A union organizing wave has swept through abortion clinics over the past few years, from California to Ohio to Pennsylvania, prompting a battle not just for working conditions but for the soul of the reproductive rights movement. The questions union activists face in the reproductive justice field are not just strategic but existential: In our post-Dobbs world, with a second Trump administration looming and further criminalization of abortion likely, does unionization distract from the larger fight of providing abortion care — or does a worker-centered approach actually ensure it?
In clinic after clinic, from Planned Parenthood affiliates to beleaguered independents, union activists are trying to find answers to these questions, opening the possibility for a radically different organizing direction away from fundraising and lobbying and toward workers and patients. What’s at stake is higher wages for clinic workers. Obviously. But it might also be a way to build a fighting, grassroots movement that can defend — and maybe expand — abortion care across the country.
In the spring of 2023, Debbie started having conversations with her coworkers at Planned Parenthood Northern California about forming a union. (Debbie asked to be identified only by her first name to avoid retaliation from her employer.) She and her colleagues were stressed by loads of new patients in the aftermath of the Supreme Court’s decision in Dobbs, which overturned Roe v. Wade and triggered a wave of new abortion restrictions. Many new patients were coming from Texas and Arizona, where they could no longer access abortion care. Debbie felt frustrated by the infrequent and inadequate pay raises. Above all, she was committed to providing high-quality, stigma-free care to patients and saw a union as the best way to do that.
Debbie’s criticisms of her workplace were so sharp because working at Planned Parenthood wasn’t just a job for her but part of her deeply felt political commitments. Before she became a clinician, Debbie did reproductive rights advocacy work at a nonprofit called Choice USA. “I view myself as a reproductive rights activist, and I carry that activism into my work at Planned Parenthood,” says Debbie, who started at the Northern California affiliate as a clinician in early 2023. “Even if I wasn’t working as a clinician, I would be doing this activism elsewhere.”
The growth of abortion clinic organizing in recent years has been thrilling to watch. Workers at clinics across the country are forming unions and demanding higher pay, more staff, and more of a say in how they provide care to patients. Since 2017, employees of at least 19 of Planned Parenthood’s 49 affiliates have campaigned for or won unions, including 16 regional affiliates, two national offices, and one advocacy affiliate. Unionization campaigns increased during the pandemic, when workers were especially frustrated with what they saw as a lackluster response from management to heavy workloads and safety concerns. Even more clinic workers turned to unions in the aftermath of the Dobbs decision, as out-of-state patients strained already overstretched and burnt-out staff in states where abortion was protected.
A major source of dissatisfaction for unionizing workers in a number of states is the divide between the priorities of Planned Parenthood as a national advocacy organization, spending millions of dollars on legislative and electoral campaigns, and those of the workers doing direct care provision in the organization’s 600 clinics.
It’s not just clinic workers but also abortion funds (which provide financial and logistical support to pregnant people seeking abortion care) that have questioned how movement resources are being used. In August 2024, a collective of 34 abortion funds published an open letter in The Nation that criticized a new initiative called Abortion Access Now, a 10-year reproductive rights advocacy campaign organized by a coalition that includes Planned Parenthood, the ACLU, the Center for Reproductive Rights, and Service Employees International Union (SEIU), the union that represents the majority of unionized Planned Parenthood affiliates. The organizations that make up the new campaign have pledged $100 million toward building “a long-term federal strategy to codify the right to abortion, including lobbying efforts, grassroots organizing, public education, and comprehensive communication strategies to mobilize support and enact change.” The campaign website emphasizes that it will be “engaging in meaningful conversations” with supporters and providers, in addition to politicians. All well and good. But critics point to the lack of details for this costly initiative and question what distinguishes this strategy from the losing one that got us here in the first place — a strategy that prioritizes lobbying and federal policymaking over supporting clinics.
“This campaign is a gross abuse of funding and publicity that deprioritizes actual access to abortion care right now,” says the letter, calling attention to Planned Parenthood’s enormous resources — including a $275 million donation from one donor in 2022. “Now is not the time to put policy advocacy and wealth hoarding over material support. Now is the time to dig deeper into the work that is happening in our communities,” the letter ends. Unionizing clinic workers argue that making their jobs sustainable is one of the best ways for Planned Parenthood to materially support the movement, as well as patients.
Fundraising revenue for Planned Parenthood almost doubled between the election of Donald Trump in 2016 and 2022, so-called rage donations that reached $454 million. Even though donations decreased in 2023, the organization still brought in $378 million. The combined annual budgets of Planned Parenthood’s national and global offices and its affiliates amounted to $1.7 billion last year. While some money went to fund care for low-income patients, clinics themselves saw little of this windfall, and some are now working with even smaller budgets than they had in 2022 — at the same time that demand is higher for the clinics still open after Dobbs.
