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Management in Practice

Leading after Roe

The Supreme Court overturned nearly 50 years of precedent with the Dobbs v. Jackson Women’s Health Organization decision. Amanda Skinner ’08, CEO and president of Planned Parenthood of Southern New England, discusses the consequences for women’s health and economic lives, and for her organization.

Pro-choice protesters outside a Planned Parenthood location in St. Louis in 2019.

Pro-choice protesters outside a Planned Parenthood location in St. Louis in 2019.

Saul Loeb/AFP via Getty Images

Q: What does the Dobbs ruling mean in terms of health policy?

We’ve already seen real-life health consequences. A 10-year-old sexual-assault survivor was forced to travel from Ohio to Indiana to get an abortion. Patients who are seeking abortion care are being turned away because they are just days, sometimes hours, over their state’s gestation limit even though what determines a gestational age is not precise. Healthcare providers in Louisiana were afraid to treat a patient who needed urgent medical care because of the real possibility of providers being thrown into jail if that care bumps up against state laws around embryonic personhood or abortion.

And then of course, we’re seeing people who are forced to travel hundreds, sometimes thousands, of miles out of state to access abortion care. Those folks experience not just the strain of waiting to receive healthcare but also burdensome logistical hurdles that unnecessarily push them further into pregnancy.

We know that banning abortion does not stop people from seeking abortions. It only puts more people in danger, puts more people’s health and lives at risk. The anti-abortion laws are not designed to protect anyone. The anti-abortion forces are actively trying to intimidate patients and providers with the bans that are being put into place. They are willing to let people die waiting for essential healthcare if it keeps them in control of other people’s bodies. I don’t think they will stop until they reach their ultimate goal of a national abortion ban.

In the United States, we have among the worst maternal health outcomes for a developed country in the world. The maternal mortality rate for Black women is three to four times that of White women. A University of Colorado study using 2017 data showed that if abortion were banned nationwide, we would see a 21% increase in maternal mortality and a 33% increase in Black maternal mortality [Editor’s note: An update of the study, currently in pre-print and using data from 2020, estimates a 24% overall rise in pregnancy-related deaths and a 39% rise for Black women]. That would be a devastating public health outcome.

Q: What is the role of full access to reproductive healthcare in women’s lives?

I don’t want to lose sight of the unique and particular impacts on women or the misogyny that these bans are rooted in, but I think it’s important to recognize that this issue impacts everyone. All people need to be able to make their own decisions about building their families.

Part of what motivated me to have a career in sexual and reproductive healthcare, first as a nurse midwife and now working at Planned Parenthood, is that if we are not free to control our reproductive lives I don’t understand how we are free at all.

Q: To what degree is this an issue for businesses?

It’s absolutely an issue for businesses and business leaders. Again and again research has shown that full access to comprehensive healthcare contributes to a productive, engaged, fully participatory workforce. Ensuring employees have healthcare that supports their wellbeing is a good business decision.

“Abortion is essential healthcare. It’s also a human right. It’s also an economic issue. We know that a person’s access to comprehensive reproductive care is directly linked to their ability to participate fully in the workforce.”

Abortion is essential healthcare. It’s also a human right. It’s also an economic issue. We know that a person’s access to comprehensive reproductive care is directly linked to their ability to participate fully in the workforce. It’s directly linked to their earning potential. It’s directly linked to their professional success. When we think about, for example, the gender pay gap and widening economic inequality, we know from historic research that abortion bans are only going to make those issues worse. Abortion bans hurt workers and the businesses that they work at. The Turnaway Study, a longitudinal examination of the effects of unplanned pregnancy on women’s lives, found that receiving an abortion doesn’t harm women’s health and wellbeing, while being denied an abortion does result in worse health, family, and financial outcomes.

Q: How is Planned Parenthood responding nationally?

I’m the CEO of Planned Parenthood of Southern New England, so I do not work for the national organization. But I can say that Planned Parenthood has been around for over a hundred years; we’re not going anywhere. We’re filing lawsuits in states to fight back against these egregious bans. We’re advocating for proactive legislation to protect access to abortion both in the states and nationally. We’re working with business leaders as well as leaders in local, state, and national government to come up with solutions to mitigate this public health crisis we’re facing.

