The story comes from KCLU’s podcast The One Oh One. You can listen to the full episode here.
In a quiet, leafy neighborhood, inside a nondescript building, is the call center for Planned Parenthood on California’s Central Coast.
If you didn’t know it was there you might not notice the signage on the building as you drive past. The only thing that might catch your eye is the odd protester sometimes standing on the sidewalk outside.
There’s also a health center inside but I’m there to visit the regional call center. For many patients this is their first point of contact with Planned Parenthood.
“We have about ten staff members here. We have call center agents, as well as case managers and some RNs,” said Carol, who manages the call center and does case management at this location.
(I am only using the first names of some Planned Parenthood staff members. That’s because threats to their safety are not uncommon. For official spokespeople who are used to speaking publicly I have included their full names.)
“We take all the incoming calls for patients who are trying to schedule appointments as well as get notification for any abnormal lab results,” said Carol.
An upbeat music playlist plays in the background as operators take calls.
“Sometimes we do get first time callers that don't know where to call,” said Carol. “They maybe heard about us through a friend or maybe through a website. If they happen to be sexually assaulted and they don't know where to go, they definitely call us to find out what we can do for them, get them scheduled and tested.”
The call center runs six days a week with operators who speak English, Spanish and Mixteco – being available to communicate in this indigenous Mexican language has become more and more important.
“We get abortion calls for patients who are either having a fetal demise that need to schedule a termination or somebody that had been sexually assaulted that got pregnant or it was just something that they wanted to do. So we make this place a safe place for them to call and schedule those types of appointments,” said Carol.
They also schedule a lot of routine tests and wellness exams.
Working at a Planned Parenthood Health Center
Planned Parenthood has six health centers across the Tri-Counties. In Thousand Oaks, Oxnard (their newest center), Ventura, Santa Barbara, Santa Maria and San Luis Obispo.
America works as a healthcare assistant at one of those centers.
“I love to work at Planned Parenthood,” said America.
I spoke with her over Zoom.
“I love to be able to provide services to our much needed community,” said America.
On a typical day her clinic sees between 30 and 35 patients. Most patients are low income, many are Spanish-speaking, and many have limited access to other health care services.
“The majority of these patients consist of preventative services like pap smears, getting mamo-orders [mammogram]. We do also see patients who need a STD screening or exams due to certain concerns. And we also do provide abortion services. For the most part, I think throughout the day. We see maybe about two to three patients for those services,” America.
As we learned from the call center, a lot of patients have language barriers, something America says they’re working to address.
“And we do have a Mixteco translating health health care assistant that guides us with that,” said America.
America says they also see patients who find it challenging booking an appointment, because they don’t have a phone, or getting to the clinic in the first place because they don’t own a car and lack resources.
“Either by walking to the health center, taking public transportation, or even asking for friends or family or even transportation to get to their visits,” said America.
Planned Parenthood says in these cases they try their best to offer same day access.
America also sees patients who have struggled to get access to basic healthcare – patients who don’t have a primary care physician.
“And it's just tough to… being able to educate every single person on the importance of having your physicals and things like that to be checked, like diabetes or high blood pressure,” said America.
When she talks about the impact of her work. America recalls one particular patient – a teenager who came in to get birth control.
“She wanted something reliable and highly effective and something that she wouldn't have to be taking daily or switching out, you know, having more hands on,” she said.
The teenager ended up going with a hormonal intrauterine device – the IUD. Years later she returned to the clinic for her first pap smear.
“She was so happy to see me,” said America. “And I was wondering, ‘Where do I know you from?’ But she said, ‘I just wanted to thank you for being able to provide your knowledge about the birth control and the services that you rendered to me’”.
These interactions are what makes this service to her community so memorable for America.
What the data tells us
According to their published data, Planned Parenthood on the Central Coast conducts over 50,000 patient visits every year. And the most common visit type is for birth control (just like America’s patient) or for sexually transmitted infections or STIs.
In the last fiscal year, their clinics provided over 70,000 units of birth control (that includes things like the pill, patch or plan B). They also gave out over 100,000 condoms. And over 65,000 STI tests were conducted. STIs are on the rise in California.
Patients also go to Planned Parenthood for cancer screenings and HPV vaccines – the cervical cancer vaccine. During the mpox (previously known as monkeypox) outbreak in 2022 – testing and treatment was offered at their clinics.
Abortions account for less than 10% of patient visits – there were 3,605 abortions procedures in this last fiscal year.
