While you would think it would be hard to argue with health care, it seems that Planned Parenthood has always been at the eye of a hurricane, right from the earliest days when founder Margaret Sanger challenged the status quo by providing contraception and other health services to women and men and educating the public about birth control and women’s health.

It is no exaggeration to say that women’s progress in recent decades — in education, in the workplace, in political and economic power — can be directly linked to Sanger’s crusade and women’s ability to control their own fertility.

Let’s start by looking at the world that Margaret Sanger faced in the early years of the 20th century. What was the reality for women – especially poor women – in terms of their reproductive lives? There was widespread ignorance of reproductive health, even among the medical professionals of the day. For too many women, they faced early and multiple pregnancies, which often resulted in early death.

Margaret Higgins Sanger (1879 – 1966) saw this in her own family. Her mother, Anne Higgins, went through 18 pregnancies in 22 years, dying at the age of 49. Margaret was the sixth of eleven surviving children, and spent much of her youth assisting with household chores and caring for her younger siblings.

Supported by her two older sisters, Margaret Higgins attended Claverack College and Hudson River Institute, before enrolling in 1900 at White Plains Hospital as a nurse probationer. She married and had three children.

Starting in 1911, Margaret Sanger worked as a visiting nurse in the slums of the East Side of New York City. During this work, she cared for too many women who underwent frequent childbirth, miscarriages and self-induced abortions from a lack of information on how to avoid unwanted pregnancy. The women of the day could not access contraceptive information; it has been prohibited on grounds of obscenity by the 1873 federal Comstock law and other state laws.

Recognizing the need for better education, Sanger wrote two columns on sex education entitled “What Every Mother Should Know” (1911–12) and “What Every Girl Should Know” (1912–13) for the socialist magazine New York Call. Her next step in 1914 was to create an eight-page monthly newsletter which promoted contraception named The Woman Rebel. She helped to popularized the term “birth control” as a more candid alternative to euphemisms such as “family limitation.”

In 1915, she traveled to Europe, where attitudes toward family planning and more laws allowing contraceptives were ahead of those in America. She learned about diaphragms for contraception and began importing them from Europe, in defiance of United States laws.

On October 16, 1916, Sanger opened the first birth control clinic in the United States, which led to her arrest for distributing information on contraception. Her subsequent trial and appeal generated controversy and publicity on the topic. Sanger believed that in order for women to have a more equal footing in society and to lead healthier lives, they needed to be able to determine when to bear children. The family planning organizations she inspired eventually evolved into the Planned Parenthood Federation of America.

Sanger continued her work, realizing that changes to federal and state laws were needed. In 1929, Sanger formed the National Committee on Federal Legislation for Birth Control in order to lobby for legislation to overturn restrictions on contraception. Following her legal victory in 1936 that challenged a provision of the Comstock laws, the American Medical Association to adopted contraception as a normal medical service and a key component of medical school curriculums in 1937.

But state laws continued to restrict women’s access to contraception. The Supreme Court settled the matter in 1965 in Griswold v. Connecticut. The Court ruled that the Constitution protected a right to privacy. The case involved a Connecticut “Comstock law” that prohibited any person from using “any drug, medicinal article or instrument for the purpose of preventing conception.” By a vote of 7–2, the Supreme Court invalidated the law on the grounds that it violated the “right to marital privacy”, establishing the basis for the right to privacy with respect to intimate practices. This and other cases view the right to privacy as a right to “protect[ion] from governmental intrusion.”

But the reproductive ignorance that Sanger had identified and fought in the early 1900’s still raged. In 1970, women themselves took self-education action. Our Bodies, Ourselves, first produced in newsprint for women by women, shared knowledge about women sexuality and health in an accessible format that could serve as a model for women who want to learn about themselves, communicate their findings with doctors, and challenge the medical establishment to change and improve the care that women received. It was published in 1973 and really started a revolution in self-care and awareness.

Local Planned Parenthoods continue to be a key part of the health care system for women and men. The clinics provide high-quality, affordable family planning and reproductive health care for millions women and men. And after 100 years, Planned Parenthood is still under political attack, even in the face of the otherwise unmet needs they fill:

In 2015, the Guttmacher Institute reported that “In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety-net health centers.” Further, Planned Parenthood is the sole safety-net provider of family planning services “[i]n one-fifth of counties in which [it] is located.” Guttmacher also found that “the average Planned Parenthood health center serves significantly more contraceptive clients each year than do safety-net centers run by other types of providers,” which means that the organization “serve[s] a greater share of safety-net contraceptive clients than any other type of provider”

If you think there would be financial consequence to defunding and closing Planned Parenthood centers, the Congressional Budget Office has run the numbers:

Permanently defunding Planned Parenthood would end up increasing government spending by $130 million over ten years, according to the Congressional Budget Office. The CBO, Congress’s nonpartisan scorekeeper, projects that defunding Planned Parenthood would actually end up increasing government spending because it would result in more unplanned births as women lost access to services like contraception. Medicaid would have to pay for some of those births, and some of the children themselves would then end up qualifying for Medicaid and other government programs.

So when you hear politicians target Planned Parenthood with closure, ask them what they would replace these health services with. If they don’t have a good answer, that is your answer.

Candidates must tell us how New York State can improve women’s whole health and better support women’s access to comprehensive reproductive health care. Because the truths of women’s lives are these:

• Three-quarters of women now entering the workforce will become pregnant on the job,
• About half of all women in the U.S. have an unplanned pregnancy at some point in their lives.
• Publicly funded family planning services in New York saved $605.8 million in public funds in 2010.
• Young people between the ages of 15 to 24 account for 50% of all new STD’s, although they represent just 25% of the sexually experienced population.
• 130,691 of New Yorkers are living with diagnosed HIV in 2013, 30% of them women.
• The Zika virus crisis illustrates the need for women to have full autonomy over their reproductive health, as well as government’s need to invest in ensuring women’s health.

So, ask the candidates for office in the elections you will be deciding this November about their plans to improve women’s health. See if their health care priorities match yours before you enter the voting booth!