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For years, abortion clinics have been at the center of a divided America, sparking opposition — and support — to the extreme. Abortion providers have been threatened by protesters, stringent building codes, specialized zoning laws and targeted regulations, not to mention a never-ending string of lawsuits.
Across the country, owning or leasing an abortion clinic is therefore no straightforward feat.
Even before the reversal of Roe v. Wade in June 2022, more abortion clinics had closed nationwide than opened in the previous decade, according to FiveThirtyEight. And as the post-Roe policies play out state by state, the fate of the remaining centers is in question.
“Many landlords don’t want to rent to you,” said Anna Eskamani, a Democratic member of the Florida House of Representatives. “It’s not necessarily that they’re anti-abortion. Sometimes they just don’t want the protesters.”
Florida is a pertinent test case as it’s a state with a lot of pre-2023 clinics, where abortion care has changed rapidly and remains in flux. At the forefront of the discourse is a potential ban that could have drastic implications not only for clinic operations but also for clinic locations. In April, Florida Gov. Ron DeSantis signed an anti-abortion measure that, if implemented, would bar clinics from providing abortion services after six weeks of pregnancy.
“This ban is cruel and dangerous, the majority of Floridians do not support this,” Stephanie Fraim, president and CEO of Planned Parenthood of Southwest and Central Florida, told Commercial Observer via email. “The long-term consequences will negatively impact communities across the state for decades to come.”
That ban, however, is on hold until the conservative-controlled Florida Supreme Court rules on the current 15-week ban on abortion. Planned Parenthood, other abortion providers and the American Civil Liberties Union (ACLU) have challenged the 15-week legislation, which is slated for a hearing Sept. 8.
“Because of the 15-week ban, we already are seeing providers leave the state of Florida,” Eskamani said.
If the six-week ban goes into effect, Florida’s abortion clinics will have to reassess how they operate — and potentially where they operate. Without the federal protections enshrined via Roe, the six-week ban could consequently contribute to a precarious environment for providers that have long grappled with backlash.
Bans and restrictions may curtail the ability of abortion centers to operate, just as they would any business, said Jen Stark, a founding member of business coalition Don’t Ban Equality and co-director of the Center for Business and Social Justice (BSR). Stark previously spoke with CO about abortion and business.
Landlord difficulties
Owning or leasing property to an abortion center is not without risks. Harassment from protestors is often directed at a clinic’s landlord or, if the facility is independently owned, to the seller who sold it to the abortion center. Neighboring tenants aren’t immune to protestors either, nor are construction workers.
“Whether they exist as a freestanding building or part of a commercial strip or nested within a building, the providers at all levels — from the receptionist to doctors and nurse practitioners — are often targeted and intimidated off-site to bully them out of providing care,” said Stark. “This is about real estate and so much more.”
Eskamani — who worked as a senior director for Planned Parenthood of Southwest and Central Florida from 2012 to 2018 — similarly recalls real estate-related roadblocks in opening the affiliate’s Kissimmee clinic in 2014, as well as in later relocating the Downtown Orlando health center, because of landlords’ reluctance to deal with the harassment that is part of the package.
Both in and out of Florida, protestors come in varying extremes. At the more intense end, anti-abortion protesters rallied in 2011 outside of a Maryland middle school attended by the daughter of a clinic’s landlord. This year alone, arsonists burned clinics in Wyoming and Illinois, a pattern that existed back in 2007, when arsonists set fire to centers in Albuquerque, N.M.
Even tamer opposition — protesters holding signs outside the building or leaving negative reviews online — are the kinds of nuisances that most commercial real estate professionals studiously avoid.
To cover a landlord’s bases, leases sometimes come with stipulations against abortion care that explicitly prohibit a business from providing reproductive services at a given location. For example, one of Eskamani’s constituents owns a health clinic in Orlando. His lease specifically stated that he could not provide any abortions, although he never planned to in the first place.
“There’s a lot of these pressure points for property managers and landlords,” said Eskamani. “Even if they’re not anti-abortion, they’re gonna put anti-abortion language in their leases because they see it as avoiding the attention of anti-abortion extremists, which could impact the other tenants they have in that same strip or plaza.”
These barriers to leasing make it all the more challenging to know where a clinic can and cannot open. They also raise the stakes for clinics that are already in operation. Once an abortion provider has a building secured, it wants to protect its building and lease, as finding a new location is difficult, said Eskamani.
Like abortion centers, landlords have little recourse when they are harassed, particularly in Florida where the state does not protect either from harassment. That’s ironic, said Eskamani, because Florida recently signed a bill that allows health care providers to deny care to patients as they so choose. So, if a doctor discriminates against a given patient, the law outlines protections to prevent that doctor from harassment. But there is no such safeguarding for those involved with abortion.
Self-ownership
For some of Florida’s abortion providers, the future of their businesses may be theirs to control, at least when it comes to real estate.
This is because many of Florida’s clinics — both those under the Planned Parenthood umbrella, as well as independent clinics — are owned by the tenant. Planned Parenthood of South, East and North Florida, for instance, owns six of its eight clinic locations. It is these self-owned clinics, specifically Planned Parenthood’s Jacksonville and Treasure Coast health centers, that have seen the most demonstrations from opposition, according to Michelle Quesada, vice president of communications and marketing. (The remaining Planned Parenthood locations in Golden Glades and Pembroke Pines, Fla., are leased.)
Elsewhere in the state, Planned Parenthood of Southwest and Central Florida owns four of the clinics it operates, according to property records on real estate data site Reonomy — in Kissimmee, Naples, Sarasota and Tampa.
