The Struggle to Unionize Planned Parenthood in Texas

A Bid to Transform Abortion — And the Labor Movement

By Amy Littlefield

Illustration By Somnath Bhatt

An illustration of the Planned Parenthood logo held up by workers

Last spring, several weeks after she was forced to lay off all six of her employees at Planned Parenthood’s North Austin Health Center, Katie Dickerson was summoned to a Zoom meeting. On the screen was a balding attorney named Michael Abcarian. His law firm, Fisher Phillips, helps employers with “maintaining your union-free status.” Dickerson would later write that the meeting left her so terrified for her job that she spoke of it only to her mother.

Dickerson is a single mom of three for whom working at Planned Parenthood of Greater Texas (PPGT) was a dream job. She ran a water-damage restoration business before starting work in 2018 for the organization she saw as the “beacon of the choice movement.” Despite not having finished college, Dickerson worked her way up to earning $58,000 a year as a multisite manager. She loved overseeing the health center assistants, who were as dedicated as she was to the organization’s mission. “I had set my path in life,” she recalled. 

Beloved by her staff, Dickerson saw herself as a liaison between the health center assistants, who did the day-to-day work of running the clinic — everything from monitoring the front desk to taking vital signs and counseling patients — and the executives of a sprawling affiliate that spans hundreds of miles.

Then Covid-19 hit. At Planned Parenthood’s three Austin locations, long-simmering frustrations boiled over. Workers had previously complained about understaffing, inconsistent training, and low pay. But now, in the absence of clear direction in the early days of the pandemic, they were forced to devise their own safety protocols, improvising screenings and lower-contact ways of seeing patients. 

“We were acting faster than management was delivering because we knew that it was our health and our family’s health at risk,” Emily Binford, a health center assistant at the South Austin location, told me. After staff complained about a lack of sinks for handwashing, the Central Austin facility was shut down for renovations and most of the employees were moved to North Austin,  raising concerns about social distancing. (PPGT said policies and information regarding the coronavirus were emailed to center managers in January, February, and March.)

Even as the workers grappled with fear of Covid, they found themselves on a traumatizing new front in the abortion wars, as Texas officials seized on the pandemic as an excuse to ban most abortions. Binford had to call patient after patient, cancelling their appointments. “That’s honestly the worst thing I’ve ever gone through, is telling desperate people that they can’t get the procedure that they need,” Binford said. The workers kept a spreadsheet so they could call patients to reschedule as soon as the courts granted a reprieve. Of the three Austin clinics, Binford’s in South Austin was the only one that offered surgical abortions. 

The crisis highlighted how essential the clinic staff’s work was and how little support they were getting in return. Then, at the end of March, Ken Lambrecht, the CEO of PPGT, told staff that they would not be paid beyond their normal allotted time off if they had to stay home due to Covid-19. The affiliate claimed an exemption from a federal law that required employers to provide extended leave for Covid-related reasons. 

“I think that was the point where we all kind of broke a little bit,” said Francesca Rae, a health center assistant in North Austin. She remembers looking around at her coworkers in shock when Lambrecht announced the news during a Zoom meeting. It was their lunch break. Patients were waiting outside. Lambrecht and the rest of the executives, meanwhile, were working from home. “So, we’re being told that we don’t have any more paid leave for Covid while we’re about to come face to face with a whole bunch of patients who are waiting to get in at the end of our lunch hour and you’re telling us this from your house?” Rae recalled. 

The staff in Austin, who had been messaging and meeting off-site for months to talk about forming a union, got to work. 

“We said, ‘hey, not only is this egregious, but this is a great opportunity to get other people in the affiliate on board with what we’re trying to do, because now these problems are so obvious and so acute,’” said Ella Nonni, a health center assistant in North Austin. Workers in Austin messaged colleagues in far-flung centers across the affiliate. 

The pushback was immediate. When Nathalie, a health center assistant in South Austin who asked that her last name be withheld due to concerns about retaliation, reached out to a colleague at another health center, that employee alerted the affiliate’s security officer. He messaged Nathalie and her managers, instructing her not to text any other employees who she didn’t know personally. A day later, someone leaked a petition the Austin workers had written to demand paid Covid leave, hazard pay, and a delay in nonurgent visits, emailing it to a senior manager.

Three days later, the layoffs began.  

