On June 24, 2022, the U.S. Supreme Court delivered its ruling in Dobbs v. Jackson Women’s Health Organization. The culmination of a years-long political struggle between health care providers and right-wing politicians in Mississippi, the Dobbs decision overturned 50 years of legal precedent that guaranteed the federal right to abortion. Now that abortion’s legal status is left up to individual states, 20 have moved to restrict or ban abortion so far, especially in the South and Midwest. Many of these states have used so-called “trigger laws” that were already set to take effect if Roe v. Wade were ever reversed.
The Dobbs decision has been surrounded by popular resistance. More than a month before the official ruling, an unknown leaker shared a draft ruling with the press, leading to days of protests outside the Supreme Court. In the following weeks and months, grassroots organizers and advocacy groups staged massive rallies in major cities and state capitols — and a swath of new protests recently took place to mark a year of living in a post-Dobbs country. Even while public policy swings “pro-life” in many states, mass movements for gender liberation, racial justice and popular democracy have continued making demands for bodily autonomy and the right to reproductive health care.
In Tennessee, where one of the strictest abortion bans in the country took effect just after the Dobbs decision, reproductive rights advocates have been hard at work figuring out the best way forward. Few of them have felt Dobbs’ impact quite like CHOICES, a nonprofit community health agency in Memphis known for its wide range of reproductive and sexual health services. Founded a year after Roe v. Wade’s passage, CHOICES has long been on the front lines of health justice work in the South. Last fall, the agency opened a second location in Carbondale, Illinois for abortions and gender-affirming health care that would otherwise be inaccessible to Tennessee patients.
Dr. Nikia Grayson, chief clinical officer at CHOICES, has seen the major challenges and opportunities of this work firsthand. I recently spoke with Dr. Grayson about the organizing landscape for abortion access post-Dobbs, and the relationship between service providers, policymakers and grassroots movements for reproductive rights.
How long has CHOICES been weighing the possibility that federal abortion protections could be removed? What kinds of responses has CHOICES considered in the past?
When Amendment One was passed in 2014, we knew then that the writing was on the wall for abortion access to be severely diminished in Tennessee. And then, especially after SCOTUS agreed to take up the Dobbs case in the fall of 2020, we knew Tennessee would lose abortion access and we just began to prepare for that.
CHOICES and the clinic have been participating in advocacy for many years by serving as a plaintiff in lawsuits against the state of Tennessee when they had passed other harmful restrictions on abortion, such as our waiting period, parental consent laws and more. So we saw this coming, and this attack on abortion rights and abortion access has been happening for a long time.
A month before the official Dobbs decision, CHOICES announced plans to open a second clinic in Carbondale, Illinois, that started seeing new patients in October. What factors did CHOICES consider when deciding to open that new clinic, and why did Carbondale stand out as a location?
When the Dobbs case was taken up by the Supreme Court, we began then thinking about what would happen not just in Tennessee, but in the Southern region of the United States in terms of abortion access. We knew that it was really important for us to plan ahead, because we knew that many people were not. I think a lot of people were just waiting to see what was going to happen, but we were trying to be as proactive and forward-thinking as possible. Jennifer Pepper, who is our CEO, was like, “We really need to look at Illinois.” And we chose Carbondale because it was the southernmost point in Illinois where we felt like we could put a clinic.
Carbondale was ideal for many reasons. It’s a blue dot in a sea of red in the southern part of Illinois, which is the closest state that has constitutional protections for reproductive healthcare, including abortion care. It’s a college town. It’s approximately three hours from Memphis and three hours from Nashville. There’s an Amtrak stop there that runs between New Orleans and Chicago. And the community was very warm and welcoming, and really eager to support us.
When we visited Carbondale, it was important for us to figure out what the community felt about us coming and what the community needs were. We weren’t just bringing an abortion clinic to Carbondale, we were bringing a reproductive health care clinic. We wanted to also know how we could support that community as well, because we really do believe in being a good community partner.
Outside of policy fights, we’ve seen protesters hit the streets in support of abortion rights, and start informal networks to share resources and information about safely accessing reproductive health care. In your mind, what’s the relationship between social movements and the work of health care providers like CHOICES? How can the two best support each other?
I think providers like CHOICES are where those rights move from theory to reality. We are putting into practice what people are fighting for. We’re doing the thing that larger movements are fighting to protect. And so, I think people should keep showing up and keep marching and keep protesting and keep demanding. But I think they have to also partner with the providers and organizations that are trying to organize and move policy as well. Here in Memphis, we do a lot of work with Sister Reach and Planned Parenthood — and these people who are taking to the streets to fight, I think it’s important that they partner with those organizations as well. Because those organizations really do have a lot of knowledge and an ability to organize in a way that can be really effective. (Healthy & Free Tennessee is doing some wonderful work too.)
