I was flipping through brochures in the conference room at Stanton Healthcare in Boise, Idaho, when its founder, Brandi Swindell, cracked the door open. “Want to talk to a patient?” she asked, her blonde hair framing the joyful smile on her face. “She just found out she's having twins!”
I followed Swindell into the exam room, where the nurse practitioner was moving the ultrasound machine away from the table and back into the corner. Brandy (she asked her last name not be used), 26, was sitting up on the exam table, her glance moving constantly to me, to Swindell, to the nurse, and repeatedly back to the large monitor on the wall where her ultrasound image was being projected. There, the image of two small sacs — the very first visual clue of a baby growing —was clear and undeniable.
Pro-life clinics seek to replace Planned Parenthood as recipients of federal money without providing abortion or contraception.
According to the APA, there is no evidence that having an abortion causes mental health problems for most women.
In 10 years, Stanton Healthcare grew from one small-scale CPC into a network in five states and Northern Ireland.
“I'm shocked. I kind of want to cry a little bit,” Brandy told me, her eyes wide. “I just didn't really expect any … I expected one. You know, like a normal appointment. When I saw two, it was a shock. I'm still in shock.”
Brandy and her husband had been trying to have a baby since they got married 18 months earlier, but all three previous pregnancies had ended in miscarriage. After experiencing what she believed was an unusually light period four weeks earlier, then missing her next one, she took a home pregnancy test to see if there was any possibility that she might be pregnant again, then waited before seeking out an ultrasound to be certain she could see something in the image. The waiting paid off, and Brandy was able to determine she was now five weeks pregnant and likely to be the mother of twins.
- We will not simply EXPOSE. We will not only DEFUND. It's time to REPLACE Planned Parenthood.
For patients like Brandy — pregnant, uninsured, and without medical care — Stanton Healthcare provides a lifeline for getting health services that they may otherwise be unable to access in the state, and Swindell has an ambitious goal for her network: She hopes it will become the pro-life movement's replacement for the entire Planned Parenthood organization.
“We will not just COMPETE. We will not simply EXPOSE. We will not only DEFUND. It's time to REPLACE Planned Parenthood,” reads one set of marketing materials that promotes what Swindell has called the “Stanton Revolution,” while another has the simpler “Replace Planned Parenthood” as its motto.
With a personality that switches between earnest confidante and hard-hitting businesswoman, Swindell, 39, believes she has the political connections, activist background, and business plan to make replacing the Planned Parenthood network a reality, even without providing any basic contraception methods at all. While Stanton clinics intend to offer a full range of women's reproductive health services that address pregnancy, sexual health screenings and STI testing, and gynecological issues like ovarian cyst diagnostics or annual pelvic exams, not one Stanton affiliate will be offering contraception — either hormonal or IUDs, or even simple barrier methods like condoms. For women's health advocates, especially those hoping to reduce the nation's unintended pregnancy rate, the concept leaves them concerned. Increasing women's options for accessing no or low-cost health care is always a positive, they say, but some worry about the effect of leaving birth control out of the equation.
The foothills and mountains that run through Idaho are part of what draws Swindell to her home state — and are also what makes the issue of women's health care access one that resonates with her so soundly. Like other rural, conservative states, it becomes increasingly difficult to get to a health-care provider once you move outside the biggest metro areas.
Swindell, a self-proclaimed “snow bunny” who adores snowboarding, hiking, and fishing, said it was an experience in the woods that led her to pro-life work. While Swindell was working at a national park during the late 1990s, a friend she met at the camp became pregnant and went to a clinic 2.5 hours away for an abortion. Swindell said when she saw her after the procedure, it was like seeing a completely different person.
“I could feel it in the air and I could see it in her limp body, she was lying in the fetal position and she had had the abortion,” Swindell said. “That experience changed her. She wasn't the same vibrant girl that she was before.”
(The American Psychological Association determined in 2009 that there is no evidence that having an abortion causes mental health problems for most women.)
Swindell had always considered herself pro-life, but she said that incident was a turning point. Soon she moved to the East Coast and met national activists who helped her find her own place in the movement. She worked with Rock for Life, an anti-abortion music ministry, and Christian Defense Coalition, and even did some international work in Ireland with Youth Defense, an Irish anti-abortion organization. She helped launch Generation Life, a youth action group meant to help recruit younger people to the anti-abortion cause.
