by Sarah Jaffe
“Some days, I would drive to Colorado Springs, which is an hour and a half south of me. Sometimes I would drive to Steamboat Springs and stay a couple of days. I would fly or drive all over the state,” she explained. “Frequently, I drove to Casper [Wyoming], when that clinic was still open, to provide coverage for a couple of days. There were times where I was flown to Durango and flown back to Denver in the same day. I would fly down in the morning, get a rental car, work all day, drive back to the airport, and fly back to Denver on the same day. That is a sixteen- or seventeen-hour day, at least. I could do it, but it was very emotionally draining.” It occurred to her then that there might be a more efficient way for PPRM to solve staffing issues and improve retention, but she liked the work, so she kept going.
When in the clinics, she did a wide variety of tasks: checking patients in and verifying their insurance, counseling patients and providing education on sexual health and pregnancy—“very intimate counseling services,” she noted—as well as taking part in medical procedures. Brink was trained to give injections, draw blood, and provide ultrasounds for patients; she assisted with insertions of intrauterine devices (IUDs) and abortion procedures. She scheduled patients, collected payment, and dispensed medication. The clinics, supported by donation as well as payment for health-care services, served low-income patients on Medicaid as well as those who had insurance. The days could be exhausting—some days, with a lot of walk-in patients or a crisis, there’d be no time for a break or for lunch, Brink said. “You felt like you just didn’t have the time to calm your body so that you could go back out there and continue providing care.”
As a traveling staffer, Brink’s job was the same wherever she went, but, she said, “the frustrating part with that is often clinics are run a little bit differently.” Every clinic’s providers had things set up very specifically for the way they liked to work, she explained, but those specifics could vary widely from clinic to clinic. She had to remember where equipment was kept, which drawer to file patient charts in, at each different center, refreshing herself with each new arrival. Her travels also allowed her to get to know her coworkers at over twenty-four different clinics. “I loved that part of my job. But I always would tell my partner that I felt like I had to be a different person at work every day—I had to change my personality just a bit to fit in with the clinic I was going to be at,” she said. “It wasn’t a negative thing as much as it was just the nature of that position. It definitely wasn’t for everyone. I just happened to be good at it.”
Planned Parenthood’s political arm is kept separate from the clinics, which are run by separate nonprofit organizations, like PPRM, that are affiliates of the Planned Parenthood Federation of America (PPFA). The clinics are not directly controlled by PPFA, but they bear the same name and mission, and many of the staffers, like Brink, have a background as reproductive justice activists and got involved in the clinical work as part of their devotion to the cause. Others, Brink said, took jobs at the clinic because they had been patients there. Some of the staffers were students planning to get medical degrees and become providers themselves. Some, like Brink, wanted to move up into management and make reproductive health care their careers; others just wanted a job they could feel good about, that helped them live their values. Many of them continued to get their own health care at the clinics—it was part of PPRM’s benefits system. For nearly all of them, Brink said, a commitment to reproductive justice motivated their work.3
But working at PPRM also made the staffers a target for anti-choice protesters and politicians. It was a lesson that Brink had learned when she first became involved in reproductive justice work in high school; she was reminded of it when, in 2015, the Colorado Springs Planned Parenthood was the site of a mass shooting that left three dead and nine wounded. At some clinics, the staff and patients ran a gauntlet of shouting protesters in order to get inside. And for the staff, there were other stressors that shadowed each day of work. Brink spoke of a “heightened sense of security that you have to have every day when you are talking to patients.” Planned Parenthood had been the target of several anti-choice “sting” videos alleging that the clinic was selling fetal body parts or otherwise perpetrating horrors, as part of an attempt to get the organization shut down. “You had to be cautious with what you said on the phone and who you said it to. The antis are always trying to get something out of you, and any of it can and will be twisted if you are being recorded,” Brink said.4
The most important part of the job, she said, was the patients, and it was to them she felt her loyalty, even as her days ratcheted emotionally “from zero to sixty, and sixty to zero, back and forth.” She would go from a patient worrying about a cancer diagnosis to a patient thrilled about a positive pregnancy test. While the positive appointments were exciting, she said, “it is emotionally exhausting because you are having to adjust. You are dealing with people’s lives and it is not just like, ‘Okay, here is my fifteen minutes with you. Let’s move on.’ These are people and we had to and wanted to treat them with the amount of respect that they deserved in the time that they were going to be there.”
The staff had to put their own lives and their own problems on hold in order to provide the best care they could. “We can do it, but as a human you can only do it for so long,” Brink said.
CHARITY IS A RELATIONSHIP OF POWER.
