Top leaders propose to reinvent the 87-year-old organization, to ensure its survival in a changing health-care market. But others fear it may lose sight of its original mission: providing birth control and other reproductive services.
NEW YORK - Planned Parenthood, one of the most forceful advocates for birth control and access to abortion, is bitterly debating a reinvention that would turn its 900 clinics into health-care centers treating everything from the flu to cuts and bruises.
The plan to add primary care to Planned Parenthood's roster of family planning services would be one of the most dramatic changes in the history of the 78-year-old nonprofit organization.
The plan is being promoted by Planned Parenthood's national leadership, which wants to ensure the group's financial health in an increasingly competitive health-care market. Mary Rauh, a board member of the Planned Parenthood Federation, the New York-based group that links the affiliates, said the group is approaching "the threshold of an era."
"The question is, will there be a place in the reformed health-care system for a niche provider, a reproductive-health provider?" Rauh said. "It looks very risky to depend on that for our future. . . . We might get frozen right out of the system."
Critics fear it would dilute the power of an organization that has led the fight on virtually every major reproductive issue of the past century.
"Never has a document seemed so out of touch with our mission," said a confidential letter sent to affiliates by clinic executives in New York City, Chicago and Los Angeles.
"The word `abortion' is mentioned only eight times" in the 68-page reinvention blueprint, the letter complains, "and never in the discussion of our future."
The plan, which has not been discussed publicly, is outlined in confidential memos obtained by The Associated Press, and several Planned Parenthood officials described it in interviews.
Serving 2 million people a year
Planned Parenthood was founded in 1917 by Margaret Sanger, a leading advocate of birth control.
It treats more than 2 million people a year. Abortions account for less than 10 percent of the group's services and are not available at all clinics. Most of Planned Parenthood's business consists of such services as counseling, gynecological exams, pregnancy and breast-cancer tests, and dispensing contraceptives.
Officials at individual clinics stressed that the plan was preliminary, and said they were willing to keep an open mind. But they also were wary of such a bold change.
The reinvention proposal "would totally revamp a 78-year-old organization around the cornerstone of providing primary care, with no evidence that it will work," said a Feb. 10 internal memo from the clinic in Eugene, Ore.
Planned Parenthood must "not simply roll the dice on a decision that may destroy the most effective and highly regarded family planning . . . organization on earth," the memo said.
The debate takes on increased urgency because many states are steering low-income Medicaid patients - a key Planned Parenthood patient group - into managed-care plans such as HMOs. So far, Medicaid patients in 27 states belong to some form of managed care.
By expanding its services, supporters of the plan say, Planned Parenthood would be better able to negotiate contracts with HMOs to provide services to patients they might otherwise lose. Supporters also fear that Congress may cut funding for contraceptive and reproductive-care programs used by clinics.
"The whole structure of health care has changed," said Elizabeth Hrenda-Roberts, executive director of Planned Parenthood Pennsylvania Affiliates. "We can't pretend we can be here by the grace of God."
Membership to weigh the plan
The final decision rests with the membership, which is expected to consider the plan in April in Chicago. A task force, including federation President Pamela Maraldo, is working on a second draft of the plan.
Those familiar with the plan said it would not force individual clinics, which have independent boards, to provide primary care. But if they resist, clinics could receive less in revenue-sharing and other benefits controlled by the national federation.
The plan also suggests that the organization might venture into cash-producing businesses such as publishing.
Even without the plan, change is already taking place. Some clinics have branched into prenatal and infant care and gynecological surgery. Although the core group of patients remains women, some clinics are seeing larger numbers of men.