Oklahoma has been providing financial support to Planned Parenthood for nearly two decades, even though the state is among the most socially conservative in the nation. But that changed this month, when the state announced abruptly that it was cutting off nearly $500,000 to three clinics in the Tulsa area.
The decision, which ended a food program housed at the clinics, put Oklahoma at the center of a fight that has lately moved out of the federal realm and into the states: the effort to defund Planned Parenthood, the nation's largest abortion provider and an organization that is increasingly seen by critics as an arm of the Democratic Party.
Officials in nearly a dozen Republican-led states, including Arizona, Kansas and Indiana, have cut at least some funding for the group since 2011, when Democrats rejected a high-profile effort by congressional Republicans to block federal grants for the group.
Despite the Hyde Amendment barring the use of federal funds to pay for abortions, in several cases officials targeted federal money that they are responsible for disbursing.
For example, in Shelby County, Tenn., officials revoked a federal family-planning grant for a Memphis Planned Parenthood and instead gave it to a Christian nonprofit organization. And in Texas, the state government barred groups tied to abortion providers from getting public funds, affecting all 49 Planned Parenthood centers that received such money.
And on Friday, a federal judge issued a temporary injunction in Arizona, blocking a new law that bars Planned Parenthood clinics from receiving money through the state to provide medical care because the organization also performs abortions.
In North Carolina, New Hampshire and Tennessee, clinics were able to recoup at least some of the money by appealing directly to the U.S. Department of Health and Human Services. But the arrangements have deepened a concern raised by critics and supporters alike -- that Planned Parenthood has become so embroiled in partisan politics that its mission to provide health care and family planning services to women is threatened.
"The good news is, the health and rights of women are center stage in the American political debate today," said Jill June, president of Planned Parenthood of the Heartland, which includes the three affected clinics in Oklahoma. "The bad news is, the health and rights of women are center stage in the American political debate today. . . . It's distracting. We are having to defend ourselves when what we want to do is provide services to people."
Planned Parenthood has found itself at the center of the presidential election, with President Barack Obama mentioning the group five times during Tuesday's debate at Hofstra University. Obama, who is counting on women voters to help him win reelection, noted that Republican challenger Mitt Romney promised to cut federal funding for the group.
"There are millions of women all across the country who rely on Planned Parenthood for not just contraceptive care," Obama said. "They rely on it for mammograms, for cervical cancer screenings. That's a pocketbook issue for women and families all across the country."
Supporters of Planned Parenthood say the GOP has taken a hard right turn on reproductive matters in recent years, turning away even from contraception and specifically targeting the organization. But Planned Parenthood has drawn fire for taking an increasingly prominent role in politics, with its activity almost exclusively on behalf of Democrats.
Part of the difficulty for the organization is that a variety of groups carry the Planned Parenthood name. Some are charitable health clinics, such as the ones in Oklahoma, whose services range from sexually transmitted disease testing to nutritional counseling to primary care. Others are overtly political. The distinctions are often lost in the hyper-partisan political sphere, and to many critics, the distinctions are irrelevant.
Planned Parenthood Federation of America serves 5 million men, women and adolescents per year worldwide, and it is affiliated with about 800 Planned Parenthood clinics across the country. Abortion represents about 3 percent of what the group does, and many health centers -- including the ones in Oklahoma -- do not directly offer the procedure.
On the political side, there is the Planned Parenthood Action Fund, a nonprofit "social welfare" group that is permitted by the Internal Revenue Service to participate in politics. And there is Planned Parenthood Votes, a super PAC. Together, they are spending a record amount of money for Planned Parenthood on this year's election -- nearly $12 million, most of it attacking Republicans.
In addition, Cecile Richards, executive director of the Planned Parenthood Federation of America, spoke at the Democratic National Convention and is on leave from the group to publicly campaign for Obama.
Campbell Brown, a former television journalist who has expressed support for Planned Parenthood, recently wrote an op-ed for the New York Times criticizing it for abandoning support for Sen. Susan Collins of Maine and Rep. Robert J. Dold of Illinois -- two Republicans who have supported Planned Parenthood in the past.
"Planned Parenthood has only itself to blame" for becoming a conservative target, she wrote. "It has adopted a strategy driven by blind partisanship, electing to burn bridges instead of building them. That strategy is damaging, and possibly imperiling, its mission."
Dawn Laguens, executive vice president of the Planned Parenthood Action Fund, said her group has taken pains to reach out to Republicans but has had little choice but to work more diligently on behalf of Democrats at a time when she says GOP lawmakers are taking unprecedented steps to curb women's access to abortion and contraception.
She noted the recent Republican-led "personhood" efforts aimed at giving full rights to fertilized eggs, as well as Virginia's controversial move to require women to get ultrasounds before obtaining abortions. Also, Romney has said he would end federal support for Planned Parenthood and favors the overturning of Roe v. Wade, the Supreme Court decision that legalized abortion nationally in 1973.
"We're not on the side of a party," she said. "We're on the side of policy. And there's just a clear, dramatic distinction between what President Obama has been committed to and delivered and what Mitt Romney and Paul Ryan have promised to destroy. So we don't have a choice."
Laguens said the Oklahoma situation is especially stinging. For 18 years, the state has been steering federal Women, Infants and Children money to Planned Parenthood to provide nutrition services and give out food stamps.
Last year, state Rep. Jason Murphey, a Republican who opposes abortion, tried unsuccessfully to pass a bill cutting off funding. This month, the Department of Health took action. Officials say the decision was prompted by Planned Parenthood's diminished caseload and high cost of the services, among other problems. Planned Parenthood officials, however, said politics played a role, and abortion foes cheered the decision.
"It's problematic when the state basically sends somebody into a facility where abortion referrals are highlighted," Murphey said. "And I take issue with the fact that you would have an organization that is so controversial getting taxpayer funds."
The $460,000 supported staff and overhead for the clinics. The women were also offered further health screenings by the clinics, which do not conduct abortions but refer women to other facilities that do. Unlike other states where Planned Parenthood could appeal to the federal government to step in, the rules of the Women, Infants and Children program do not allow such intervention.