The pandemic lit a fire under unionizing campaigns across the nonprofit sector. Workers who had often been willing to sacrifice their wellbeing to their employer’s mission rose up to demand a greater say in how that mission was carried out. In Planned Parenthood clinics, where workers face the same precarious conditions as at many other non-profits, combined with the risks and time pressures of providing health care, long-standing frustrations crystallized into a matter of life and death.

Workers in the reproductive health sector face an additional set of challenges when they organize because of the political stigmatization of abortion. When Ella Nonni went public, denouncing her layoff as retaliation for the union campaign in an interview on news station KXAN, the anti-choice group Live Action, known for its secret, deceptive videos of Planned Parenthood employees, was one of the few outlets to amplify it. Supporters of Planned Parenthood, meanwhile, slammed Nonni in anonymous comments posted to the petition when it was publicized online. “It is sad you were laid off, but do you realize Other Non- profits in Austin also laid off employees,” one comment read. “It doesn’t mean the organization doesn’t care. Thanks for giving Governor Abbot ammo.” (A reference to Texas’ Republican governor, Greg Abbott.)

“Planned Parenthood is the Walmart, is the McDonald’s of our field.”

“You’re demonized by both sides,” Binford reflected. “People are anti-union anyway but then even people that are pro-union have trouble reconciling the Planned Parenthood that they see or the organization that they see in the media that fights for justice with the fact that we’re saying that we’re being unfairly treated as workers. And there’s this incredible amount of loyalty to Planned Parenthood. Like, I feel guilty talking with you about Planned Parenthood because it’s ingrained in us to be loyal.”

It’s hard to overstate the role of Planned Parenthood both as a political force and a provider of reproductive health care. In the 2020 elections alone, it vowed to spend $45 million to support pro-choice candidates. Its health centers, run by local affiliates, serve millions of patients, offering a range of services, from gender-affirming hormones to pap smears, often on a sliding scale. Many a teen has turned to Planned Parenthood when they have no other option for birth control or STI testing — and many of these patients later go on to work for the organization. The name Planned Parenthood has also become all but synonymous with abortion, even though unaffiliated clinics provide 58 percent of such procedures, making it the target of relentless political attacks and even violence from the right. 

At the same time, Planned Parenthood faces criticism from the left for its political strategy of downplaying its role as an abortion provider and for workplace issues at its affiliates. Like many nonprofits of its size, the organization has come to mirror the anti-labor model of the corporate world. Workers at several affiliates have accused their bosses of trying to stymie union drives, with the most high-profile fight happening at Planned Parenthood of the Rocky Mountains. 

“At Planned Parenthood, we support the right of all workers to unionize,” Adrienne Verrilli, vice president of communications at Planned Parenthood Federation of America, said in a statement. “Planned Parenthood’s skilled, dedicated staff are at the core of who we are, and we are committed to creating a positive environment for them while mitigating the harmful effects of the ongoing pandemic as much as possible.” The national office does not have control over personnel decisions at the 49 affiliates, Verrilli added.

“Planned Parenthood is the Walmart, is the McDonald’s of our field, and they have the most power over workers in our slice of the work and so of course they would receive the most criticism,” Ksenia Varlyguina said. She and her co-workers organized a union at Planned Parenthood Global in Miami. Weeks after securing an agreement on their first contract in 2018, Varlyguina and five others in the 11-member unit were laid off in what Planned Parenthood said was a financial move due to a loss in grant funding.

Now, staff at 10 of Planned Parenthood’s 49 affiliates and its national offices in Miami, New York City, and the District of Columbia are all unionized, according to the organization. “There’s no stopping what we’ve all started,” Varlyguina said.

The conditions faced by thousands of Planned Parenthood workers are far from unique. Nonprofits of any stripe are beholden to wealthy donors who want to fund marquee projects with trackable outcomes rather than invest in unglamorous line items, like salaries, that build sustainable organizations. 

“Overworked, burned-out workers are not simply extra-passionate: they are exploited,” Sarah Jaffe writes in her new book Work Won’t Love You Back. “The system allows rich philanthropists to reap the tax benefits of their charitable giving while maintaining control over their fortunes.” As Jaffe notes, workers committed to an organization’s mission have often been willing to accept such exploitation as the price of doing meaningful work. That is shifting. 

Since 2016, workers at roughly two dozen reproductive-health-related organizations have formed unions.

