DES MOINES, Iowa — Ruth Richardson waited near the Iowa capitol’s grand staircase, just outside the limelight. At the podium nearby, abortion-rights supporters railed against the state’s conservative swing on abortion following the overturning of Roe v. Wade, calling Republican bills “nonsense,” “pseudoscientific” and “speaking for the extreme.” Richardson glanced at her speech and its somewhat different message.
Not that Richardson disagreed with what speakers were saying. As the new president and CEO of Planned Parenthood North Central States, which oversees the organization in blue-leaning Minnesota and four red-leaning neighbor states, Richardson is one of the region’s pre-eminent supporters of reproductive rights.
But as the abortion debate continues to rage, the former Minnesota legislator sees a post-Roe opportunity to reframe Planned Parenthood’s mission: Instead of dated binary arguments, she believes the debate in modern America must focus on health equity.
“I don’t think people understand the intersections between access to abortion and a full range of health services,” she said. “It’s trying to have a more comprehensive conversation and connect the dots in ways people don’t spend enough time thinking about.”
She points to Iowa ranking last in per-capita OB-GYN specialists; reports have shown states with the restrictive abortion laws are losing OB-GYNs. She speaks about Black women being three to four times more likely to die from pregnancy-related causes nationally, and six times more likely in Iowa. She worries about health care deserts in rural areas.
Richardson talks about the freedom to have an abortion as well as the freedom to have a child and raise that child.
Abortion opponents scoff at this equity focus as disingenuous, given the racist beliefs of Planned Parenthood’s founder — something the organization acknowledges and denounces — and its clinics disproportionately being located in minority neighborhoods.
“This is not about social justice and not about equity,” said Cathy Blaeser, co-executive director of Minnesota Citizens Concerned for Life. “They offer a dead baby to women who have real support needs. They take her hard-earned money and leave her in the same social need as when she walked into their facility.”
At the Iowa abortion-rights rally, Richardson was experiencing whiplash. The night before, she was celebrating. At First Avenue, the famed Minneapolis music club, she walked the runway with her 2-year-old granddaughter, Trinity, in a fashion show fundraiser. Now she was in a different world, where Iowa’s high court was weighing a six-week abortion ban. The next week, she’d head to Nebraska for state Supreme Court arguments on abortion.
In Iowa, the 47-year-old stepped into the limelight and began to speak.
“We know the consequences of bad policy,” she said. “Iowans are already living in them. … Thousands who once received reproductive health care are going without — and that includes contraceptives. Unintended pregnancies have increased. Infant deaths have soared in recent years. And Iowa mothers are more likely to die today than 30 years ago.”
Last summer, when Iowa passed a restrictive abortion law in a one-day special session, a thousand people filled this rotunda in protest. The ban has been stuck in court ever since. This crowd was much smaller, about 120.
Richardson plied them with her story: How her life dedicated to helping families affected by fetal alcohol syndrome and women battling addiction led her here.
“My great-grandmother was a Black midwife in Mississippi,” she said. “I learned early on, from the stories of my mom, of my aunt, grandmother, my great-grandmother — I learned that health care is not the same for everyone. I didn’t know words like social determinants of health, or health equity. But I knew what I was hearing wasn’t just.
“I also learned it didn’t have to be that way.”
Talk with friends, family or colleagues, and one thing always comes up: Richardson is a quiet person.
Said Luz María Frías, whom Richardson worked for at St. Paul’s Human Rights and Equal Economic Opportunity department: “When she announced she was running for office, I was blown away. She was the last person on earth! An introvert, doesn’t like attention. But she’s got this gift at being able to persuade folks in a stealth fashion.”
Rep. Cedrick Frazier, a law school classmate, said people look for calm amid chaos: “That’s Ruth. All the time.”
Richardson’s story began in St. Paul’s Frogtown neighborhood, the sixth of eight kids in a family scraping to get by. Faith bound them. Richardson was raised Jehovah’s Witness, knocking on strangers’ doors and reciting Bible verses as a kindergartener. Their house was full: kids from her mother’s day care, dozens of foster children they took in as the crack epidemic ravaged the Black community.
Her dad drove trucks, taxis and buses. Richardson remembers riding her dad’s bus and him pointing out William Mitchell College of Law. She was a proud nerd, a high school kid who scoured used bookstores for books on Black history. Her first job was guiding tours at the Minnesota Capitol. She became the first in her family to attend college, then went to law school at William Mitchell while raising toddler children. She became involved in battling homelessness and fetal alcohol syndrome.
In June 2022, as America’s abortion landscape shifted, Richardson was leading Wayside Recovery Center, an addiction treatment center for women and their families. She was also serving her second term in the Legislature, where she’d been pivotal declaring racism a public health crisis and tackling maternal and infant health. A recruiter called.
“Planned Parenthood wasn’t on her mind at all. It was set at her feet,” her sister Linda Agnes said. “Everything she’d done in life led her to that place. It’s not common to see a Black woman in such a large role. She’s a champion for people of color and for underprivileged people.”