Swindell was working with national and international activists, but at heart she considered herself an Idaho girl. By 2002 she had moved back to Boise and immersed herself and Generation Life in local activism. In 2004, she made headlines again when she and Bryan Fischer, a vocal far right social conservative, sued the city to block the removal of a statueof the Ten Commandments that was on public park property. Their effort failed, however, and Swindell, then just 28, ran for a seat on the Boise city council in 2005 in order to try to change the city from the inside. She lost to incumbent Democrat Maryanne Jordan.
Meanwhile, Swindell was shifting her focus from Generation Life in favor of her new passion project, Stanton Healthcare, which she named after suffragette and women's rights activist Elizabeth Cady Stanton. “I wanted a special name. I wanted a name that conveyed what I was feeling in my heart about women,” said Swindell. “Elizabeth Cady Stanton, when her first son was born, on the day she delivered him, she raised a flag outside her house announcing [the birth], which was a really big deal. It was countercultural, to be like, 'I just spread my legs and had a baby, everybody.' I just kind of love that about her.”
Swindell's first Stanton center opened in 2006, operating in a building provided to her by her local church. It opened as a basic small-scale crisis pregnancy center, offering physical resources and emotional support to pregnant women in order to persuade them to continue their pregnancies and not have an abortion. “I realized that we didn't have a clinic or center here in Boise doing ultrasounds and we have the highest percentage of abortions in Idaho,” Swindell said. “I was like, 'How is there no center here?' So I went, 'OK, I guess I better roll up my shirt sleeves and start it.'” Soon she grew out of that space and into what is now Stanton Boise.
At first glance, Stanton Healthcare may not look much different from the approximately4,000 crisis pregnancy centers operating in the United States. Most of its services are through its Boise location, but Stanton also uses a mobile ultrasound clinic to get to underserved, rural populations and refugee communities in the state — many of whom have no access to any local health care or transportation to travel to an appointment. Stanton Boise is located directly next door to the Boise Planned Parenthood clinic, in a building that Swindell was able to purchase for $250,000 — $170,000 of which she had to raise in just one year in order to receive an $80,000 grant to pay for the rest. Inside, the reception area smells of lavender essential oils and a stone fireplace dominates one wall. The hardwood floors lead to exam rooms, a “baby boutique,” and even a “spa” room for prenatal massage.
For Stephanie Reyes, a 24-year-old uninsured mother expecting her third child, Stanton's services are the only care she has been able to receive during the first 23 weeks of her pregnancy. Reyes found out about the organization when trying to find support for a family member who was unexpectedly pregnant. Little did she realize she would need similar services a few weeks later when she, too, was expecting a baby.
“They treat you like a friend,” Reyes said, holding her nearly 4-year-old daughter in her lap as we spoke. The young girl, big-eyed and with a small shy smile, soon wiggled free to play with the toys in one corner of the exam room while Stephanie met with Stanton's nurse. “The resources have been good. They help you with maternity clothes, baby clothes. They do free ultrasounds, which is amazing,” she said.
Reyes was one of three Stanton clients I saw when I was at the clinic, all of them pregnant and none of them conflicted about giving birth, not surprising since Stanton is very open about being a “life-affirming medical clinic” that will not offer abortions. In each case, the patients turned to Stanton to access ultrasounds, pregnancy confirmation, and some basic prenatal care they could not obtain due to lack of insurance, a problem for newly pregnant women in Idaho, where a lack of Medicaid expansion leaves all but the very poorest unable to qualify for subsidized coverage on the federal insurance exchange.
Brandy, the woman who had just learned she was pregnant with twins, already had an appointment set up with a local doctor for prenatal care, but her health insurance policy wasn't going to go into effect for another six weeks. In order to have it cover her pregnancy as a preexisting condition, she needed to have medical proof of the pregnancy. For Brandy, having her pregnancy covered by her insurance was especially important since, with a history of miscarriage, her pregnancy would be considered high-risk and require more medical appointments and support. Plus, waiting an additional six weeks to find out whether this pregnancy would be viable would have been torture.
Reyes said that without Stanton, she wouldn't have had any prenatal care. Reyes was visiting the clinic for her fourth appointment, where they both helped her with her Medicaid application and gave her an ultrasound. In it, she learned she was having another boy. “I feel embraced here,” she said. “I would tell everyone if they can't afford somewhere to go and check how their pregnancy is going, Stanton is here to help them.”