Since 2016, workers at roughly two dozen reproductive-health-related organizations have formed unions, including the Center for Reproductive Rights, ACLU chapters, and Emily’s List, according to the organization ReproJobs. The #MeToo movement and a national reckoning over racial injustice have fueled public airings of racism and abusive behavior in nonprofits often run by older, white feminists. Staff uprisings have ousted leaders at National Organization for Women (NOW), International Women’s Health Coalition, Women Deliver, Planned Parenthood of Greater New York, and Planned Parenthood Pennsylvania Advocates, where workers forced out a CEO and a board chair before winning voluntary recognition of their union.

These workers are organizing to advocate for themselves and to build a more sustainable movement based on the understanding that the well-being of workers is intertwined with that of those they serve.  

“I always made it really clear that if I was working for the community that community included the workers,” said Lola, who worked in education at PPGT and asked to use a pseudonym to preserve her relationship with former colleagues. For Lola, joining the union organizing committee felt like a step toward reproductive justice, a term coined by Black women organizers that broadens the concept of reproductive health from a narrow focus on abortion. Encompassing a range of issues, from police violence to paid parental leave, reproductive justice includes the right to have or not have children and to raise those children in safe and sustainable communities. For Lola, union organizing got to the core of reproductive justice because it meant working to create “safe conditions that we can all thrive in.”

The push to unionize in the reproductive health sphere has coincided with the growing embrace of the reproductive justice framework, and that’s no coincidence. Both tendencies are animated by the feeling that mainstream feminist nonprofits have not prioritized racial and economic justice for their staff or in their advocacy. 

“I think that especially with our organization, having these leaders, we’re never going to get there,” said Emily Escobar, who was, until recently, national campus organizer at the Feminist Majority Foundation (FMF).  Staff there unionized after The Lily exposed racism among FMF leadership; they saw a union as the way to address these concerns. “We need to pass on the torch to the young people, the folks of color who have the knowledge and the experience about what is needed to radically transform our systems,” Escobar said. 

Workers like Escobar have found solidarity and support through ReproJobs, which started as a job-posting site but has morphed into a kind of digital workers center for the reproductive health industry. ReproJobs is run by activists who call themselves Hermione and Luna, carefully guarding their identities so they can give full-throated support to workers within such a close-knit space. They amplify worker complaints about racism and union busting, host unionization trainings, collect salary data, and connect workers to each other. 

“From what we’ve seen, it’s kind of like organizing begets organizing. The more that people see that others in the field have done it, the more they feel like, OK, maybe we can do it,” Hermione said. “We often put people in touch with each other behind the scenes, especially at affiliates of larger organizations.”

Emily Likins-Ehlers, a doula and former union organizer, writes a column for ReproJobs fielding queries like “How do I pick a non-problematic union?” Union leaders don’t always prioritize abortion, but Likins-Ehlers believes that can change as abortion clinic jobs become union jobs. 

“If SEIU has a nursing home that’s shutting down, every worker, whether they work at that nursing home or not, is part of the solidarity movement to keep those doors open and to save those union jobs,” Likins-Ehlers said. But when Montana, where they used to work at a clinic, passed a series of bills targeting abortion, there was little pushback. “If this affected union jobs, all of a sudden the whole AFL-CIO would be activated,” Likins-Ehlers said. “So the solution to this is, like, we have to take over the labor movement.”

Union leaders don’t always prioritize abortion, but that could change as abortion clinic jobs become union jobs. 

When union campaigns do succeed, they offer glimmers of this future. Crystal Grabowski, a health care assistant at Planned Parenthood of Western Pennsylvania, learned about unions from her dad, who worked as a toll collector on the New York State Thruway. “My dad and I disagree on pretty much everything, but he taught me that unions are good. He taught me that being a union steward was worthwhile, and I internalized that,” she said. Her dad is anti-abortion. But when Grabowski shared on Instagram the news that her union won its election, her father liked the post. “It was the first time he ever acknowledged me, where I worked, and what I do, and it was because of a union victory,” she said. 

The anti-choice movement has sought to demonize abortion workers, Grabowski continued. “They try to make us seem like heartless, cold people. But I just think we’re just not seen enough.” 

