While Planned Parenthood is synonymous with abortion, the organization also provides basic health care to millions of​ Americans who have few other options. Financial strains now undermine those services.

A New York Times review found that the clinics have been in decline for decades, undermined by structural and political headwinds and left to make do as national leaders prioritized the fight for abortion rights over finding a more sustainable way to fund health care.

Planned Parenthood’s health care operation has shrunk from a high of 5 million patients served across 900 clinics in the 1990s to 2.1 million patients and 600 clinics today, with staff members complaining that patient care is compromised by low salaries, chronic understaffing, high turnover, inadequate training and aging facilities.

Here are four takeaways from the reporting:

Planned Parenthood may need structural reform

Few people outside the organization understand that there is a significant difference between Planned Parenthood Federation of America, the national office that most people associate with the brand, and the 49 Planned Parenthood affiliates located across the country. The national office does not provide health care. Rather, it funds legal, political and public opinion work that supports abortion rights. The clinics are run by the affiliates, which are stand-alone nonprofit organizations.

The affiliates have been buffeted for years by political challenges that hurt their ability to raise the money necessary to cover procedures that patients cannot afford.

For the past two decades, leaders say they had to prioritize the fight for abortion rights over clinics because the political fight was fundamental to the organization’s ability to operate. They argue that the organization managed to deliver quality health care, despite increasing financial constraints. Yet clinics have degraded over time.