Civil Liberties

The Playboy Interview With Cecile Richards

Few jobs in America invite more conflict than the one Cecile Richards has held for more than a decade. As president of Planned Parenthood since 2006, she is viewed as either a champion of women’s rights or a baby murderer, a savior or evil incarnate. It all depends on the color of your politics. But red or blue, it helps to hear Richards out, if only to test the edge of your razor-sharp opinions on subjects such as sex education, HIV treatment, transgender health care and the most volatile topic of all, abortion.

Richards is stepping away from her position even as her biggest battles are escalating. A pro-life White House is determined to protect the sanctity of the “unborn” while progressive minions rally in seas of pink pussy hats. Add in the #MeToo movement and a sense that our nation is irreconcilably divided on issues such as birth control and immigration reform, and you can see why Richards will stay busy long after her exit in May.

Her opposition might best be described as volcanic. In 2015, after a secretly recorded video surfaced of a Planned Parenthood official purportedly discussing the sale of aborted fetal tissue, Richards endured more than four hours of brutal questioning by congressional Republicans who wanted to cut nearly half a billion dollars in annual federal funding for Planned Parenthood. The deceptively edited video was found to be part of a smear campaign, and congressional and state probes into the charges found no wrongdoing by Planned Parenthood, though the Trump administration has indicated it may conduct a further review.

Richards, 60, clearly thrives under such pressure. At five-foot-10 and with short platinum-blonde hair, she exults in her role as professional rabble-rouser—hence the title of her new memoir, Make Trouble. It’s a personality trait she shared with her late mother, the Texas politician and all-around-firebrand Ann Richards, who famously skewered George H.W. Bush in her keynote address at the 1988 Democratic National Convention with the bon mot “He was born with a silver foot in his mouth.” Cecile Richards was born in Waco in 1957, the oldest of Ann’s four children with her husband, David, a prominent civil rights attorney. The family moved to Dallas and later to Austin, the only hospitable place in Texas for a household of liberals who, as Richards puts it, “never backed away from a righteous fight.” In ninth grade she got in trouble for wearing a black armband to protest the Vietnam war. “My parents couldn’t have been prouder,” she says.

A life of activism followed. Richards skipped commencement exercises at Brown University to unfurl a FREE SOUTH AFRICA banner and spent the early years of her marriage to Kirk Adams—they now have three grown kids—organizing unions for nursing-home and hotel workers. After returning to Texas to help her mother become elected governor of that state, Richards founded America Votes with the goal of rallying more citizens to the polls. She also served as deputy chief of staff to Nancy Pelosi in her role as House Democratic whip. In 2006, Planned Parenthood hired Richards as president, and in just over a decade she has grown the organization’s corps of volunteers and supporters from 2.5 million to 11.5 million, with 700,000 new donors coming on since the 2016 election—the largest funding surge in Planned Parenthood history. One in five American women uses the organization’s services at some point in her life. With these milestones behind her, Richards is turning her focus to getting more women into public office, among other pursuits.

On a cold winter morning in Manhattan, Richards sat down in her spacious Central Park West apartment with journalist David Hochman, whose last Playboy Interview was with Vox.com’s Ezra Klein. Says Hochman, “What struck me most was how human Richards is. She’s at the center of so many storms and yet comes across as warm, connected and excited about life. She met me with her little dog, Ollie, in her arms and later became animated talking (with an uptick in her Southern drawl) about her passion for baking pies. Even if you don’t agree with Richards’s ideas, you might still want to get some Texas barbecue with her.”
Planned Parenthood has been around for more than 100 years. If your opponents had their way and defunded it, what would that look like for America?
First, let me clarify and say the phrase defund Planned Parenthood is misleading. Planned Parenthood does not get a blank check from the federal government, and there’s no line item in the federal budget that goes to Planned Parenthood. We work like other health care providers or hospitals in that we get reimbursed for health care services. We get Medicaid reimbursements for services like birth control, cancer screenings and the testing and treatment of sexually transmitted infections. More than half our patients, about 1.4 million, are low-income folks who rely on Medicaid for the preventive care that Planned Parenthood provides. In other words, the people who need us most are the folks who already have the least access to care. Take that away and you’ll see trouble immediately.

