A Planned Parenthood clinic in Colorado Springs was the site of a horrific attack last November that left two police officers and one civilian dead.
The attack was the deadliest that any abortion clinic has faced in years — but abortion clinics were already accustomed to violence. Since 1977, the National Abortion Federation has logged hundreds of attacks on clinics that terminate pregnancies.
In the wake of that attack, a growing number of people have tried to understand the role Planned Parenthood plays in America's fraught debate over abortion rights. Why did an attacker choose one of their clinics? Why is Planned Parenthood always at the center of Congress's attempts to restrict abortion access? Why do anti-abortion groups film sting videos at their clinics, as opposed to the hundreds of other independent clinics that exist — ones that are smaller and might be easier to wage war against?
The answers go right to the heart of America's fraught debate over abortion. Planned Parenthood isn't just a provider of abortion — it's the main provider of abortions in America, and it benefits from public funds. In the aftermath of Roe v. Wade, as the pro-life movement has gone from trying to outlaw abortion to restricting access to abortion, anti-abortion activists have come to see Planned Parenthood as their most important and vulnerable target.
The effort to destroy Planned Parenthood has included everything from undercover sting videos to near-government shutdowns — and, in the eyes of Planned Parenthood's defenders, this broad campaign to demonize the group is creating an atmosphere in which violence against Planned Parenthood clinics is inevitable.
What follows are the most basic answers to the most basic questions about Planned Parenthood and its increasing centrality to America's fight over abortion.
1) What is Planned Parenthood?
Planned Parenthood is a major American provider of reproductive health services. It operates more than 700 clinics that, in 2013, saw an estimated 2.7 million patients. About 80 percent of the services it provides are either birth control prescriptions or testing for sexually transmitted diseases.
Planned Parenthood is also the country's largest abortion provider. In 2012, it terminated 327,166 pregnancies. To put that in context, the Centers for Disease Control and Prevention estimates there were 699,202 legal abortions in the United States that year — meaning Planned Parenthood provided just under half of them.
Planned Parenthood's role as the major abortion provider in the United States has long made it a target of abortion opponents.
Most abortion opponents would like to see a world in which abortion is illegal — but don't see a way, right now, to get there. The Supreme Court has repeatedly affirmed a women's right to choose, starting with the landmark 1973 decision Roe v. Wade. State-level efforts to outlaw abortion have fizzled, often due to a lack of political support, as many see such laws as too extreme.
So most pro-life groups have focused their efforts on making abortion less accessible. If they can make it more difficult to obtain an abortion, the thinking goes, that can be a successful, incremental strategy toward making abortion less common in America.
Given the high number of abortions it provides, Planned Parenthood is at the center of this effort. Anti-abortion activists see discrediting and defunding the organization as one of their best ways to reduce abortions in the United States. Legislators have pushed laws that call out Planned Parenthood by name, in an effort to make abortion less and less accessible to American women.
2) Why is Planned Parenthood so controversial?
Planned Parenthood is controversial, in part, because of the hundreds of thousands of abortions it provides. But there's a second factor that's equally important to understanding the debate around Planned Parenthood, and that's the hundreds of millions of taxpayer dollars the clinics receive annually.
Just over 40 percent of Planned Parenthood's budget comes from government grants and reimbursements, the organization's most recent budget report shows. Between June 2013 and 2014, Planned Parenthood received $528.4 million in public funding, a big chunk of its $1.3 billion national budget. That money, by law, cannot go toward providing abortions — but Planned Parenthood's critics point out that by subsidizing the organization's other operations, the money is subsidizing everything Planned Parenthood does, including abortions. So pro-life groups have aggressively targeted Planned Parenthood's public funding — at both the state and local level — as a way to reduce abortion access in America.
"Federal money keeps the lights on in facilities that house abortion clinic," Rep. Joe Pitts (R-PA) argued in a January press release. "It is time we shut off the flow of money to such groups,"
To be clear: The vast majority of Planned Parenthood's public funding does not go toward funding abortion. Most of Planned Parenthood's public funding goes toward the clinics' more common services, like contraceptive prescriptions and screenings for sexual disease for low-income women and men.
It is possible that some public money might pay for abortions in cases of rape, incest, or to save the life of the mother, which are legal uses of federal funds under current law. But there is no evidence currently suggesting that Planned Parenthood illegally uses federal funds to pay for elective abortions.
Conservatives argue that such analyses miss the point.
"Money is fungible," Rep. Jim Sensenbrenner (R-WI) said at a 2015 hearing, making the case against Planned Parenthood. "You and I know that."
3) Why does Planned Parenthood get government money?
Planned Parenthood mostly gets government money to provide reproductive health services, like Pap smears, sexual disease screening, and contraceptives, to low-income men and women. Planned Parenthood is often one of the few providers in a given area to accept public insurance, so it ends up getting lots of reimbursement from those public plans.