In the face of a devastating political climate and budget cuts at many clinics as donors move on to other issues, there is a growing sense among workers and supporters that Planned Parenthood is choosing to spend its money on the wrong things. For instance, clinic workers at Planned Parenthood Northern California have been told there’s not enough money to pay staff higher wages, pitting providers’ needs against their patients’, according to Debbie and Genna, another clinician who has been there for over six years.
“We heard from management even before bargaining began that there wasn’t enough money to improve pay, that any money for staff will come out of patient care,” says Genna, who also asked to be identified only by her first name. “But we know there’s more money that can make conditions better for workers, and we are pushing back.” (Planned Parenthood of Northern California disputed the workers’ account.) Other reproductive rights nonprofits have used similar tactics in the past to pressure workers to accept lower salaries. “If we pay you more, that’s less money for the women that we’re serving,” said Vicki Saporta, the former president and CEO of the National Abortion Federation (NAF), according to former employees quoted in Huffington Post in 2018. (Saporta denied making the comment and is no longer affiliated with NAF.)
“Now I might have eight exam visits back-to-back, and I’m totally fatigued.”
Pitting patient interests against clinic workers’ needs exposes a longstanding tension between the leadership of national reproductive rights nonprofits and the clinic workers and abortion funds providing direct services to patients. With the fall of Roe, clinics are adapting to a quickly changing legal landscape and feeling the strain as patients flood out-of-state clinics. After the strong outpouring of financial support in the rage-donation era directly after Dobbs, clinics, funds, and large repro organizations all saw donations wither in 2023. To take one example: Citing a decrease in donations and growing demand as patients are forced to travel farther for care, Planned Parenthood’s national Justice Fund announced in July 2024 that it would only subsidize 30 percent of costs for low-income abortion seekers, a decrease from the previous cap of 50 percent in most states. The impact of this change was immediately felt at cash-strapped clinics and local abortion funds, which were left to fill in the gaps.
The entire repro movement is facing an onslaught of well-funded legislative attacks from the right, and much of the movement’s resources are going to legal defenses in state after state. That donations are dwindling just as need on all fronts has grown is a recipe for disaster. In asking for better pay even amid a budget crunch, workers are pointing out that they are at the frontlines of the emerging crisis in reproductive care. A union is one of the few tools workers have to protect themselves and their patients because they’re the ones who are feeling the strain most acutely.
The union campaign at Debbie’s Northern California Planned Parenthood affiliate faced resistance from management immediately, she says. Soon after going public in January 2024, the union tried to get voluntarily recognized. A few months later, it was forced to remove lead clinicians with clinical supervisory roles from the bargaining unit (the union has filed a complaint with the National Labor Relations Board [NLRB] to reinstate them). Finally, in April, the union was voluntarily recognized by management of the affiliate.
In bargaining their first contract, Debbie and her colleagues hoped to address pay, especially for physician assistants. Another issue, Debbie and Genna say, was the lack of transparency and little advance notice for abrupt policy changes, especially ones that impacted pay — which began occurring after the union went public in January 2024 but before it was formally recognized by management. One physician assistant was expecting a 4.5 percent merit increase, but after a sudden policy change, she got 3 percent. When the clinic started a pilot program to see patients on Saturdays, management originally offered staff incentive pay, but that was cut with two days’ notice, and everyone was required to take Saturday shifts. Clinic staff circulated a petition pushing back against the unpopular and unilateral policy changes made since the union effort began, collecting 270 worker signatures and another 700 community signatures.
Providers have also been exasperated by changes affecting patient scheduling, according to Debbie and Genna. There had been caps on the types of appointments scheduled each day so that clinicians could intersperse labor-intensive exam visits with shorter and less physically demanding counseling sessions. That policy was changed at the affiliate, again with just a couple days’ notice. “Now I might have eight exam visits back-to-back, and I’m totally fatigued. It makes it challenging to provide the high standard of care I want to provide,” says Genna.
The pay policy of travel stipends for float providers also changed with little warning, the clinicians told me. Float providers who travel to rural clinics in the region are given travel stipends to cover gas, food, and car maintenance. In the spring of 2024, the stipend was changed from $77 an hour to $21 an hour, amounting to a $10,000 a year pay cut for the 15 to 20 float providers in the affiliate. Debbie and Genna voiced concerns that rural clinics might have to close on days they can’t find providers able to travel and that float providers risk being maligned unfairly by management, which sometimes claims that “you don’t want to serve your patients in these remote communities,” says Genna.