At the same time, healthcare is local, so across the country, Planned Parenthood affiliates are delivering healthcare to the patients coming through our doors. We’re providing education to young people and their families and to educators about sexual and reproductive healthcare. And we’re working in every possible way to dismantle barriers to access to care.

Planned Parenthood is an unusual organization. We are a healthcare provider. And we are an educator. And we are an advocacy, movement, and cultural change organization. Because we’re not just one thing and because we think about our work through all of those lenses, we’re better able to consider the full and intersectional lives of the patients we serve.

For our patients to make decisions for themselves, it’s not just about the physical existence of a health center nearby. It’s not just about having knowledge or information. It’s not just about having the right to access that care. All of those things need to be working in concert with each other. That was a challenge even before the Dobbs ruling. The battle over abortion bans is not merely about access to abortion. It’s really about the freedom to control our futures and our lives.

Q: How has the staff at Planned Parenthood of Southern New England reacted to the ruling?

Our staff are fired up, galvanized. They are rightly upset about the decision—feel it is an attack on the work that they do every day, the people and communities that they serve. Themselves.

They are ready to make sure that our doors are open, that we’re there for our patients and communities, and that we’re there for people who need to come to us for care because they can’t get that care in their own state.

They are raising their hands and saying, what more can I do? Which makes me, of course, incredibly proud. And I want to support them as they navigate such a challenging, emotionally draining, stressful time. I want to make sure that our staff have the resources and capacity to do the work we need to do today, but also to keep doing it tomorrow and next year and 10 years from now, which means we need to be tending to our team and tending to their ability to have the resilience and fortitude to keep doing the work.

Q: What sort of operational changes will be necessary?

We saw it coming and took steps in all facets of our work to be ready. We optimized the hours in our health centers for patients’ ease of access. We’re adding a dedicated staff person specifically to make sure that patients coming from other states have all of the supports and resources around them that they need.

Because Dobbs pushed the decision back to the states, the landscape is very chaotic and rapidly changing right now. As of August 2, 15 states have an abortion ban in effect. We anticipate that 26 states ultimately will pass bans.

However, the safety of our patients and our clinicians is paramount—their physical safety, health safety, mental wellbeing, and of course their legal safety.

Q: What about longer term?

Where we are today is the result of a decades-long effort to shame and stigmatize not only abortion as a procedure, but the people who have abortions.

Renee Bracey Sherman, who is a reproductive justice activist, often says, everybody loves somebody who has had an abortion. And that’s true. One in four women in the United States has had an abortion. Everybody loves somebody who has had an abortion. One of the most powerful ways to destigmatize abortion is storytelling. Maybe you don’t have a story to tell, but you can really listen to somebody when they talk about their abortion. You can remember, oh, I love this person.

We have a lot of work to do to change attitudes, to move to a place where people can say “abortion” without fear, shame, or stigma, to talk about abortion as the healthcare procedure that it is. To not feel embarrassed, ashamed, or stigmatized personally, if they have had an abortion or if they love somebody who’s had an abortion. That’s part of how we shift the culture around abortion in the longer term.

Q: You worked as a healthcare practitioner for a long time before attending Yale SOM. How did the program change the way you saw healthcare?

I spent 10 years working as a nurse-midwife in a community with tremendous socioeconomic, racial, ethnic, and religious diversity. I spent my time caring for one person at a time. I was focused on the person right in front of me trying to help them navigate the challenges that they faced.

When you’re really in it with that person, it can be hard to see the upstream systems issues creating barriers to that person living their healthiest life. SOM helped me see the systems issues more clearly.

The other thing that became very clear was the interdigitation of economic policy, health, and healthcare. I remember when the Affordable Care Act was passed, my first thought was that it wasn’t healthcare reform so much as insurance reform. But reform in the way we pay for healthcare in this country is directly connected to changes in the way healthcare is provided. That may not be a reality that we all love, but that is the reality.

SOM let me see that my life’s work of trying to deliver the healthcare that I think people deserve necessarily involves systems change. And it let me see how I could help make that systems change happen.