DES MOINES, Iowa (AP) — About 400 workers at Planned Parenthood offices in five states said Thursday they plan to unionize as their employer deals with the potential loss of business in states where abortions may become illegal if the U.S. Supreme Court overturns the landmark 1973 Roe v. Wade ruling.

Workers for Planned Parenthood North Central States in Iowa, Minnesota, Nebraska, North Dakota and South Dakota said they have signed cards showing majority support for unionization, and on Thursday they formally filed for a union election with the National Labor Relations Board, said Ashley Schmidt, a training and development specialist for Nebraska and western Iowa.

They plan to join SEIU Healthcare Minnesota & Iowa, an affiliate of the Service Employees International Union that has about 1 million members in 29 states, including doctors, nurses and laboratory technicians. SEIU locals represent Planned Parenthood workers in other regions, including those serving Oregon and Washington, New York, and Washington, D.C.

Union organizing in a variety of fields has gained momentum recently after a decades of decline in union membership in the U.S. The Biden administration has been supportive of efforts to expand unions, and organizers have worked to establish unions at companies including Amazon, Starbucks, outdoors retailer REI and Google parent company Alphabet.

The Planned Parenthood workers seeking to join the union in the Midwest include nurses, education outreach workers, community organizers and other nonmanagement employees at 28 clinics in the five states. They provide services such as reproductive care, cancer screening and abortions.

On a call with reporters Thursday, employees discussed concerns about unequal pay for similar positions in different locations, lower pay than other health care providers, high turnover due to exhaustion and burnout, and a feeling that management doesn’t always listen to worker concerns.

“Unfortunately, I have seen many of these people move on after their ideas and concerns went unheard by the executive team for far too long. Across our affiliate both clinical and administrative staff are overworked, underpaid and undervalued,” said Sadie Brewer, a registered nurse who provides abortion services at a St. Paul, Minnesota, clinic.

Molly Gage, a human resources vice president for Planned Parenthood North Central States, said the organization prioritizes autonomy and choice in people’s personal lives and respects that same right for workers.

“We support our employees, and it’s up to them to decide if and how they want to be represented by a union. We look forward to continuing the conversation with staff about how we can best serve patients throughout this pivotal moment for abortion access,” Gage said in a statement.

Workers began discussing unionizing last year, before a leaked Supreme Court draft opinion surfaced indicating the court may allow states to ban or strictly limit abortion availability, said April Clark, a registered nurse and a senior training specialist at an eastern Iowa clinic.

Clark said the potential for changes in abortion law makes joining the union more important for workers.

“We know it means we’re going to be faced with stress not only for patients but for staff in the upcoming months if Roe does get overturned,” she said.

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