Helping newly pregnant patients is a specific role that Stanton Healthcare plays in the community, and one that is more urgent in a state like Idaho, where the legislature has refused to expand Medicaid under the Affordable Care Act. While lower-income uninsured women will often be eligible if they are pregnant, the process for coverage can take time and assistance, and only after she has been accepted into the program will her medical expenses retroactively be covered. At Stanton, a pregnancy can be verified at no cost to the patient, and staff will also help an expectant mom to fill out the paperwork to get her Medicaid application underway.
And then there is the “baby boutique,” the overflowing shelves with bins of baby goods, from clothing to baby carriers, bottles and bouncers, even breast pumps, all for mothers who need assistance.
Bambi, 32, was already the mother to four boys ages 4 to 16. She didn't think she could conceive again after a doctor told her that her chemotherapy treatment for cancer a few years earlier likely made her eggs infertile. But after she went into a hospital for severe ovary pain, she learned she had a cyst that had ruptured — and she was pregnant. Bambi said she was told she'd likely miscarry because of the cyst, and the entire family was struggling financially, so she never followed up with a doctor. She arrived at Stanton 28 weeks pregnant and wearing her boyfriend's T-shirt and sweats because none of her own clothes fit and she couldn't afford new ones.
“This has been the first smile I've had for months now,” Bambi told me as she sorted through pink and white onesies. She had just learned she was having her first girl. “The boys are going to be excited because we weren't having no more babies, so now to find out we're having a baby sister, they're going to be super stoked.”
Because Bambi's other children were so much older and she didn't think she could have more babies, she hadn't kept anything from the boys in their tiny home. After spending time in the baby store, however, it was clear that Bambi would have a substantial pool of supplies to start her out. And as she left carrying a tub of clothing, two Stanton volunteers followed, each with their arms full of baby necessities too. “We are going to go get her some maternity clothes next,” Swindell told me after Bambi drove off.
Going beyond pregnancy tests and baby booties is characteristic of Swindell, according to Promise Salwei, who is not only her assistant but was once a client. Salwei, who volunteered with Generation Life when she was a teen, had been living in Alaska when she got pregnant unexpectedly at age 25. She originally decided to have an abortion, but the nearest clinic was four hours away and she couldn't get in for a week. After a few days of waiting and a conversation with a friend who also was pregnant, Salwei decided to tell her mother about her own pregnancy, and shortly after, she called Swindell to see if she could get services through Stanton. Salwei moved back to Boise and started getting prenatal care at the clinic when she was 5.5 months along. Less than a year after Salwei gave birth, Swindell asked her to come work for the organization as her assistant.
As both a patient and employee at Stanton, Salwei has been able to witness firsthand how Stanton has evolved from a pregnancy center to a women's health center, and why that change has been so necessary to the reproductive health care landscape locally. “Can I share about the cysts?” Salwei asked Swindell.
“Oh yeah, you can,” Swindell responded.
Salwei told me about a time the nurse practitioner at Stanton was performing practice ultrasounds on the staff as a way to train, and she decided to offer to play “patient” since she had been experiencing severe pain but had put off seeing a doctor because it would be expensive. The nurse saw what she believed was a cyst and suggested Salwei follow up to take care of it. “It saved me a lot of money coming here, and even though they couldn't diagnose me, I was able to go to my doctor and I ended up having surgery and having five cysts taken off my ovary,” said Salwei.
“But we can diagnose now,” Swindell added. “We have a medical person that specializes in women's care.”
- “We hope to be much like Margaret Sanger was, a revolutionary of her time. I know, can you believe I'm using her?”
Upgrading staff to be able to provide direct medical care — STI testing, diagnostic ultrasounds not just for pregnancy but issues like cysts and even mammography if a partnership with a local hospital in the works for the fall comes to fruition as Swindell hopes — are all key components for Stanton to be more than a pregnancy center, but a fuller women's reproductive health organization.
“We hope to be much like Margaret Sanger was, a revolutionary of her time,” Swindell said, referring to the founder of Planned Parenthood, whom most of the pro-life movement vilifies. “I know, can you believe I'm using her?” she said, pointing to the irony. “We want to be that revolutionary. We want to be that almost countercultural. Once this headquarters is built in Meridian [a Boise suburb], it will become the primary flagship.”
Her Meridian, Idaho, “flagship,” which is expected to open in spring 2017, will be located on one of a set of two plots of land, both purposefully bordering the current Meridian Planned Parenthood clinic that opened in 2013. “I came out here and was looking at things and looking at space and this and that,” Swindell said. “I started praying, a group of us started praying, and we realized that this lot was for sale. We thought, Man, would it be that someday we would have a center here? Our whole approach is again accessibility, making sure that women have access, and so it makes sense.” On one lot, Stanton is preparing to break ground for a 7,000-square-foot building to house their medical care center, their parental education center, and their 18-month “Wellness Program” for new mothers and their babies. The other lot's use is yet to be determined.
