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“I’m the head of Planned Parenthood. We’re done making excuses for our founder.” That’s the headline of an op-ed by Alexis McGill Johnson, president and chief executive of the Planned Parenthood Federation of America. Published in the New York Times on April 17, 2021, it’s a searing indictment of the organization she leads, and the deeply flawed woman who created it, Margaret Sanger.

Sanger’s association with the KKK, her support of involuntary sterilization, and the racist roots of the birth control pill—McGill Johnson owns it all. And she acknowledges that the damage Sanger and Planned Parenthood did isn’t just past tense. “We must fully take responsibility for the harm that Sanger caused to generations of people with disabilities and Black, Latino, Asian-American, and Indigenous people. . . . We must examine how we have perpetuated her harms over the last century—as an organization, an institution, and as individuals,” she writes.

It’s a big change from PPFA’s traditional celebration of their story as a feminist triumph. But it doesn’t go far enough. Here’s why.

Pro choice . . . or no choice

Margaret Sanger wasn’t some monster, vibrating with hatred for disabled people and racial minorities. She truly thought she was doing the world a favor by helping (and in some cases, forcing) people who were struggling in life to suppress their fertility. She believed that was the key to eliminating women’s problems. And, by and large, that’s still Planned Parenthood’s approach today. Then, as now, society is not really set up to support women’s lives. Then, as now, Planned Parenthood in all sincerity responds to that injustice by putting the burden on women’s bodies.

Needless to say, the burden doesn’t belong there. You only have to review research from the pro-choice Guttmacher Institute to see what’s really going on. When asked why they’ve “chosen” to terminate a pregnancy, women in the studies echo the same sad chant: they can’t afford a baby. A child would destroy their chance at an education or a career. They must sacrifice the pregnancy so they can take care of the children in the family who are already breathing. Their partner is a lowlife. Many of their reasons are a result of systemic racism and sexism. They really have no choice.

Planned Parenthood helps such women end their pregnancies and then sends them home. Home to poverty, unemployment, educational stress, crushing family responsibilities, or an abusive partner. The cliché image of a young woman who escapes an unwanted pregnancy and is thereby “liberated” to achieve her incredible dreams is an exception. In fact, almost half of all abortions in the United States are actually repeat procedures, with women winding up again and again in the clinic waiting room, particularly women of color. The same cycle with the same miserable causes repeats itself. Planned Parenthood’s role in the cycle is to extract roughly $500 each time.

If you didn’t cry, you’d laugh at one recent study that showed the Pill is responsible for a 30 percent increase in women’s wages. Note that the gain wasn’t due to companies banning sexism and racism or making a commitment to promote women or acknowledging that women with children are an asset to a company and society—it was a result of millions of women (more or less) voluntarily ingesting a carcinogen on a regular basis. And even at that price, the wage gap is still holding steady at around 82 cents for every dollar earned by men. The numbers are worse for minority women.

What would Planned Parenthood look like if it didn’t target a woman’s body as the fulcrum of her problems? What if Margaret Sanger’s organization reached for changes that actually did transform women’s lives and snapped the cycle? It would look much more radical than doling out abortion pills and IUDs. It would look like prenatal care and postpartum mental health services. It would feature affordable infertility treatment and family planning that, at a minimum, doesn’t cause cancer or damage organs. It would look like advocacy and practical help for child care, domestic violence, fair housing, and education.

Planned Parenthood may never be that organization, though, because it was founded on Sanger’s belief that women’s reproductive power is the problem that needs to be solved for humanity to reach its full potential. Indeed, PPFA’s previous leader, Dr. Leana Wen, was unceremoniously fired after she incurred insider wrath because she tried to broaden the nonprofit’s mission beyond abortion and contraception. After her firing, Wen wrote, “There was immediate criticism [after she was hired] that I did not prioritize abortion enough. While I am passionately committed to protecting abortion access, I do not view it as a stand-alone issue,” she wrote. “As one of the few national health care organizations with a presence in all 50 states, Planned Parenthood’s mandate should be to promote reproductive health care as part of a wide range of policies that affect women’s health and public health.”

PPFA didn’t go for that, at least for now, and neither has our culture at large. That’s why, in the United States, we’ve witnessed hard-fought court battles to secure free birth control for women, but we still don’t have bare basics like national paid maternity leave or abundant affordable housing. There’s a mismatch between what women want and what we’re offered by our society. We want effective family planning that’s safe for our bodies and our planet. We want support to care for our families and to achieve our dreams. We’ve settled for Margaret Sanger’s Planned Parenthood.

It looks like Sanger and PPFA are finally going through a long-overdue breakup, with a new awareness of how their mission to help women has sometimes dramatically backfired. It remains to be seen whether American women are also done settling.