Wednesday, November 24, 2010

Another One Bites the Dust: Feminist Clinic in Washington State Closes

We need to expand access to abortion services. We all know this. So, the question may now be, within our own Abortionland, what exactly does expanded access mean? How can abortion access expand without crushing little, struggling clinics? Is it even possible for different service delivery models (hospitals, Planned Parenthood, etc.) to expand without hurting independent clinics? And if possible (which I believe it, of course, is), is it realistic? Will providers set aside competition for altruism (increased access)? And at the risk of sounding cynical, should they set aside competition? And....are independent, feminist clinics now obsolete?

These questions are – hopefully – being asked by people besides me. You’ve probably heard all the buzz about another feminist abortion clinic closing down: Cedar River Clinics’ Yakima site (one of three in Washington State) just closed down last week after 30 years. Let me say that again: after 30 years.

I read about this closure on RH Reality Check’s site here. It’s a lovely tribute to the Yakima clinic which appears to have served women from all over the Pacific Northwest and beyond (Oregon, Washington, Idaho, and Montana). The closure also has created a big hoopla – a controversy even – because Cedar River Clinics points the finger directly at Planned Parenthood as the reason for their closure! (Ballsy, I know!) The comments on the article obviously get very feisty. (Pretty fun to read if you’re in the mood for feistiness!)

It seems like there is this clear divide, an us versus them between some independent clinics and Planned Parenthood. If you’re not up on the debate, the issue seems to be the apparent recent Planned Parenthood decision to expand all their abortion services… even in areas where there are already providers. It’s pretty obvious there are many who are uncomfortable with this pointing of fingers, saying that by pointing fingers at Planned Parenthood, abortioneers are unnecessarily feeding into all the negative media that the antis put out against them. (After all, Planned Parenthood does do a lot of good work.) Well, on this blog, we pride ourselves in talking about the things that are hard to talk about. We speak the unspeakable – the unpopular, even – at the risk of antis twisting it however they will (they’ll always twist things around).

Let’s say the independent clinics out there are right: Planned Parenthood plays a role in closing down little clinics (not intentionally, I’m sure). Should people NOT talk about it just for fear of what the antis are going to say? Of course not!! Sure, we’re all in the same boat: we want to provide abortion services to women; but like I talked about here in September, there is, of course, competition. We're only in the same boat up to a point. Abortion rates are down. Clinics still have a business to run. If another provider comes in and offers the exact same services (same gestational limits, for example) as another clinic in town, then that’s direct competition. If a small clinic is already struggling, a direct competitor will surely hurt said struggling clinic. It sounds like that’s precisely what happened in the case of the Yakima Cedar River Clinic and the Yakima Planned Parenthood.

We don't like to talk about competition: it's the big elephant in the room. The reality is, competition exists. The analogy of the big corporate store coming in, causing the little independent store to close is very similar to the small abortion clinic versus a corporate-like Planned Parenthood. I am an idealist at heart, so it's difficult for me to even acknowledge the elephant. I want to tuck myself into a little world of abortion safety where everyone is in it just for the women and the focus is so entirely on that, not politics and competition and business models and strategies and blahblahblah. The harsh - ever so harsh - reality is that when big corporate business comes in and succeeds, it offers a service that customers/clients/patients respond to. They're doing something right. That doesn't mean the small, independent clinic is doing anything wrong...

Or are they? Little businesses often fall prey to "treading water syndrome." They can be hyper-focused internally and don't always invest/have the resources to look externally. For all business - non profit or profit - it's vital to not only scan your external environment, but do an in-depth analysis. The for-profit sector and non-profit sector are not really that different. (Despite how much I'd like to bury my head in the sand and pretend they are.) They compete. And abortion providers compete, too. In the case of Yakima, it appears that Planned Parenthood came up with a strategy that worked for them. You can bet your bottom dollar that Planned Parenthood has the resources to do an in-depth SWOT analysis and probably really researched the opportunities in Yakima (and other places). Did Cedar River Clinics? Like so many small businesses, did they focus too much on putting out fires that they didn't stop to recognize Planned Parenthood as an external threat and then decide what to do about it?

