Public health crisis looms as women from North Carolina’s neighbor to the west will soon be forced to travel out of state for reproductive healthcare
The U.S. Supreme Court’s decision ending the constitutional right to abortion in the United States set into motion an immediate chain reaction in Tennessee on Friday with one now-inevitable outcome: A near-total ban on abortions within state borders in a matter of weeks, or even days.
Abortion providers and advocates warn of an impending “public health crisis” in a state where more than one in three pregnancies are unintended and pregnant women face poorer than average outcomes. Tennessee ranks 41st in the nation for maternal mortality — a burden disproportionately shouldered by Black women, who are more than four times as likely to suffer maternal death.
Clinic operators in Tennessee have either ceased operations entirely, or expect to by the end of this week. They are beginning the pivot from providing soon-to-be criminalized procedures to deploying “navigators” to guide those facing unwanted pregnancies through the financial and logistical hurdles of finding the nearest out-of-state clinic where abortion is legal — all hundreds of miles away from each of the state’s six existing abortion providers.
“Let me be very clear. Banning abortion will cause a public health crisis and we will not forget that the Tennessee and Mississippi lawmakers who systematically rolled back our rights and bartered our bodies for votes are the ones who got us here,” said Ashley Coffield, CEO of Planned Parenthood and Mississippi, signaling the state political fight to come.
Abortion opponents, jubilant over the end of their long-fought battle to overturn Roe v Wade, said they would take the day to celebrate even as they continue to aide women facing unwanted pregnancies with adoption referrals and other assistance. But, said Tennessee Right to Life President Stacy Dunn, they would not rest long.
“We will work so no women is coerced or pressured by her employer to have an out of state abortion that will be fully funded by her workplace,” Dunn said Friday, as corporations across the nation announced plans to offer travel assistance to employees who seek abortions outside their home states.
She also hinted abortion foes are now preparing to target efforts underway to link girls and women in Tennessee to out-of-state abortion resources.
“We will work to protect our women and girls from the marketing efforts of out of state abortion facilities who will try to lure women and their money to their unsafe and unregulated abortion facilities in their state,” she said. “This type of coercion, pressure and manipulation of women is unacceptable and those businesses who’ve tried this should be held accountable.”
Next legal steps
The state is on two tracks to formally end the right to abortion in Tennessee.
Tennessee Attorney General Herbert Slatery signaled Friday he would quickly begin the process to codify the state’s 2020 “trigger law” banning nearly all abortions in Tennessee on the 30th day after the Supreme Court decision. Formally called the “Human Life Protection Act” the law contains only narrow exceptions for the life of the mother, but none for pregnancies that result from rape or incest. The law makes abortion a crime: A Class C felony for physicians — or anyone else — who performs an abortion, punishable by up to 15 years in prison and a fine of up to $10,000. Women seeking an abortion face no criminal penalties.
Simultaneously, Slatery filed an emergency petition with the 6th Circuit Court of Appeals Friday that could bring abortion access in Tennessee to a halt even sooner. Slatery is asking the court set aside its temporary stay on a six-week abortion ban, known as the “Heartbeat bill” because it bans abortions after a fetal heartbeat is detected, often before a person knows they are pregnant. A challenge to that 2019 law has been winding its way through the courts. The federal court set a Monday afternoon deadline for more written arguments and could rule on Slatery’s petition soon afterward.
Gov. Bill Lee on Friday called the Supreme Court’s decision the “beginning of a hopeful, new chapter for our country.” In Tennessee, one of 26 states that will now severely curtail abortion access, the coming chapter raises fraught questions anticipated in the Court’s dissenting opinion in the Dobbs v. Jackson Women’s Health Organization case.
“The majority’s ruling today invites a host of questions about interstate conflicts,” the dissenting opinion said. “Can a State bar women from traveling to another State to obtain an abortion? Can a State prohibit advertising out-of-state abortions or helping women get to out-of-state providers? Can a State interfere with the mailing of drugs used for medication abortions?
“The Constitution protects travel and speech and interstate commerce, so today’s ruling will give rise to a host of new constitutional questions. Far from removing the Court from the abortion issue, the majority puts the Court at the center of the coming ‘inter-jurisdictional abortion wars.’”
