When Grace Larson started working at a Minneapolis Planned Parenthood clinic in the summer of 2021, she was thrilled. The organization had meant a lot to her as a young woman.
“I remember getting free pregnancy tests there,” she said. “I remember getting free health care at Planned Parenthood when I couldn’t afford it, and referring my friends to do the same.”
And yet, Larson said, her “rose-colored glasses” about her job had shattered by the following spring. In May 2022, Larson and 400 of her co-workers at Planned Parenthood of North Central States voted to unionize with SEIU Healthcare Minnesota and Iowa. In the process, they joined a national trend of reproductive health workers seeking union representation, from the Guttmacher Institute and the Center for Reproductive Rights to independent clinics nationwide. But it’s the effort at Planned Parenthood, the country’s name-brand provider — and employer — in reproductive health, that may do the most to make visible a workforce often overlooked in the furor over reproductive rights: the workers who actually make reproductive health care possible.
Since 2017, employees of at least 19 of the organization’s offices have begun publicly considering a union, campaigned for one, or won one.
As of publication, staff have, at minimum, announced their intent to form unions at two national offices, one advocacy affiliate and the 239 health centers managed by 16 of Planned Parenthood’s 49 health care affiliates — regional offices that coordinate clinics. Capital & Main has also identified workers from three more affiliates in a national online chat where Planned Parenthood workers trade advice on poor working conditions, the rushed care they say is a result, and whether unions should be part of the solution.
Workers say that one source of their discontent comes from divides between the leadership of Planned Parenthood Federation of America, a national advocacy nonprofit, and staff doing direct care in clinics. The most obvious divide is financial. Fundraising revenue for the national federation almost doubled between the election of Donald Trump in 2016 and the week of the Dobbs decision in 2022, when it reached $454 million. (Data after July 1, 2022, is not yet publicly available.)
Sarah Jaffe, author of the book Work Won’t Love You Back: How Devotion to Our Jobs Keeps Us Exhausted, Exploited, and Alone, who has written about labor issues within reproductive health spaces at length, said her sources within Planned Parenthood have repeatedly noted the so-called Trump bump post-2016. “Everybody was donating to the ACLU and Planned Parenthood, which, not coincidentally, both had union struggles going on,” Jaffe said. “There’s a real sense that there’s money coming into this organization, [but] it’s not being spent on the right thing.”
In Nebraska, Ashley Schmidt, who helps train new workers and oversees professional development within Planned Parenthood North Central States, told Capital & Main that her starting salary in 2019 was $15 an hour. Schedulers routinely overbooked appointments, creating massive wait times, frustrated patients and rushed medical care. Turnover at the office was striking, and it continued to worsen — during contract negotiations last year, it climbed to 44%.
Schmidt earned so little, she recalls, that her utilities got shut off. To continue working that winter, she began taking calls for work in her car, which was heated, instead of her home, which was not. Both Schmidt and Larson say they have colleagues who’ve worked second jobs to make ends meet. And they point out, too, that overburdened workers will struggle to provide good care.
“We’re human beings that don’t even get a lunch break, so we’re running on empty tummies and we’re rushing to get through it,” Schmidt said. “We’re always trying to be the best caregivers that we possibly can, but we’re also human beings and human errors are going to be inevitable when we’re overbooked and underfed.”
Jaffe explains that people go to work at places like Planned Parenthood because of their dedication to a cause, and workplaces sometimes exploit that desire for meaningful work.
“Planned Parenthood sort of [takes] full advantage of that, frankly, saying, ‘This is mission-driven work and you’re gonna make up in feeling good about yourself what you’re not going to get paid,’” Jaffe said. It doesn’t help, Jaffe added, that “at places like Planned Parenthood, you get sort of the worst of the health care industry and the worst of the nonprofit industrial complex.”
That seemed to be the case in western Pennsylvania, according to Crystal Grabowski, now a union leader with UE Local 696, who first began discussing a union with their colleagues at Planned Parenthood’s western Pennsylvania affiliate in 2019. The threats to reproductive rights had flooded clinics with patients just as funding boomed, piling onto a do-gooder culture that already tended towards overwork. Then the pandemic hit. Suddenly, workers began to feel like their very jobs meant serious risk to their health — and perhaps even their lives. “It had been hard to talk about the union before, but COVID made it easier,” said Grabowski. “People were like, ‘Oh, I’m being exploited — I’m an essential worker, but I don’t get paid well.’”
