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Wednesday, November 24, 2010


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?





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