And over 80% of all patients are at or low-income – to paint a fuller picture of that: if it’s a family of four, the household income is around $55,000. Planned Parenthood says they are a safety-net for many.
In terms of ethnicity, the majority of patients are Latinx – 53%.
Inside Planned Parenthood HQ
My next stop is Planned Parenthood’s administrative office.
In the lobby a book by Betty Friedan, the famous feminist author and activist, sits on the table. In the guest toilet, free tampons and sanitary pads are on offer as is the latest issue of Ms. magazine and other reading material you might expect to find at the Planned Parenthood HQ.
I’m there to speak with two members of the organization's leadership, who both speak in strong and passionate terms about what Planned Parenthood stands for and the services they provide.
One is Dr. Maryam Guiahi – the chief medical officer for Planned Parenthood on California’s Central Coast.
In Guiahi’s office there are plaques for her many qualifications, gynecology and family planning books, and cards written to her from patients.
I also noticed there's a bit of a decorative theme.
“There are lots of uteruses in my office you'll see,” said Guiahi. “I have a plush uterus that was given to me for my birthday. I have a rock that one of my staff members made that has a picture of a uterus and my name on it. And I don't have it in the office right now, but I've gotten other accessories like earrings with uteruses and fun things like that. So lots of decor.”
Uterus themed-decor is not a surprise for someone who says working at Planned Parenthood was an obvious choice.
“Planned Parenthood speaks to me. It speaks to my heart, because it really allows me to be the physician that I planned to be when I was a little girl," said Guiahi. "You know, when you're idealistic and you're younger, you just want to take care of patients. You want to take care of vulnerable communities."
For Guiahi that means taking care of patients regardless of what insurance they have.
“If that's a service we offer, we provide it no matter what,” said Guiahi.
As you learned earlier, many of Planned Parenthood’s patients struggle financially. Most do have some kind of insurance – through employer plans or Medi-cal. But for those without, Planned Parenthood has its own Patient Assistance Program and they will also access funds from the state through a program called Family PACT – which provides money for family planning services to low-income Californians.
Guiahi has worked at Planned Parenthood since 2020. But she has been in the reproductive health field for many years as she describes: “fighting the good fight”.
“I have dedicated my life to supporting patients and advancing reproductive care. And really, Planned Parenthood is the leader in sexual and reproductive care,” said Guiahi.
As we have learned, over 90% of patients come to Planned Parenthood for non-abortion related services. But for the less than 10% who do, Guiahi says they work to make it as available as possible.
“So, I would say the vast majority of our patients know what they want and they know they want an abortion. If they didn't, of course, we would be providing options, counseling, but the vast majority know what they want,” said Guiahi.
And that means often, patients also know if they want a medication abortion or surgical procedure abortion.
“For patients who are ten weeks or under, which is the majority of our patients, they do have the option of choosing medication or choosing a procedure,” said Guiahi.
Guiahi says 90% of patients who are seeking abortion do it in their first trimester. But for those who are seeking an abortion in their second trimester (after 14 weeks), she says it is common for these to be wanted pregnancies where something has gone wrong.
“Commonly in the second trimester I'm taking care of patients who have highly, highly desired pregnancies. These are IVF pregnancies. These are pregnancies that occur finally after two or three miscarriages. These are planned pregnancies who unfortunately get the news of something like a devastating fetal anomaly, maybe one that won't be able to survive or fetal demise in the second trimester. Those are really hard situations to navigate with patients. You know, this feeling of ‘I don't want an abortion, but I have to have one now’, Right,” said Guiahi.
She says she also sees adolescents who might not have known they are pregnant.
“Who sometimes present later, often because their parents finally notice that something's going on and then they realize that their parents are actually supportive of this decision and then they come together but they are presenting later,” said Guiahi.
And patients struggling with addiction.
“We know that there is an opioid crisis in this country and in California. So we see patients who are struggling with addiction and realize then that they're pregnant and are concerned about the harms. And so sometimes choose abortion for those reasons,” said Guiahi.
Abortion is legal in California up until the point of viability - around 24 weeks – there are exceptions if the mother’s health or life is at risk.
But there are limited places where you can actually access an abortion, even in California. That’s something that Guiahi has been prioritizing.
“And so we've really spent the last two to three years focusing on improving access, making sure that abortions are available in all health centers. Procedural abortions in most,” said Guiahi.”