Jordan Culpepper used to drive past the Planned Parenthood center in downtown Austin and think, “That’s the place I’m going to work.” She was doing cooking demonstrations at Whole Foods, but dreaming of becoming a sexual-health educator, helping others to shed the shame and stigma that were part of her own religious upbringing. The building, with its pale yellow-brick facade, looked dilapidated, but Culpepper saw its charm, admiring the faded mural of a woman cradling the earth. “I just was like, this is the place! This is the place for me!” Culpepper thought. She was thrilled to get hired as a health center assistant at the downtown clinic, even though it meant making less money than she had at Whole Foods. 

Francesca Rae, who worked in North Austin, felt similarly. In March 2019, she posted a selfie of herself in scrubs. “At orientation, they gave us ‘alternate ways’ to tell ‘more conservative’ family and friends about where we work,” she wrote. “Personally I was like forget that I’m gonna shout it for all to hear, I WORK AT PLANNED PARENTHOOD, and I’ve never been more excited about a job,” Rae wrote.  

Planned Parenthood affiliates attract enthusiastic workers like this. 

“I literally wrote a paper in high school about how I wanted to work at Planned Parenthood because I thought it was so cool,” said Elisa, who asked to be referred to by a pseudonym because she still works in the reproductive health movement. Elisa stuck with her job in public affairs at the headquarters in Dallas even after a supervisor told her she was the second pick for the job, hired only because they just couldn’t have another white person in the department. She stuck with it after she was chased by dogs while doing outreach work, and after she broke her toe and felt pressured to come to work anyway. “At the end of the day I would tell myself this is for the movement, this is for the cause,” Elisa said. “Think about it, people need health care.” Elisa left in 2018 after her white supervisor said she would always be above her in the organizational hierarchy. 

In response to these allegations, PPGT said it is committed to being an inclusive workplace and acknowledged that it is part of a racial justice reckoning underway at organizations nationwide. PPGT’s board is working with consultants to develop a strategic plan to make PPGT an anti-racist organization, it said. 

Culpepper, meanwhile, soon learned that the building she had admired was blooming with mold.

“It just always felt like they did not listen nor care to entertain or pretend to listen to the bread and butter of the whole organization, which is the clinic-level staff,” Culpepper said, referring to the executives at PPGT. “We call on people to be donating to the people that are dealing with the front lines. But then, you know, also, they can work in asbestos and mold. That’s fine.” 

After a particularly bad storm during which part of the ceiling caved in, staff were relocated temporarily. Katie Dickerson, Culpepper’s supervisor at the time, put her water-damage expertise to work, voicing her staff’s concerns to management, and noting that she herself had a persistent cough that a doctor thought could have been caused by the mold. The building was finally shut down for renovation. 

The workers also complained of feeling overworked and stressed. One day, Culpepper was sent home after she broke down sobbing because there were not enough staff to deal with the flow of patients. (PPGT said it strives to respond quickly to any staff concerns.)

“This whole system where our reproductive rights are dependent on teeny nonprofits — how did that happen instead of having a national health system that pays for it all?”

These chaotic conditions are common in a for-profit health care system that incentivizes seeing as many patients as possible. Free-standing reproductive health centers — many of which were created by feminists when medical providers refused to offer abortion after it was legalized in the 1970s — may be isolated from the rest of the health care system, but they are not immune to its economic pressures.    

“This whole system where our reproductive rights are dependent on teeny nonprofits — how did that happen instead of having a national health system that pays for it all, which is what they have in so many other countries?” said Jenny Brown, author of Without Apology: The Abortion Struggle Now. “That’s the basic historical problem that I think needs to be fixed. We need a health care system where everybody has a union and it’s one big union.”

The day before the layoffs, Katie Dickerson had to break some difficult news to her staff in North Austin. The switch to telemedicine they had been working hard to implement would not lighten their in-person patient volume, as they had believed. Instead, they would have a full schedule of patients for visits like STI checks. Staff were outraged. Francesca Rae stayed home the next day in protest. 

Kalie Kubes, a flow facilitator in South Austin, was at home for a different reason. She had taken two weeks of paid Covid leave when it was first offered in March. She has medical issues that put her at high risk and is hard of hearing, so she could not understand her colleagues when their mouths were covered by masks. On April 8, 2020, during a call with HR, Kubes calmly protested her employer’s decision to place her on unpaid leave instead of adjusting her work duties to accommodate her disability. The next day, she started getting messages from her colleagues. They were being laid off, one by one. Kubes waited for her call. 