The Meridian site will be the model for Stanton's upper-tier medical centers, the ones that offer ultrasound, pregnancy confirmation, uterine and ovarian diagnostics, STI testing and treatment, prenatal care and postnatal follow-up, and occasional mammography. It will also be the meeting place for developing new affiliates like the Detroit center currently looking for a space to purchase. There are already affiliates in Idaho, North Carolina, and Alabama, and an international Stanton in Belfast, Ireland, just down the street from aMarie Stopes, an international abortion and family planning agency. Based on their plans for growth, Swindell expects to have 30 Stanton affiliates operating within 18 months of the Meridian flagship's opening, and add 15 to 20 new clinics per year afterward. While some of the Stanton clinics opening their doors will be the full-fledged medical models like the Meridian and Boise sites, others will be able to identify as a Stanton clinic on a smaller scale, either with more limited medical services, by launching mobile centers in remote areas, or even as a doctor taking referrals and using his or her own office as a part-time clinic so patients can access care.
Obtaining any hormonal contraception or condoms will be off the table at all of them, however. According to Swindell, who believes many forms of birth control may be abortifacients that interfere with allowing a fertilized egg to implant, hormonal birth control and especially the birth control pill may be less appealing to a new generation of women and girls more interested in natural and holistic ways to address their health. If so, that would be a dramatic shift. According to the CDC, which has tracked birth control usage for decades, hormonal birth control popularity has always remained essentially unchanged.
Rather than hormonal birth control and barrier options, Swindell and her staff instead plan to offer fertility-tracking classes and promote “sexual integrity,” an updated version of abstinence-only that is meant to be less negative and “shame”-based toward sex and instead promotes a “personal, positive and pro-active life-style that empowers the recipient to make well informed decisions in sexual matters now and in the future.”
“There's this pressure that women have to go on the birth control pill. I have to tell you, it's a very empowering when you realize, 'I don't have to put that synthetic hormone in my body. I don't have to be chained to the birth control pill,'” she said. “There's a movement of people for whom the birth control pill isn't organic, it's not green, it's not holistic. We think we're going to fill another niche or a gap that's lacking, actually, at clinics like Planned Parenthood.”
But fertility tracking and abstinence can't be the only options, says Ginny Ehrlich, CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy. “Where we would probably have common ground with this group is we want to reduce teen births. But the data shows the way to do that is to make contraception available to teens and young women,” Ehrlich said. “Our position is that women should have access to the full range of contraceptive methods within 60 minutes of where they live. A part of that full range of methods is natural family planning. But natural family planning in and of itself is not full range.”
Still, Swindell says if a person really feels she must use contraception, there are plenty of places to get it besides at a Planned Parenthood clinic.
“Our position is clear, we don't think women should be going to Planned Parenthood for any reason,” Swindell said. “I really think that it's a myth that people think that Planned Parenthood is the only place to get that. It's not. Our recommendation is that women should not be going to Planned Parenthood for any of their health-care needs whatsoever.”
Hannah Brass Greer, Idaho legislative director at Planned Parenthood Votes Northwest and Hawaii, tells me she agrees with Swindell that there is a crisis in access to health care for the low-income and uninsured in the state. Where she disagrees is the idea that Planned Parenthood isn't needed in order to address it.
“We don't have enough health-care providers in general, and that includes family-planning providers,” Brass Greer said as we sat together at the table in a conference room at Planned Parenthood's Meridian affiliate. Through the window, I could easily catch a glance at some of the land that Stanton now owns.
Like Stanton, Planned Parenthood is also seeing patients who remain uninsured because Medicaid wasn't expanded in the state. These uninsured and often low-income clients need not just a variety of services, but financial assistance they cannot get from a regular doctor or medical center. “There are about 80,000 patients [in Idaho], at least, that fall into that gap,” Brass Greer explained. “We have funds to help them. That's not available at all the other providers in this state, even the ones that do offer family planning. Closing Planned Parenthood would jeopardize the over 7,400 patients [our Idaho clinics] saw last year, but also the people that we're getting to now through our online health services.”