The history of charity, and of the development of what we now sometimes call the third sector—nonprofits, nongovernmental organizations (NGOs), or, in the United States, 501(c)(3)’s, referring to their tax-code designation—is the history of the powerful distracting from their power by “giving back” to the less fortunate. This relationship has created a trap for today’s nonprofit workers, who enter a field hoping to do good while also making a living—one that has been shaped by the fact that for centuries it was performed by people who didn’t need a wage. Like other caring fields, nonprofit work was structured as women’s work—in this case work for wealthy women looking for something to do with their time. And that expectation continues to configure the work that people do in this sector—now a massive part of the workforce, about the same size as the entire manufacturing sector in the United States. “The charitable ethic is based on hierarchy, and dependency on the part of the recipient; it responds only to immediate material needs and relocates collective concerns into a realm of private benevolence,” wrote Amy Schiller, a political scientist who studies philanthropy and has worked in the nonprofit sector. In other words, charity is necessarily asymmetrical and reproduces inequalities.5
The problems of today’s nonprofit sector are outgrowths of this necessary inequality: nonprofits exist to try to mitigate the worst effects of an unequal distribution of wealth and power, yet they are funded with the leftovers of the very exploitation the nonprofits may be trying to combat. Nonprofit work then is also caring work, also service work, privatized, on the one hand, unlike public school teaching, but supposedly not in service of the profit motive. Nonprofits are not, despite their supposed lack of interest in profit, exceptions to the capitalist system but embedded in it, necessary to its continued existence.
But even before the rise of capitalism, charitable giving or philanthropy was an expression of inequality; the rich as far back as ancient Greece gave back by sponsoring public buildings, festivals, and even schools. Caring for the poor and the needy was less the focus of such giving than institution-building—the ancient version of today’s wealthy donors stamping their names on theaters and sports stadiums. It was with the rise of Christianity that charity became specifically about giving to the destitute. And such giving provided the benefit not of a pretty building that could be used in life, but the expectation of rewards in the afterlife for the donor.6
This shift meant that the poor now had, in a way, use-value to their wealthier neighbors. Giving to them was a way to demonstrate one’s own goodness and worthiness—one’s deservingness, perhaps, of that unequal accumulation of wealth to begin w
ith. The church, meanwhile, mostly mediated between the two, the donor handing over the money and the church doing the charitable works on their behalf. Giving to the poor was thus shaped the same way as the purchase of indulgences—a way to buy forgiveness for one’s sins through good works, a one-way system sanctioned by the church. Such an attitude marked poor people as different from everyone else—they were either worthy objects of magnanimity or potential troublemakers, but either way, the have-nots were fundamentally different from the haves. And it wasn’t only the church but also the state that began to take an interest in their behavior.7
The religious obligation to give to the poor in its own way encouraged begging, but if everyone was to take up begging, who would do the work? After all, the need for laboring hands required that people be enticed—or coerced—to work. That resulted in early regulations of poor people, including an act of the English Parliament in 1531 that registered poor people who were deemed actually unable to work, giving them legal permission to beg. Hospitals came into existence as extensions of the church’s charitable function, places where the sick and destitute who had no other means of support (those without family to do the caring) could be looked after. Everyone else had to get a job or face brutal punishment.8
Such regulation was a sign that the poor were beginning to be seen as a potential problem, a force capable of unrest, of uprising. They had to be controlled, corralled into the workplace or the workhouse, under the watchful eye of their betters. The state would provide relief, but only under certain circumstances (mostly, as Frances Fox Piven and Richard Cloward noted in their classic Regulating the Poor, when the poor threatened to raise hell). And meanwhile, churches and private donors were expected to mop up around the edges, maintaining a more or less harmonious society.9
Charity has thus long been intertwined with the need to press workers into service and the accompanying suspicion of anyone who does not work. The Poor Relief Act of 1662 codified this relationship in England, setting up the poorhouse as the option for those who truly couldn’t work and didn’t have families to look after them; anyone else would be put to work. The relief system at this time was a shock absorber for early capitalism, managing the people who were displaced from an agricultural system and slowly integrating them into the new wage-labor system. “Relief arrangements,” Piven and Cloward wrote, “deal with disorder, not simply by giving aid to the displaced poor, but by granting it on condition that they behave in certain ways and, most important, on condition that they work.” Such relief could expand and contract, and it also required a new type of worker—those who managed the poor.10
Hospitals and universities had long existed as not-for-profit entities, recognized and taxed differently from other businesses, but the formalized, professionalized nonprofit sector, taking on the work of caring for society’s less fortunate, arose in the nineteenth century alongside the spread of industrial capitalism. And it was, broadly, women’s work. Middle-class women, considered “guardians of moral virtue” and not expected to earn a wage outside the home, expanded their circle of influence from the household outward through the embrace of public service work—though that service work was mostly done through private institutions rather than the state. Some, guided by the church, went into missionary work; others did their moral reforming closer to home, in the burgeoning cities, where the working classes were often crowded into foul tenements, or, in the United States, within a growing movement to abolish slavery.11