In North Austin, Dr. Richard Wallner was the first to be called in and let go. A doctor for 41 years, Wallner was flummoxed that the staff at the bustling locations in Austin were laid off when centers elsewhere that saw far fewer patients kept their staff. The organization, which runs 22 health centers across Texas, declined to offer details about the scope of the layoffs, except to say that 82 positions were impacted by Covid-related decisions last spring, a total that included the layoffs and a hiring freeze. These decisions were based on factors that included the number of patients served and availability of other community health care resources, PPGT said. A tally kept by the workers counted about 30 people who lost their jobs. More than two-thirds worked in Austin. 

“I just think that they saw these folks as a liability because of their concerns and then saw an opening to get rid of them.” 

“The thing that hurt me was that all the people in Austin, I feel like, are much more dedicated to the cause of Planned Parenthood and those are the ones that got sacrificed, which really doesn’t make sense unless it’s a financial or labor-related issue,” Wallner said. “I just think that they saw these folks as a liability because of their concerns and then saw an opening to get rid of them.” 

“Planned Parenthood of Greater Texas supports the right of all workers to unionize,” CEO Ken Lambrecht wrote in a statement in response to questions about the layoffs and employee complaints. “Every day, we do everything we can to continue to provide the essential, time-sensitive care that our patients rely on,” the statement said. “The impact of the pandemic on our organization has required difficult decisions, including a reduction in staff positions across our organization last April.”

Nonni, Rae, Kubes, Nathalie, and Culpepper were all let go. Lola and Binford kept their jobs but felt guilty and demoralized and eventually quit. “I had asked these people to trust the union and trust that if we have enough people involved they can’t fire everyone. And then they fired everyone,” Binford said. For Rae, the saddest part is remembering the excitement she had felt a year earlier, when she had posed in front of a mirror in her scrubs, exuberant about working for Planned Parenthood. Now, she tells her friends not to donate to the organization. She once proudly displayed a bright pink Planned Parenthood bumper sticker on her car. After the firings, she scraped it off with her key. 

The Monday after the layoffs, Katie Dickerson arrived to find a chaotic scene. Patients were scheduled for appointments like STI checks and breast exams with no staff left to see them. “We didn’t just lose all of our staff who were devoted and didn’t do anything wrong other than unionize, but we made it so we were unable to see anybody in the community,” Dickerson said. She sobbed as she called patients to cancel on them. When her supervisor arrived, Dickerson told her that she “felt very strongly that something very, very wrong happened here,” as she later wrote. Dickerson was even more mystified when the affiliate started paying health center assistants to travel from Waco, an hour and a half away, to fill shifts at her clinic in Austin. Then, during the Zoom meeting, she was interrogated by Abcarian about her interactions with her former staff and her knowledge of the union campaign. 

“At the conclusion of the meeting, Abcarian told me that he hoped that I had not taken notes or recorded and that if I even spoke about my meeting with him, I could be in a lot of trouble,” Dickerson wrote in a statement to the National Labor Relations Board in support of her former colleagues. About two weeks after the meeting with Abcarian, Dickerson called her mother. She had been touring houses, having been assured that her job, which she had wanted since high school, was safe. The next day, Dickerson was fired for failing to “effectively perform your job functions and meet the expectations of your manager position.” Sick with distress, she went to bed for three days. Her mother remembers hearing her daughter moaning when she called to check on her. Dickerson has since regained her footing and rebuilt her water-damage business. What sticks with her is a comment her supervisor made to her the night before she was fired. 

“She said, ‘We need to clean the slate,’” Dickerson recalled. “And I think that I was just the last part of the slate that needed to be cleaned.” 

Many of the laid-off staff I spoke to used words like “traumatizing” and “heartbreaking” to describe the layoffs. Shelby Herrera, a former organizer from Office and Professional Employees International Union Local 277, sank into a depression over the fate of workers she had been meeting with in secret for months. 

“They would have been one of the unions that represents exactly what the labor movement is about,” Herrera said. “Because that’s what we need; we need young, progressive workers, we need workers who are fighting for the communities that they serve.” 

The workers have not given up on that fight. “My goal then and my goal now is to make Planned Parenthood be what it says that it is,” Binford said.

Amy Littlefield is a freelance journalist focused on reproductive health care. She was part of the union organizing campaign at Rewire News Group.