When Frank and Lillie Gilbreth were asked by a visiting matron to head a new local chapter of Planned Parenthood in Montclair, New Jersey, Frank responded with a whistle. When a flock of the Gilbreths’ twelve children appeared in the parlor within nine seconds, setting a family record, the lady from Planned Parenthood, one Mrs. Mebane, nearly fainted. “Shame on you!” she shouted. “And within 18 miles of national headquarters.”
That memorable scene from Cheaper by the Dozen radiates the charm of another era. Today in 2003, the Planned Parenthood Federation of America (PPFA) and its global partner, the International Planned Parenthood Federation (IPPF), are scarcely 18 miles from any womb on the planet. The besieged and politically radical movement that planted its first clinic in a New York City brownstone in 1916 is now one of the largest nonprofit organizations in the world, with more than 60,000 distribution sites, an annual combined budget of more than $750 million, and an aura of establishment respectability that sometimes belies the group’s brute political power and relentless public-relations machinery.
The most recent report by the Chronicle of Philanthropy ranks PPFA the 54th largest charity in the United States, which puts it in the company of Princeton University and Notre Dame in private annual receipts. Confirming her agency’s status as a most unusual guardian of public health, PPFA president Gloria Feldt was quoted on April 13 in the Washington Post to the effect that her group would now enter U.S. presidential politics and “be a presence in Iowa and New Hampshire. It’s time for us to be involved at that level,” she said. Such is the media touch of PPFA that this statement was accepted uncritically by the Post, for PPFA was heavily involved in the 2000 presidential race. Its political wing, the Planned Parenthood Action Fund, financed 500,000 recorded-message phone calls from Barbra Streisand to targeted female voters urging votes for Al Gore. Another 500,000 e-mail messages from Whoopi Goldberg and other Hollywood stars were sent to prospective voters.
PPFA has long been an adept player at national politics. The Action Fund, through its Responsible Choices Action Network project, pursues the goal of converting clinic clientele into legislative and political activists for the organization, its government-funding streams, and its policy goals, particularly the maintenance and support of legal abortion. The Action Fund, like some of its pro-life counterparts, including the National Right to Life Committee, is recognized by the Internal Revenue Service as a 501 (c) (4) organization. This tax designation means that the organization is a nonprofit and generates little or no taxable revenue but that contributions to it are not tax deductible, as they are for 501 (c) (3) charities. These 501(c) (4) groups are free to develop separate Section 527 funds for political purposes, such as voter identification and get-out-the-vote drives, and membership political action committees (PACs) that give money directly to candidates or engage in independent spending on behalf of particular politicians.
The McCain-Feingold campaign finance reform law that took effect the day after Election 2002 essentially banned large “soft-money” contributions to political parties. While it imposed time limitations on “issue advocacy” advertising by 501 (c) (4) groups, limits that now face constitutional challenge, it left intact their ability to solicit unlimited contributions from individuals to support such advertising and other voter-motivating activity. The result: mammoth “soft-money” contributions to Section 527 groups like Pro-Choice Vote, the beneficiary of a onetime gift of $11.7 million from actress Jane Fonda. In fact, three of the top four and six of the top 25 Section 527 groups in the United States, measured in terms of gross receipts from January 2000 to March 2002, were singularly focused on the abortion issue. In contrast, not a single pro-life group was among the top 100 Section 527 groups. Planned Parenthood Votes came in at the third largest, according to Public Citizen.
Planned Parenthood’s Corporate Enterprise
PPFA’s growing role in political campaigns reflects its overall financial growth—a phenomenon that transcends changes in the political climate in Washington, D.C. In 2002 I undertook a detailed study of its financial and business prowess for the Gerard Health Foundation of Natick, Massachusetts. As the 30th anniversary of Roe v. Wade loomed, it seemed more important than ever to understand the social and business proficiency of PPFA, which has found a way to prosper no matter which party controls the White House or Congress. It also seemed clear that any health entity willing to spend so freely in the political arena must be able to generate the kind of excess revenues that elude pro-life groups.
