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In a small room at CHOICES Memphis Center for Reproductive Health, a tiny green light flashed on Adina’s phone.
“Thank you for calling CHOICES. How can I help you?”
The caller, like so many others who light up the phone lines at CHOICES, wanted to know if the clinic was scheduling abortions.
“Unfortunately we are not,” Adina said. “We have run out on our appointments. However, I can refer you to somewhere. It is about four hours away.”
Less than two minutes before, CHOICES had booked its last available abortion appointment on July 8, the final abortion scheduled for at least a few weeks as the nearly 50-year-old organization prepared for possible bans.
WATCH: How abortion providers are adjusting to new realities in a post-Roe world
Adina, who asked to go by her first name because of the sensitive nature of her work, and her colleague Giselle Quintanilla had been fielding calls all morning under a whiteboard that read “Answering the phones is an Act, a Science, and Ministry.” Below that, a “pro tip” suggested something that was no longer possible: “Challenge yourself to offer everyone that calls today an appointment today.”
Pregnancy math is complicated and CHOICES, like all abortion providers in Tennessee, had to contend with a tangled system of existing restrictions. That call had come during an especially complicated time. A leaked draft Supreme Court opinion had recently revealed the highest court in the United States was likely to overturn Roe v. Wade, a move which could set off trigger laws in several states – including Tennessee. CHOICES was working on borrowed time, not wanting to book appointments they might have to cancel, but also wanting to squeeze in as many patients as possible.
Adina works the front desk, answering calls from many patients seeking abortion services on June 27. Photo by Lucy Garrett for PBS NewsHour.
The staff at CHOICES had heard the decision would come down on July 11, so they figured they could schedule appointments through July 8. That would leave enough time to see patients once, wait the mandatory 48 hours, then see patients a second time to carry out the abortion.
When the day began on June 21, CHOICES was still booking appointments. By 10:45 a.m., they had just two appointments left on July 8. At 10:52, Quintanilla booked the final slot, reminding the patient to bring $200, identification and only one adult guest to the procedure.
Three days later, the Supreme Court issued their decision, overturning Roe, which had guaranteed a constitutional right to abortion for nearly 50 years. Within days, a Tennessee trigger law would force CHOICES to stop performing abortions for patients who were more than six weeks pregnant, or who had a detectable fetal heartbeat. A second state trigger law banning abortion entirely would take effect in a little more than a month, meaning CHOICES now expects to halt all abortion services around Aug. 18.
But on that day in June, staff were still fielding calls from patients, some desperate, some calm, but nearly all seeking abortions.
Quintanilla answered the phone, as Adina explained the situation to another patient. Quintanilla sighed as she and Adina each hung up. “That last patient was crying,” Quintanilla said.
Adina said her caller sounded like she was about to cry too.
“They’re going to make me sad,” Adina said. “That’s so sad.”
Later that afternoon, they were able to schedule a few more appointments for the next day, helping some patients seek the care they needed. For some, it ultimately wouldn’t matter. Within a week, CHOICES would stop performing abortions for anyone further along than six weeks, and the vast majority of their patients are beyond that. Most of the appointments between June 27 and the ones they’d made for July 8 would have to be canceled.
In 1974, one year after the Supreme Court decided that abortion was a constitutional right, Memphis Center for Reproductive Health was founded.
The CHOICES building is hard to miss. It sits on one of the main roads running east to west through Memphis. Its façade is a mosaic of yellow, lime and dark green geometric shapes; its entrance is on a side road, making it invisible from that main road. Inside, the clinic is bright, its lobby a collection of mid-century modern furniture and houseplants. Exam rooms feature murals painted by a local artist. Bowls of condoms sit seemingly everywhere, and the stairwell sports a bright neon sign reading “onward.”
Since its inception, the clinic has expanded its services to include the full spectrum of reproductive health care.
When it opened, “CHOICES became the first nonprofit health care provider in the country to offer both birth services and abortion care under one roof,” according to its website. It’s the only nonprofit, non-hospital abortion and birth facility nationwide, said Kate Bauer, executive director at the American Association of Birth Centers.
CHOICES CEO Jennifer Pepper poses for a portrait in the boardroom in their Memphis, Tenn. offices on June 27. Photos by Lucy Garrett for PBS NewsHour.
CHOICES provides the gamut of reproductive services, including contraceptives, gender-affirming care, well-person exams (formerly well-woman exams), birthing services and abortions, until they become illegal.
CHOICES takes insurance, including Tennessee’s Medicaid, though by law it cannot accept Medicaid for abortions. On its website, it lists the costs of services, and in an effort to be accessible, accepts cash and provides financial assistance to some patients.
The vast majority of the 5,266 patients CHOICES saw in 2021 were Black, between 25 and 34 years old and from Tennessee, according to its annual report. The clinic performed nearly 3,900 abortions that year, 63 percent of which were medication abortions. They also had more than 900 wellness exam and birth control appointments respectively, 730 perinatal and birth services appointments, and 430 gender-affirming hormone therapy appointments.