If you chart the country like a heat map, you’ll see that the states that make it hardest for women to get care are the ones with the highest rates of teenage pregnancy, unintended pregnancy, sexually transmitted infections and HIV infection. It’s unbelievable in the 21st century that we’re still fighting for these services, but that’s what’s happening in Mississippi, Alabama, Louisiana, Georgia and my home state of Texas, which is sort of the poster child for everything you can do wrong when it comes to women’s health and reproductive health. And it’s not just a Southern problem. Ohio is a good example, where they’ve tried to shut Planned Parenthood out of pretty much everything, and we’ve had to sue for services like HIV testing. In Paul Ryan’s district in Wisconsin, Planned Parenthood is currently the only option for family planning or women’s health for many low-income women. Without Planned Parenthood, you’d see higher maternal mortality rates, repeat teen pregnancies, dangerous abortions—it wouldn’t be pretty. 

What was it like to watch the Mississippi governor sign a bill this year that would ban almost all abortions after 15 weeks of pregnancy?

It’s another dangerous bill in a state that’s already home to some of the worst health outcomes in the country for women and kids. This law is on top of existing restrictions and the fact that Mississippi is home to only one provider of safe, legal abortion. Many women already must drive for hours or even leave the state to access abortion. It’s a dire situation made worse. But it ain’t over till it’s over, in Mississippi or anywhere else. A lawsuit has already been filed, since the law is unconstitutional. And not long ago, the voters of Mississippi went to the polls and voted down a ban on legal abortion, so I don’t believe the governor is representing the needs of women in his state to make their own decisions about their pregnancies. It’s a personal issue, and it should be the decision of the pregnant person, not politicians.

In your opinion, when does a human life begin?

This is a debate people have different feelings about based on their religion or their personal feelings. For me, it was when my babies were born, and they’ve been such an important part of my life. That was it for me. 

What about from an abortion standpoint?

I’m not sure what the difference is in that question. 

Is there any point during pregnancy when an abortion would be terminating a life?

That’s a question medical folks have dealt with, and I’m not a doctor. I’ve spent a lot of time with OB-GYNs, and they will tell you there is no specific moment when life begins. It depends on the pregnancy, and that’s frankly why doctors and their patients should be in charge of these decisions and not government. For Planned Parenthood, it depends on the state and what kind of abortion services we provide. We go to whatever the legal limit is, but it isn’t the same state by state. [Editor’s note: Federal law permits abortion into the third trimester in certain cases, though the vast majority of abortions are performed within the first 13 weeks.] There are women with really troubled pregnancies, and unfortunately there are very few doctors in America they can go to. This is where there’s a real inequity of care. These women are in heartbreaking situations as it is, and then they have to fly across the country to have someone provide them with health care. That seems incredibly cruel, and I’d like it to change. 

The White House isn’t exactly in your corner on any of this.

Not at all. We knew Planned Parenthood would be a target for this administration, and it really has been. Mike Pence had been the architect of getting rid of Planned Parenthood when he was in Congress, though he was wildly unsuccessful. He introduced the first federal measure to block our patients from care and then introduced something like five more measures. He also signed eight anti-abortion bills into law as governor of Indiana. He’s been waiting for this moment. The biggest myth perpetrated by people like Pence is that if Planned Parenthood shut down, these women could simply go elsewhere. That just isn’t true. For a lot of women, we’re all they’ve got.
The core issue for conservatives is that they don’t want federal dollars going to abortion, right?
As I think most folks know, the federal government does not pay for abortion services at Planned Parenthood or at hospitals except in very limited circumstances. That’s per the Hyde Amendment, which has been law for more than 40 years. I disagree with that law, and I think it has prevented low-income women from having all their options available to them; however, it is the law. The reimbursements the federal government provides to Planned Parenthood, or any other hospital or health care provider, are for preventive care: breast exams, cervical cancer exams, family planning, STI testing and treatment—the very things, in many cases, that prevent unintended pregnancy. The question for me is, why single out Planned Parenthood since we abide by the same regulations that every other health care provider in America abides by?

