The “it” is what those who support or oppose abortion rights have anticipated since the day last year when the Supreme Court announced justices would review Mississippi’s previability abortion ban — a decision that could allow states to impose even greater restrictions on when patients can obtain the procedure, or ban it entirely.
If that happens, Tennessee is among 13 states where abortion care will become widely illegal. While some states’ “trigger bans” could take effect within hours of a Supreme Court decision, under Tennessee’s law, Choices would be able to continue to see patients for at least 30 days.
But the services the clinic offers for those 30 days may be limited. Pepper expects that a separate Tennessee law banning most abortions after an ultrasound detects cardiac activity, or at around six weeks, would likely take effect within days if Roe falls. Almost 4,000 patients received abortion care from Choices last year, and only about 10% of the procedures were done earlier than six weeks of pregnancy.
For patients, the ruling was always going to land at a volatile time.
Many of those who arrive at Choices have jobs that pay hourly. They have to figure out child care. They have to figure out how to get their first appointment and then turn around and do it again two days later because Tennessee requires women to wait 48 hours after their initial consultation to have an abortion.
The clinic’s staff members worry about the many corners pregnant people would be pushed into all at once, in a city where the infant mortality rate in some ZIP codes is more than twice the national average and where roughly 1 in 4 residents live below the poverty line . What about those who don’t have a car that can make it for three hours on the road to reach the nearest safe location for an abortion?
Maria Hassol, the operations director, worries about patients being blindsided by the court ruling.
“Many times, patients don’t know this is happening — it could create an issue,” she said. At a meeting with the clinic’s attorneys, she urged, “We have to tell them.”
Pepper said later in an interview that the clinic’s mission is in its name.
“We’re Choices,” she said. “We can’t not provide information.”
So, the clinic’s leaders made what Pepper described as a “gut-wrenching” call in anticipation of the Supreme Court decision to only book appointments for callers who had not reached their sixth week of pregnancy by June 27.
On the morning of June 13, Lily Picard, an abortion doula who also works at the call center, spent more time providing the number of a clinic in Illinois than booking appointments at Choices.
A whiteboard on the wall outlined administrative tasks and offered a reminder: “Answering phones is an art, a science, a ministry.”
When guiding patients through the abortion process as a doula, Picard thinks carefully about how, or whether, to place a hand on a patient. You never know if someone has had a traumatic experience of being restrained or held down, Picard said. An effort to provide comfort could be a trigger. That was part of adapting to what patients needed during their procedure. Sometimes that meant guiding them through meditation.
Now it meant trying to support the callers who might not make it through the clinic’s doors. Allowing them to express their anger, their grief.
“It’s very heavy,” Picard said.
By the next morning, the leadership team had made a new call. Pepper saw a prediction from a well-known constitutional law professor that the court’s decision, widely expected by late June, could come in July. The clinic would allow women to book appointments past the sixth week of pregnancy for now, but planned to begin waiving the $200 fee for the consultation visit. If the decision landed before their second appointment, that was money that the patients would need to travel to what Pepper calls “haven” states.
sIn the call center, the workers were now explaining to patients that there was uncertainty about whether they could receive care. Several accepted the risk and made appointments anyway.
“It’s a lot to manage,” Pepper said. “Folks like definitive information. Nobody likes, ‘We think this is what we know.’ There’s a lot to hold in that uncertainty. But I think if we continue to put the patients’ perspective first that they need service and let that lead our decision-making and not let fear or anxiety lead our decision-making, I think that’s what’s best for our community. And so that’s what we’re trying to do as best as we can every day.”
After that 30-day clock runs out, Choices will not shut its doors. The clinic has been working to crosstrain staff in the other health care services the clinic provides, including midwifery. In 2021, almost 90 pregnant people delivered their babies with the support of the center’s midwives. The clinic also launched a fellowship program to support Black midwives.
Keeping busy, Pepper said, has helped her deal with the grief. If all goes according to plan, the clinic in Carbondale will open on Aug. 1. Interviews for staff are slated to begin soon and a building has been purchased.
“Everybody keeps saying it’s an aggressive timeline,” Pepper said.
“Well, the Supreme Court started it first y’all.”