Look, I am a huge fan of supporting local businesses. I support my local book store. Unless....Amazon meets my needs when browsing the internet at 1am. I would go to my independent abortion clinic if I knew it was locally owned. Unless... Planned Parenthood was more convenient (price, location, abortion days/times that fit my schedule) and made themselves more known to me (advertisement). I'm talking about the marketing mix. The Four P's:
- Product
- Promotion
- Place
- Price

Do I wish that Planned Parenthood could've expanded their gestational limits in, say, Spokane where they could've better met the needs of rural women? Or maybe opened a clinic in a region of Washington State (or Idaho, or Montana, or Oregon) where there wasn't an abortion provider at all, instead of going to Yakima and directly competing? Hell, yes. That would've been the altruistic thing to do: the thing that would've truly been in rural women's best interests (women travel upwards of 10 hours because Yakima is the only provider going further than around 15-16 weeks west of Missoula and east of Seattle). There are large areas of Washington state without abortion providers, so it seems there was/is growth potential there. Why didn't Planned Parenthood take the high road instead of directly compete? On the other hand, we could all ask Cedar River Clinics why they didn't expand to an unserved area to improve access, too.

My point is: Cedar River in Yakima must've missed some opportunities for growth that Planned Parenthood captured. So if small, independent clinics are doing anything wrong at all, it may be that they don't/can't meet the demands of the clients and what their needs are when (gulp) Planned Parenthood did/does (like Amazon sometimes meets my needs better than my local bookstore). And this does make me cringe. But we're talking about consumer behavior here.

Planned Parenthood has nothing on a legacy of a feminist clinic. It can't stand up and say it's been there for its community like a small clinic can say; but if the competition wins, it's not just because they're terribly corporate. Look, little independent clinics need to LEARN from Planned Parenthood. What do they do that's right? Branding. Clients trust them. They're everywhere. Like McDonalds. Independent clinics need to be firmly rooted in their communities. They need to promote themselves. They need to advertise. They need to be involved. They need to prove to their communities they know them better than Planned Parenthood does. They can't ostracize themselves just because they do abortions. They have to have their finger on the pulse of their clientele. Offer different days. Different hours. Have nice buildings. Decorate them well. Have them in good locations (see my dream clinic blog). Ask clients what they want. Make appointments shorter. Small, independent - even feminist - clinics will become obsolete unless they figure this out, significantly invest in strategy, and learn from Planned Parenthood. My sincere hope is that they will....

...who will pick up this gauntlet?


  1. really? Do you really think it's that simple? If the small, community, non-profit, 1)clinic 2)bookstore 3)corner grocery 4) family farm had the national capital and deep pocket to do those things we wouldn't be having this conversation. Consumers can also make a choice (when all other things are equal) to buy & shop local. Support your Independent feminist abortion clinic.

  2. Hi. I regularly post as Arekushieru at RHRealityCheck. I think this post missed the point of the thread, there, actually. We were discussing the fact that finger-pointing isn't necessary. The 'business model' that PP follows works well for it, but not necessarily for the independent feminist clinics. But that is, almost, entirely out of PP's control. That is what we were referring to. I don't care if anti's take something and run with it, in general. I do care if they take something false and run with it, though.

  3. Francine - thanks for your comment. I don't think any of this is simple. Obviously, small independent clinics don't have the deep pockets and funding that Planned Parenthood does. More reason to constantly look externally, check-in with clients, acknowledge Planned Parenthood as a competitor and deal see what THEY can do to compete with PP. If a Planned Parenthood moves in and expands their service, the local clinic needs to get loud. It needs to make its presence known in the community and rally their supporters. Talk to clients, see what their competitors are offering, then do better.

    If the consumer doesn't even know there ARE options to begin with (I've heard abortioneers talk about how locals don't even know they have a local abortion clinic or how they don't have enough $ to advertise, or how their clinic doesn't diversify their funding sources, etc) to shop local, then how can they?

    I am challenging local independent clinics to make their light shine. To learn some things from Planned Parenthood. From the for-profit sector in general. To dig deep and see if there are ways they can scan the field and be innovative in their service delivery. If they fail to do that, then consumers will go to the place that offers them most of what they demand. It's consumer behavior. Does it mean it's right or what even I want to see happen? No. I want to see clients go to local clinics. But there can be a silver lining. That competition can bring BETTER service delivery. It can cause all involved to make sure they are giving not just great client focused care, but AMAZING care - to make them EVEN better than they already are.

    In no way shape or form am I saying not to support the local clinics. I've worked for local clinics. They're amazing and I hate what seems to be happening. But it's like you said - it isn't all that simple. The entire finger can't be blamed on Planned Parenthood. I think maybe the small clinics need to look at how they can change in order to survive. That's all. Because I really WANT them to survive.

  4. Thanks for clarifying, freewomanholyinheritance. And thanks for posting here, too. :)

  5. I'm very sad to hear about Yakima's closure. It was a good long run and an icon of feminist care. Thanks for pointing towards Amie Newman's article, which is an excellent analysis of the situation. I'd like to add to the saga that here in Washington state(I'm sure elsewhere as well), family planning funds (the "Take Charge" Program) are being cut as of March 1st. Planned Parenthood is scrambling to survive these cuts as well.