Well, Planned Parenthood is often seen as an abortion factory that masquerades as a reproductive-health organization. It’s the country’s largest provider of abortions, with more than 300,000 procedures done each year. The argument is that if a woman on federal assistance comes in to talk about family planning, the result may very well be an abortion.

That’s no different than it is at any hospital. If a woman on Medicaid goes to a hospital for family planning and they provide a full array of health care options, including safe and legal abortion, that hospital gets reimbursed for that service, as they should. That’s the same thing we do. It’s no different. I think the difference is that we’re the largest women’s health care provider in the country. In my view, if you’re a woman on Medicaid, you should have the same rights to whatever health care provider you want as a member of Congress does. That’s fair and equal.

Maybe the biggest hot-button issue for Planned Parenthood has been the donation of fetal tissue for what’s often called stem-cell research. Why is this a cause worth championing?

For a very long time fetal-tissue research has been important in helping to lead to all kinds of medical advances—everything from vaccines for polio and measles to research on degenerative eye disease, Down syndrome and infectious diseases, to name a few. Almost every family has been helped in some way by this research, and there’s still much more to do. Fetal-tissue donation is offered only at a limited number of our health centers, but Planned Parenthood is proud to support women who choose to donate fetal tissue, honoring their desire to contribute to potentially lifesaving research and cures.

President Trump reinstated the gag rule that blocks foreign aid to any nongovernmental group that discusses abortion. He also appointed officials to the Department of Health and Human Services who are contraception skeptics, right?

That’s right. HHS is a dangerous place right now when it comes to women’s health. It’s been filled with folks who are not health care experts but instead are anti-choice, religious ideologues. They’re rewriting the rules for the [Title X] family planning program to steer it away from birth-control options and more toward what they call “fertility awareness” and the rhythm method. They’re doing the same thing with sex education, basically trying to move back to an abstinence-only mind-set.

You have to admit, abstinence is a pretty effective way to avoid getting pregnant.

Abstinence should always be part of a sex-education program, and we teach it as an option at Planned Parenthood. The problem is, it can’t stand on its own. We absolutely believe that young people should know about abstinence, but we also know that young people think about sex, and that at some point they’re probably going to be sexually active. If they know only about abstinence and don’t know how birth control works, that puts them at a high risk for pregnancy and STIs. People on the right believe that teaching kids about sex leads them to have sex earlier, but no credible study has found that a comprehensive sex education encourages early sexual activity. All the research shows that it delays it, actually. You don’t just go out and have sex because you’ve learned about it in school.

Are you suggesting that young people will discover sex on their own?

Put it this way: I’ve had three kids. It’s not like we as adults created the idea of sex and had to pass that down to them. Kids are already thinking about it. One of the most important things we can do as a society, and as parents, is give young people the information they need about their bodies. I mean, the questions we get at Planned Parenthood in 2018 are just stunning.

Give me an example.

It’s misinformation on all levels. People are constantly wondering if they can get pregnant from unprotected sex, and of course the answer is yes. Or someone will say they heard you couldn’t get pregnant if you drink Mountain Dew, or if you stand on your head after sex or during sex. There are a ton of myths out there. We’ve done a terrible job in this country of talking to young people about the basics of sexuality and about risky behavior. That’s why it’s so heartbreaking to see a state like Texas no longer participating in the HIV Prevention Program, for political reasons. I mean, who in this country wouldn’t want to keep a young person from getting a sexually transmitted infection, particularly HIV, if they could do something about it? This is where politics really gets in the way.

Is it politics or God? Aren’t religious beliefs and morality shaping these decisions?

For some these are religious issues, and I have total respect for people whose religious values are that they don’t want to talk to their kids about sex or they don’t want to use birth control. I have no problem with that. That’s their business, but it’s not the business of government to put their political values, if you will, or even religious values on anyone else. I think the mind-set on the right actually goes beyond religion, frankly. It’s really about women and sex.
I think there are men, a lot of them in office, who simply don't believe that women should be able to have sex freely.
Women and sex? Say more.
I think there are men, a lot of them in office, who simply don’t believe that women should be able to have sex freely. They don’t think women should control their own bodies, and they’re apprehensive about how things are changing for men and women. They’re frustrated that women now represent more than half the undergraduate students in this country and half the law students and medical students. Women are everywhere, and for some men that is unsettling. People may think our opponents are rallying around religion, but it’s really about control over women’s opportunities. These men may not get it, but women get it, trust me.

