SACRAMENTO, Calif. — As Christine Ruiz sits in an exam room for some aesthetic skin treatments, she looks nervous. She’s not new to injectables like Botox, but this is the first time she’s received them at a Planned Parenthood clinic.
“So, I usually do the elevens and then across the forehead. I really like the little lip flip,” Ruiz says to her clinician, describing what she wants done.
The Sacramento clinic is part of Planned Parenthood Mar Monte, the largest Planned Parenthood affiliate in the country, covering Northern California and parts of Nevada.
It has started offering a new set of services, ranging from Botox to IV hydration for skin rejuvenation, or for after a night of drinking, all of which patients pay for with cash. They can also request sedation for certain procedures, like the placement of an intrauterine device.
The shift comes as Planned Parenthood faces financial uncertainty after President Donald Trump and Congress stripped funding for the abortion-rights organization as part of the tax and spending package passed last year. The cuts, which prevent Planned Parenthood and other organizations that perform abortions from accepting Medicaid as payment for non-abortion services, are set to expire this summer. Congress could renew them for another year.
The affiliate says about 75 to 80% of its patients are on Medi-Cal, California’s Medicaid program. Revenue from the new offerings could allow the affiliate to continue providing reproductive healthcare while it tries to fill the funding gap.
“I’m really excited by the idea of patients coming to us because it’s a way they can support us financially. I think that’s exciting and we get to hear their stories,” says Dr. Laura Dalton, the Chief Medical Operating Officer of Planned Parenthood Mar Monte.
Tracy Barbutes for NPR/Tracy Barbutes
The affiliate has closed five clinics since the cuts.
“It is spicy,” Ruiz says, trying not to flinch as the needle pokes her upper lip.
She says she relied on Planned Parenthood for access to birth control and reproductive healthcare when she was younger. She’s now in her early 50s.
“I felt respected. I felt supported. I felt like the care that I got was without judgment,” Ruiz says. “So, when the opportunity came up, I was like, ‘Sure, why not support that?'”
Planned Parenthood charges $9 per unit of Botox, which, depending on location, could be 25 to 50% cheaper than other providers.
California Gov. Gavin Newsom, a Democrat, and state lawmakers have allocated hundreds of millions of dollars in state funding to Planned Parenthood and other organizations like it since the federal cuts, including $90 million in February.
Samantha Pohlman, a registered nurse, injects Xeomin IncobotulinumtoxinA near Christine Ruiz’s eyebrow during a cosmetic treatment at Planned Parenthood – B Street, in Sacramento, Calif. in March./Tracy Barbutes for NPR
The organization’s leaders, though, say it isn’t clear whether that will cover costs for core services, including cancer screenings, STI testing and contraceptive care, in the long run if Congress reinstates cuts.
That spending has sparked a backlash among politicians and groups opposing abortion rights. “We’d be shocked if California taxpayers support Gavin Newsom’s $90 million ‘Botox bailout’ for Planned Parenthood, which happens to be a key backer of California Democrats,” wrote Marjorie Dannenfelser, the president of Susan B. Anthony Pro-Life America, an anti-abortion lobbying group, in a statement to NPR.
According to Dalton, the affiliate’s providers are seeing a spiked interest in aesthetic services, many for cosmetic reasons. But, she points out, Botox can also be used for migraines and gender affirming care. These aesthetic services, she says, are a way for patients to exercise bodily autonomy.
But that argument doesn’t sit well with some who support the organization’s overall mission.
“I’m concerned about creating a closer association between anti-aging procedures like Botox and feminism,” says Jessica DeFino, a beauty critic and author of the popular Substack beauty newsletter called Flesh World.
“I think Planned Parenthood is associated, you know, rightly, in the cultural imagination with women’s rights, with feminism,” DeFino says. “I don’t think the aesthetic use of Botox is really in line with the push for freedom from gender-based discrimination.”
Planned Parenthood Mar Monte says this shift is about making sure reproductive care remains available.
While the affiliate offers Botox and IV hydration at select locations for now, it’s exploring an expansion into cosmetic fillers and GLP-1 weight-loss treatments. Dalton says the new services could serve as a blueprint for other clinics trying to keep their doors open.
