A neon sign of the word "onward" hangs from a wall alongside a staircase.
A neon sign reading “onward” illuminates the stairs down to the lobby of CHOICES Center for Reproductive Health last year. Photo by Andrea Morales

In the year since Tennessee’s abortion ban went into effect on Aug. 25, 2022, about 14,000 pregnant people in the state have been forced to find other solutions for their unwanted pregnancies.

Some have driven hours to out-of-state clinics for abortions. Others have ordered and taken FDA-approved pills, with possible risk of prosecution. Still others, unable to obtain an abortion in Tennessee, have carried their pregnancies to term. Some have even turned to unsafe and ineffective methods, such as taking herbs, large amounts of alcohol or medications unintended for pregnancy termination.

There are problems with these choices, however. Traveling out of state can be a practical and financial burden that is insurmountable for many, especially working people, who would need to find childcare and take time off from their jobs. Though FDA-approved medications such as mifepristone ordered online are safe, some people may be alarmed by the normal bleeding the medications induce. 

If they go to the emergency room or to see a doctor, they may be reported to legal authorities — wrongly so, according to Elisabeth Smith, director of state policy and advocacy at the Center for Reproductive Rights, a reproductive-rights legal organization.

“While thousands of people are safely ordering pills online from places where abortion is legal, and while there is technically no law in Tennessee that criminalizes self-managed abortions, we have seen prosecutors (nationwide) unjustly go after people for doing so,” Smith said in a statement.

And the final option can also have devastating effects.

“We know that carrying unwanted pregnancies to term increases economic hardships for women for years to come,”  said Ushma Upadhyay, project co-chair of the abortion survey #WeCount and professor at University of California, San Francisco’s Advancing New Standards in Reproductive Health program.

She cited the Turnaway Study, whose researchers interviewed 1,000 women during a five-year period ending in 2016. The study showed that women who were denied an abortion and carried a pregnancy to term were four times more likely than those who got abortions to live below the federal poverty level following the pregnancy, experience serious health repercussions and remain bound to abusive partners, among other issues.

International studies have shown that unwanted pregnancies are linked to high rates of infant mortality and child malnutrition, abuse and mental illness; such children are also more likely to struggle in school. 

According to the June #WeCount report, a national effort by the Society of Family Planning, Tennessee has had the third-largest decline in abortions since the June 24, 2022, Dobbs v. Jackson Women’s Health Organization decision that overturned Roe v. Wade. Only Texas and Georgia had larger drops in the number of abortions.

In Tennessee, the average monthly number of abortions has plummeted, from 1,180 in April 2022 to virtually none since Tennessee’s “trigger” ban went into effect Aug. 25, 2022. Thus, the drop of 1,180 abortions per month over the yearlong period since the ban went into effect brings the estimated number of people unable to obtain the desired abortion to more than 14,000.

Two cars are parked out front of an abandoned building. Above the building are two billboards. One says, "Abortion is a right." The other, "Cherish Life. Heartbeat 18 days from conception."
Two signs next to each other on Lamar Avenue last year: “Abortion is a Right” and “Cherish Life.” Photo by Andrea Morales for MLK50

Abortion bans most harshly affect the most vulnerable, said Giovanni Dortch, the Memphis-based collegiate and public policy initiative lead at the nonprofit HER Initiative, a health resource for Black women and girls.

“These are people who are already marginalized,” she said. The maternal death rate of  Black women is 2.6 times higher than for white women. “The people who are being impacted by these new laws are people who are already vulnerable in the medical landscape, people who are already fighting against biases just to get the care they need.”

Indeed, a July 2022 analysis by The New York Times indicated that states with abortion bans tended to have poor records when it comes to maternal and child health, with Tennessee cited among the worst states for maternal mortality, infant mortality and child poverty.

And it could even get worse. Dortch pointed out there are indications that OB-GYNs may not want to work in states where they have to run a legal and ethical gauntlet — which could result in maternal health “deserts” in abortion-ban states.

Help is available

Despite the difficulties, help is available for Tennesseans seeking an abortion. Though most states bordering Tennessee also have bans or severe restrictions in place, organizations around the country are pulling together to offer women options.