    As losses accrue, I'm wondering if anyone is ever going to pull together a history of the FWHCs (I put in 14 years at the Tallahassee FWHC). I've had trouble explaining to women in their 20's what they've gained from the women's health movement- they take a great deal for granted without knowing the history of the struggle.

  6. Risaden- thank you for commenting. I agree that it's very sad the Yakima clinic has closed. It is also sad that many clinics are struggling and that state-wide budget cuts are happening. That certainly won't be good for anyone.

    I also thought Amie's article was great.

  7. I just wanted to mention - in case it is not clear- that I think it's horribly sad the Yakima clinic is closing and echo Amie Newman's concerns that people don't seem to be addressing the issue of independent clinics closing.

    My frustration lies with the big questions that don't seem to be getting discussed. How can we increase access w/o it hurting little clinics? And what can indie clinics do to protect themselves? Those questions are borne from a love of feminist clinics. I feel angry that no one is talking about solutions. None of this is simple - it's very complex....

    I completely agree the expansion of PP is part cause. Well, what to do? What. Does the feminist community want to have done about it? It's not enough to say PP did this. It's not enough to raise awareness. So *now what*? I haven't even seen an official FAN statement. Why not?

    If it seems I'm being harsh, it's because I WANT the feminist clinics to survive. My personal opinion is they give the best client care. Which then frustrates me even more that no one is being loud and coming up with solutions.

    I'm also not saying I was offering a solution, but I asked tough questions and I hope that more discourse will occur around how clinics can survive. So I will ask another question: why do some independent bookstores survive when a big chain store comes in? Why do others not?

  8. I think it would be tough for most independent nonprofit clinics to survive in a "one clinic town" if a national organization set up shop nearby. An national organization with cost sharing and "branded fund raising" that can be subsidized until the competition can no longer make payroll is most likely to survive. The two types of feminist clinics are both committed to women and well intended. I think the most distressing question here is "Are there any women who will no longer be served and how will unmet needs be addressed?" It isn't which clinic deserves to be there. There could be some "first come, first serve" issues here but it's really about having access to a compliment of services that Planned Parenthood doesn't traditionally offer. The independent clinics do a lot of Reproductive Justice work and define "choice" more broadly offering specialty gyn programs for some who have no place else to go. The proceeds from paying clients go toward subsidizing services for others who sometimes have no other resources. It really isn't just about ME having my local feminist clinic available when I need it. Some health services are not easily funded really can't be replaced. I've always felt my local clinic is more emeshed in my community and better able to give voice to my needs when it comes to deciding what services to include and sometimes even in community education. Perhaps a public awareness campaign about some of the differences and a annual campaign for a bigger reserve fund to "sustain the stand off" and other challenges that come with being controversial in a smaller community would be a good idea? If a local business cannot outlast in these situations until it can regain enough market share to stay in business, it will go away. I didn't say "fair market share" since there's nothing fair about some folks losing access to healthcare when the clinic with more comprehensive services goes away. Very sad...but true.

  9. I'm not sure why FAN hasn't spoken, but I think that one of the reasons that Indie/Feminist clinics don't speak out is because it gets viewed as PP bashing. Airing dirty laundry. They don't want to give the appearance of in-fighting and fodder for the antis to run with.
    I agree that Independents need to stress the things that they do well and differently and try to as karenb put it..." outlast in these situations until it can regain enough market share to stay in business".

    I thought the article was great!
    I'm glad about a girl wrote it and that this issue is being addressed and talked about. It has felt hard to do this even with really informed people who automatically assume I an anti PP because I work at a feminist/independent clinic. Thanks again.

  10. From the FAN President Anita Kuennen of Blue Mountain Clinic in Missoula Montana: “The Yakima clinic closing is a wake-up call to all who support access to choice and access to health care. Feminist Abortion Network believes in the value of locally-based locally-responsive clinics, and in the strength of diversity in the health care ecosystem. Now is a critically important time to support your local feminist clinic. We urge you to go to the FAN website (, find the feminist clinic nearest you, and send them a check for your support. You can count on FAN members; collectively we have provided abortion for over 1,000 years.”

    The point is that it takes resources, financial and human resources invested in staying strong, doing outreach and implementing the types of 4P marketing strategies described in this column. When donors contribute charitable donations to nonprofit feminist clinics, they have a big impact on their ability to serve the local and regional community.

