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Interview with PPMSM CEO Lori Lamerand (Downtown Birmingham Bloomfield)

Published May 1, 2012 in Downtown Publications features section.

By Lisa Brody, News Editor.

 

Published: 05.01.12| Updated: 05.15.12

05/01/2012 - Lori Lamerand, CEO of Planned Parenthood of mid and South Michigan began her gig at the organization years ago as a medical assistant, working her way to the top of a $14 million non-profit organization with 17 health care clinics across the southern part of the state. She addresses in a straightforward manner the issues Planned Parenthood is facing across the country, and right here in our backyards, and discusses why the organization is important and relevant.

DOWNTOWN: Tell us a bit about yourself, how long you have been with Planned Parenthood, why you joined Planned Parenthood, and how many offices of the organization fall under your general management.

LAMERAND:
I've been with Planned Parenthood 27.5 years. I started as a medical assistant all those years ago when our organization was one-and-a-half health centers with a budget of $1.5 million, and have held a bunch of other positions in the meantime, to becoming the CEO seven years ago. We now run 17 health centers across the entire bottom of the state. The affiliate is the product of four mergers with sister affiliates and this year we'll see 70,000 men, women and teens. We do see men, too; 6 percent of our patients are men. We have a 31-county service area that goes as north as Saginaw and Bay County, and all the way to Berrien County in the southwest corner of the state. About 83 percent of the state's population lives there.

DOWNTOWN: Can you explain exactly what Planned Parenthood is, what services it offers, and who comes to its clinics and offices? How do people pay for their services?

LAMERAND:
Planned Parenthood is a health care non-profit whose mission is to ensure that people have access to reproductive health care and we make sure of that by providing the care itself, offering education and doing public advocacy. We work on several levels. The Planned Parenthood that does medical services is an IRS-designated 501 (3)(c) organization, so we are a charity, and we have the ability under that designation to talk to our legislators about issues that are important to us. We also have a 501 (c)(4) organization, called Planned Parenthood Advocates of Michigan, and that designation allows for some lobbying. There's also a PAC—a political action committee, which gets involved with politics.

Most of our patients pay something out of pocket, but it is on a sliding scale based on a family's income and the number of people in that family supported by that income. We get some people paying their own fees; we certainly take third party reimbursement, both Medicaid insurance as well as private coverage. In addition, as I mentioned, we are a charity, so we have a number of people who entrust us with their hard-earned dollars through donations and we access several federal, state and foundation grants to make up the rest.

DOWNTOWN: About how many women does the mid and south Michigan organization service each year? Why do women choose to come to Planned Parenthood rather than someplace else, like a doctor's office or a health clinic?

LAMERAND:
This year it will be very close to 70,000 (served). Many women don't have access to a doctor's office because they don't have insurance coverage and the fees are prohibitive, based on their income. Certainly, a number of our patients have lots of other options and do have insurance, choose Planned Parenthood because of our philosophical bent that we put to our care, in that we put a lot of effort in ensuring that our patients have a voice in their own health care, in what's being decided in their health care, and they're really empowered to make decisions that are good for their health. We make sure they get lots of information. Patients at Planned Parenthood experience a different level of discourse between they and the providers because we give a lot of information, such as the specifics of their situation, and give them the options for decision-making for a whole host of things, from something as simple as what birth control might be good for them to what they might like to do with an unplanned pregnancy, how they may want to manage an abnormal Pap smear result, etc., etc. We give people information and some advice, and together with the clinician, they take the best course of action.

DOWNTOWN: Your promotional material states that one in five women has turned to Planned Parenthood sometime in her life. How do you know that? Is there an age that tends to come in more than others?

LAMERAND:
We have done national surveys. Nationally, more than 4 million women will access health care at a Planned Parenthood health center this year. I think many people think of Planned Parenthood as a provider for very young women, and certainly we do see young teens, but that is not the predominant age we help. Our patients range in age from about 12 to 45; and the most popular age range is 24 to 35, during child-bearing age.

DOWNTOWN: How did Planned Parenthood come about? Do you believe it is still relevant?