So the trouble comes down to conservative men feeling threatened by women?

You can look at it practically. Who has been in charge for the past umpteen million years? Not women. As Gloria Steinem always said, no one ever gave up power without a fight. The old guard is scared as women take action like never before. It’s such an exciting time to be a woman and to be an activist. Every day, someone comes up to me on the subway or wherever and wants to know what they can do next, how they can get involved. People are fired up. Women are organizing, joining political groups, going to marches, running for office. It’s a healthy sign. Women are no longer waiting for instructions or waiting to have all their ducks in a row. This is the time.

Trump may be the best thing to have happened to the feminist movement.

I guess if there is a silver lining—or, as someone called it, a tin lining—to this administration, it’s how it has engaged more people than I would ever have imagined. As painful as the months since November 2016 have been, seeing how bad this administration has been for so many people and how they’ve tried to turn back progress, there’s also an undeniable flip side. Trump has lit a fire for millions of people—women, yes, but also men—to step forward, be heard, get involved in fighting back and making trouble, and I’m tremendously optimistic about where we’re heading.

The ground is shifting under our feet everywhere, not just in Washington. I’ve been working on progressive issues or social justice or women’s issues my whole life. I’ve never seen anything like this. It’s multigenerational. It’s not just young women; it’s older women saying, “No way are we going back to those days.” One of my favorite signs at marches is the one I see older women carrying that says, how long do we need to keep fighting this crap? It has been so inspiring to see #MeToo and Time’s Up become massive grassroots movements that connect people to a changing of the tide. It may have started in Hollywood, but it has shifted to people around the world standing up for dignity and respect. Once this all gets boiling, that’s when you will see real cultural and social change.

Getting the birth control benefit covered under Obamacare was a major victory for you. Do you think that legislation will hold up?

It’s so important. It was one of the biggest fights we had at Planned Parenthood, to get birth control available for everybody at no cost, but it happened. Now, more than 55 million women are eligible for no-cost birth control. That really matters, because it gives women freedom regardless of their income level or which state they live in. Birth control is now a right in all 50 states under various insurance plans. Yes, it is absolutely something the current administration is trying to roll back, but here’s the thing: Once you give 55 million women freedom like this—and these are women from every background and political persuasion—it’s hard to take that freedom away. Women started sending us their Walgreens receipts that said “zero co-pay.” Once women began to understand this was a benefit they had, they understood what it would mean for the administration and Congress to rescind those rights. That knowledge is energizing women to show up and not just let politics happen to them.

More than 500 women are running for office in November, most of them Democrats. What impact might that have?

It could be huge. Women are a lot more effective once they get in office. They actually get things done. They can work across party lines. Most of them do not do this so they can be called “Congresswoman.” They do it because they need to get things done. Women in office and women running for office have an especially hard burden: not only to get elected but to work twice as hard once they’re there—and thank God they do. The ideal vision overall is that we protect the Senate, because I think they’re the only rational body holding the line right now. Maybe not so much under Mitch McConnell, but it has generally been the place where you can have high-level conversations about important topics, from immigration to abortion rights. So holding the Senate—getting women in the Senate—is crucial, and I’m also optimistic about the Democrats taking back the House.

What is it going to take?

My biggest interest for November is getting more women to vote. If women voted, even if you added five percent more women to any contest, that could be the tipping balance, and women are poised to do that. They’re already running the phone banks. They’re running the get-out-the-vote organizations. Black women in Alabama are a key reason Doug Jones is now in the United States Senate. Women in Virginia did a ton of work in electing a Democrat in the governor’s race there, and they helped flip many seats across the country. Especially with so many women running for office, both incumbents and new faces, it feels like this is a singular political moment, and I hope they recognize that. In a funny way, that has been the story for many years; it has just never been told. Women are the reason Barack Obama was re-elected, I believe. He was a great first-term president, but women really fueled his 2012 campaign.