Our study identified the elaborate structures that mark Margaret Sanger’s brainchild as a corporate enterprise with a New York Stock Exchange-style profile. Over the past few decades, even as its core business of marketing contraceptives stagnated, PPFA developed new functional arms; reorganized and eliminated underperforming outlets; internalized such routine business needs as property management, software development, and insurance; and turned a “profit” nearly every year. Nonprofits do not pay dividends to stock holders or pay taxes, but they can generate income in excess of expenses. For PPFA, net income from 1997 to 2001 was more than $300 million; nearly $126 million of that was in 1999 alone, the second to last year of the Clinton era.
Margins like these are all the more remarkable given the fact that there has been little change in the group’s client base, except in a few key areas. In 1990, for example, PPFA saw 1.8 million women for contraceptives. By 2000 that number had climbed only to 1.87 million, an almost negligible increase. (Men continue to populate sports bars at a much higher rate than they visit PPFA clinics—PPFA saw an average of one male patient per week in its 875 clinics nationwide in 2000.) During the same period, however, total PPFA income more than doubled, from $331.5 million in 1990 to $672.6 million in 2000. Even allowing for inflation, it’s hard to believe that the organization’s per-patient costs could have increased so dramatically in the 1990s.
Where does PPFA have significant client growth? Interestingly enough, only among abortion patients and women seeking the “morning after” pill. From 1990 to 2000, PPFA’s abortion turnstile clicked at an increasingly rapid rate, from 129,155 times in 1990 to 197,070 in 2000. The growth is all the more impressive given that the total number of U.S. abortions reported to PPFA’s research arm, the Alan Guttmacher Institute, declined by 300,000 over this period. Emergency contraception prescriptions, a megadose of oral contraceptive pills that women use “the morning after” intercourse in a process that’s occasionally abortifacient, jumped threefold—to 310,000—in a single year. Even the number of male and female sterilizations performed at PPFA is down significantly. The challenge to the organization’s reproductive hegemony is a daily concern: Each year PPFA must replace more than four in ten of its clients who either “graduate” from its programs or fail to return for continued services.
The Government Pays the Way
One genius of the PPFA enterprise is that despite its greening balance sheet and ever-deeper involvement in abortion over the past ten years, it has steadily enlarged its federal subsidies. While weaknesses and inconsistencies in the way government financing is reported on IRS tax returns make exact calculations of PPFA’s publicly funded share precarious, my analysis of the most detailed IRS 990s for PPFA affiliates suggested a government contribution of just over 39 percent. If that number holds up across the entire organization, then PPFA had income of some $262 million from government sources in 2000. PPFA’s 1999 annual report, however, asserted that 30 percent of its total revenue comes from government grants and contracts. Accepting PPFA’s own percentage brings the number to at least $202 million. Either way, Margaret Sanger’s campaign for free love continues to cost the taxpayer a heady sum.
Election of more pro-life members of Congress has resulted in some significant legislation but not—at least not yet—any reduction in the largesse PPFA enjoys from the U.S. Treasury. With Republicans in control of the White House and both chambers of Congress this year, the United Nations Population Fund has been denied a $35 million appropriation, unborn children have been deemed eligible for coverage under the Child Health Insurance Program, abstinence-education funding has been increased, and a new ban on partial-birth abortion is likely to become law. On the other hand, Congress has infused more money into Title X of the Public Health Service Act, the major conduit for family-planning grants that allow PPFA and other groups to expand the scope of their services or open new facilities. For decades, PPFA has used such grants to launch new initiatives and new affiliates, some of which receive more than 70 percent of their income from the government.
However, although tax subsidies to PPFA have increased, it can’t spend all the money. The excess income is being channeled into six-figure salaries, stock market and other securities investments (one PPFA affiliate in Iowa invested, appropriately enough, in Victoria’s Secret stock), and real estate that PPFA affiliates purchase and then rent from one tax-exempt entity to another—a common but very smart tactic for nonprofits. The money recirculates within the organization and bolsters its overall balance sheet.
Title X funds actually dwindled in the 1980s as the Reagan administration and George H. W. Bush blocked reauthorization of the program and sought passage of a new abstinence-education law, the Adolescent Family Life Act. But with the election of Bill Clinton, the floodgates opened and Title X spending ballooned from $150 million in 1992 to $239 million during his last year in office. The new momentum for Title X continued into 2003, as members of Congress spread butter on both sides of the bread, dramatically increasing abstinence funding while boosting Title X appropriations to an annual level of $275 million. PPFA centers receive roughly a quarter of this sum.
