Opening a Closed Door : A quarter century of power struggles have helped prevent family planning clinics from making inroads into South-Central L. A. Now, that could change.

The map on the wall of Planned Parenthood’s Los Angeles headquarters speaks legions about a city wary of confronting what may be the most racially charged subject of all: who tells whom what about having babies.

Eleven red dots that denote existing family planning clinics punctuate the coast, the San Fernando Valley and parts of central and eastern Los Angeles County. But historically black South-Central Los Angeles remains a blur of beige dots--places where research showed years ago that private clinics were needed but never built. Not by Planned Parenthood. Not--until another agency recently set up a teen clinic in Lynwood--by anyone.

“In South-Central, there is a just a big geographic area where there are no private subsidized clinics,” confirms Tom Kring, executive director of the Los Angeles Regional Family Planning Council. “Ironically, in wealthy neighborhoods that can better afford private care, it is easier to find (subsidized) clinics.”

Why?

“It’s a big question--one for us to ponder,” responds Dr. Joan Briggs Babbott, a Vermont pediatrician who moved here five years ago to become executive director of Planned Parenthood-Los Angeles. “It’s about power, isn’t it? Money power, knowledge power, professional power, physical power. . . . It’s too bad that 20 or 40 years ago, somebody didn’t get out this map and think of these things.”

Somebody did.

What neither Babbott nor Kring knew was that the map reflects intense battles fought a quarter-century ago over precisely those things--money, knowledge, professional ethics and one race’s power over another’s reproductive destiny. The battles surrounded the formation of Los Angeles Regional Family Planning Council, the relatively obscure agency Kring now heads, The Times learned from interviews and aging files.

For years, such topics have been virtually taboo. Yet their legacy persists.

The African-American community, for complex reasons, has largely spurned county hospital clinics and in effect shut out Anglo-run non-profits. The Latino community has generally welcomed family planning services but rarely shaped them.

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Those on whom the battles had the most impact played no role at all. They are a generation of girls, mostly girls of color, who are growing up in South-Central Los Angeles neighborhoods that have some of the highest teen birthrates in the state--and virtually no private non-profit family planning clinics.

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Shown the maps, told the numbers, Rep. Maxine Waters--the South Los Angeles congresswoman known for fighting fiercely for equal resources for her constituents--falls silent.

A private memory comes back to her: An image of herself as a young working mother who had to leave her South-Central neighborhood to go to a downtown Planned Parenthood clinic, where she participated in a study testing the contraceptive Depo-Provera.

Then, a flood of memories from her public life: snapshots of crack-addicted babies in hospital wards. Of 17-year-old girls pregnant with their third child. And of blank expressions on colleagues’ faces in Washington when she tried to explain how devastating the cycle of poverty is--not for taxpayers, but for young girls.

“This makes me feel really guilty,” Waters says, finally. “Teen-age pregnancy is devastating-- devastating --our community. We talk about it an awful lot, but we’ve kind of left it to somebody else . . . It’s time to do something about this . . . it’s time to . . have some of the women in my community come forward.”

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Throughout history, women have had little say about the sort of reproductive health care offered them. So have communities of color.

Sixty years ago, U.S. public health doctors let African-American men suffering from syphilis go untreated in its now-infamous “Tuskegee study.” Planned Parenthood founder Margaret Sanger advocated eugenics, a movement with racial overtones from which Planned Parenthood has long since disassociated itself.

It was with reason, then, that some African-Americans were wary when President Lyndon B. Johnson introduced subsidized family planning in 1964, not as a health issue but as a “vitally important aspect” of his “War on Poverty.” Was the government trying to reduce black poverty, many wondered, or reduce the number of black babies?

The program was introduced into Los Angeles a tense 18 months after the Watts riots. It was administered not by a health department, as is the case today, but by the federal Office of Economic Opportunity. The OEO set up a new planning council, Los Angeles Regional Family Planning Council, whose job it was to coordinate the program and distribute government funds according to need.

Half a dozen doctors were named to serve on the new council, all but one a male Anglo associated with a major research hospital.

Dr. Herbert B. Avery, the assistant ob-gyn director at John Wesley Hospital in South Los Angeles, was the only African-American.

