that other efforts to protect abortion access could prompt lawsuits that would get heard before conservative judges who might make decisions that further curtail access?

We have to explore every single avenue to fight back and that means litigation even when the courts aren’t favorable, it means mobilization even when the seats have been gerrymandered in many states. I think the point here isn’t to worry about which court will take it. It is to also demonstrate to the public, which by and large supports access to abortion, that lawmakers and the judiciary are far out of step with where the residents of many of these states are.

I think it’s just important at every turn to demonstrate who is fighting for freedom, who is trying to protect access to health care, who is trying to protect the very fabric of trust that is the currency of a relationship between a provider and a patient, and who is trying to scare people and shame people and stigmatize people from getting the care that they’re asking for. And so yes, I’m very concerned about the limited pathways, but I’m also very concerned that we try everything that we possibly can in order to demonstrate that we are not going back.

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How do you view the Biden administration’s response to overturning Roe so far?

The administration has to do everything they can to protect access to abortion and other reproductive health services in this country. I think that they have put forth some initial very important steps around access to medication abortion, as well as the work that the Department of Justice is also looking at with the Reproductive Rights Task Force to address and monitor some of these right to travel laws.

There is more that the administration can do around supporting travel, around declaring a public health emergency, around strengthening the information around medication abortion and fighting disinformation. So the conversations that we have with the administration are focused on the experiences that patients are having every day in trying to seek access to care, and sharing stories that providers are sharing about the concerns that they and their staff are having around being targeted for providing the care in particular ways. Those are the stories that should inform the policy and the additional work that will come from the administration.

I wanted to ask about the situation in Ohio where a man was charged with raping a 10-year-old and the abortion provider has received intense scrutiny despite abortion being legal in Indiana. What concerns do the calls for investigations into the doctor raise for you?

It’s just another example of how extreme anti-abortion politicians are. They created this abortion access crisis and they’re so hell-bent on their agenda to make it inaccessible, that they’re actively putting people’s health and lives at risk. The fact that this doctor has been outed on Fox News, her name and photo, the fact that a National Right to Life official said that they thought the 10-year-old should have been forced to give birth, is demonstrating that they will go to any lengths to shame and create fear and terror for providers and patients themselves.

And so to come back to the Biden administration, I think that these are the concerns that we have to make sure the administration understands and is helping to address. Figuring out how to support and protect people who now have to travel across state lines, ensuring that providers are not facing these terroristic threats around their license and fear for their own safety. But it’s an example of how extreme the politicians have been in trying to use their power and control to control our bodies.

Some Democrats have been discouraged that even with their party in charge at the federal level, Roe was still overturned. How do you think about Planned Parenthood’s political strategy and motivating people to vote in November?

I would say the Democrats have been acting. We’ve seen [multiple] votes on the Women’s Health Protection Act, legislation that would protect people’s right to access abortion. We’ve seen the House pass that legislation and we have a very divided Senate.

As for the motivation: For the last 49 years, we have relied on the Supreme Court as our backstop to hold up this constitutional right. And I think what voters need to understand now is just how critical state and local elections are, how critical state supreme courts are, how critical governors are as a backstop for protecting access. And that maps on to our Action Fund’s electoral strategy. We want to make sure that we are protecting governors where we can, that we are expanding the majority in the U.S. Senate, and fighting in key state houses to protect access to care.

And despite what you may have heard, everyone I hear from has actually gotten quite energized. Abortion is polling at the highest levels in terms of of motivation and enthusiasm for turnout, and so I think that’s going to continue because the impact is being felt immediately and will continue to be felt over the next few months. And I think that’s probably why you’re seeing a lot of folks who oppose access to abortion, many GOP candidates, who aren’t talking about it because they know they don’t have the answers.

You mentioned the impact of all these changes is already being felt. As abortion clinics close and people who have worked there are unsure about their own futures, how do you make sure Planned Parenthood and the broader reproductive rights movement feel sustained to push back?

Planned Parenthood is over 100 years old, and its formation is grounded in resistance and its goal to provide the best sexual and reproductive health care possible. That is going to continue. Planned Parenthood provides access to contraception, to STI testing, to breast cancer screening, to gender affirming care, to behavioral health and mental health. And that work is going to become even more important, particularly in places that have lost access to to abortion, because we have been a critical part of the public health infrastructure.

Writ large, the movement has always been under the assumption that this is a long fight. It’s been a long fight to hold and sustain what we have had under Roe and also recognize the fact that Roe was not enough. And I think now that we are in a world where we are no longer defending Roe, we have actually an opportunity to reimagine and reconstruct something better. And I think that is the animating idea that is bringing the movement into full focus around what is possible to create and settling in that it is going to be a very long road to restore our rights, to get back into the Constitution, and to continue to be able to provide the best and most comprehensive sexual and reproductive health care imaginable.

Businesses have been trying to figure out how they should respond to the Supreme Court ruling as well. What do you want companies to be thinking about as they decide how they are going to navigate this new landscape of abortion?

I think they have to be looking at it through the lens of their workforce, I think they have to be looking at it through the lens of their consumers and stakeholders, as well as the communities and states they’re operating in, because it’s incredibly important for them to be providing the benefits. No company, and quite frankly no lawmaker, should want a resident to be held hostage in their state and not be allowed to cross state lines to get access to care, and they should facilitate that and cover it.

And if they choose to locate in a ban state, I think they also should be using their voice to talk about the impact of loss of access to abortion for their communities and for their workforce. I believe the Institute for Women’s Policy Research has found that the impact to the economy is upwards of $105 billion [per year]. And so thinking about also what it means to do business in states that no longer have access to care, how that will impact their workforce and morale and their responsibility to the communities that they are in. Last, I’d say that companies play a very big role in our political system. They often give donations to both sides of houses and to consider whether or not funding some of these incredibly extreme lawmakers is the best way to demonstrate their support to their workforce or the communities that they’re serving.

Given that it took conservatives nearly 50 years to overturn Roe, and now you’re in some ways starting this new era, how far in the future are you looking as you try to restore access to abortion going forward?

I think the fundamental question for our movement right now is, who are we going to be now that we are no longer defending Roe? This is a generational fight, and the work that we are doing right now, not only to rebuild and strengthen an infrastructure to provide abortion in the states where we can, is important, but we have to acknowledge that we shouldn’t be looking to the future state being one in which you constantly have to travel for access to abortion care. And that means fighting state by state. It means coordinating, connecting with movements that are also experiencing the same potential loss, the guarantees that we have come to understand have been guaranteed by the 14th Amendment. It means aligning and being very systematic in building power across the states. Most of these states, the majority of people support access to abortion care. The only reason we are here is because the people in power have gerrymandered themselves in power. And it’s our job to unpack them and to leverage direct democracy to fight back—and that will take a while.

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