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The power in CHOICES: Inside a Memphis abortion clinic’s decision to move to Illinois

There’s a story Maria Haley wants to tell. It’s about a woman, who isn’t terribly unlike herself. This woman was a patient, of Hispanic descent, still struggling to learn and imitate the flat sounds and uneven rhythm of the English language. Married to a man, a U.S. citizen, the relationship had become toxic. She had decided to leave, but doing so would come with its own snare of complications. Still, when it came down to it, she didn’t have much choice. She turned to a shelter in Memphis that helps people leave domestic violence situations. He threatened her, reminding her that without their marriage, she would be living in the country illegally.

Then, she found out she was pregnant. Already a mother to one child, it would be nearly impossible to protect the one she had and leave her marriage in addition to giving birth and caring for — and protecting — a new baby. So she went to CHOICES. There, she met Haley, who not only helped her get abortion care, speaking to her in the language she knew best, but also empathized with what she was going through and took the time to listen and connect with her. “It was heartbreaking to see that, on top of all the other barriers she had [to abortion care], there was this man who was abusing her,” Haley said. For Haley, this part of her work is crucial.

It’s easy to see why people confide in Haley. As the Latinx coordinator for CHOICES, (then) a full-spectrum reproductive care facility in Memphis, she seems naturally suited for her job. There’s a familiar warmth about her, and she speaks carefully, emphatically. Her words never come across as contrived or saccharine. She has also helped patients who want to continue their pregnancies, perhaps contrary to their partner’s wishes, or those of their family. This is the power of CHOICES. “Everybody’s entitled to what makes life better for them,” she says. “Because we only live once, and it makes a difference when you make your own decisions and don’t have to be thinking about what anyone else thinks about it, because nobody knows what you’re living or going through.” Approaching—and entering—CHOICES feels a bit like stepping into a reproductive health wonderland. The exterior of the first level of the clinic is painted a muted white, and on the second level, a swarm of geometric shapes in alternating shades of green. A handful of protesters outside and a brief interaction with a security guard in a grimmer, glass-surrounded in-between space serve as reminders that this is, in fact, a clinic for full-spectrum reproductive care. (Or at least it was, up until about a month ago.) Still, the interior resembles a trendy hotel more than a doctor’s office. The walls are painted in bold colors, the lobby features warm lighting and modern, comfortable seating. No peeling vinyl chairs or drab fabric blends in sight.

The first time I visited CHOICES was in the fall of 2021, back when abortion was still considered a right protected by the Constitution, and before Tennessee’s trigger law had banned the procedure. Even then, it wasn’t easy to get abortion care in the state. Tennessee has long been a “post-Roe state,” before that was a legal designation meaning Roe was dead in the spirit of the law long before it was actually overturned by the Supreme Court this summer. The state required a 48-hour waiting period between mandated counseling and abortion care, as well as an ultrasound in which the image was either shown to the patient or, if the patient declined, described verbally. Additionally, state lawmakers banned the use of public funds for abortions, except in cases of rape or incest, for which the burden of proof falls on the patient, along with a significant amount of red tape. All of these state laws remain in effect, on top of a law that bans abortions with very limited exceptions.

Even a year ago, CHOICES was preparing for the end of abortion access in Tennessee. Clinic director Jennifer Pepper, an unapologetic abortion advocate with an infectious laugh and an affinity for an A-line skirt, has a knack for looking ahead and making big plans, no matter her naysayers. Her track record speaks for itself: In 2020, CHOICES moved into a new clinic, and early the following year, the group opened a birth center that has become a hallmark of the group’s services. The move was a direct response to the horrifying infant mortality rate in Memphis and its surrounding areas, which has remained higher than the national average. (Though the vision originally belonged to CHOICES’ former executive director, Rebecca Terrell, Pepper, along with Dr. Nikia Grayson, got to see it through.) In 2021, the suggestion that they may be able to slow down was met with a polite smile from Pepper, if not an outright, “Bless your heart.”

“I was writing my budget report to my board and I was like, it’s not gonna slow down next year,” Pepper remembers. “So everybody just buckle up.” It’s the autumn of 2021, and we’re sitting in her office, sipping seltzer, contemplating the future fall of Roe. “If Roe falls in any way, and they don’t even have to gut it completely for us in the South, right? Just throw a little more state’s rights into that, and then you will have essentially gutted Roe for much of the country, especially in the South.” She mused over the potential scenarios. Will they help bring a lawsuit? Would there be ways to support people who are self-managing their abortions? Maybe they would need to start some sort of travel service? After all, it’s only two-and-half hours to Carbondale, which is in the haven state of Illinois…

Carbondale, it turned out, held the answer. Now, CHOICES is opening a clinic that will provide abortion care in the college town, and they are hoping to expand into another full-spectrum care center, like what they were once able to have in Memphis. A pop-up on their website informs visitors of the current situation: “Starting August 25th, CHOICES can no longer provide abortion services in Memphis due to a new law banning abortions entirely in Tennessee. A new CHOICES clinic is opening in Carbondale, Illinois in mid-September. Please check back soon for updated information on that facility, the services available, and scheduling.”