Which, for Planned Parenthood, was exactly the point.
“We’ve done a great job the last 100 years making sure cisgender white women have access to health care, birth control, STI testing and abortion,” said Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States. “But medicine in general has left a lot of populations behind. It’s time for us to start focusing on what marginalized and racialized communities need.”
Richardson’s ascent came as abortion opponents celebrated what they saw as a long-deserved correction to one of America’s great sins. They see Richardson’s equity focus as Planned Parenthood masquerading as something it’s not.
“If she really was concerned about health equity, then she’d get out of the business of killing Black children and instead get into the business of helping these Black women create a responsible adoption plan,” said Denise Walker, a longtime Black Minnesota abortion opponent and director of Rich in Mercy Abortion and Miscarriage Recovery program. “She’s telling Black women to exterminate their own people.”
Planned Parenthood employees in red states mourned the end of Roe, especially in places like South Dakota that enacted the nation’s most restrictive abortion laws. Richardson’s role became like a cheerleader for a losing team.
“It’s so easy to be demoralized in a place like Iowa where we’re constantly fending off attacks,” said Mazie Stilwell, director of public affairs for Planned Parenthood Advocates of Iowa. “But she came and told us we cannot allow them to steal our joy. What they want is nothing more than to just break us down, and we will not allow that to happen. We were talking about it for months after that: ‘Remember what Ruth said!’ “
On a gray winter day, Richardson led Gov. Tim Walz past a reinforced door and into her office. Security is everywhere at Planned Parenthood North Central States’ headquarters in an industrial St. Paul neighborhood, where protesters are ever-present.
“That door is heavy,” Walz said.
Abortion bans in neighboring states have prompted Planned Parenthood to expand in Minnesota, but Richardson fears this won’t reduce gaps in care between haves, who can afford travel for an abortion, and have-nots.
Richardson and the governor had just spoken on a panel where they heard about abortion patients from as far away as Texas and Florida traveling to Minnesota. Abortions in the state have increased significantly since Roe was overturned; a recent study showed that nearly a third of Minnesota abortions are for out-of-staters. One patient drove 800 miles into a blizzard — but since the blizzard closed Planned Parenthood’s facilities, the woman stayed in a hotel for a week.
Richardson kept steering the conversation back to fairness. The gap in access, she said, will only widen for those already struggling.
The health center manager walked them to the rooms where 80 to 120 abortions take place weekly. (In March, Richardson led Vice President Kamala Harris on a similar tour.) Richardson, the governor and Lt. Gov. Peggy Flanagan hovered over an exam table.
The governor asked about Iowa’s pending Supreme Court case. The sharply divided court last year blocked a 2018 abortion ban, then Iowa lawmakers went back and passed virtually the same ban again. Richardson said legal uncertainty sowed confusion among patients.
“People are afraid, and providers are as well,” Richardson said.
Planned Parenthood’s Minnesota facilities have increased capacity: more exam rooms and appointments at their Uptown facility, an expansion in Mankato, increasing investments in telemedicine. The organization announced in January the consolidation of some clinics and the elimination of dozens of positions but stressed the changes will help them treat more patients.
Before the governor left, he turned to Richardson: “We got your back,” he told her.
In other states under Richardson’s umbrella, those in power do not have her back.
A Planned Parenthood health center manager in South Dakota said they’re barred from discussing abortion with patients. In North Dakota, the state’s only abortion clinic — unaffiliated with Planned Parenthood — moved from Fargo to Moorhead.
In Iowa, Richardson strode into a lobbyist room just off the House of Representatives chambers. The House was about to debate a bill that Republicans said would protect religious freedom; Democrats said it would allow discrimination against women and LGBTQ people. Planned Parenthood broadening its mission toward things like gender-affirming care is part of this larger philosophical shift. But when Richardson brings health-equity arguments to Republican leaders in red states, they often fall on deaf ears.
Rep. Jennifer Konfrst, Democratic leader in the Republican super-majority House, greeted Richardson warmly.
“It’s unrelenting,” Konfrst said. “It’s just thing after thing after thing after thing. It’s still legal in Iowa — for now — and that’s the best we can hope for until we get a pro-choice majority in the House. We’ve gotta hold on as long as we can.”
Richardson can hardly believe how much things have changed in such a short time. “It’s like bizarro world,” she said.
Konfrst predicted their side would win in the long run. She brought up a recent poll showing 61% of Iowans believe abortion should be legal in all or most cases. The new law is virtually identical to a 2018 abortion ban struck down in courts — only this time Roe no longer provides a shield.
“It was theoretical then,” Konfrst said. “Now it’s real.”
A bell rang: Time for debate and voting. Richardson thanked her: “I know how exhausting it is, but I have so much hope for the future.”
“You’re amazing,” Konfrst said. “Now I gotta go fight some terrible bills.”
Later that evening, Iowa representatives voted on the religious freedom bill that Democrats and Planned Parenthood opposed as discriminatory. It passed overwhelmingly.