The clinic distributed more than $563,000 in patient assistance funds to 3,610 patients, a 66-percent increase from 2020, the report notes.
CHOICES’ CEO Jennifer Pepper was out of town, sitting at a St. Louis coffee shop checking her phone to see if there were updates on the Supreme Court’s decision about abortion. On that day – Friday, June 24 – she saw that it was official – the U.S. Supreme Court had overturned Roe. She drove straight back to Memphis, on the phone with clinic staff and attorneys the entire way.
CHOICES was given legal advice that the clinic could continue to see as many patients as possible as they sorted out the legal implications of the impending trigger ban. By that afternoon, the clinic was given legal instructions: CHOICES could keep seeing patients that weekend, until the trigger ban took effect Monday morning.
Within hours of the decision, the clinic had received more than 5,000 calls, Pepper said, the amount they normally see in about a week. By early afternoon, the phone system had crashed from the volume; staff could place outgoing calls but none could come through.
“A lot of it was patients calling that had appointments and wanted to know [what would happen],” Pepper said, as well as some people still trying to book appointments.
WATCH: Why finding accurate facts about abortion has become more difficult in post-Roe America
Over that weekend, CHOICES saw 16 patients on Saturday and 23 on Sunday, a clinic day they added to see more patients, Pepper said. All were second visits after the required 48-hour waiting period. They also were able to squeeze in a few patients Monday morning.
Then, that Monday morning, services stopped.
About one in 10 patients already scheduled were early enough in their pregnancies to have abortions, Pepper estimated. In a normal month, they see about 30 patients who are earlier than six weeks along, out of an average 325 total abortion patients.
“It was hard on staff. I mean, patients were angry, patients were sad, patients were confused, and all rightfully so. And the staff was holding all that for people all weekend, and they did a phenomenal job,” Pepper said.
Before the decision, when CHOICES couldn’t take on a patient, they would refer people to clinics in nearby states including Illinois, Georgia, Arkansas and Kentucky. But now, Arkansas and Kentucky also had trigger bans, and the other clinics were overwhelmed with an influx of patients. There was nowhere to send people.
“The pool of the availability of abortion access just keeps getting smaller and smaller, but the need does not change,” Pepper said. “It’s overwhelming to think about.”
For Joy Evans, a patient educator at CHOICES, providing safe, accessible abortions is personal.
When she saw the clinic was hiring in 2020, she said, “I jumped on it because I have had an abortion and I came to CHOICES when they were just a little bitty two-story house.”
To obtain an abortion, Tennessee requires two appointments separated by a 48-hour mandatory waiting period. After the first appointment, where patients get an ultrasound to see how far along they are, they go to Evans, who helps explain the process to them, answers their questions and schedules their second appointment.
Evans is 44 and has always had accessible abortion care, she said. It pains her to think of people who want abortions finding alternatives to safe care or having unwanted babies, she said.
And Evans said she’s motivated by the importance of providing care for vulnerable patients, like victims of rape, people with differing abilities and children.
For all her patients, Evans tries to be a sanctuary, as her patient educator was for her when she had her abortion.
Lily Picard (left) and Joy Evans both work supporting patients as they receive abortion care at CHOICES. But they’ll each soon take on new roles in the organization when the clinic is no longer allowed to provide abortion services. Picard’s bag features pins supporting abortion rights. Photos by Lucy Garrett for PBS NewsHour.
“She was empathetic, but she was sincere about it. And everyone treated me with respect. I did not feel like, ‘I’m so embarrassed,’” Evans said. “That’s what I want to provide, or that’s what I have been providing for the last two years.”
After patients leave Evans, wait the mandatory 48 hours, and return for their second appointment, they meet Lily Picard. Picard is tall, with a long pink ponytail and a purse adorned with pins that read “Madame Vice President” and “abortion is fine.” Picard, who has long been driven by a mission to provide reproductive health care, has worked what she calls her dream job as an abortion doula at CHOICES since November.
She recalled a conversation she had when she was a teenager, when her mother told her that she could always access an abortion if needed. “It was always made clear to me that that was nothing shameful. It was something that was available. And we should take advantage of that health care,” Picard said.
Growing up, she saw volunteers escorting patients into Planned Parenthood clinics and she knew she wanted to help too. She trained to be an abortion doula, helped patients remotely in the height of the coronavirus pandemic, and when a position opened at CHOICES last fall, she immediately applied.
“I cried when [CHOICES] called me and told me that I got it,” she said. “I am so happy that I’m here and that I get to do this work. It’s so important.”
WATCH: Poland’s strict abortion laws leave few safe options for women
As an abortion doula, Picard’s job is to help physically guide people through the procedure. That can be anything from standing quietly in the room, to listening to patients explain their circumstances, to physical touch – and to know when physical touch is unwanted. She talks them through what sensations they might feel, such as pinching, cramping or dizziness. She fans them to keep them cool, since procedural abortions can often make patients feel warm, she said. Much of her job is talking, and equally important, listening.
