Getty Images, FUSION

NEW YORK—On the eve of Tuesday's primary, on a crowded stage in a nondescript Midtown Manhattan hotel, Cecile Richards stood by Hillary Clinton's side and laid out the stakes of the upcoming presidential election.

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"Congress and state legislatures across the country, instead of protecting and advancing the right of women to reproductive healthcare, to safe and legal abortion, they are persecuting women and doctors," the president of Planned Parenthood Federation of America and Planned Parenthood Action Fund told the room, barely pausing before launching into her next point. "And I am here to say, candidates are talking about whether to punish women? Women are already being punished in America."

Richards then turned her attention to her home state of Texas—and fellow Texan Ted Cruz: "Senator Ted Cruz is pledging to end Planned Parenthood and outlaw abortion. He says that women are victims and he wants to protect us. Don't you just feel safer already?"

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The room exploded into a mix of boos and applause.

As the face of the country's most visible, and politically beleaguered, provider of reproductive health and family planning services, Richards is also one of the most influential advocates for access to healthcare in the country right now. So I sat down with Richards the week before the rally, at the organization's sunny New York office, to talk about 2016, the Democratic and Republican primary fields—the Planned Parenthood Action Fund endorsed Clinton in January, the first primary endorsement the organization has made—and how Planned Parenthood has shifted its approach to providing services as the political landscape across the country has grown increasingly— and unprecedentedly—hostile.

Our conversation has been condensed and lightly edited for clarity.

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Do you feel that reproductive healthcare is being treated as a niche issue in this election?

Well, ironically, it’s not being treated as sort of this separate issue in the Republican primary. I feel like every single time I turn around there’s then a statement by one of the Republican candidates about how they want to end access to abortion. And it’s been very consistent. I do wish it was more part of the Democratic debate, not only because it’s an important issue, but because it’s been talked about so much. Because the difference between—certainly between the parties—is vast.

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So it's a question of who is shaping the narrative.

Exactly. I’ve been really pleased at the amount of conversation—and I think the interjection by Secretary Clinton of the issue of reproductive healthcare and rights into the conversations, in the debates.

But I do think it’s important because it’s not good enough just to vote the right way on these issues. The attacks on women’s basic rights and access to healthcare is so deep and profound in this country right now—and state after state after state—that we need a president who’s not simply a solid vote. We need someone who’s going to be a champion and also who can talk about these issues and get them into the dialogue—the policy dialogue.

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And the policy dialogue, at least as it stands right now, seems primarily centered on restrictions that make access to abortion difficult or impossible.

If you look at the priority of this U.S. Congress, the obsession with passing bills to restrict women’s access to healthcare, access to safe and legal abortion, access to Planned Parenthood, access to birth control—this has dominated the Congressional agenda. They basically can’t get anything else done. And even when we saw the efforts of—I mean, the shutdown of the government and the effort to only reopen the government if Planned Parenthood was eliminated—that shows the degree to which this is dominating the politics at least of one party.

We’re seeing [this in] legislatures all across the country. They’re not focusing on job creation, education, healthcare access. They’ve been completely obsessed with finding every which way to restrict healthcare access and rights of women. So it is extraordinary.

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Women are the majority of people in this country. So what happens in government, what happens in policies at the state legislature, at the Supreme Court, in Congress, in the White House, impacts all of us.

To that point, President Obama’s veto has been a tremendous stop gap against efforts to defund Planned Parenthood. Does Planned Parenthood have a contingency plan in the case of a Republican victory in November, since all three candidates in the primary have vowed to defund Planned Parenthood?

Absolutely. We’re always ready for whatever comes next—and we’ll do everything in our power, not only to protect the rights of Planned Parenthood patients to come to Planned Parenthood, but protect the rights of all people in this country to have access to healthcare.

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Because unfortunately what we’ve seen is—and we saw this in the state of Texas where they tried to shut down Planned Parenthood—what happened is they shut down dozens of women’s health centers, many of which had nothing to do with Planned Parenthood. So the impact of these kinds of restrictions go far beyond our own patients. We’ve been around 100 years. We’re celebrating our 100th anniversary this October. We’ll be around another 100 with or without this government.

I just think it’s critically important that people understand when they say they’re going to defund Planned Parenthood—that is what Ted Cruz has said, Donald Trump, John Kasich, those are things they voted on, they’ve enacted in their own states—we don’t get a check from the federal government, we’re not a line item in the budget. We operate just like every other provider to patients in this country, which is we get reimbursed for providing preventive care services. That’s the vast majority of reimbursement we get.

And in large part, it has nothing to do with abortion. Very few abortion services are actually reimbursed. We’re talking cancer screening, birth control, well-woman visits. Millions of folks turn to us for healthcare and my position, and I think the position of Planned Parenthood and really the majority of the American people, is people that turn to Planned Parenthood for healthcare should have the same right to choose where they want to go, what doctor they want to see, what clinician they want to see, just like members of Congress do.