They also now allow abortions for abortions later in the second trimester – 22 weeks – than they did in the past.
“Because we know in the past we were kind of a desert in one respect, with respect to second trimester abortion care. And so really filling in that gap for patients so that they don't have to be told they need to go to L.A. or San Francisco,” said Guiahi.
If a patient is beyond 22 weeks they will be referred to surgical centers in Los Angeles and San Francisco.
The challenges
Down the hall from Maryam Guiahi’s office is the office of Jenna Tosh, the CEO of Planned Parenthood on California’s Central Coast.
Many of the things in her office reflect her life and work – the walls showcase Tosh’s degrees. There’s photos of her children. And of her with Former President Obama and California Governor Newsom.
And there’s a poster showing the history of contraception.
“Which I just think is really interesting because it shows hundreds of years of history of contraceptive methods, which is, I think, something that a lot of people think of as new, but it's really not. You know, people have always exercised control over their fertility,” said Tosh.
Tosh sits at her desk, sipping from a mug that has the word ‘resist’ on it. Many hands reaching upward frame the word. A candle with the late Supreme Court Justice Ruth Bader-Ginsburg on the front, sits on some drawers behind her.
Next year marks 20 years at Planned Parenthood for Tosh. She has been at the Central Coast affiliate for eight years and before that she was at Planned Parenthood in Orlando, Florida.
“I grew up in New York where I had access to Planned Parenthood and where Planned Parenthood took very good care of me as a young person who had questions and needed a non-judgmental and compassionate place to go that I could afford,” said Tosh. “And so I had a very personal connection to Planned Parenthood, as is the case for almost all of our donors and supporters and many of our staff. And that caused me to want to be part of this movement and the fight to ensure that all people have access.”
Her priority - like Guiahi’s - is making sure as many people as possible can access the care they offer.
“In most cases, someone who needs an abortion on the Central Coast will be referred to Planned Parenthood. There are some other providers of medication abortion, including Cal Poly and UCSB now, which is part of a state mandate related to medication abortion access for college students. But the vast majority of patients who have an abortion on the Central Coast will come to Planned Parenthood,” said Tosh.
Like many other healthcare providers in the region, Planned Parenthood is also facing a challenge with the shortage of healthcare workers.
“I don't think that you could find a health care provider in our three counties who would say that this hasn't been a challenge for them,” said Tosh. “I think all health care providers are still struggling with provider shortages, with staffing shortages, and that that is the biggest challenge that the industry faces collectively. There is no health care without health care workers.”
Tosh says this was a problem before the Dobbs decision which overturned Roe v Wade and before the COVID-19 pandemic.
Another challenge, Tosh says, is that this region doesn’t have a lot of reproductive training institutes and then there’s the high cost of living.
“It's no stranger that housing is a challenge in this region. And so I think that we often find that to be a struggle as well, that putting down roots in this region can be costly. And we often see people have to put down roots and then travel and have a commute,” said Tosh.
When the Supreme Court overturned Roe v Wade more than 16 months ago – declaring that the constitutional right to abortion, upheld for nearly 50 years, no longer exists – the Central Coast’s Planned Parenthood prepared to accommodate more out-of-state patients seeking abortions. They planned for between 100 and 300 extra patients a year – they say those numbers turned out to be more or less on point.
Tosh says the overturning of Roe v Wade was a surprise, but she wasn’t shocked.
“It was very clear that this was the direction that the Supreme Court was headed in. We had seen a decades-long assault on reproductive rights, including an effort by anti-abortion politicians and activists to radically change the federal judiciary and the composition of the Supreme Court,” said Tosh.
The threats to abortion access from outside of California continue today. Access to mifepristone – a pill commonly used in medication abortions – may soon face another ruling from the conservative majority Supreme Court.
“The purpose of cases like this one is to further erode access to abortion care. I just think we have to be really clear about that,” said Tosh.
As Planned Parenthood marks 60 years in the Tri-Counties next year, the organization says it is remaining vigilant but that it's also important to remember that, in many parts of the country, they have public opinion on their side.
“So this is our moment, I think, to fight for the future that we deserve to really put equity at the center, to work with young people as partners and to recognize that we have public support. And what we need to do is continue moving forward, put one foot in front of the other and actualize that support,” said Tosh.
They say they remain proud of the work they do – as the region’s primary provider of abortions. And, for the vast majority of patients, as a safety-net for many who struggle to access basic reproductive healthcare.
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