LAMERAND:
Planned Parenthood was founded about 100 years ago by a woman named Margaret Sanger who was watching the hardships people were enduring in the tenements of New York City and started disseminating information to women who certainly didn't have resources about how to prevent births. At that time, women were having a baby a year. Many of them were in very difficult situations, and had recently emigrated from other places, and she felt very strongly that people needed the information to make good decisions about their own family sizes. She opened a clinic in Brooklyn, and was arrested and had real political opposition, and out of that the first Planned Parenthood was born.

Absolutely (it's still relevant), even in the context, if we're lucky to have the Affordable Health Act upheld by the (U.S.) Supreme Court, there likely will not be enough providers to help everyone covered under that act, so if you take a page out of the Massachusetts book, people were thrilled to have Planned Parenthood as an option. This country has a dramatic shortage of any providers, of doctors, nurses, mid-level assistants, there's simply not enough to cover what the demand will be so to have places other than doctors offices is helpful. Secondly, we have not had a long history in this country of dealing with patients who struggle with income disparities, and Planned Parenthood knows how to do this. We do it on a much smaller budget than most people think is possible. And, as long as abortion remains safe and legal in this country, there will not be enough providers for that service. And while Planned Parenthood works every day to reduce the need for abortions by providing women with adequate family planning services, the fact of the matter is, there are dire circumstances where that is the choice that women make, and we believe it is very important that is provided appropriately.

DOWNTOWN: One of the most controversial medical procedures Planned Parenthood performs is abortions. By some estimates, on a national basis, 10-15 percent of the annual revenue of Planned Parenthood is spent on abortions. How many are performed in Michigan, especially in southeastern Michigan, each year?

LAMERAND:
Of our 17 affiliates, four perform abortions. Less than 3 percent of our visits have anything to do with abortion services. It's around 3,000.

DOWNTOWN: Where does your funding come from? How large of a budget does the south Michigan service area operate with on an annual basis?

LAMERAND:
Our funding comes from patient fees, grants of various natures, and donations. Our budget is about $14.5 million.

Downtown: How concerned are you about efforts at defunding Planned Parenthood, both on the national and state levels? How would these revenues be replaced?

LAMERAND:
Incredibly concerned. I've been involved with Planned Parenthood for 27.5 years, and the opposition to Planned Parenthood is unprecedented. I think the characterization of a war on women is not an overstatement. We really have come to a place where we're debating not only if abortion is appropriate; good thinking people can disagree about that, but it is a legal procedure in this country, but beyond that we're debating whether or not women should have access to contraception at all. There are bills all over the place that would ban contraception in the Personhood Bill. We have a person on the national stage in Rick Santorum saying he thinks it would be appropriate for states to outlaw contraception. I think we're in a place where the damage would really be extreme. Nearly 80 percent of Americans support funding for Planned Parenthood, and 98 percent of women use birth control at some point in their childbearing years. To paint this as a trivial or fringe issue is incredibly shortsighted.

Planned Parenthood would not exist as we know it now. It's not really us that would get defunded. We're but the conduit for women to get the health care they need. Who really gets defunded is in our direct service area, over 70,000 people who would not have access to health care in another way. Over 70 percent of our patients only get health care because of a sliding fee scale. The notion that other providers would pick up the slack is absurd.

DOWNTOWN: I understand that Planned Parenthood has received federal funding since 1970, when President Richard Nixon, a Republican, signed into law the Family Planning and Services and Population Research Act, amending the Public Health Service Act. Title X of that law provides funding for family planning services, including contraception and family planning information. Nixon is quoted as saying Title X funding is based on the premise that "no American woman should be denied family planning assistance because of her economic condition." For many years, the law enjoyed bipartisan support from liberals who saw contraception access as increasing families' control over their lives, and conservatives who saw it as a way to keep people off of welfare. Recently there has been a reversal, with attacks on contraceptives and on women's use of them. Why do you think there has been such a change in perception or rhetoric on the topic of contraception, 50 years after the "pill" came about?

LAMERAND:
I think it mostly is because all things are political. The nature of the Republican party, certainly, has changed. No one has done anything with Title X since then. It was recognized that it was a disparity issue; the repercussions for women of not contracepting are far weightier than for men. The second thing, it is an economic issue. In Michigan, we know, every $1 spent on contraceptives will save $5 the very next year in Medicaid costs related to pregnancies and births. Family planning is a good economic decision. The religious right of the Republican party has taken over, and this is where we've landed.