In early September, moving trucks pulled into the lot at CHOICES, and furniture and equipment were loaded up for that two-and-a-half-hour drive north. The college town, home to Southern Illinois University’s main campus, is settled some 24 miles from the state’s southwestern border. CHOICES, along with a clinic led by Dr. Alan Braid, a physician who made headlines a year ago by publicly defying Texas’ six-week abortion ban, will provide accessible abortion care in the small city for the first time since 1985, when Carbondale Memorial Hospital ceased providing abortions that were not deemed “medically necessary.” An NPR report explains that, “George Maroney, the hospital’s administrator at the time, said the community in and around Carbondale was split on the issue—a third supported abortion rights, another third wanted to ban the practice entirely and the final third didn’t care.”

It’s hard to say what that breakdown looks like at present. The CHOICES team knows they will be met with some level of opposition, though they are determined to do so with a cheery mindset. And Carbondale itself, Pepper says, is not so conservative as the rural areas that surround it. “In comparison to doing this work in Tennessee, it has felt like night and day, from the regulatory aspects and the supportiveness of government and elected officials and health care systems,” she says. “Not perfect, right? But compared to all of the hurdles and the absolute lack of support from government agencies and elected officials in Tennessee, Illinois has felt very different in a very good way to us.” Still, anti-abortion groups, heartened by the Supreme Court ruling that overturned Roe, have pledged to focus their efforts in haven states like Illinois, and some have already begun to make good on that promise. In Las Cruces, New Mexico, the new home of the Mississippi clinic that was at the center of the Supreme Court case was welcomed to town with protests and the news that a crisis pregnancy center was moving in next door. And, as Pepper points out, the annual anti-abortion campaign, 40 Days for Life, begins on September 28, which will likely mean a dedicated cadre of protesters at the new CHOICES through early November. “It’s just one of those things where you hope for the best and prepare for the worst,” she says.

To be sure, the Memphis organization is still providing remarkable services. Their midwifery program, led by Black midwives, aims to provide personalized care to those who have been left behind by the medical system, shoved aside in favor of greed. But the way CHOICES practices midwifery honors a past that is often erased by professionalized medicine, which painted midwifery, commonly practiced by women, as dangerous and unsanitary. The program is a powerful statement on community-centered medicine and that all people, regardless of race or economic standing, deserve to experience birthing on their own terms, but it’s also a top-of-the-line facility led by Dr. Grayson, chief medical officer and a certified nurse midwife.

When Grayson was in graduate school, pursuing a master’s degree in anthropology and public health, she decided to dive into Memphis’ infant mortality crisis. As a result, she spent time interviewing families that had experienced infant loss. “They talked about just not being seen or heard, or didn’t understand why they were experiencing the losses that they had experienced that were generational,” she said. “I talked to these older Black women in the community, and they talked about their experiences with birth, and many of them had utilized midwives. And at this time, there were no midwives in our community—definitely no Black midwives—and I thought that was strange. So as I started just doing more research and realized that Black midwives were, at one time, prolific in the community, and they had basically been pushed into extinction through demonization and politics, I felt like it was my job to work to restore Black midwifery to our community, especially here in the South.”

CHOICES also offers contraceptive services, STI/STD care, well-person exams, and trans-affirming health care, among others. Its mission is rooted in the reproductive justice framework, created by Black women in 1994 to address the ways the reproductive rights movement, led largely by upper-middle-class white women, was not meeting their needs. Instead of centering abortion in reproductive health care, reproductive justice includes the entire spectrum of care, declaring that people must be able to access all manner of care to live healthy, fulfilled lives. That also includes maternal health care and infant care for people who wish to parent, and the resources to raise children in a healthy, safe environment.

CHOICES has been around since 1974, and over the past near half-century, they’ve learned a thing or two, especially as they’ve focused on reproductive justice and offering top-notch care. “I think one of the things that has made us successful is our focus on community, right?” Dr. Grayson says. “So we know what the community needs are, because they tell us what their needs are. And we are also open to innovation and new ideas. We’re not afraid to try new things.”

Becca Andrews

Becca Andrews | bandrews@reckonmedia.com

Becca Andrews is a reporter at Reckon News and the author of "No Choice: The Destruction of Roe v. Wade and the Fight to Protect a Fundamental American Right."

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