In a statement, Planned Parenthood Northern California said that the “questions posed about our procedures, statements, and community partnerships are misleading and false. In fact, we know that our employees are the key to fulfilling our mission, and that their expertise is at the center of everything we accomplish, which is why we are focused on caring for them, just as we care for our patients.” The statement went on to say “we are bargaining in good faith to reach a first contract that further supports our staff and continues to create a positive work environment.”
It’s entirely possible that every Planned Parenthood clinic could be unionized in the not-too-distant future. The Planned Parenthood Keystone union in central and eastern Pennsylvania was voluntarily recognized by management in March 2024. The decision to unionize came after massive layoffs in the summer of 2023, which occurred despite a $7.5 million donation in March 2022. Workers at Planned Parenthood North Central States and Planned Parenthood League of Massachusetts announced plans to organize within weeks of the Supreme Court leak indicating the court’s intention to overturn Roe. Clinic staff at Planned Parenthood of the Pacific Southwest won a three-year agreement in July 2024 that raises wages by 15 percent over three years, the first union contract for any Planned Parenthood workers in California.
The collective power of thousands of unionized workers could shift the direction of Planned Parenthood nationally and could even exert enough influence to realign the wider reproductive health, rights, and justice movement toward more radical priorities. For example, in 2022, around the time of the Dobbs decision, a loose group of reproductive health workers active in their unions organized on Instagram and Twitter and started an account called ReproWorkers. They shared their experiences organizing their workplaces and connected people who reached out with questions to labor organizing resources and to others in similar workplaces. Workers from Planned Parenthood affiliates, independent clinics, and reproductive rights organizations like NAF and the Center for Reproductive Rights found a community focused on building stronger connections between the labor movement and the reproductive health, rights, and justice field.
Platforms like this one are part of how unionized repro workers are challenging the policies of Planned Parenthood leadership and building support for a different set of political priorities. When a May 2024 article in Prism exposed Planned Parenthood’s years-long relationship with weapons manufacturer Raytheon for IT and cybersecurity services, many in the repro field were outraged. ReproWorkers organized a public statement calling for Planned Parenthood to immediately divest from Raytheon, signed by over 1,000 Planned Parenthood supporters, patients, donors, and current and former employees of both the national office and local affiliates.
A previous petition organized by ReproWorkers in December 2023 opposed Planned Parenthood Federation of America’s weak statement in response to the Hamas attack on October 7 and Israel’s military campaign in Gaza. Signed by over 500 Planned Parenthood union members, employees, and supporters, the statement called for an immediate and permanent ceasefire in Gaza. “To truly chart a path towards reproductive justice for all, Planned Parenthood must call on political leaders to stop supporting Israel’s mass slaughter with billions of dollars in military aid — money that could fund health care access here in the U.S.,” says the statement. This organized response to Planned Parenthood’s position on the genocide in Gaza and the pressure exerted by unionized Planned Parenthood workers points to a new relationship between clinic workers and the national organization. But it remains to be seen whether this new relationship can change Planned Parenthood’s political positions or shift its priorities when it comes to redistributing funds.
Long before Instagram organizing was a thing, an activist in the repro field noticed how difficult it was to find jobs without any connections. A friend of hers had just graduated and wanted to work at an abortion clinic or repro-focused nonprofit but struggled to find a job, especially one that offered health care benefits. “I was in bed rewatching Star Trek, and I just made a logo and a website. Two of us just started posting jobs when we found them, put them up on Twitter and Facebook, just to help new people find jobs. We were trying to help solve a problem for a friend and didn’t intend to create a big org.”
ReproJobs amassed a social media following quickly. Soon, it was advocating for transparency about salaries and benefits as a way of making the field more accessible.
“Then, in the summer of 2015, Sandra Bland had just been murdered. I was at a policy meeting for my day job, and everyone was going around the table acting like nothing had just happened, I was so upset that no one else was bringing this up. Everyone was moving on, just business as usual,” says the ReproJobs founder, who has chosen to remain anonymous to protect herself from professional retaliation. ReproJobs started posting about racial justice and police brutality. “It felt like a larger issue that was a problem with the entire repro movement, that racial justice was not an issue that we were for real fighting for.”
Out of the blue in 2019, ReproJobs was offered funding from a sympathetic follower. When asked what they would do with money to grow their small operation, the ReproJobs founders said they wanted to help unionize the reproductive health, rights, and justice field. The funder, the daughter of a union member, heartily endorsed the project.