Patients “just tell me about their lives. Tell me about their kids. Tell me about their relationship and why they’re going through this and almost asking for forgiveness, sort of. And me reassuring that that’s not necessary. They don’t need any forgiveness from anyone, even themselves,” Picard said.
It’s “soul crushing” that abortion access is ending in Tennessee, she said, especially knowing that there will be people who will want or need abortions, but for those with fewer resources, leaving the state to get one will be difficult, if not impossible.
“This is going to ruin lives,” she said. “This is going to ruin futures. This is going to ruin children. This is going to ruin so many people.”
CHOICES faces an uphill battle in Tennessee, where support for abortion is limited. A May 2022 Vanderbilt University poll of Tennesseans found that 61 percent of respondents said abortion should be illegal in all cases, or illegal except “in cases of rape, incest, or when the life of the mother is in jeopardy.” About half said they were definitely or somewhat “pro-life.” By contrast, nationally, 61 percent of Americans think abortion should be legal in all or most cases, according to 2022 Pew Research center survey.
Tennessee’s trigger law, the “Human Life Protection Act,” bans all abortion except where the life of the mother is at risk. In 2019, it passed overwhelmingly in both chambers of the Republican-controlled legislature.
But even after they stop providing abortions, CHOICES will be in a position where it can remain open and can continue offering some services. While Pepper said that no staff will be laid off, some may see the majority of their duties disappear.
Some, like Picard and Evans, will see their entire jobs change.
“This was my dream, doing this job that I have now. But now I’m trying to formulate a new dream. I’m hoping to do some work with the birth center upstairs,” Picard said.
Evans, too, will be transitioning to full-time work as an LGBTQ services coordinator, a position she’s excited about, even as she’s disappointed to leave abortion care.
There’s another option for staff who want to stick with providing abortions. Last fall, as Pepper and the CHOICES executive team grew more worried about abortion access ending in Tennessee, they decided to open a second location in the southern Illinois town of Carbondale. Both Memphis and Carbondale are stops on the City of New Orleans Amtrak line, which runs daily between Chicago and New Orleans. CHOICES hopes that relative proximity will help people who don’t have access to other modes of transportation.
The Carbondale clinic will be about a three and a half hour drive from both Memphis and Nashville, and under two hours from St. Louis, Missouri, where abortion is also subject to a trigger ban.
The recovery area for patients who have undergone an abortion procedure. Photo by Lucy Garrett for PBS NewsHour
Pepper said the plan is to have the Carbondale location open and offering medical abortions by early August. There will likely be some overlap between when the Carbondale clinic opens and the Memphis clinic stops offering abortions.
One of the abortion doctors at CHOICES, who asked to speak anonymously because of the sensitivity of his job, plans to continue living in Memphis and commute regularly to the Carbondale clinic.
His job has taken him from clinic to clinic across Tennessee and to two other states as he’s navigated restrictive abortion laws. At some points in the last five years, he would regularly spend 30 hours a week in his car.
WATCH: How the rape of a young girl in Ohio became a flashpoint on the abortion debate
Since the law was enacted, he’s said he’s seen patients who are eligible after their first visit, but by the time of their second visit, would have been pregnant past the six-week cutoff, or had a detectable fetal heartbeat.
He’s frustrated, he said, that he can’t perform a procedure that was deemed medically safe just a few weeks ago.
“It’s terribly difficult to have to tell someone you know that they’re pregnant, you know that they could safely have an abortion, but that you can’t provide it because of the law,” he said.
“Nothing has changed about the medicine. Nothing has changed about the safety of abortion. The only thing that has changed is the law.”
On the last day of June, Pepper walked into CHOICES at 7 a.m., long before other staff clocked in.
In the quiet clinic, she sat in one of the recovery room chairs, contemplating a piece of art that moved from their old building to their new space, noticing all of the medical equipment that has helped people for years. She thought back to the first baby born at CHOICES, a moment she called a “tectonic shift” in CHOICES history, because it symbolized the new model for reproductive health care that the clinic wanted to pioneer.
That morning felt like a similar shift, Pepper said, this time representing the end of that model.
“The care that’s provided in that space has really helped people make determinations around their own lives and control their own destinies. And that kind of work will continue to happen there through different services,” Pepper said.
But alone in the clinic that somber Thursday morning, Pepper cried a little, she said, mourning the imminent end of abortion in Tennessee. Still, she knows CHOICES will continue, and like many of her staff, she’s determined to one day offer abortions again.
“CHOICES is going to continue to exist in Memphis. Yes, we’re going to begin to exist in Carbondale. But we are going to continue to exist in Memphis to help our community and serve them in all the ways that we legally can,” Pepper said. “And when this thing rights itself in Tennessee, CHOICES will provide abortions in Tennessee again. And those things I’m certain of.”
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