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I feel like Planned Parenthood is in an interesting position when it comes to talking about this. So overall, 3% of the services provided by Planned Parenthood are abortion services—which is just the statistical reality about the work the organization does. But also, because abortion so often gets talked about as though it's not legitimate healthcare, that 3% talking point can almost feel like an apology. Like, "It’s just 3%."

In many states, we are the only abortion provider for many communities. So it’s not an unimportant part of the care that we provide at all. And in fact the 3% conversation really happened as Congress was voting to defund Planned Parenthood and saying that it was about reducing access to abortion, which it actually has the direct opposite effect.

What they were ending was access to birth control. So it was really more about making that point. But I’m very pleased at how a whole new generation of young activists, the reproductive justice community in particular, has really lifted up unapologetic storytelling about what women’s lives are really like. I do think we’ve really seen a change in the last five years. It’s been wonderful to see mainstream magazines now covering abortion stories of women and of men, of families, and beginning to get this conversation into the public sphere.

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Look, one in three women in this country have had an abortion. This is not a rare occurrence, it’s something that women deal with every, you know, every woman at some point probably deals with some question around pregnancy and it’s important to have that conversation more open. And I think it’s also exciting, frankly, to see mainstream culture— including Hollywood—start talking about abortion in more realistic terms.

Not just "shmashmortion" anymore.

Exactly.

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In terms of the scope and ambition of the legislative agenda—or even just the volume of bills being introduced–do you think there's anything to be learned from the anti-abortion movement? Americans United for Life has created this body of draft legislation that has remade the political landscape in some really significant ways because it's just: sign, stamp, circulate.

The anti-abortion movement isn’t burdened by providing a single person in this country healthcare. And it’s true that organizations like Planned Parenthood, we not only provide healthcare to 2.5 million people every year—including many women who are very challenged with getting access to care—but we’re also working, we’re litigating, we’re advocating and all of that. So I would just point out that there’s a difference between people who are actually in this work to make sure that women’s lives are better and there’s people who are completely focused on a political agenda.

That said, of the last three years we have worked very hard at Planned Parenthood to bring together legislators from all across the country and particularly from states that are, you know, probably in the middle and even some states that are very conservative, to work together to introduce model legislation even in legislatures where they may not be successful this year but they begin to build a cadre of support. And we’ve also worked to make sure that legislation that’s introduced that’s successful at the local leve—that it then gets replicated across the country.

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One of things that is just absolutely true was that the 2010 elections completely realigned the legislatures in this country and so, in some ways, you can have all the legislation that you want, but if the legislature actually doesn’t represent the people of the state, it’s very difficult to make much progress. So I think that 2020 is going to be a very important year. Look at the state of Texas—we did poll after poll after poll, we mobilized thousands of people in there to fight against HB2. The polls showed that people in the state of Texas were overwhelmingly against what was happening in the legislature, but there was really no way to change who was in the legislature when the lines were drawn in a way that discouraged—or they’re completely controlled by one party or the other.

With the political landscape so hostile to abortion rights, and to reproductive health more generally, does Planned Parenthood think about what it means to offer care beyond the brick and mortar clinic? Is there such a thing as a post-clinic Planned Parenthood?

So we started 10 years ago investing a lot of resources in expanding access to information and care online. Because I think, regardless of where the legislatures are going, if you invest in new medical technology, new opportunities to reduce barriers to care, some of that is going to trump politics. So it’s not simply that the politics get worse, it’s that there’s more opportunities there.

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So we now—even though we see 2.5 million more patients in our health centers each year—we see 6 million online every month who are coming for all kinds of information that may be very difficult to get if you don’t have sex education in your schools, for example. We’re now in some states offering birth control online, in the state of Iowa doing remote video conferencing for telemedicine for women who live in an area where they don’t have an abortion provider.

I believe we continue to invest in that technology, I believe it’s critically important. All of this is work that we continue to do despite the state legislatures and despite the Congress. And I have an enormous amount of faith that medicine just keeps getting better and as long as we have a strong, robust—not only Planned Parenthood but group of people in the medical profession in the movement who are pushing forward in these areas—that it’s already changing access.

A lot of really bad bills have been passed and signed—without a doubt. But under President Obama, even with all of the difficulties of the Affordable Care Act, 55 million women now have access to no-cost birth control in their insurance plans. I can tell you that’s a radical change from even five years ago. We were just trying to get pharmacies to fill prescriptions. So I think that it’s important that we absolutely continue to fight as they come, but also push forward and acknowledge the progress when we make it. Because I think there are things that are happening that actually give me enormous hope.