What about you? Your former boss Nancy Pelosi said you are so organized as a leader that you could be president.

And she knows how to butter everybody up.

Seriously, is running in 2020 something you’d consider?

Well, I think I could do a better job than the one who’s in there now, for sure. But it’s not an aspiration I have. I clearly hope that we elect a woman sometime soon. We’re overdue and it’s important, and I think we will. As I said, women are the most potent political force in the country right now. If we can get our act together, we could determine everything not only this November but two years from now. At Planned Parenthood we’ve done an extraordinary job of engaging women as voters around issues of reproductive rights, but I’ve also learned that women need much more: They need equal pay, they need affordable childcare, they need paid family leave. So I’m excited about stepping aside from this current job and working on a host of issues that change women’s opportunity in this country. I want to live my values. I spent a lot of time grooming the next generation of leaders. It’s hard to do, but you’ve got to move aside and let one of these amazing people do this, and now I can use my energy and whatever talent I have left to do something else. I’ve marched. I’ve organized rallies. I’ve raised money. I’ve raised awareness. I’ve fought Congress. I’ve done all this, but if we don’t shift that into political power and voting, we won’t have finished the job. Frankly, if half the members of Congress could get pregnant, we wouldn’t be talking about Planned Parenthood. We’d be talking about how we could better fund family planning.

Is it true that the number of teen pregnancies in this country is rapidly decreasing?

It’s amazing. I want to shout it from the rooftops. We’re at a record low for teen pregnancy in the U.S. We’re at a 30-year low for unintended pregnancy in general. We’re also at a record low for abortion rates since Roe v. Wade was decided.

How do you explain that?

It’s a little early, but I think we’ll see that it’s because more women are eligible for no-cost birth control. Not just that, but there are all kinds of birth control now. You don’t just have a pill that you have to remember to take every day. There’s the patch, the sponge, the ring, the cervical cap, condoms, female condoms. There are all kinds of choices.

What is the most effective form of birth control?

Well, the most effective one is the one you use, which I guess is an obvious point. But definitely the longer-acting methods like IUDs are highly effective, though not everybody likes them and they don’t protect against STIs, which is why we always advocate dual use. Use a method that protects you from unintended pregnancy, and then use a condom to prevent STIs.

Why not just make birth control available over the counter?

We should, and I think in the near future we will. There are over-the-counter pills going through the FDA approval process, which I believe will take another few years. But it’s going to happen. I mean, they’re sold over the counter around the world. The Plan B pill is available over the counter now. If you have unprotected sex, you can take what used to be called the morning-after pill as an effective method of preventing an unintended pregnancy. That happened under the Obama administration.

What about that long-promised male birth control pill?

It’s not here yet, but I think it’s a great idea. My only problem with it is how would you know that the guy took it? I hate to be that way, but men have to be as engaged in birth control and preventing unintended pregnancy as women are, and that’s changing. I’m excited about the birth control shot, Depo-Provera. Right now you get it from a nurse or doctor once every three months, but we just did a clinical trial on a self-injectable that you could take home and do yourself, which is amazing. Studies show that women stay on their birth control at much higher rates if they can take it home.
I also see the abortion pill, which was introduced by Planned Parenthood in the U.S., taking hold. It was developed in the 1980s as RU-486. It’s an easy and nonsurgical way for a woman to terminate a pregnancy early on. If you’re eight weeks pregnant or less, it works about 98 out of 100 times. At 10 weeks, it works about 93 out of 100 times. Women are already using it overseas. It gives them the ability to take their care into their own hands, particularly in states where they’re making it impossible for women to get to a provider of safe and legal abortion. That technology is only going to get better.
I just don't believe we'll have the political change we need until culture aligns and drives it.
You write in the book about your own abortion. What did that experience do to guide you as the head of Planned Parenthood?
I didn’t think about it that much except that, like a lot of women who have either had an abortion or, more important, had children, I became even more adamant about abortion rights. The responsibility of having a child is a lifetime decision. This isn’t about having a cute little baby; this is about having a person you’re responsible for forever. I didn’t realize how important it was to talk about my own abortion until I did. It’s important for people to talk about their abortions because it makes them feel less alone. Women face so much stigma and shame around this decision. But I think that’s changing too. We have a long way to go, but folks are coming out with their abortion stories, and that’s new. The reproductive-justice community was on this a long time ago, but it’s refreshing to see abortion stories in movies that are not hysterical depictions. Jenny Slate’s movie Obvious Child was the first abortion rom-com, but you’re seeing it in television shows too. Shonda Rhimes featured an abortion story on Scandal. For Kerry Washington’s character to have an abortion and for it to be a matter-of-fact occurrence was huge. I just don’t believe we’ll have the political change we need until culture aligns and drives it. It will become unacceptable to shame women and act as if abortion isn’t and hasn’t always been simply part of our world.