  11. As a member of FAN and director of a feminist health clinic I appreciate the discussion here and also mourn the loss of one of our member clinics in Yakima. A few points to consider in this dialog:

    a) access is not always improved with the PP model - in fact pricing is quite variable for women seeking services and not always transparent during the consolidated booking process that many affiliates are using. In Montana women may pay more than double the cost of a first trimester surgical procedure based on the PP fee structure. Scheduling hassles often lead women back to our clinic after weeks of trying to get on a PP schedule somewhere in the state. As mentioned earlier, women calling the centralized scheduling number may not be informed that they can get services from a local provider in their community or nearby unless they explicitly ask - and the information they receive varies. In my mind this is not woman-centered or justice minded with respect to access.

    b) competition is natural, and of course necessary for a non-profit clinic to participate in for survival. Historically the feminist clinics have been on the cutting edge of adapting to external and internal impacts of providing abortion care. The onset of medical abortion in the US influenced a lot of the policy direction of PP and abortion providers in the last decade, along with decreasing abortion rates nationally. Many feminist clinics are adapting to the changing ecosystem. Blue Mountain Clinic of Missoula, has broadened the mission to include full family practice, mental health counseling and at risk youth services to the community. Many other feminist clinics have also expanded to meet additional unmet needs in their communities.

    c) One strategy that is in discussion at FAN is how to capture more national support for our clinics as a network to position ourselves with more resources to do the work mentioned in several of the comments above. However without some initial capacity building support, this is on the plate of FAN members already covering multiple work responsibilities associated with running clinics. Our vision is to create awareness, build our capacity and identify the strategies that will keep any further feminist clinics from closing and continuing our critical contributions to access - even if we don't always take credit for it in the media. I urge anyone who has benefited from care at a feminist clinic to consider making a donation to FAN this year and help us take the leap for sustaining access and feminist abortion care. Anita Kuennen, RN , director Blue Mountain Clinic and President Feminist Abortion Network.

  12. I haven't been an abortion provider -- I've been a supporter of choice for 55 years AND I have been a bookseller.

    Here's is what I believe is your fallacy: PP is a non-profit. Barnes & Noble isn't.

    The independent abortion provider is probably in the same psychological spot an independent bookseller is: considering the Four P's. Now, an independent bookseller is more likely to create a market than an independent abortion provider is; people will move to a place because there's a great bookseller in town! The variables for the indie abortion provider are uncontrollable and unlikely to be in any census records. So the Indie A.P. is doing a lot of seat-of-the-pants reckoning, and making an investment in that reckoning.

    So for PP -- which has not only a high profile but a century of various kinds of wealth -- to move in where an Independent has succeeded is really the worst kind of poaching. PP has the deep pockets needed to go somewhere really difficult, like Spokane in your example.

    PP's actions mean there has been no net gain in abortion provision AND that someone who had invested years of life and some degree of personal wealth has now lost that investment. What is PP trying to prove, anyway? I have been on enough nonprofit boards to suspect that there's a big ego in the Yakima area that wanted control, and damn the public good.

  13. I want to thank everyone for all their comments. I think the most important thing is that dialogue occurs.

    I certainly don't think I have all the answers on how to "fix" this problem; the closure of abortion clinics across the country is a problem and it's very sad that feminist clinics in particular are closing.

    In part, I wrote this blog out of frustration for not hearing anyone discussing in the media possible solutions to the obvious problem(s). The issues are obviously complex and in no way did I mean to take away from that complexity; however, I still find myself asking the same questions as I did in the first paragraph of this blog.

    On that note, though, I really, really appreciate Anita's comments. I am happy to read someone representing FAN share some of the thoughts. One of the things I've wondered is if FAN can't get funding to be an independent non-profit (kind of like a membership group representing feminist clinics) and try to, say, tackle obtaining joint grants to help sustain the clinics? Would it be possible to hire an employee (full-time - if you got funding to do so?) whose job was to chase major RFAs (not small grants - but LARGE grants) to be shared among the clinics?

    Obtaining grants and reporting on them take a lot of money, so spending time chasing anything less than $100k is probably worthless.

    I love that Blue Mountain has diversified/expanded its programs to adapt to changes. In fact, I had written something about that a few months ago in another blog. It sounds like - I hope! - that's working for you. Maybe that can be used as a model for other indie abortion clinics.

    Let me just say that I am grateful for all of you responding. I hope that this post at least helped propel further discussions that then can turn into action points and help out the independent clinics.

    Diggit - btw - thank you for your comments and I agree. It sounds like there's a great big ego in Yakima!

    Thanks again, everyone.


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