In advance of the ban, Memphis’ CHOICES Center for Reproductive Health took the extraordinary step of establishing an abortion clinic in Carbondale, Ill., a state where abortions are legal. CHOICES had been providing abortions for nearly 48 years and wanted to maintain abortion access for its clientele. Carbondale is about a three-hour drive from Memphis. 

The Carbondale clinic opened last October, a little more than a month after the Tennessee ban went into effect. The clinic, which also offers gender-affirming care, has since seen more than 2,600 patients, almost all of whom sought abortion services. Of those patients, 70% are from Tennessee, said CHOICES president and CEO Jennifer Pepper. Arkansas and Mississippi residents are also among the clinic’s most common patients, a population that Memphis CHOICES has traditionally served. In all, Carbondale CHOICES has seen patients from 20 states, some from as far away as Maine.  

For comparison, Memphis CHOICES performed 3,893 abortions in 2021 and 3,108 in 2022, until the ban went into effect at the end of August.

Adjusting to the new legal realities, as well as quickly opening the new center, was “hard, to say the absolute least,” said Pepper. “We had to retrain staff and retrain even our board of directors about how they think about our services … and try to be normal human beings while we’re doing all that.”

In 2021, CHOICES opened a birthing center in Memphis. Today, after the ban, Pepper said that anecdotally she has heard that some women who gave birth there initially wanted an abortion but were unable to obtain one.

“Yes, we had to stop doing abortions in Tennessee, but we did not have to stop taking care of our community,” she said, comparing CHOICES to clinics that have had to close completely. 

The CHOICES Center for Reproductive Health before it dropped Memphis from its formal name ahead of its clinic opening in Carbondale, Ill. Photo by Andrea Morales for MLK50

Last week, however, CHOICES’ Memphis site laid off 14 employees.

“We find ourselves at a pivotal juncture where our dedication to providing vital healthcare services intersects with the formidable challenges posed by recent policy changes,” Pepper said in a statement, referring to changes brought by Dobbs and the subsequent state abortion ban.

Still, in concert with other organizations, CHOICES is continuing to provide abortion access.

Alison Dreith, Pepper’s friend from her childhood in Alton, Ill., is a director at Midwest Access Coalition, a fund that helps with travel coordination and costs, lodging, food, medicine and childcare for those seeking abortion access. Dreith was also instrumental in helping Pepper choose Carbondale as a site for the new clinic and helping to set it up.

The fund is only nominally for Midwesterners; it also aids people coming to the Midwest for care — which would include Tennesseans traveling to Carbondale, for example.

Since Dobbs, “We’ve doubled the amount of clients we see,” Dreith said. “We’ve increased our staff. We’ve increased our budget.”

Before Dobbs, she said, about 90% of her patients were from the Midwest, but now the majority are from the South. This year so far, as of the first week of August, Tennessee has sent her the fifth-largest number of patients (67), after Texas (371), Indiana (115), Wisconsin (81) and Illinois (73). 

By comparison, in 2022, the organization helped 52 Tennesseans.

CHOICES, like many other organizations, has a patient assistance fund, which can pay for up to 100% of the cost of the abortion procedure. (Without financial assistance, procedures can cost from $550 for a medication abortion to $800 for an in-office procedure.) Combined with help from an abortion fund like MAC, which pays for travel, patient assistance funds can make an abortion — even for a person from a banned state — feasible, if not easy.

For her part, Pepper has her eye on both the short and long term. Despite recent staff cuts, Pepper said CHOICES in Memphis has prioritized continuing and even bolstering patient reproductive health care. It aims to expand its midwifery practice and plans to add outpatient vasectomy and tubal ligation procedures. As it looks forward to celebrating 50 years in 2024, Pepper said CHOICES will continue to take care of its community in a world to come.

“CHOICES will be able to provide abortion when it’s legal in Tennessee again, and that is absolutely part of the future plan.”

Download the PDF

Sono Motoyama writes about public health in Memphis.

This story is brought to you by MLK50: Justice Through Journalism, a nonprofit newsroom focused on poverty, power and policy in Memphis. Support independent journalism by making a tax-deductible donation today. MLK50 is also supported by these generous donors.

Got a story idea, a tip or feedback? Send an email to info@mlk50.com.