We’ve come all this way, and you haven’t used the term pro-choice once. Why not?

I think the pro-choice, pro-life nomenclature is completely outdated and irrelevant. Those terms were used to create a political binary that’s just not where people live. We quit using pro-choice at Planned Parenthood because it’s a simplification of a complex personal issue, and people don’t want to be labeled. Once you get beyond labels, folks’ shoulders relax and they can have a conversation.

What’s your preferred term?

I don’t have one. That’s the thing about getting rid of labels: You can’t just create a new one. The question is, do people believe that women should make their own decisions about their pregnancy in consult with their doctors, or do we think that should be government’s decision? Overwhelmingly, people do not want government or anyone else to make decisions for them.

You grew up in a house where battling for progressive causes was as normal as selling Girl Scout cookies. Was it ever difficult to be in a liberal minority?

Texas makes it easy for you to be progressive in some ways. My parents were unrepentant liberals in Dallas, which meant we were pretty much against everything that was happening politically. That’s what makes me so comfortable in the work I do now. I’ve always been tilting against the prevailing political climate and conventional wisdom, and I’m grateful to my parents for giving me that. You always lost more than you won, and that was good conditioning.

Do you remember your parents giving you “the talk” about sex?

Barely. My parents weren’t typical Texas parents, but they were just as hung-up as everybody else. I do remember my mother trying to draw anatomical things. What’s interesting is that when I was growing up in Texas, there was better sex education than there is now. I mean, it was crazy antiquated and taught by coaches in my high school—because every teacher in Texas is a sports coach—but it did the job. Parents are the best at sex education, but a lot of them don’t feel equipped or know what to say. They think that with social media and the internet there’s too much information out there already, so a lot of parents avoid talking about it. I think the worst thing we can do for kids is pretend sex doesn’t exist.

How young do you think kids should start learning about sex?

It should absolutely start in elementary school with age-appropriate material: talking about parts of your body, what to expect from puberty. Certainly by middle school and high school it needs to be discussed in a big way. Again, it doesn’t have to happen at home, though I think it should. We teach sex education at Planned Parenthood. Churches and temples teach it. But somebody needs to do it. If you don’t talk to people when they’re young, when are you going to talk to them?
Europe seems so much more, shall we say, chill when it comes to matters of sexuality. Anything we could learn from them?
Well, you look at Europe and see lower rates of every troubling thing we see here in terms of sexually transmitted infections, unintended pregnancy, even abortion rates. In Europe, non-stigmatized sex education begins at a very early age. There’s not a lot of debate about whether it works; we know it does. The debate here is whether we’re going to let politics and politicians and particularly a bunch of old dudes in Congress decide what and when young people can learn. As with women’s health care, these old guys are wildly out of step with the American people. This is not a Republican or Democrat issue. Parents don’t want their kids to get pregnant before they’re ready to have a family, and they definitely don’t want them to get sick when they can avoid it.

Help us clarify a few things. Can you get, say, HPV or gonorrhea from a toilet seat?

That’s a popular misconception. People write in to Planned Parenthood’s text-chat hotline with questions like this all the time, and our experts at the call center in New York reply in real time. The answer is no.

Can you contract HIV by getting a piercing or tattoo?