While public funding is critical to PPFA’s success and central to its claim to represent the American mainstream, the group’s official strategy dictates financial diversification. PPFA claims 700,000 donors. A loose definition might be at work in defining so many donors as active, but there’s no doubt that PPFA garners huge sums from direct-mail donations, major gifts, the “usual suspect” foundations, as well as, for IPPF, most Western governments and Japan. In fact, IPPF in 2000 drew more than 86 percent of its income from government sources, raising less than $2 million from individuals. IPPF’s agility in managing its government sponsors is so refined that within a year, it was able to appeal to foreign governments and recover 60 percent of the money it lost under President Reagan’s pro-life Mexico City policy.
The Pro-Life Movement Must Adapt
How can pro-life organizations cope with an opponent with so much public investment and such a well-developed strategic vision? For 30 years right-to-life activists have pursued a contrasting strategy. We have aimed to win legislative victories, not government contracts. We have held oratorical contests to sharpen our arguments, not national training seminars for executive directors, as PPFA does through the National Executive Directors Council, a separate ad hoc entity. We have viewed government as a force to be restrained, with prohibitions on funding practices to which we object, not as an ally to be harnessed for service to the goals of maternal and child health and sexual restraint. We have stinted on funding high-quality research, while PPFA has taxed its local centers to pay for research projects that anticipate and refute our arguments.
Schools of public health now train the next generation of PPFA leaders, and a new 25-year strategic plan for PPFA envisions the perpetuation of abortion-on-demand and the institutionalization of the group as one of the ten best places to volunteer and work in America. Right-to-life groups often state that they are working to put themselves out of business. PPFA has no such desire, and as a result advocates of life should be under no such illusion. The tangle over the sanctity of human life, and the ultimate meaning of human liberty, is the human condition. It will last as long as humanity itself, and it’s likely—as the debates over cloning and stem-cell research teach us—to intensify before it ebbs.
Fortunately, one component of President George W. Bush’s compassionate conservatism is a vision of government that actively supports, rather than undermines, family and faith. It is a vision that will be anything but easy to realize, but it contains some of the seeds of a pro-life renaissance. Just as it’s impossible to imagine serious progress being made against abortion in an environment where PPFA’s government funding is soaring, it’s impossible to believe that a culture of life can be built when the nation’s health-promoting institutions—especially the Department of Health and Human Services and the U.S. Agency for International Development—underwrite and encourage a culture of death.
Unlike PPFA’s New York Stock Exchange–caliber organization chart, the right-to-life movement looks like a Rube Goldberg improvisation, featuring ordered chaos that produces occasional success. Its 40 largest organizations have a combined income under $100 million per year, live a pay-check-to-paycheck existence, and seldom draft or follow strategic plans. That the pro-life movement has accomplished as much as it has while being organizationally overmatched is a tribute both to the workings of Providence and to the strong residue of pro-life sentiment in the American populace. The most recent national election brought pro-life gains in both houses of Congress. President Bush has engineered a tremendous victory against tyranny overseas. But we have been here before. In 1980 and in 1991, to be precise. The time has come for pro-life leaders, especially the generation that fought so many long and noble hours from 1973 to the present, to recheck and renew their game.
The pregnancy-care and abstinence movements are among the most impressive spontaneous social phenomena in American history. With the encouragement of national networking groups like Heartbeat International, CareNet, the National Institute of Family and Life Advocates, and the National Abstinence Clearinghouse, local groups have made real progress in medicalizing and marketing their services. They have drawn upon new resources in high-quality advertising, in ultrasound technology, and in survey research to help in such areas as promoting adoption and delivering abstinence education. They are perceived positively across the political spectrum, even as the depth and the details of their programs are not yet fully understood by the general public.
With any grace, and with the benefit of a second term for President Bush, the next phase of the work of these groups can begin. And if it does, it will start with something like PPFA’s sense of shared purpose, a desire to fuse volunteer spirit with professional excellence, and a conviction that government in the 21st century can affirm such values as life, marriage, family, and fidelity. If it continues, it will continue with new bonds of prayer and action among Catholics and evangelicals who recognize the transcendent meaning of their missions to mother and child. And if it succeeds, it will succeed with a renewed sense of the riot of life and the joy of generosity.