BILLINGS, Mont. — On Friday, the staff of a Planned Parenthood clinic in a quiet residential neighborhood here conducted four Pap smears, nine contraceptive appointments, two screenings for sexually transmitted diseases and three pregnancy tests. Of the 24 patients seen that day, two had abortions.
It was a typical workload for this health center and for Planned Parenthood, the organization that emerged as the final sticking point in the budget talks that nearly led to a government shutdown.
House Republicans were eager to cut off money to the organization, which is the nation’s largest abortion provider and a political force in Washington. President Obama blocked the effort, but groups that oppose abortion rights have vowed to raise the issue again and, in the meantime, are pushing for congressional hearings.
Planned Parenthood and its backers say that it serves a broader function than performing abortions, particularly in rural and medically underserved communities where the group has most of its clinics.
In Montana, women — and a few men — cross lines of protesters to tend to their most intimate problems. They drive hours to get birth control pills they cannot buy closer to home. They are screened for depression, cervical cancer, osteoporosis and high cholesterol. Many lack health insurance.
Many also get abortions. In Planned Parenthood’s more than 800 health centers in the United States, the group completed more than 300,000 abortions in 2009 — one out of every four in the country — the latest year for which data are available. Of the 15,000 people treated at Planned Parenthood of Montana last year, nearly 1,000 had the procedure.
Those abortion numbers have led some abortion opponents to call Planned Parenthood an “abortion mill.” In a recent floor speech, Sen. Jon Kyl (R-Ariz.) said that abortions represent “well over 90 percent” of what Planned Parenthood does — a remark that his office later said was “not intended to be a factual statement.” According to the national group’s statistics, the proportion is closer to 3 percent.
Of the five clinics in Montana, one doesn’t offer abortions. One performs them three days a week; the others, one to two days a week. Planned Parenthood also partners with four medical centers throughout the state.
“It’s a small part of what we do,” Stacy C. James, president of Planned Parenthood of Montana, said Friday afternoon at the Heights clinic in Billings, one of two Planned Parenthood centers in the city. As if on cue, a half-dozen giggling teenage girls tumbled into the lobby, slipped condoms into the pockets of their ripped jeans, and left.
“That said, I am so glad we do” abortions, James said. “It’s not something I want to set aside. I am so proud that we provide this service, even though our primary goal is to prevent pregnancy.”
The possibility that Planned Parenthood could lose its government subsidy sent ripples of anger and panic through the waiting room of the clinic. It sits amid a neighborhood of townhouses and low-slung apartment complexes, where herds of antelope sometimes traverse the parking lot.
But there are hints of the violence that has sometimes erupted at abortion clinics. The decorative boulders out front are reinforced with steel in case someone tries to ram a car through the front door. The intake window is made of bulletproof glass. On the sidewalk, a rotating group of activists participates in a subdued, perpetual protest.
On Friday, Amy Seymour, 46, huddled inside her “40 Days for Life” sweat shirt as the evening chill set in, the lone protester left as the clinic neared closing time. She acknowledged that Planned Parenthood provides some service to the community but said the abortion issue was a deal-breaker.
“All the other stuff they do is fine,” she said. “But there’s a whole segment of the population that is being murdered.”
The question of whether Planned Parenthood should continue to receive $363 million in federal funding is the latest front in a long-running war between social conservatives and the 90-year-old organization. The sum, a combination of Medicaid dollars and money set aside for low-income women’s health, makes up about one-third of the group’s $1.1 billion budget. By law, none of the federal money can be used for abortions.
Foes contend that no matter the mix of Planned Parenthood’s services, abortion is at the heart of its mission. They also say that many of the other services are designed to lead women to that decision, one they say is misguided. They say federal funding keeps the organization financially afloat.
The opponents got a boost this year when an activist released undercover video purporting to show abuses on the part of Planned Parenthood staff. Supporters of the group said the videos were highly edited. New Jersey’s Planned Parenthood affiliate later fired an employee who was shown giving advice to a man posing as a pimp about ways to avoid laws on reporting child abuse.
“In the past, it was very difficult to overcome their PR operation,” said Marjorie Dannenfelser, president of the Susan B. Anthony List, an antiabortion lobbying group. “But given the enormous problems that were exposed in their corporate model, that really stirred up a lot of concern about what’s going on in these clinics.”
Also irksome to many conservatives is the work Planned Parenthood does outside its clinics. It has a political action committee that endorses pro-abortion-rights candidates — most of them Democrats — and backs controversial policy proposals, such as last year’s health-care overhaul.
Planned Parenthood and a California affiliate together spent more than $700,000 on federal lobbying last year, according to the Center for Responsive Politics. Its political action committee contributed more than $148,000 to federal candidates during the last election cycle and recorded more than $900,000 in independent expenditures, the watchdog group said.
About 73 percent of Planned Parenthood’s clinics are in rural or medically underserved communities, which is why many patients go for nonreproductive issues. In Montana, general practitioners are on staff because so many people go for primary care.
Many of the women and teens who show up, however, have decided to terminate pregnancies. About 75 percent of the abortions conducted here are induced with the abortion pill. The rest are done surgically. The group does not do what opponents call partial-birth abortions.
Because the state is so large, some Planned Parenthood clients drive hours to get to one of its clinics. Recently, the only pharmacist in Broadus, a remote town in southeastern Montana, stopped selling birth control pills for religious reasons. Women there must now obtain them through the mail or drive more than 150 miles round trip to Planned Parenthood.
Montana has less restrictive laws on abortion than some of its neighbors, so women and girls sometimes travel from North Dakota and Wyoming to terminate pregnancies.
Lillie Cannon, a 28-year-old graduate student, went in to the Billings clinic Friday for a birth control appointment. Her first visit to a Planned Parenthood was at age 18, she said, and she has come since.
“I do kind of think there is an emotional stigma that surrounds Planned Parenthood,” she said. “It kind of feels like people see it as a place where people just go for abortions. In my situation, I was able to prevent it.”
A 19-year-old woman with a 9-month-old on her hip was one of those who was not able to prevent it. She had gone by Friday for a follow-up visit. A longtime opponent of abortion, she said she rethought her position after finding herself with child again so soon after her first, complication-riddled pregnancy.
“I thought, ‘Oh, no, not again. I can’t go through this again,’ ” said the woman, who declined to give her name. “I already have a daughter. I was in and out of the hospital with her. For me and my fiance, to bring another child into the world was not the right decision.”