Actually, yes. It’s possible to spread HIV if your piercer or tattoo artist uses the same needles for different clients, which, obviously, they shouldn’t do. So before you commit, find out whether the person uses a new needle for each client and how the needles are sterilized.

Is it true you can’t get an STI from oral sex?

Oh, you can definitely get an STI from oral sex. It’s a good idea to make sure you’re protecting yourself and your partner by using condoms and/or dental dams.

You can get herpes only if your partner is having an outbreak, right?

Herpes can be spread even when there are no visible signs of an outbreak. There’s no cure for herpes, but medication can help with symptoms and lower the chances of passing the virus to other people. The good news is, outbreaks usually become less frequent over time, and though herpes can be uncomfortable, it isn’t dangerous. People with herpes have relationships, have sex and live perfectly healthy lives.

Most women have orgasms just through vaginal sex, correct?

Uh, nope. Isn’t this Playboy? Who told you that?

The old joke goes that 80 percent of people masturbate, and the other 20 percent are lying. Planned Parenthood says masturbation has a health benefit. Playboy readers are all ears. Do tell.

I’m tellin’ you, masturbation is good for you. There’s a lot of research on this out there. Masturbation can release sexual tension, reduce stress, help you sleep better, improve self-esteem and body image, relieve muscle tension.… Should I keep going?

We’re good, thanks. Last one: If you have an STD, what’s the best way to tell your partner or the person you’re dating?

It’s no fun to tell the person you’re dating that you have an STD, but it’s definitely the right thing to do. There’s no one way to have this conversation, but here are a few tips. First, stay calm and remember you’re not the only one dealing with this; millions of people have STDs, and plenty of them are in relationships. Having an STD is a health issue, plain and simple, and it doesn’t mean anything about you as a person. Second, know your facts. There are a lot of myths about STDs out there, so read up on yours and be ready to answer your partner’s questions. Third, think about the timing. Pick a time when you won’t be distracted or interrupted, and choose a place that’s private. Finally, remember to put your safety first. If you’re afraid your partner might hurt you, you’re probably better off with an e-mail, a text or a phone call. Some health departments have programs that can let your partners know they were exposed to an STD without giving them your name, unless you want them to. It’s totally normal to be worried about how your partner will react, and there’s no way around it: They might get freaked out. You might need to give them a little time and space to process the news. And of course Planned Parenthood is a great resource for safe and confidential information, testing, treatment and support.

What’s your view on the rise of hookup culture? For people under the age of 30 especially, there’s a sense that casual sexual encounters are fine.

One of the things that amazes me when I get questions from young people is how often they ask things like “How do I know if someone really likes me?” I do think young people, even if they’re more sexually active today—which, by the way, the research isn’t showing to be true—they’re looking for the same thing everyone is looking for, which is human connection. There’s as much looking for authentic relationships and love as there ever has been. I’m not an expert on the psyche of teens or college students, but research shows that most young people, male and female, regret these experiences in uncommitted relationships. I think it underscores the need for more honest conversations about the results of our sexual behavior and what it means to have an equal and consensual relationship where you’re both getting pleasure and having your needs met. It’s not just about one person being sexually harassed or coerced; it’s about having the right to say what you want.

You hear so much talk on college campuses and elsewhere about consent in sexual situations. In your opinion, what are the hallmarks of a consensual relationship?

Consent is all about setting your personal boundaries and respecting the boundaries of the person you’re in a relationship with. If I could go back in time and give some advice to my teenage self, consent would be a big part of it: Your body is yours. You get to decide what you do with it. At Planned Parenthood, there are a few things we talk about when we talk about consent. It’s freely given: a choice you make without pressure, manipulation or being under the influence of drugs or alcohol. It’s reversible: Anyone can change their mind at any time, no matter what. It’s informed: You can consent only if you have the full story. It’s specific: In other words, saying yes to one thing doesn’t mean you’ve said yes to everything. And it’s enthusiastic: When it comes to sex and relationships, you should only do things you want to do, not what you think you’re expected to do.

Then there’s pornography, which permeates our culture like never before. What’s that doing for sex?

