When Linda Williams applied for the top local job at Planned Parenthood, it took her nine months of interviews -- the human gestation period -- to persuade hiring managers she was tough enough.
"I look kind of sweet," chuckled the petite, longtime Palo Alto resident, who grew up in Texas and Oklahoma. "I do -- I always have. It has its advantages."
That was 21 years ago, a time of confrontational blockades of abortion clinics across the country, including a clinic in San Jose. Planned Parenthood wasn't sure Williams, previously a manager at the Red Cross, was up to the challenge.
She finally got hired after a Planned Parenthood board member from Arkansas, who "knew the Southern genre," reportedly gave his assessment to the selection committee. "He said something like, 'She's as tough as a burnt boot,'" Williams recalled, breaking out into a grin.
In the two decades since, Williams has grown what was just a Santa Clara County operation into the largest Planned Parenthood affiliate in the nation -- encompassing 42 California and Nevada counties and operating 34 full-service health centers, plus 12 to 15 satellite centers. Her operating budget has grown from $3 million to $90 million.
Though the organization is famous as an abortion provider, 97 percent of its work revolves around prevention -- chiefly contraception. Just 3 percent of patient visits are for abortion services, according to service data.
Ironically, despite an increasingly permissive culture and far more information sources, Williams observes that people's "specific knowledge about sex is not appreciably more sophisticated than when I was a teenager in Oklahoma."
People still call hotlines, with frequency, to ask questions like, "Is it possible to get pregnant the first time you have sex?"
"The fact that information is available all over the Internet doesn't mean people access it," Williams said.
"The more distraught someone is, the less likely they are to search methodically."
Williams' far-flung empire of clinics, known as Planned Parenthood Mar Monte, served more than 261,000 mostly low-income patients -- from Bakersfield to Yuba City to Reno -- in nearly 553,000 medical visits in the past year. Locally, a full-service clinic operates in Mountain View and a satellite clinic on the campus of Foothill College.
Her two newest counties -- San Mateo and Alameda -- were inherited this fall when Planned Parenthood booted its five-county, San Francisco-based Golden Gate affiliate from the organization, citing financial and administrative irregularities. The change left Williams scrambling to find venues to serve patients in the new counties.
The largest category of medical visits to Planned Parenthood -- 79 percent -- falls under family planning, with pregnancy tests and primary care, each around 5 percent, a distant second and third.
As people have trouble obtaining health insurance, some women have come to rely on the organization for primary care as well as family planning.
"They've stayed with us, just kind of settled in, and we are their medical-care provider in many cases," she said.
The organization also increasingly serves children.
"We help with delivery of healthy babies, but in some places it's very hard for us to find referral sources for pediatric care for those babies.
"They are so poor, and for a sick-child visit, many pediatricians cannot afford to have a large Medi-Cal practice.
"We finally said, we're putting all this energy into finding (pediatric) care, maybe we should just offer it. We completely underestimated the complexity of it. Integrating serving children in those centers where we do is more complicated than we expected."
Of Williams' 34 full-time clinics, 12 currently serve children and 13 offer adult primary care.
Despite battle scars from decades' worth of abortion wars, Williams' burnt-boot exterior softens when the subject turns to what she considers the highly individual and complex calculus of choice.
"The nexus of issues around contraception and abortion is in some ways the nexus between religion and sexuality, and that's a very powerful nexus point, imbued with a lot of emotion and religious symbolism.
"It arouses very strong feelings in many people, pro and con."
Even some of Planned Parenthood's own donors don't consider themselves "pro-choice," she said, but "they know we do more to help women prevent unintended pregnancies than any other organization in the country."
From time to time a woman who has picketed outside a Planned Parenthood clinic will come in as a patient, seeking to end an unintended pregnancy of her own, she said.
"If our staff recognizes her as a protester, they'll do their usual kind of counseling and will even push her a little and say, 'Are you sure you want to (have an abortion), given that you've demonstrated a belief that's counter to this?'
"They will say some variant of, 'My situation is different.'
"'And we say, 'Yes, it is -- and so is every woman's,'" she said.
Americans hold split and complicated views on abortion, as reflected in polling data.
Nationally, if people are asked whether they are "pro-choice" or "pro-life," nearly 50 percent will say "pro-life," Williams said.
But when asked who should be empowered to make a decision about abortion, a "pretty reliable 70-plus percent say it should be the woman and her doctor."
Beyond managing the clinics, Williams spends a lot of time on the road, working on national strategy for Planned Parenthood, most recently in the area of health care reform.
"Like any other health care entity, we have to be alert to the business issues and the mission issues," she said.
The group anticipates a deluge of previously uninsured patients and also is seeking a business model to continue serving the uninsured.
Currently, more than 80 percent of Williams' revenue comes from government and the rest from private sources, including individual contributions.
California leads the nation in its level of family-planning support for low-income women, a program developed under former Republican governor Pete Wilson, she said.
"There was a big awards ceremony in Los Angeles, and Pete Wilson gave the most moving talk because it was from the heart.
"He said the (family planning) program was one of the proudest achievements of his governorship because he felt it was one of the things that did the most to promote equal opportunity in California."
Nobody works in family planning for two decades without amassing a wealth of stories, and Williams has her share.
For example, "the oldest pregnant person we've ever seen in one of our clinics was 57."
Some people, she said, are surprised to learn Planned Parenthood also supports teens who choose to have their babies through its "Teen Success" program.
First launched locally with support from Becky and Jim Morgan of Los Altos Hills, Teen Success has spread to 37 venues around the country.
"We have a weekly support group for 12 pregnant and/or parenting teenagers between the ages of 12 and 18 -- and yes, we do have 12 year olds," she said.
"There's child care, and for two hours the girls really concentrate on themselves, and it becomes very precious time for them. The goal is to work with them so they achieve a high school diploma or the equivalent, and they don't have another pregnancy during their high school years, because a second pregnancy is quite common.
"About 97 percent of the Teen Success moms in our group do finish high school or the equivalent and, thanks to the Morgans, we now have a scholarship program for those who qualify to go on for post-secondary work."