Avery was convinced the program was “a political-economic move instituted by the rich to control the birth rate of the poor.” In his mind’s eye, he saw birth control pills stacked up like candy bars at stores in black neighborhoods and women coerced into abortion, which he, like many who had grown up in conservative African-American churches, believed “wasn’t God’s way.”

“The first cry that came out of the black community was, ‘Genocide!’ ” Avery recalls now. “I laid out the agenda . . . and that word arose in the community.”

To the new council, he argued that black women would forgo services rather than be subjected to the “indignity” of crowding into public clinics. Federal funds, he said, had to be routed through existing African-American institutions women knew and trusted: private doctors’ offices.

That demand only raised suspicions among some white members of the new council that Avery’s underlying motive was not principle but profit. After all, every other doctor in the program was working through a public institution.

Avery bolted from the council and submitted a separate proposal to Washington in the name of a group called the Watts Extended Health and Family Planning Council. Federal officials rejected the plan, saying it was too costly, and ordered the two groups to work together.

Doctors on both sides remember the meetings that followed.

“These meetings were very hostile, angry meetings,” says Avery, now 59. “They had to do with power.”

Says one Anglo participant, who spoke on the condition he not be named: “There was yelling and screaming. Everything became a black-white issue. . . . It almost came to blows.”

In the end, LARFPC agreed to channel money through the Watts group and the Watts group agreed to join LARFPC--on one condition.

“We basically drew a line and told Planned Parenthood and everybody else, ‘Don’t come over here,’ ” Avery says. “ ‘If you want to do anything, you come here and do it through us.’ ”

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That was 25 years ago.

Things changed, over time. The Watts group disbanded. Given so many other pressing issues, few community doctors took up the controversial banner of family planning. The handful of private non-profit clinics funded by Los Angeles Regional Family Planning Council were short-lived.

Planned Parenthood attempted to open a clinic in South Los Angeles, where research showed three to five were needed. But, according to Dr. Hugh Anwyl, a minister who headed Planned Parenthood-LA from 1971 to 1988, LARFPC wouldn’t fund it.

“So,” he says, “we moved into an expansion mode of our own in other parts of the city.”

But expansion nationwide screeched to a halt in 1980 with the election of Ronald Reagan, who was backed by anti-abortion groups. More than 1,000 family clinics were forced to close. In California, shortfalls were compounded when Gov. George Deukmejian cut back state funds.

The remnants of a system set up by a handful of men in the 1960s were frozen in time.

Today, only one private non-profit agency receives Title X federal family planning funds in South-Central Los Angeles. That agency, the JWCH Institute, grew out of the now-defunct John Wesley Hospital where Avery once worked.

JWCH spurns the terms “family planning” and “clinic” and calls its offices “women’s health centers.” But with the exception of one new teen clinic, its centers are inside county comprehensive health-care centers, only 2% of whose patients are African-American.

Ironically, it is in such public settings that Avery now practices. Rarely, he says, does he have a black patient. Where are African-American women going for care?

“That’s a heckuva a good question,” he replies, puzzled. “I don’t know.”

The question plagues Sylvia Drew Ivie, whose multiethnic T.H.E. Clinic just outside South-Central, in the Crenshaw District, has the largest caseload of African-American patients of any local subsidized family planning agency.

“I ask that question all the time,” she says. Asked how many African-American women she believes receive no family planning at all, she answers: “Most.”

LARFPC, whose job it is to help determine unmet need, had to lay off its research staff early in the Reagan Administration. Only last year, when state budgets increased under Gov. Pete Wilson--and independent clinic directors demanded it--did LARFPC hire a specialist to figure out just how many women were not receiving care.

The results, calculated according to an established formula that takes into consideration income, age and survey data, were startling but not shocking:

In Los Angeles County, six in 10 women at risk of getting pregnant unintentionally are going without family planning services. Most of these 322,000 people--women 14 to 44 who earn too much to qualify for Medi-Cal and too little to pay private doctors--are women of color. Most live in South Los Angeles. Many--a disproportionate number--are African-American.

But a recent study of 300 African-American women in Los Angeles showed that they were not avoiding care over political issues like genocide.

“Genocide was not an issue,” says Donna Tate, who worked on the survey with a county-sponsored program called Great Beginnings for Black Babies. “A distrust of the county system in general was.”