For women who've grown up with Roe v. Wade, and have gotten complacent, this is what we've been warning you about. The good news is, all of these attacks on women are really getting called out as absurd and inappropriate.

DOWNTOWN: Whether you are pro-choice or pro-life, explain how family planning services of Planned Parenthood offers reduce the need and opportunity for abortions. Many anti-abortion activists dispute that greater access to contraceptives reduce abortions. Why do you think they do, and how do you counter their argument?

LAMERAND:
We do a bad job as a country helping people manage their fertility. More than half of all births were unintended. That doesn't mean that at the time of the birth the person is disappointed they're pregnant, but it wasn't intended, and that's the highest rate of developed countries. We have an inherent problem. What we know is if you give families the right resources for spacing children and the right resources to take care of children, people get started in life on the right footing. That's our premise: if you offer people information the opportunity to manage their fertility in a proactive way, we will reduce the need for abortions by reducing the number of unwanted pregnancies. They absolutely dispute it. For some activists, it's not just about abortion, it's about control. Some of these people would like to roll back the clock to Margaret Sanger days at the turn of the last century.

DOWNTOWN: Were you surprised at the backlash the Susan G. Komen organization received when they announced (albeit, briefly), that they were pulling their substantive funding of Planned Parenthood? What do you account for that kind of broad base reaction and hostility?

LAMERAND:
I think we were all pretty surprised by that, and delighted, not by the misstep, because that's how we viewed it, but really by the way social media allowed people to have their say. I think what the message came out over and over again, is that it's not "their" money any more than the money we take in as donations. People give us their precious and hard-earned dollars and they trust us to be good stewards of that money and to do with it as we say we will. Many Komen supporters are also Planned Parenthood supporters, which surprised them, not us. We knew that. They also had always been a non-partisan breast cancer organization, and that move took them out of that realm.

DOWNTOWN: Planned Parenthood provides breast exams, HIV testing and counseling, Pap tests, and testing for sexually transmitted diseases. Let's talk about those services, which seem to get less notice. How often do you detect a women's breast cancer? What is your protocol in those instances? What about other gynecological cancers? HIV and AIDs seem to get less attention today. How prevalent is in southeastern Michigan? How do you help women and children who come to Planned Parenthood receive treatment and counseling? Do you refer them out, or do you provide those services?

LAMERAND: Most women we see are young and healthy, but young women get breast cancer. While Planned Parenthood does not offer mammograms at most of our centers nationwide, mammograms is more of a later in life screening option. The first screening for most young women is clinical breast exams, and without Planned Parenthood services, many women would not have access to that. Abnormal cervical issues that are found on Pap exams are very common occurrences and we insure that women can care for that. We refer it out if it is an issue we can't help with.

HIV and AIDS are more prevalent than people realize. New cases of HIV infection are more prevalent among women, and we see a fair number. We don't provide ongoing treatment. Our whole focus is on prevention, so we can provide more to more people than if we were all things to all people.

DOWNTOWN: Does Planned Parenthood offer adoption services and counseling? If so, why do you think that message is lost in the din of other noise surrounding Planned Parenthood?

LAMERAND:
It does not, but it has a large and robust referral system with Catholic Social Services in Ann Arbor, and other adoption services that can make those arrangements. We get accused of not offering that as an option, and that is absolutely erroneous. When we have a women with an unintended pregnancy, we lay out the options factually, in terms of what she may do, without direction, and then give her referrals. Unfortunately, adoption is not a popular option.

DOWNTOWN: It's reported that lesbians receive less frequent gynecological care than heterosexual women, thereby placing them at greater risk for gynecological cancers and sexually transmitted diseases. Does Planned Parenthood do anything to help with that community, and to bridge the gap in communication with the LGBT community?

LAMERAND:
We've worked in concert with the LGBT community for a long time. But it's one of the places I think we haven't done enough. With our new center in Ferndale, my hope is to offer our services in a more robust fashion, reach out, offer services like uterine insemination, hormone therapy for people who are in gender transition, those sorts of things. The statistics do show that lesbian women get uterine, breast, ovarian cancer at the same rate as heterosexual women, but they die almost three times as often because they're not caught soon enough. We know that people who identify with gender issues are not comfortable with the health care industry, so we have been working very diligently to try to insure that our staff all have the proper training and understanding of that community so that we can more proactively engage in their health care.

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