That’s something we’re all trying to figure out. I don’t know. The questions to focus on, particularly for young people, are “What is healthy sex?” and “What is consensual sex?” The internet is good for a lot of things, but there’s a lot of bad stuff out there as well—violence against women, portrayal of sexual activities that are unsafe and unrealistic. That’s one of the reasons we’ve invested in peer education on sexuality. When I came to Planned Parenthood about 12 years ago, I met these high school students in Kalamazoo, Michigan. They had learned everything about sex and all the issues we’re talking about. They were kind of the Underground Railroad for sexual information in a place like Kalamazoo. They would talk to teachers about what they knew; they’d go to the school board and fight for sex education. I said, “You’re not sex educators; you’re our truth tellers.” These engaged young people are the future. They began to build a movement within our organization, and it brought kids together across the country, from Kalamazoo, Miami, East L.A. and beyond. There’s now an LGBT component and similar groups on other campuses. We began taking them to Congress. There are many doors I can’t get into, but you bring a teenager from anyone’s congressional district and they’ll get a meeting immediately. They can talk about what it means to not have sex education or affordable birth control or just about their lives. You can’t say no to these kids. It’s like what we’re seeing among young people in this country in the wake of the shootings in Florida. The kids of this next generation are the best lobbyists I’ve ever seen. We had young women, teenagers, stand up at town hall meetings and take on U.S. senators over the issue of Planned Parenthood. That’s something you never forget.
Men can be advocates for women and feminist activists. That has been another generational change.
What can the average guy do to support reproductive rights?
For starters, don’t wait for instructions. These are your issues too. I guess I would say women need men’s support, and it’s not an us-against-them situation. Women are saying we want the same opportunities that men have had. Lots of men understand that. I was so moved by the men who marched last year. I think of my own father, who saw his wife become governor of Texas, which was challenging for him, but he supported her.

I’d also like guys to think that Planned Parenthood is for them too. Men can come in and get STI testing and treatment. We do more than 4million tests a year. In a lot of states and communities Planned Parenthood is probably one of the few places men can go where there’s no judgment, just straight-up health care. We do vasectomies too. The only time it’s hard to get an appointment is March, when many guys get vasectomies so they can sit on the couch and watch March Madness basketball for a week. We also provide LGBT services, and in a number of states we’re doing hormone-replacement therapy. It’s been incredible to see as we expand transgender care how many people drive across state lines to come to Planned Parenthood. One young man just said to me Planned Parenthood was the first place he went where the medical provider knew more about what he needed than he did. He had to be his own advocate in the health care system.

More broadly, men can be advocates for women and feminist activists. That has been another generational change, which is exciting. So many partners and couples come in together. You see so many men at events and rallies and public meetings, whether it’s about reproductive-care access or abortion rights. The legal right to abortion in this country is as high as it’s ever been. I think that’s a reaction to what women have done, but also to what good men have done, to fight for these rights. It’s why we’ve had them for more than 40 years.

Looking ahead, is there anything you want to do with a little more free time?

I don’t picture myself ever just sitting around. I’ve been trying to learn Italian. I’ve been going to sailing classes way up in Maine; I love doing that. There are things I’d love to master as a cook. I’ve been trying to make a perfect cacio e pepe pasta and still have not quite gotten it. I may have to go to Rome for a week to get that done. I’ve always wanted to go to the Isle of Skye, which I’m doing this fall just for fun with a friend.

And what’s your hope for the future of women’s rights? Will it always be a fight for reproductive freedom?

If we’re doing the right thing, yeah. If we believe in progress and in taking away barriers, there’s always going to be a next fight. As I try to tell people who are discouraged about what’s happening right now in this administration, you have to take the long view sometimes. One hundred years ago women couldn’t vote, birth control was illegal, women didn’t have equal rights. And now women represent half the workforce, they’re half the student population, they’re taking over government. They’re doing things that were unthinkable even 25 years ago. We got birth control covered for every woman, and we’ve held our ground on abortion rights. Those are big advances. Life is so much better now for women than it ever was before. But we can never stop fighting. If we’re a movement, we have to constantly be moving.