Planned Parenthood was already on heightened alert against threats of violence this year after a storm of criticism from abortion opponents over how it handles the tissue of aborted fetuses used for medical research.
Now some affiliates of the reproductive health organization say they will scrutinize their security measures even further after a gunman's deadly attack on one of the nonprofit's clinics in Colorado on Friday.
The key, they said, is balancing the need for a welcoming environment for patients while guarding against anti-abortion extremists who have carried out arsons, bombings and shootings on providers since the Supreme Court legalized the procedure in 1973.
"We don't want to militarize our health centers," said Stephanie Kight, chief executive officer for Planned Parenthood of Greater Ohio. "We're trying to take a common sense approach to our security and not turn every single facility into a fortress."
Three people were killed and nine injured when a gunman, identified by police as Robert Lewis Dear, 57, opened fire on Friday at the Planned Parenthood clinic in Colorado Springs.
None of the dead were employees at the health center. However, eight people have been killed in attacks linked to abortion opponents since 1993, according to the National Abortion Federation.
Authorities have refused to discuss a motive for the shooting in Colorado Springs. According to news reports citing unnamed law enforcement sources, Dear said "no more baby parts" during his arrest, an apparent reference to Planned Parenthood's abortion activities and its role in delivering fetal tissue to medical researchers.
The women's healthcare provider has been under attack by conservatives since an anti-abortion group released secretly recorded videos last summer that it said showed Planned Parenthood officials discussing the illegal sale of aborted fetal tissue.
Planned Parenthood, which has denied any wrongdoing, said it had increased security over the last few months as "inflammatory rhetoric" about the organization intensified.
"While we do not disclose specific security measures, some health centers have increased patrols from dedicated security guards, while others have upgraded their monitoring systems," said Eric Ferrero, vice president of communications at Planned Parenthood Federation of America.
After Friday's attack, Kight said she reminded her staff to be well-versed in their extensive safety protocols. The affiliate's 20 health centers in Ohio already feature double vestibules and secured doors to control who can enter and some have "safe rooms" where staff could be locked in but still have access to outside communication, she said.
She said the next step will be to conduct a formal security audit to determine if tighter controls are warranted.
Jennifer Aulwes, spokeswoman for Planned Parenthood Minnesota, North Dakota, South Dakota, said health centers in those states also will review their security plans to ensure there are no gaps.
Health centers have seen an uptick in threats and protesters since the release of the covertly recorded videos, she said. The shooting will force them to double down on efforts regarding safety.
"This, I think, heightens our level of urgency about it," she said.
(Reporting by Colleen Jenkins in Winston-Salem, N.C.; Editing by Frank McGurty and Chris Reese)