Abortion services are ceasing
“We feel confident that after July 1 there will not be any more abortion services at our affiliates for patients to access,” Coffield said.
The Knoxville Center for Reproductive Health immediately suspended all future appointments on Friday, “while we assess the continued legality of abortion in Tennessee.” The nearest out-of-state abortion clinic to Knoxville is in Asheville, North Carolina, about 180 miles away. North Carolina is among the states with abortion access, but has stringent abortion restrictions in place, among them requiring a 72-hour waiting period between clinic visits before someone can obtain an abortion and parental consent for a minor.
The Bristol Regional Women’s Center, which provides medical and surgical abortions in Northeast Tennessee, declined to comment Friday, saying they would be issuing a statement this week. The nearest abortion provider from northeast Tennessee is Asheville, Winston-Salem or Greeneville, North Carolina.
Carafem, a national chain of clinics providing reproductive health and abortion services in Mount Juliet, could not be reached for comment. Melissa Grant, their chief medical officer told a Washington, D.C. television station Friday they “fully expect that in the coming days we will lose the ability to provide” abortion services at that location. Coffield said Illinois clinics will be the likeliest destinations for those seeking abortions who live in Middle Tennessee. Illinois requires proof that parents of minors seeking abortions must be notified.
CHOICES – the Memphis Center for Reproductive Health will soon end abortion services for the predominantly African-American clientele at their Memphis location, which also serves women in neighboring states such as Mississippi who had already limited access to abortion care. The center, the oldest abortion clinic in Tennessee, expects in August to open a new clinic in Carbondale, Ill., about a three-hour drive north.
Abortions have been declining in Tennessee for more than a decade, but more than 8,600 were performed in 2019, the most recent year data is available.
The options that remain
The Supreme Court’s historic decision Friday will leave thousands of people facing unwanted pregnancies with an even more complicated set of choices: Should they decide to terminate their pregnancies, they will have to arrange for time off work and travel out of state, if they can afford to —and in some cases make the trip twice to comply with mandatory waiting periods.
In East Tennessee, clinics in Virginia and Florida may also be options, Coffield said.
Clinics in states with legal abortion are expecting an influx of new patients from multiple states who have similar trigger laws or have longstanding abortion bans in their laws that will be revived now that Roe is gone. In total, 26 states will have near total abortion bans.
And while medication that induces abortions are being discussed as a possible option for women and girls in states where abortion has become inaccessible, a measure signed into law by Lee in June make mailing abortion pills a felony, punishable by a fine of up to $50,000 and up to 20 years in prison for a physician, manufacturer or distributor of the drug.
It remains uncertain how the state could enforce the criminal portion of the law with out-of-state providers of the medication, but the measure also includes a provision allowing any prosecutor in Tennessee to file a civil lawsuit against any individual who mailed the drug to Tennessee.
Others facing unwanted pregnancies may, as anti-abortion advocates hope, opt to carry their pregnancies to term.
Gov. Bill Lee, a staunch abortion opponent, said state officials have been preparing for years for the end to legal abortion and promised “in the coming days, we will address the full impacts of this decision for Tennessee.”
Already, Lee noted, the state has expanded postnatal access for women on TennCare from 60 days to 12 months postpartum and launched Tennessee Fosters Hope, a public-private partnership to provide more foster care.
The governor also noted the state has given more than $430,000 to Psalm 139 Ministries, a Christian-based effort to purchase ultrasounds for pregnancy centers that counsel women against abortion. A news release from the governor’s office on Friday provided contact information for three faith-based pregnancy centers: Hope Clinic for Women, the Psalm 139 Project and Agape Child and Family Services.
Coffield urged girls and women facing unwanted pregnancies to visit abortionfinder.org, a national database of abortion providers, and reproresource.org, which provides regional information, to identify an available abortion provider out of state. Then, she said, patient navigators at Planned Parenthood affiliates in Tennessee can step in to provide logistical and financial support.
“Call us and we will help you get there,” Coffield said.
Anita Wadhwani is a senior reporter for the Tennessee Lookout, which first published this report.