Newly funded, ReproJobs launched a blog and started a newsletter. It hosted a webinar on how to unionize your workplace. It hired a former clinic worker and union organizer to start a column called “Ask a Union Organizer” to offer advice to clinic workers. It produced reports looking at the salaries and benefits offered by clinics and repro nonprofits, showing how far behind many organizations lagged in terms of worker benefits like parental leave.
ReproJobs found that unionizing seemed strangely contentious in an otherwise progressive field. “A challenge for our movement is that I heard people talk about labor organizing as a ‘them’ problem; for working-class people, not for us,” says the founder of ReproJobs. “Repro wasn’t talking about clinic staff as workers; we saw ourselves as part of the movement, not workers. We needed people to understand that we are all deserving of fair wages and benefits.”
After Roe was overturned and clinics in states with bans shut down or reduced their services, ReproJobs started an emergency fund for workers who lost their jobs, distributing around $1,000 to each worker who applied. It also hired a resumé and interview coach to help laid-off repro workers find jobs in related fields.
When ReproJobs was founded, there were two unionized repro workplaces in the country. Now there are over 50. The founders sunset the organization in July 2024, 10 years after its humble start. “It’s okay for things to exist for a moment,” says the founder. “Our job was to build a movement to help workers thrive, and I think we did that. We need labor to keep taking us seriously, but we also need to take labor more seriously.”
Planned Parenthood executives have changed their approach to labor organizing in recent years; multiple affiliates’ unions have been voluntarily recognized, though not without their own fights and obstacles. “Four years ago, I never would have expected any affiliates would voluntarily recognize a union,” says Crystal Grabowski, a United Electrical, Radio and Machine Workers of America (UE) bargaining committee member and a former health care assistant at Planned Parenthood in Western Pennsylvania. “It’s great to see Planned Parenthood change their tune now that they’ve seen where things in the labor movement are going.”(Planned Parenthood’s national organization did not reply to a request for comment.)
“The most difficult part was how to bargain for a contract for a clinic that might not exist soon.”
Some of the starkest tensions in today’s growing repro labor movement stem from organizing in an increasingly hostile political environment. Under Trump’s previous presidential term, he implemented a “domestic gag rule” to Title X, the federal family planning program, blocking federal funding to any health care clinic that offers abortion care or refers patients to other facilities for abortion care. Close to 900 clinics nationwide lost federal funding, including every Planned Parenthood clinic. It’s likely that will happen again, which could lead to further budget shortfalls and unwillingness to spend more money on staff salaries and benefits. In moments of crisis, as abortion clinic workers have seen, they are expected to sacrifice for the good of their patients.
At the same time, donations to reproductive rights organizations spike around major national threats to abortion access. There will likely be another Trump bump of donations to pro-choice organizations when he takes office and calls for a “minimum national standard” (a.k.a, a national abortion ban) or for the nineteenth-century Comstock Act to be enforced, banning the mailing of abortion pills. It’s possible that the infrastructure and networks built by unionizing might give frontline clinic workers a vehicle to exert collective influence on how Planned Parenthood navigates these upcoming years of financial and political uncertainty.
Another inherently contradictory issue that unionizing clinic workers are facing is how to organize their workplaces when, depending on constantly changing state laws, their work may be criminalized and their clinics closed. “The most difficult part was how to bargain for a contract for a clinic that might not exist soon,” says Lauren Rump, a patient advocate at Preterm, an independent, nonprofit abortion clinic in Cleveland, Ohio, where workers unionized in 2022. “We got a lot of the things we wanted because management assumed it wouldn’t matter once the clinic closed,” adds Rump, including three months of severance pay with health care coverage, the creation of patient care and labor management committees, and a staff representative at all board meetings. The clinic is still operating after Ohioans voted to protect abortion rights in the state constitution in November 2023.
Union contracts are already leading to better patient care, decreased staff turnover, and more stability in a highly stigmatized and isolated area of health care. If unionized clinic workers haven’t exactly turned Planned Parenthood in a more radical political direction, there are many who see their union campaigns as an important part of growing a base to challenge both right-wing and ineffective Democratic control of reproductive rights agendas. “When clinics like Planned Parenthood identify with the rich Democratic donors, we are separating ourselves from our base of supporters,” says Grabowski. “When we started the union, we had more conversations with people in the community. We’re not seen as a cause that people can donate to but as neighbors, and that creates a healthier, protected base for abortion care.”
Anne Rumberger is a freelance writer and an activist with Chicago for Abortion Rights.
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