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Now, once again, Planned Parenthood is trying to set up a clinic in South Los Angeles.

The decision came last May, after board member Mary Jane Wagle watched a young parent running from a burning building with a box of looted diapers.

What clearer proof could there be, she asked herself, that social causes underlying the riots began at birth or even earlier? An urban planner and single mother who had worked in South-Central, she proposed at the next board meeting that the agency open its long-delayed clinic in Compton.

“I felt we hadn’t been moving fast enough to do what the women and children of the community needed,” says Wagle. “We hadn’t moved faster precisely because of the sensitivity issue, to avoid having anybody feel like we’re coming in deus ex machina to solve problems for them.”

The board members, who cast a unanimous “yes” vote, included a growing number of people of color. Planned Parenthood’s clinics have multilingual staff. At the national level, Planned Parenthood-World Population, had been headed by a black woman.

Many independent clinics appreciate the fact that organizations like Planned Parenthood have carried on the lion’s share of costly abortion battles, because religious opposition to abortion in their communities makes it difficult for them to do so. But they also fear Planned Parenthood as a Goliath that can “put down” a clinic nearby and siphon off the local donors they need to survive.

Predictably, response to the suggested clinic in Compton has been mixed.

Dr. Ezra Davidson, a prominent African-American doctor in Los Angeles who has been president of the American College of Obstetrics and Gynecology, says he believes Planned Parenthood should be “less timid” about moving into poor areas because the need is so great.

“We’re hurting ourselves in scaring organizations off,” he says.

The two women who are perhaps best known for offering quality family planning care in South Los Angeles are holding off judgment until later this week, when Planned Parenthood has called a meeting and asked key community figures for input.

Donzella Lee oversees family planning for the Watts Health Foundation which, while primarily a health maintenance organization, offers family planning services to several area high schools.

“We are not opposed to other people offering good quality services to our population, but they have to learn about the cultures and not think everyone has to speak in the same way and act in the same way,” Lee says. Then she adds: “But people can’t continue to talk about territories. We have to do some partnerships.” (In November, one small, landmark partnership occurred: the Watts Health Foundation and Planned Parenthood-LA co-sponsored an event at Markam Junior High School in South-Central that was called “Families of Color, Sharing Common Ground.”)

Meanwhile, Sylvia Drew Ivie of T.H.E. Clinic says point-blank that she’d prefer that a community-based organization meet the unmet need. She says she recently tried to open a clinic in the area that focused on medical problems--and was unable to get funding.

“I suppose what I’d like to see is Planned Parenthood saying, ‘We can help you develop private sources of funding, and maybe we can share with you our knowledge from 18 years in the community,’ ” she says.

Joan Briggs Babbott, a no-nonsense grandmother with a warm desk side manner, says “building coalitions” is exactly what Planned Parenthood hopes to do more of. She acknowledges she has an uphill battle ahead, but asserts that her organization has changed faster than its reputation.

“I know we still have a kind of good-girl-in-white-gloves reputation,” she says. “But my God, if we who are in the field can’t work together, how are we ever going to get anybody else to? If we don’t have cross-cultural understanding that starts at birth, how can anyone else?”

Meanwhile, Maxine Waters, a longtime supporter of both Planned Parenthood and community-based agencies, says she has begun talking to officials in the Clinton Administration about the issue. She says she is looking into a program that would offer women the same sort of Depo-Provera injections she used to get every three months. The contraceptive has just been approved for use in the United States.

“I’ve racked my brains about this,” Waters says. “If it means starting my own program, I’m going to do it.”

Poverty and Fertility The state Office of Family Planning estimates that 519,317 women age 15 to 44 in Los Angeles County, who are at least 200% below the poverty level, are at risk of unintended pregnancy. Although eligible for benefits, about 62% of those women are not being served by either Family Planning or Medi--Cal. Women who are eligible for Family Planning or Medi--Cal, but are not being served. 321,747: 61.96% Women served by Family Planning or Title X funds. 127,730: 24.4% Women served by Medi--Cal. 70,840: 13.64% Sources: California State Office of Family Planning. Figures are 1990 estimates. A formula from the Allen Guttmacher Institute was used in determining who is at risk of pregnancy. The formula includes fertile women between 20 and 44, sexually active women between 15 and 19.