Of course, I think it’s really important that people continue to support independent clinics like CHOICES. Independent clinics provide the majority of abortions in the U.S., but we receive the least amount of funding. So we need everyone who is marching and signing petitions and protesting to also support the clinics and abortion funds and the organizations that are doing that work — and really look to them for leadership and guidance. Because those organizations like CHOICES, like Healthy & Free Tennessee, like Sister Reach, are mobilizing our efforts, and we need all of those voices and all of those bodies and all of those people who are really passionate about this to come together, because there’s definitely power in numbers.
In December 2021, a right-wing domestic terrorist burned down a Planned Parenthood clinic in Knoxville, Tennessee, and pro-life protesters have frequently tried redirecting patients to “crisis pregnancy centers” that pose as health clinics. I’d imagine that the past year has raised the stakes for protecting staff and patients. How has CHOICES approached these safety concerns?
Our patient and staff safety is paramount. Especially when we built our new clinic, it was really important for us to think about the safety of our patients, and for them not to have to encounter protesters or people who are yelling at them from the street. The way we built our new clinic, people are safe from that. We have it gated and, of course, we have security — we’ve always had security at our clinics. We always put in place measures to be protective of our community.
We also partner with NAF, which is the National Abortion Federation. They offer classes around protection, they have a security detail at NAF that comes to visit, we do safety drills and things of that nature. And we’re very active and proactive about being aware of what’s happening, being in communication with law enforcement, and staying up-to-date about any potential threats that are happening in the community.
Crisis pregnancy centers, unfortunately, get a lot of money from the government — which is really sad, considering they’re not real clinics that have clinicians and staff persons who are providing non-judgmental care. I think that part of being a clinician for me is providing people with information that will empower them to make the best decisions for their life. Providing them with high quality, non-judgmental care is really important. We should not be using our power over people in vulnerable situations, in vulnerable states, to coerce them to do things that they don’t feel is best for them and their family. I feel very strongly about that.
When you think about how organizers and service providers have fought to preserve access to reproductive health care over time, are there examples from history (or from other states in the current moment) that stand out to you?
I’m a nurse midwife by training, and I think about the struggle in this country for midwives to be able to practice. That’s a huge example of, historically, how a group of providers has been almost pushed into extinction and marginalized.
Outside of the United States, midwives provide the majority of care for pregnant people. It’s only in the United States where we have this separation, where midwives are highly stigmatized and highly marginalized. At CHOICES, we are a midwifery-led clinic, so we recognized the importance of that midwifery model of care, that it is patient-centered, relationship-based, and really about empowering our communities.
As service providers, we’re fighting to provide people with the care they need and deserve. I see this restoration of midwifery not just at our clinic at CHOICES, but I’m seeing it around the country. I see it in D.C. with Community of Hope, which is a federally-qualified health center there that has a birth center. I see it at the University of Illinois Chicago, with Karie Stewart leading them. But I also recognize that, historically, midwives cared for pregnant people who wanted to be pregnant and didn’t want to be pregnant. So they provided abortion care for them and access to prenatal care and birth.
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I was just in Bali a few weeks ago for the International Confederation of Midwives conference, and a lot of our issues are the same: looking for respectable care, for bodily autonomy, and preserving people’s right to choose what’s best for their bodies and their families. I think this is a fight we’ll continue to have for another 150 years. I don’t think we can ever let up, we always have to be pushing forward — because any time we let up, people will try to erode people’s rights like we’re seeing happen now in the United States.
Looking ahead, where do you see this struggle going in the coming months and years? Do you see opportunities to gain more ground for abortion access, and how can we stay ready to take advantage of those opportunities when they come?
I don’t know that we’re the best [people] to answer it, being health care providers. I think lawyers and advocacy experts may be better. But I do believe that we should be hopeful. I stay hopeful: That’s what keeps me in this work.
I think that we will go through a dark time where we continue to lose rights. We’re already seeing that with attacks to strip away rights for transgender people to have access to the care that they need and deserve. And we know that they’re not done whittling away at abortion rights and reinforcing the conditions that are creating this health care crisis that we’re seeing.
But as a movement, we have to stay focused and talk about the big picture. All of these rights are interconnected, and all of our movements are stronger when we work together. So I think that the opportunities and advantages we have that are coming down the line are that there’s strength in numbers. Because when one of us is oppressed, all of us are. I really do believe that.
I recognize that some of the seeds that we’re planting, we may not see them grow to fruition, but my hope is that my children will and that my grandchildren will, too.
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