Much of the work these women did was unpaid, voluntary labor that because they were women was not really seen as labor at all, and this expectation has crept into the work of women like Ashley Brink in today’s nonprofit sector. And yet it was very much work. Some of it could be done from the home, but most of it required them to go outside, to investigate the conditions they found so offensive, from those of enslaved people laboring on plantations to the working conditions in factories to slum housing to prisons. Women reformers spoke at meetings, gathered signatures on petitions, taught one another, and challenged the ideas of men—and such work, though inspired by their gendered roles, taught many of them to think about their own social position. The early feminist movement drew many of its leaders from the abolitionist ranks. Susan B. Anthony and others turned their attention to the limits placed on their own movement as they fought to break the chains of others.12
In this movement, though, we can see some of the contradictions that remain in today’s nonprofits. Through their abolitionist commitments, white women were able to gain some level of power for themselves, power that was not necessarily shared with Black women who had experienced slavery personally. These women were able to do abolitionist work because they did not need to work for money, because their husbands or fathers had enough of it to allow them to take up the unpaid work of the movement. White women like Anthony and Elizabeth Cady Stanton turned from abolitionism to making the case for women’s rights in explicitly racist language; they believed that their education levels qualified them for the vote and to speak for others. They were thus, despite their opposition to one oppressive system, as Angela Davis pointed out, reliant on the inequalities of another one—industrial capitalism. They would work around the edges, perhaps demanding better housing for the poor or supporting a shorter workday for women in factories, but their investment in the system as it existed meant they often ignored the realities of exploitation.13
The spread of higher education—and in particular, the opening of a limited number of colleges to women—created a generation of would-be workers primed for charity work. Large numbers of women who attained college degrees remained single, and those who did not go into teaching searched for other ways to have influence in the world. In Saidiya Hartman’s words, “slum reform provided a remedy for the idleness of the privileged, a channel for the intelligence and ambition of college-educated women, and an exit from the marriage plot and the father’s house.” The women’s club movement disguised women’s work as socializing; Black women’s clubs in particular organized to work in their own communities, demanding better public services. Yet the social Darwinism popular in this era was also reshaping attitudes toward charity work: still entangled with the work ethic, charity was to be given only in forms that would enable those best fitted to succeed to pull themselves up by those famed bootstraps. This form of charity wound up being more labor intensive than simply distributing money. Women worked as “friendly visitors,” going into the homes of charity recipients to teach them how to live better and to make sure they weren’t wasting what they were given or behaving immorally.14
But there was another model even during this period that did more to break down barriers created by capitalism. The settlement house movement encouraged would-be do-gooders to live and work in the houses alongside the poor people they served. In doing so, they built friendships across the boundaries of class, and they learned that poverty was not, in fact, a matter of individual failing, but a result of inequalities that could be challenged collectively. This was at least the start of a political understanding of women’s caring work, and the settlement house women often took to political agitation as a result. Jane Addams, who established and lived in the Hull House settlement in Chicago, understood it both as a way to give women useful work to do and a way to provide not just the basics of life but language lessons, art and handicraft education, and even entertainment for those who would otherwise be trapped in slums. The women—though men, too, worked in the houses—saw themselves as “social housekeepers.”15
The settlement houses sought to give their residents alternatives to working in the factory system. Some of the skills taught in the houses, like the production of handicrafts, aimed to offer another way to make a living, and they also learned from the arts and crafts that immigrant workers had themselves brought from their countries of origin. The handicrafts would not provide most residents with a sustainable living, though, and often wound up as just another way to impress upon the residents the value of har
d work. Some women, such as Ellen Gates Starr, who sought in handicrafts a form of work that she could do out of love, realized that it was not enough for poor women to make crafts that would adorn the homes of the wealthy. Starr became an agitator for changes to the industrial system and was arrested on a picket line with striking waitresses—jeopardizing, as historian Eileen Boris noted, contributions from wealthy donors to Hull House, where she lived.16
Starr was not the only hell-raiser to come out of the settlement house movement. Florence Kelley used Hull House as a base for her organizing around demands for shorter working hours and the prohibition of child labor. Eventually, she became the director of the National Consumers League (NCL), which aimed to use the buying power of women to influence working conditions for the women who in factories made and in retail shops sold the things that they bought. The NCL’s influence extended to presenting evidence before the Supreme Court that overwork was harmful to the health of women workers. The Women’s Trade Union League (WTUL) also counted settlement house women among its ranks, alongside socialists and women unionists. While the upper- and middle-class women gave money and lent their names and status to the struggle, wage-earning women organized on the shop floor and led strikes.17
“Social housekeeping” pushed at the limits of what was permissible for elite women. Addams and others cleverly worked within the image of wife and mother while carving out space for women to do real work, political and caring and teaching work. But, historian Alice Kessler-Harris wrote, “the only remaining question was whether they could be paid for their work without losing status.” Some women thus began to agitate for professional status for the social service work they were already doing, fighting for education, training, and scientific rationales for change. The Progressive Era saw the opening of new fields for women, who became factory inspectors, visiting nurses, and the like, serving in roles that were outgrowths of the old “friendly visitor” role. The training required for these jobs meant that women won access to expanded higher education, including medical and law schools. As long as the women’s desire for education was “rooted in virtue and not in ambition,” as Kessler-Harris wrote, they could even go to business school.18