Larson, in Minnesota, says that assessment aligns with her experience.
“The mission is how they’re able to exploit their workers, because we love the patients,” said Larson. “We do this for the patients.”
Workers also object to what they say is a cultural divide between higher-earning executives in regional and national offices, and the majority of clinic staff, from receptionists to nurses.
In Colorado, Ashley Brink, a traveling health center assistant working for Planned Parenthood of the Rocky Mountains, voted for a union in 2017 partly to address what she called ”a disconnect” between the local staff and management. “A lot of times, people in leadership or in management had never have never done the jobs of health center staff, have never had those conversations with patients, have never stepped foot in health centers for more than 15 minutes to say hi,” she said.
Beyond the cultural divide that Brink mentions between boots on the ground versus executives in offices, there’s a yawning gap in salaries between the two groups. Workers across the affiliate’s 24 clinics had begun considering a union that year, to address what they say were low wages, overbooked scheduling and high turnover. Then, in 2017, the Planned Parenthood affiliate shuttered six clinics with little warning — including the organization’s only clinic in Wyoming. The announcement came a year and a half after a deadly shooting at the Colorado Springs clinic which, paired with the election of Donald Trump, resulted in record donations, Brink noted. (According to tax documents, Planned Parenthood of the Rocky Mountains’ revenue and assets have more than doubled since 2016.) “What it felt like for me was that we were just going to remove the services and leave this gaping hole in the community without affordable reproductive health care,” said Brink.
The closures pushed workers to organize, and in December 2017, a majority of the affiliate’s workers voted to unionize with SEIU. In response, Planned Parenthood of the Rocky Mountains challenged the vote with the National Labor Relations Board. It also hired Fisher Phillips, a law firm whose website advertises a specialty in union “decertification campaigns” and previously offered “union avoidance” services. (Eventually, the affiliate and SEIU came to an agreement outside of court. In September 2018, they signed a contract.)
In Minneapolis, the unionization effort Larson, Schmidt and their co-workers launched in spring 2023 became a pitched battle.
Workers noted how limited resources seemed to be in clinics — and the scale of executive compensation. In fiscal year 2021, Planned Parenthood North Central States paid its chief operating officer, Cindy Kaiser, $532,522 in salary and $33,863 in additional compensation. “It was three years before I got my first raise at Planned Parenthood,” Schmidt said. Her initial $15 per hour wage translated to roughly $30,000 a year, when a living wage for her family was closer to $78,000. “While it is certainly not about the money when you work for a nonprofit, we cannot pay our bills with a mission statement,” said Schmidt, adding that during a raise freeze, the salary of Planned Parenthood North Central States’ then-CEO increased, stoking the workers’ determination to unionize.
Tensions escalated after workers voted to unionize in July 2022. Contract negotiations were slow, say workers, and coupled with management hostility. “The union-busting started as soon as we unionized,” Larson said.
In spring 2023, Planned Parenthood North Central States management informed Larson and 11 other members of the union’s bargaining team that “final warnings” had been placed in their personnel files after management apparently obtained a copy of an encrypted chat indicating that workers were organizing. The next infraction at work, even a paperwork error, could be grounds for firing someone. When Larson sent a personal email last March to a partner organization accusing a co-worker of assault, there was no warning left. Larson said the manager of human resources fired her “on a five minute Zoom call.” SEIU filed an unfair labor practice complaint against Planned Parenthood North Central States, charging that the affiliate had fired Larson in retaliation for union organizing; the case remains open with the National Labor Relations Board.
Management’s resistance to the union’s demands was so profound that in fall 2023, SEIU Healthcare Minnesota rescinded its endorsement of the state representative who’d recently taken on the job of CEO, Ruth Richardson.
Neither Planned Parenthood North Central States nor Planned Parenthood Federation of America returned repeated requests for comment. The former has said in prior media statements that “no staff have been disciplined or fired by PPNCS for union organizing, however, unions are not designed to be a shield for misconduct.”
It took 37 bargaining sessions over 16 months before workers and Planned Parenthood North Central States agreed on a tentative contract this past January. The contract guarantees an initial 4.5% wage increase, a $19 minimum wage, lower employee premiums for health care and expanded bereavement leave.
Still, one unanswered demand left workers wary: Management refused to pay a $1 hourly premium to workers providing the abortion services that drive donations. “I am happy that we have these protections, but at the same time, I am disappointed in what we ended up with,” said Schmidt.
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