While Stanton Healthcare may see closing Planned Parenthood as a goal for their organization, Rebecca Poedy, chief operating officer of Planned Parenthood of the Great Northwest and Hawaiian Islands, does not feel the same about Stanton. Rather, she believes that more centers offering reproductive health services benefit everyone, as long as those services meet professional, high standards. “We want to bring people in our doors because we know we give high-quality, nonjudgmental health care. I think that's why people pick Planned Parenthood,” she said. “With that said, we are not in every small town across this state. If there are other health centers that are providing the same quality care that is nonjudgmental, I am happy to have other health centers in this state. If Stanton meets those standards, fantastic. I don't think Planned Parenthood is in the business of trying to shut down any health centers that are providing access to health care around the state when we desperately need it.”
Ehrlich, of the National Campaign to Prevent Teen and Unplanned Pregnancy, also sees benefit to new options for women's health care, especially in rural and remote areas like Stanton is addressing, but she says women need access to contraception as well and ideally should be able to get it in one visit.
“What we know is that women who are living on limited incomes and perhaps are working one or two jobs probably have a time and a financial barrier for going to multiple places for their health care,” said Ehrlich. “Women having access to the full range of contraceptive methods, whereby they could make a decision about what's best for them, would be the most optimal choice.”
Though Swindell is setting her organization up as the alternative to Planned Parenthood, Planned Parenthood currently does not have to worry about Stanton as a threat to its funding, at least, not at a local level. In Idaho, no state funding goes to Planned Parenthood anyway. And Title X, the federal program that has provided funding for family planning and preventive health services since 1970, requires anyone who receives federal dollars offer a range of FDA-approved birth control methods, something Stanton chooses not to do.
“We are not competing in the state of Idaho, specifically, for any other state funding,” said Planned Parenthood's Poedy. “We don't get any other state funding. We are a provider of services to Medicaid patients. We get reimbursed for those services and that's it. There is no funding pool that we are fighting over.”
This doesn't mean Swindell hasn't found ways to raise money for her organization on her own. With roughly $960,000 in donations, grants, and other income during 2014 and 2015, and a business plan to have as many as 100 new centers globally by 2025, Swindell believes she could very well eventually squeeze out and replace Planned Parenthood.
In reality, however, it may not be so simple. With more than 700 Planned Parenthood health-care centers in the United States alone, serving approximately 2.8 million patients each year, even if Stanton did grow at a rate of 20 a year, it would take 35 years to grow its network large enough to replace the organization on its own. Meanwhile, it must also compete with other burgeoning new pro-life medical centers hoping to vie as non-abortion alternatives for women's reproductive health care. One major competitor is California'sObria Medical Clinics, which has now partnered with The Guiding Star Project — another newly launched pro-life, natural-fertility-embracing health-care organization — in an effort to expand their own affiliated “holistic” women's health centers across the country.
Situations like this partnership or other pregnancy centers efforts to revamp themselves as medical centers highlight the biggest struggle facing the pro-life movement's effort to replace Planned Parenthood — the inability to coalesce around one “brand” to build. Lucky for Swindell, some movement leaders believe Stanton Healthcare could be one of their best options.
“What Brandi is doing is creating an actual alternative. Not just resources, but a medically viable alternative, and that's really what we need,” Tina Whittington, executive vice president of Students for Life of America (SFLA), said. The country's largest anti-abortion youth group, SFLA has been aggressively targeting Planned Parenthood with their “Women Betrayed” bus tour, with anti-Planned Parenthood actions on college campuses, and by organizing local Planned Parenthood protests across the nation.
“We know that Planned Parenthood is the Goliath of the other side,” Whittington said. “We need to look at what they offer that we can, too, and I think that's really what Brandi's done. She has the model down, she has the business plan, she is smart, she is savvy, and she's high-passion. She has created something that has longevity and is replicable, and I think that's the big thing.”
It took just 10 years for Brandi Swindell to grow Stanton Healthcare from one small-scale crisis pregnancy center into a flourishing network of centers and affiliates in five states plus Northern Ireland, and her ambitious goal to be the pro-life movement's Planned Parenthood alternative is well underway. Will she actually replace the nation's largest reproductive health-care provider? It seems highly unlikely, but even if she doesn't, she will make it clear that the Stanton “Revolution” cannot be ignored.
“When we say Stanton Revolution, we really believe it,” Swindell said “This model and this approach is working. It just makes sense and the timing's right. People are hungry for it.”
This article was reported in partnership with The Investigative Fund at The Nation Institute, now known as Type Investigations.
- “We hope to be much like Margaret Sanger was, a revolutionary of her time. I know, can you believe I'm using her?”
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