In mid-September, Chris Charbonneau flew to Fort Wayne, Indiana — triumphant. The CEO of the Seattle-based Planned Parenthood of the Great Northwest and the Hawaiian Islands had just pulled off a stealth operation.

Last year, Fort Wayne’s only Planned Parenthood clinic closed. The landlord didn’t renew the lease. A nurse practitioner left after a group called Created Equal distributed flyers with her name and photo. It was an attempt to pressure her to “stop doing evil,” said the organization’s vice president, Seth Drayer.

The clinic didn’t do abortions but Drayer said he considered staffers fair game because of their role in the Planned Parenthood network, which provides abortions as well as birth control, gynecological exams, STD testing and other types of health care.

“We need to go buy a building in Fort Wayne,” Charbonneau resolved.

“We,” because Charbonneau, whose affiliate already covered Alaska and most of Idaho as well as Western Washington and Hawaii, was in the process of adding two states: Indiana and Kentucky.

The merger with an affiliate 2,000-plus miles away — not yet official but already happening in practice as an alliance headed by Charbonneau — takes the Seattle-based Planned Parenthood affiliate into some of the most hostile territory for abortion rights. It also represents the lengths to which affiliates are going as they struggle to survive amid newly restrictive abortion laws and changes in women’s health care — ironically, many of them incredible advances, according to Betty Cockrum, a retired Planned Parenthood leader in Indianapolis.


The Seattle-based affiliate has “easier politics” and a “nicer fundraiser environment,” said Charbonneau. The foray into the middle of the country is an experiment in bringing those blue-state advantages to red-state areas.

Among Charbonneau’s first moves: getting back into Fort Wayne.

In the hushed way Planned Parenthood increasingly plans new clinics in uncertain terrain, she turned to a Seattle developer she knows and asked him to buy a building for her. He put money down on a pleasant, low-slung structure with a well-kept lawn, and kept the secret from Planned Parenthood opponents for months.

They brought pickets when they found out. Drayer, of Created Equal, vows to strike back, declining, for “security reasons,” to say more.

But asked whether she wants to start offering abortions there, Charbonneau said: “absolutely.” There aren’t many places around, she said, where a woman can get one.

Planned Parenthood’s national office came to Charbonneau about Kentucky and Indiana in 2017, she said. Mike Pence, an ardent foe of abortion and Planned Parenthood, had just left the governor’s mansion for the vice presidency. Making a difference became “almost irresistible,” Charbonneau said.

The Seattle-based affiliate is a powerhouse. With several mergers under its belt, it had 27 health centers and $58 million in revenue, as of its 2018 annual report. The Indiana and Kentucky affiliate, by comparison, had $19 million in revenue and 17 clinics — 21 fewer than 15 years before, according to the IndyStar, just two of them in the Bluegrass State.


“We can do this,” Charbonneau told the national office, “but we’re going to need some help.” The office promised up to $10 million.

Planned Parenthood’s board and staff in Indiana and Kentucky needed persuading.

“Isn’t there anybody closer?” she said they asked. Her answer: “The reality is red states tend to be proximate to red states.”

Yet, with people coming in from the coasts, said Indianapolis board member Mike Carter, there’s always a question: “Do you understand how people think?”

The region calls for a softer touch, said Cockrum, who left Planned Parenthood in 2017 after 15 years. It’s better to talk about women who are not ready to be parents rather than about abortion directly, she said.

The debate has evolved everywhere, Charbonneau said. “This isn’t a red-state, blue-state thing. We talk a lot less about pro-choice, anti-choice. People resist being put in a box.”


A different approach

The U.S. abortion rate dropped 20 percent between 2011 and 2017. Recent polls show most of the country still supports access, but views are nuanced. In one large survey released in August by the Public Religion Research Institute, fewer than 40 percent said the procedure should be legal in all cases.

Still, the survey shows geographic differences. In Washington, 61% said abortion should be legal “in most or all cases;” 48% in Indiana and 43% in Kentucky.

However important the right approach, Planned Parenthood supporters in Indiana and Kentucky seem to be looking mainly for other things: hard cash, efficiencies of scale, innovation. “They’re cutting edge in just about everything,” Cockrum said of the Seattle-based affiliate.

Planned Parenthood of the Great Northwest and the Hawaiian Islands helps run a lab in Bremerton that analyzes STD tests for affiliates around the country, and generates $2 million a year, according to Charbonneau. The affiliate has ventured into telemedicine, and was one of the first to use a peer approach in sex-education programs. In 2008, Charbonneau helped found a pharmaceutical company, Afaxys, that supplies low-cost contraceptives to Planned Parenthood and other entities serving low-income women.

Also alluring: “a belief in the possible,” said Patti Stauffer. She briefly headed Planned Parenthood in Kentucky and, after a 2013 merger with Indiana, directed lobbying in both states. The constant resistance, she said, was exhausting.

Charbonneau radiates optimism, nurtured by political sunshine. In August, Planned Parenthood nationwide withdrew from the Title X program providing low-income women with family-planning services rather than abide by Trump administration abortion restrictions. Gov. Jay Inslee pledged state money to help make up the loss.


