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The shouting outside the health clinic at 1144 Locust St. in Philadelphia carries into the patient waiting room.

“You don’t have to go in!”

“No one can force you to do this!”

The commotion outside is at odds with an interior like any obstetrician-gynecologist’s office: Oversize photographs of smiling couples on the walls, exam rooms with paper-covered exam tables and metal stirrups, plastic models of female anatomy to demystify reproductive health.

But to get there, a volunteer escort ushers patients past protesters on the sidewalk, and a security guard buzzes open the lobby doors. To the left is a bank of elevators to the lower-level abortion clinic; to the right is a door with automatic locks leading to a clinic offering routine women’s health services.

More often than not, patients bear right. In Philadelphia, most of the patients at the nation’s largest network of abortion clinics are not there to terminate a pregnancy.

Eight out of 10 patients who come to Planned Parenthood’s Philadelphia-area facilities are there for routine exams, STD tests, contraception, family planning guidance and other reproductive health care. Planned Parenthood Southeastern PA, which operates eight clinics in Philadelphia and the surrounding counties, saw 36,000 health clinic patients last year, compared to 8,000 patients seeking abortion care.

» READ MORE: At Pa. abortion clinics, volunteer patient escorts brace for their work to get even harder post-Roe

“We are the largest single-entity abortion provider in the country and we do it without apology,” said Dayle Steinberg, CEO of Planned Parenthood Southeastern PA. “But we are, for many of our patients, their only source of health care.”

A nationwide shortage of family medicine and obstetrician-gynecologists, and a rush to reschedule appointments missed during the pandemic have strained a limited network of medical providers who offer sexual and reproductive health services. Planned Parenthood serves patients who most likely cannot get care elsewhere, such as those who are uninsured, low-income or who live in neighborhoods without a provider nearby.

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A recent U.S. Supreme Court ruling that eliminated the nearly five-decade-long constitutional right to abortion has upended Planned Parenthood’s future. In Pennsylvania, abortion remains legal until 24 weeks, though that could change if Republicans win this fall’s gubernatorial election. Already, clinics here are grappling with an influx of patients from nearby states where abortion immediately was restricted.

The high court’s ruling has also fortified a growing contingent of protesters like Mark Houck, who has been coming from Bucks County for almost 20 years to stand outside the downtown Philadelphia clinic.

“Not everyone is here for an abortion — we get that,” said Houck, though he believes non-abortion care helps support Planned Parenthood’s mission. So he offers to all on their way in or out of the clinic antiabortion literature, a handwritten note offering help and three Lifesavers candies.

Separate services and bank accounts

The first time Julia Henrikson came to Planned Parenthood, she was a college student in need of a routine checkup. Now 28 and living in Philadelphia, she has struggled to find providers who can get her in quickly for chronic urinary tract infections that flare up unexpectedly.

She plans to call the Locust Street clinic next time she needs care. Through Planned Parenthood, she’s always been able to get an appointment within a week and feels the medical staff listen to her concerns without rushing her.

Friends don’t always understand how she can be comfortable seeking routine care from a leading abortion provider. One once asked why she didn’t go to a “real doctor.”

“I think there’s a misconception about the quality of care Planned Parenthood provides for regular services,” Henrikson said.

Inside the Locust Street facility, housed in a brick corner building with plants stretching into a sunlit front entrance walkway, the health clinic and abortion clinic essentially work independently of each other. They are physically separated by a floor, each have their own staff and even maintain separate bank accounts.

That’s because Title X, the federal grant program for reproductive health, prohibits clinics from using public money to pay for abortion care. This separation also enables Planned Parenthood to meet state-mandated requirements for abortion clinics, specifying such details as the number of sinks, hallway width, and entryway awning size.

More than half of the 8,000 patients who seek abortion care at the clinic receive oral medication to terminate a pregnancy. Others are seen for surgical abortion procedures.

Beyond the waiting area, patients find exam rooms, counseling rooms and a recovery space, where those who received anesthesia recuperate by sipping ginger ale and nibbling crackers. Appointments are coordinated around a Pennsylvania law requiring abortion patients to be counseled by a doctor, then wait 24 hours before their procedure.

On the main level, the health clinic sees some 36,000 patients a year for services such as prescribing birth control, STD testing, and treating yeast infections.

Planned Parenthood Southeast PA’s clinics in West Chester and Norristown aren’t big enough to physically separate abortion services in one building, so those clinics must alternate which days they provide abortions and all other health services.

Although Planned Parenthood is best known for providing abortions, fiscal reports show that abortion care accounted for about a quarter of Planned Parenthood Southeastern PA’s $16.2 million revenue in the year that ended June 2020, the most recent for which tax filings are available.

Health clinic services and donations each accounted for a greater share of revenue — about 35%.

No appointments anywhere else

Bobbie Trotenberg turned to the Locust Street clinic for routine gynecological checkups in the 1980s when she was in her 20s and just starting her career in public relations. The job didn’t pay much and her health insurance plan was not required to fully cover women’s health services.

“Planned Parenthood was convenient; it was accessible,” said Trotenberg, who now volunteers escorting patients inside.

On any given day, the health clinic sees a mix of patients who are uninsured, underinsured or simply can’t get in to see their usual private practice doctor.

Under the Affordable Care Act, most private health plans and Medicaid now must cover annual exams and contraception at no cost. But being able to afford care doesn’t necessarily mean being able to access it.

A decades-long shrinking of hospital birth centers in Philadelphia — Delaware County Memorial Hospital most recently shuttered its maternity ward in January — has made it harder to find providers who are accepting new patients and can see them quickly.

“People often come to us because they can’t get an appointment anywhere else,” said Phebe Brandt, a nurse practitioner who leads the Locust Street health clinic. “They realize they like the care they’re getting and continue coming.”

» READ MORE: A doctor who treated botched abortions pre-Roe looks back: ‘A matter of life and death’

Planned Parenthood shares staff across health clinics and employs more nurse practitioners to avoid staffing shortages limiting hours at many private practice clinics. Evening and weekend hours also help.

Curbing access to abortion in Pennsylvania would not stop the organization from continuing to offer other health services, but the recent court ruling has created political uncertainty that worries some.

Republican gubernatorial candidate Doug Mastriano said that, if elected, he would support a total ban on abortion, including cases of rape, incest, or severe health conditions. Republican lawmakers are also pursuing a constitutional amendment that says Pennsylvania residents do not have a right to abortion.

» READ MORE: The next Pa. governor will decide the future of abortion here

Aishat Olatunde, a Philadelphia-based OB-GYN and fellow with Physicians for Reproductive Health, worries that demand for reproductive health services — namely contraception — will outstrip supply if access to abortion becomes more limited.

“Planned Parenthood and other independent reproductive health clinics are crucial for communities,” Olatunde said. “People from lower income backgrounds who need access to basic reproductive health care really survive by being able to access basic gynecological care from these clinics.”

The Philadelphia Inquirer is one of more than 20 news organizations producing Broke in Philly, a collaborative reporting project on solutions to poverty and the city’s push toward economic justice. See all of our reporting at