There are two main ways Planned Parenthood receives public funds. One is through Medicaid, the public health insurance program that covers 71 million low-income Americans. Whenever a Medicaid patient has an appointment at a Planned Parenthood clinic, the nonprofit will bill the health plan for whatever services the patient uses. In that way, Planned Parenthood acts like any other health care provider that delivers medical care to patients and receives reimbursement from insurers. Planned Parenthood estimates about half of its patients are Medicaid enrollees.
The other source of funding is grants, largely through the Title X Family Planning Program — the only domestic grant program dedicated to family planning. Organizations like Planned Parenthood often use Title X grants to subsidize birth control, STD screenings, and other reproductive health services for low-income patients who may lack health insurance coverage.
Planned Parenthood receives Title X funds both directly from the federal government and from states, which will sometimes make the nonprofit's health center a subgrantee for the dollars they receive from the federal government.
4) Why is Planned Parenthood under attack right now?
Planned Parenthood has arguably been under attack for as long as it has been in existence. The business of providing birth control and abortion has, for decades now, been a controversial one.
But the current wave of anti-Planned Parenthood actions arguably traces back to one key politician: Mike Pence. Pence is currently the governor of Indiana, but before that he was a congressman from the same state dead set on defunding the country's largest abortion provider.
"If Planned Parenthood wants to be involved in providing counseling services and HIV testing, they ought not be in the business of providing abortions," Pence told me in 2011, when I was a reporter at Politico. "As long as they aspire to do that, I’ll be after them."
At the time, Pence had introduced legislation in three straight sessions of Congress that would prevent any entity that provides abortion from receiving funds through Title X. But the bills would typically languish in committee, never even making it to the House floor.
But in February 2011, Pence changed his approach: He introduced a budget amendment that would strip Planned Parenthood — and Planned Parenthood alone — of all federal funding. This was about a year after Obamacare passed, and many conservatives were still angry over a health law provision that allowed plans purchased with government subsidies to cover abortion. (The White House said that insurers would have to ensure only private contributions covered abortions, but anti-abortion groups wrote this off as a budget gimmick.)
And it was also around the time that a pro-life group called Live Action released its own set of Planned Parenthood sting videos, purporting to show the organization to be complicit in human trafficking. (A Planned Parenthood worker filmed in one of those videos, giving inappropriate advice to an actor posing as a pimp, was ultimately fired.)
That time, Pence's proposal did get traction: The budget amendment to defund Planned Parenthood nearly shut down the federal government. House Speaker John Boehner got behind the cause, and it became a final sticking point in negotiations with the White House. Boehner ultimately abandoned that demand, but the idea of attacking Planned Parenthood's funding stuck. And anti-abortion groups saw that sting videos could be a powerful way attack the group and its funding.
5) What did the Planned Parenthood sting videos show?
This past summer, an anti-abortion group called the Center for Medical Progress secretly taped multiple videos inside Planned Parenthood clinics. It released clips of those videos that purported to show that Planned Parenthood profited from the procurement of fetal tissue, which would be illegal.
I watched all the footage shot within Planned Parenthood clinics that CMP has released, and saw no evidence that Planned Parenthood employees committed any such crime. Multiple states have investigated Planned Parenthood on this issue, and also came to the same conclusion: The clinics had not broken any laws.
But the real point of the Planned Parenthood sting videos isn't over whether Planned Parenthood broke laws related to fetal tissue research. It was to show Planned Parenthood as a callous and grotesque organization. The first video opens with a jarring scene of Planned Parenthood employee Deborah Nucatola discussing fetal organs over a glass of red wine.
"A lot of people want intact hearts these days," she says. "Always as many intact livers as possible. Some people want lower extremities too, which, that's simple. That's easy. I don't know what they're doing with it."
There are other scenes like this, too, throughout the videos. They are, in part, choreographed by the actors posing as fetal tissue buyers (unedited footages shows the anti-abortion activists suggesting Nucatola order her glass of wine). One Planned Parenthood official appears to haggle over the fee they would accept for tissue. Many talk about fetal tissue easily, even somewhat dismissively.
The point of these videos is to make viewers uncomfortable with Planned Parenthood, and potentially split the people who are comfortable, at an arms length, with abortion from those who are disgusted by the idea of fetal tissue research. The anti-abortion group behind the videos isn't able to successfully show that Planned Parenthood did something illegal in providing fetal tissue to researchers. So the videos aim to make abortion supporters uncomfortable with the abortion procedure itself, by showing clinic workers talking very easily about the byproducts of abortion.
6) Why did the Colorado Planned Parenthood attack happen?
The motives of alleged Planned Parenthood shooter Robert Lewis Dear are not yet clear. The suspect allegedly told Colorado Springs Police, "No more baby parts," as he was being arrested, leading some observers to say that the attack was a politically motivated act of domestic terrorism. His word sound like a reference to the Center for Medical Progress sting videos — which the group marketed with a #PPSellsBabyParts hashtag — but that has not been confirmed.
We do, however, know that the Colorado attack is part of a larger pattern: Attacks on abortion clinics are common and have been increasing since CMP released its sting videos this year.
Since 1977 there have been eight murders, 17 attempted murders, 42 bombings, and 186 arsons against abortion clinics and providers.
7) Was this attack "domestic terrorism? And does that matter?