The longest-serving Planned Parenthood CEO, Charbonneau, 59, likes to point to experience in less-hospitable climates: Idaho, Alaska and, early in her career, Arkansas.

Tapped to run a campaign in that Southern state against a 1986 constitutional amendment seeking to ban public funding for abortion, she helped defeat the measure by a narrow margin.

“What I learned is that everyone thinks they have the most conservative state in the nation and everything is impossible,” said Charbonneau, relating the story with relish at Planned Parenthood’s expansive Central District health center. “The truth is there are some American values that supersede all that. People don’t want other people to tell them what to do.”

Ed Harpring, pro-life coordinator of the Archdiocese of Louisville, sees things differently. An overwhelming majority in his state oppose abortion, he said, and are prepared to vote accordingly.

He noted Christian conservative Matt Bevin, after getting elected governor in 2015, took on a Louisville Planned Parenthood clinic offering abortions. “He shut that down,” Harpring said.

The matter, which concerns complicated licensing procedures, is tied up in court.


Just one abortion clinic remains in Kentucky, operated by someone other than Planned Parenthood. Several new state laws, also facing court challenges, would restrict abortion further. One, signed by Bevin in March, would ban the procedure once a fetal heartbeat is detected, typically at about six weeks into a pregnancy.

“We hope that Kentucky will be the first abortion-free state,” Harpring said.

Bevin lost his reelection bid this month despite pillorying Democratic challenger Andy Beshear’s support for abortion rights. Planned Parenthood’s political action committee in Kentucky — overseen by a staffer in Olympia — dived into an election campaign for the first time to try to oust Bevin, investing $163,000.

It’s unclear how Bevin’s defeat might change Kentucky’s abortion policies given the rightward turn of its General Assembly.

Changing politics

“When we really started to see changes was after the 2016 election,” said Heather Gatnarek, a staff attorney for the ACLU of Kentucky. As President Donald Trump’s victory brought new hope among activists of overturning Roe v. Wade, Kentucky’s General Assembly — long split between Republicans and Democrats — turned solidly red.

Indiana’s General Assembly had gone the same way earlier, resulting in a 2011 law cutting Medicaid funds to Planned Parenthood. It was overturned by the courts, but still caused confusion, Cockrum said. Some believed Planned Parenthood was closing.


More battles over abortion restrictions followed.

Less known is how developments in health care cut into Planned Parenthood’s bottom line in many parts of the country.

Women, once advised to get a Pap smear every year, are now generally told to do so every three to five years. New methods of long-acting reversible contraception came on the market, eliminating the need to see a medical provider regularly. Emergency contraception, such as the morning-after pill, became available over the counter.

“It’s one of the best things to happen to reproductive health care in this country,” Cockrum said. “But it had a dramatic impact on patient traffic.”

On top of all that came the Affordable Care Act and Medicaid expansion, increasing health-care access for young women. Many who relied on Planned Parenthood for low-cost care no longer need to.

In Indiana and Kentucky, the cumulative effect has been jaw-dropping. In 2012, Planned Parenthood in Indiana alone saw roughly 76,000 patients. Last year, 46,000 patients came to Planned Parenthood in the states combined. And patients came less often, driving down visits by more than 60 percent.

Planned Parenthood’s national numbers aren’t quite as striking, but there’s a similar pattern. Dr. Leana Wen, who took over as president in late 2018, argued for expanding into primary and mental health care, and wanted to depoliticize the organization by talking less about abortion. A revolt ensued, leading to her ouster in July.


Ways to grow

Planned Parenthood of the Great Northwest and the Hawaiian Islands has meanwhile gained patients.

As Charbonneau tells it, the Affordable Care Act works in Planned Parenthood’s favor here. Young women “never stopped coming to us,” she said, “and now they have a payer.” State-funded family-planning programs provide even more revenue.

Recently added services, including gender-affirming hormones for transgender patients, may also be bringing in new patients.

Not all innovations pay off. In 2016, a handful of clinics tried expanding into primary care. “They didn’t come,” Charbonneau said of patients. “People weren’t expecting us to be able to treat colds and flu.”

Planned Parenthood’s core mission may resonate more locally.

Also, Charbonneau said, “We’re out advertising.” That’s part of the strategy for Indiana and Kentucky. A Facebook post after the Fort Wayne opening introduced one slogan: “These doors stay open.”

Charbonneau said that for more clinics to open, residents need to see Planned Parenthood going strong. To that end, she used some of the national money to hire 11 new nurse practitioners and give raises, hoping to reduce turnover fueled by harassment.

Rebecca Gibron, who led an Idaho affiliate before merging in 2008 with Charbonneau’s and becoming COO, said a deeper bench helped Planned Parenthood grow in her part of Idaho, south of the panhandle.

That track record in a conservative area was a selling point in Indiana and Kentucky. “This is not their first rodeo,” said Carter, the Indianapolis board member.

Stauffer, the former Kentucky Planned Parenthood CEO, said a big, geographically diverse team offers another boost. “Successes of the affiliate might not be in our backyard,” she said. But successes will happen somewhere.

“Staff can be part of that,” she said. “That sounds like that will be nice.”