A spokesperson for Planned Parenthood for Southwest and Central Florida declined to comment on the specifics of the affiliate’s landlords and lease terms, citing the security of Planned Parenthood clinics.
Self-owned clinics may have an easier time acting on protesters. Before they can address trespassers, for example, leased clinics may have to get permission from their landlord or property management. Appealing first to a landlord inhibits swift access and swift action on security issues, said Eskamani.
Ownership equips abortion clinics to better operate a location on their own terms, but those terms are limited. An abortion provider can’t dictate legislation, and it lacks real say on real estate issues, as well — such as unwanted neighbors, like crisis pregnancy centers, which tend to crop up around clinic sites.
Under pressure
To better protect abortion clinics, some Florida municipalities have enacted buffer zone policies to prevent protestors from closely harassing patients.
The City of Clearwater, Fla. passed legislation that requires protestors to stay five feet away from the entrances to the Bread and Roses Woman’s Health Center.
The clinic used a fence to keep protesters at bay. However, backlash from anti-abortion protestors met these efforts in the form of a June lawsuit. The case argued that Clearwater protestors now have to stand beyond that tall fence, which inhibits information sharing and results in shouting.
While many of the issues faced by Florida’s clinics are ongoing, they are not unique to the state, or to today’s political climate. Violence directed at clinic staff and patients increased 128 percent from 2020 to 2021. “Even when Roe was the law of the land, it was still very difficult to relocate, very difficult to open up new health centers,” said Eskamani.
In 2017, two practitioners in the plaza where Planned Parenthood’s Kissimmee clinic is located sued the clinic for allegedly violating property restrictions. The lawsuit cited building deeds that prevented neighboring tenants from providing surgical and imaging services. The restrictions, however, were outdated, and the Florida Supreme Court ultimately ruled in favor of Planned Parenthood.
Yet because of that lawsuit, there was a period of time when Planned Parenthood could not provide any abortion services at the Kissimmee site, said Eskamani. “So even when you buy a property and move in and do everything right, it doesn’t stop extremists from going after you for all these different reasons.”
Thanks to the dominance of conservative politics in Southern states, it’s easy to pinpoint clinics in Florida and its Gulf Coast neighbors as among the most restricted. But when it comes to leasing, stories abound — and have long abounded — across the country of abortion clinics shut down or drummed out of business. In left-leaning Austin, Texas, an abortion clinic shut down after a wealthy anti-abortion activist offered the clinic’s landlord five years of rent.
Meanwhile, last September, Washington, D.C.-based DuPont Clinic signed its first lease in California at 8920 Wilshire Boulevard in Beverly Hills, planning to open in October 2023. Yet once permits were issued in May, landlord Douglas Emmett rescinded the lease, leaving the clinic at a standstill — and with a lawsuit in the works.
On Aug. 14, DuPont Clinic sued Emmett and announced plans to sue the City of Beverly Hills, claiming wrongful termination of the lease. DuPont attributes the lease cancellation to pressure from both the city and protestors.
“During this process, the City of Beverly Hills not only met with these extremists and shared DuPont’s private information, but directly and intentionally interfered with DuPont’s permits,” DuPont Clinic wrote in a statement shared on the site X, formerly known as Twitter.
The business of abortion
Finances, particularly for independent clinics, present another concern, regardless of whether a clinic is leased or mortgaged. Planned Parenthood tends to have more flexibility than Florida’s independently owned centers that aren’t affiliated with larger organizations. When waiting to secure that Kissimmee property, “We can reschedule patients to Orlando, which is not convenient, but you have that option, right?” said Eskamani. “If you’re a small independent clinic, you’re not gonna have that kind of flexibility.”
Many of Florida’s independent clinics, as well as their landlords, declined or did not respond to requests for comment.
Like Planned Parenthood’s locations, independent clinics are a combination of self-owned and leased. Even when self-owned, however, they still have to generate income to cover staff and other business expenses. The assumption that clinics are organizations with flexible revenue is inaccurate, said Eskamani.
“If you’re unable to provide abortion services, unless you diversify the care you’re providing, you’re just not going to have the ability to maintain the cost of that property,” said Eskamani.
Florida’s abortion clinics may already be diversified enough. As businesses, many offer an array of services. Particularly in communities with health care deserts, these clinics tend to fill a gap that’s often not discussed, said Stark.
“Providers of abortion care provide comprehensive reproductive health care: sexually transmitted infection testing, cancer screening, blood pressure screening, LGBTQ-inclusive care,” said Stark.
Some services fall outside the realm of health care. In some communities, the local reproductive health care provider is the place to go for job training classes or to find professional clothing for interviews, said Stark.
With a six-week ban looming, increasing awareness of these services could benefit Florida abortion clinics. Diversifying isn’t necessarily about a pivot or a change of business policies, said Stark — rather, it’s demonstrating to communities the full scope of what health care providers are already doing.
A future in flux
The future of reproductive care in Florida is hardly decided, and the state’s activists are fighting to put the subject to a vote. More than 130,000 people signed a petition through Floridians Protecting Freedom to get abortion on the ballot in 2024, with a proposed amendment to protect access to abortion.
Stark’s own BSR conducted an April poll with Morning Consult that found that workers across regions, ages, income and education levels prefer to live in states where abortion is legal and accessible, at a ratio of 2 to 1.
If abortion reaches the ballot, Eskamani feels confident that Florida will secure abortion rights once again. Even with that time frame, however, there may still be a year where Florida follows the six-week ban, which could impact not only its operations but also its real estate. “If [clinics] close, reopening them is going to be very difficult,” said Eskamani.
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