The FBI defines domestic terrorism as events that appear intended to "intimidate or coerce a civilian population" or "influence the policy of a government by intimidation or coercion." Pro-choice groups have argued attacks on abortion clinics fit this definition, and ought to be treated as domestic terror attacks. NARAL Pro-Choice America privately delivered a petition to the DOJ on this issue last week last Wednesday — two days before the Colorado attack.
"The technical term really reflects the use of violence against limited targets to scare a lot of people into doing their bidding," says Sasha Bruce, NARAL's senior vice president for campaigns and strategy. "These actions are intended to scare women away from seeking an abortion. It fit the bill even before the awful, awful incident Friday in Colorado."
It's not entirely clear what would change if the Department of Justice did categorize these attacks as "domestic terrorism." There is no set way that the agency is instructed to handle those cases, no rulebook that requires a specific type of investigation or resources.
Bruce argues that categorizing these attacks as domestic terrorism could lead to more resources being committed to the investigation. She pointed to the Obama administration's new Domestic Terrorism Counsel as one possible group that could become involved in investigations, if the agency treated abortion clinic attacks as domestic terrorism incidents.
8) Have there been more attacks on Planned Parenthood clinics since the release of the videos?
Yes. As Vox's Emily Crockett has written, a September FBI bulletin noted an increase in attacks on reproductive health care facilities since the Center for Medical Progress began releasing videos. There were nine criminal or suspicious incidents over the summer.
The FBI Intelligence Assessment described these actions as "consistent with the actions of lone offenders using tactics of arsons and threats, all of which are typical of the pro-life extremist movement."
"It is likely criminal or suspicious incidents will continue to be directed against reproductive health care providers, their staff and facilities," the assessment continues.
Less than two weeks after CBS reported that, another abortion clinic was firebombed in California. It was the fourth arson at a Planned Parenthood location in as many months.
And all that, of course, was before the Colorado attack.
Planned Parenthood's defenders argue that an attack like this one should not be surprising. The sting videos released this month, and statements from some anti-abortion advocates, aimed to convince people that Planned Parenthood doctors are cold-blooded murderers.
"Planned Parenthood murders children — none of their other services matter," one widely shared article from October declared. "Planned Parenthood is breaking the law by killing babies born alive," another headline read.
"Sorry, David Daleiden [Center for Medical Progress founder, who spearheaded the recent sting videos]," NARAL Pro-Choice America president Ilyse Hogue wrote in a Facebook post last year. "You don't get to create fake videos and accuse abortion providers of 'barbaric atrocities against humanity' one day and act shocked when someone shoots to kill in those same facilities the next."
When you take specific steps to argue that Planned Parenthood doctors are cold-blooded mass murderers, it is hard to make sure none of them decide that violence is the appropriate response.
9) What are pro-life and pro-choice groups saying about the attack on Planned Parenthood?
Pro-choice groups were, perhaps unsurprisingly, quick to condemn the attacks on Colorado Springs Planned Parenthood clinic.
We will never back away from providing care in a safe, supportive environment that millions of people rely on and trust.— Cecile Richards (@CecileRichards) November 27, 2015
Pro-life groups moved slower, and many people noticed that Republican presidential candidates were especially slow to speak on the attack. At least two pro-life groups, Operation Rescue and Priests for Life, did post statements Friday condemning the violence. No candidate responded until Saturday, the day after the attack, and even then, most of their remarks tended not to mention Planned Parenthood by name. Instead, they posted prayers for the first responders and condemned the general idea of violence. Ted Cruz posted the first statement:
Praying for the loved ones of those killed, those injured & first responders who bravely got the situation under control in Colorado Springs— Ted Cruz (@tedcruz) November 28, 2015
The violence puts Republican candidates in a somewhat awkward spot. As the New Yorker's Amy Davidson has observed, many have been quite adamant in their anti–Planned Parenthood rhetoric throughout the campaign season. Speaking in favor of Planned Parenthood cuts across many of the arguments they've spent months now making.
In the September G.O.P. debate, Cruz called Planned Parenthood a "criminal enterprise," guilty of "multiple felonies." He has signed a letter saying that one of the group’s founders, Margaret Sanger, sought the "extermination" of black Americans. (She did not.) "When millions of Americans rose up against Planned Parenthood, I was proud to lead that fight," Cruz said, in a debate in October.
[Jeb] Bush has called Planned Parenthood’s practices "horrifying," and has said that the group is "not actually doing women’s health issues. They are involved in something way different than that." John Kasich also tweeted Saturday—also without specifically mentioning Planned Parenthood. Marco Rubio, who seized on the shooting of Cecil the Lion as a reason to ask where the outrage was over Planned Parenthood and "dead babies," didn’t have anything to say about the victims in Colorado. Neither did Chris Christie, who, in one debate, talked about Planned Parenthood engaging in "the systematic murder of children in the womb to preserve their body parts."
Democratic candidates Hillary Clinton and Bernie Sanders both put out statements saying they stood by Planned Parenthood, as did President Obama. "This is not normal," he said in a Saturday statement. "We can’t let it become normal."