When Rebecca Terrell took on the momentous task in 2017 of raising $4.2 million for a groundbreaking new reproductive health-care clinic, she didn’t expect the project would be deeply affected by the Trump administration’s steel tariffs.

Terrell, executive director of CHOICES, founded in 1974 as a nonprofit abortion clinic in Memphis, Tennessee, anticipated obstacles when she set out to build a 16,000-square-foot facility that would include both abortion care and a birth center. What she didn’t anticipate was that CHOICES would feel the impact of a Trump trade policy, announced last March, that seemed completely unrelated to her work.

“When the news broke about the tariffs, I just didn’t know what the impact would be,” Terrell told Rewire.News. “I had no idea that just about all of our building materials would be affected: Masonry, steel, plumbing. Everything. The tariff may seem like it is targeting one thing, but it has such ripple effects.”

The Trump administration has enacted, or attempted to enact, a wide range of policies that limit access to reproductive health care, but the steel tariffs have had a more indirect effect on reproductive health care. Terrell estimates that the steel tariffs are adding $250,000 to the clinic’s construction budget. Trump’s tariffs have forced CHOICES to pay for some building materials in advance, before construction begins, to preempt costs going up even more. Construction is expected to take 14 months, and the new building is planned to open in 2020. The earth movers are scheduled to arrive this week.

“For a small non-profit to take on something of this size was a pretty big leap of faith,” Terrell said. “People had to trust that we would be able to pull this off. We do abortion and transgender care and midwifery, and not everyone is onboard with that. There’s a lot of stigma and obstacles and it feels a little bit like whack-a-mole. The steel tariffs are just one other thing we have to jump through.”

Since 2009, CHOICES has dramatically expanded its medical services beyond abortion care to include STD testing, Pap smears, pregnancy testing, fertility services, transgender hormone management, and more. Its vision is to provide full-spectrum, or “wrap-around,” reproductive health care, including birth services. CHOICES opened a midwifery and family health practice in 2018, which is operating out of a temporary location separate from the rest of the clinic.

Once the new building is open, CHOICES will be the first nonprofit in the United States to bring all these services under one roof.

“We really felt like the separation of abortion care from birth services was arbitrary, non-productive, and very stigmatizing,” Terrell said. “We believed that everything should be together and that’s how people could best access care.”  

CHOICES isn’t the only reproductive health clinic affected by the president’s steel tariffs. Blue Mountain Clinic in Missoula, Montana, started fundraising to renovate and expand its building at the end of 2016. The clinic was seeing 10,000 patients a year, and Trinda Rieck, Blue Mountain’s director of development, said they needed more space to keep up with demand. Its “Raise the Roof” campaign secured around $1.2 million to add three exam rooms and a second floor for administrative offices, expand the in-house lab, upgrade the HVAC system, expand the waiting area, and build a separate consultation room for patients with heightened privacy needs.

The goal was to increase patient capacity by 35 percent, and the project was going smoothly until the tariffs threatened to increase costs in an already tight budget. “We actually sped up our timeline to place our order for our new HVAC system and steel studs so they would ship before the tariffs went into place,” Rieck said. Blue Mountain is celebrating the new building’s grand opening on January 22.

CHOICES, meanwhile, aims to provide care to 25,000 patients a year and support 200 births. The Memphis facility will include a state-of-the-art birth center with three suites for labor, delivery, recovery, and postpartum care; a meditation garden where moms can walk around; built-in labor slings; and tubs for water births. The midwives on staff will provide perinatal care to expecting moms and train new midwives. Making midwifery services and training accessible to people of color and those with low incomes will be a priority. 

“In Memphis, we’re dealing with a Black maternal mortality rate that is horrific and so many times higher than white women,” Terrell said. “It’s an issue that has been successfully raised into the public eye, and we are saying, ‘OK, we are going to address it.’ CHOICES is really something the community needs.”

CHOICES kicked off a capital campaign to fund the project in mid-2017 and raised over $4 million. Then, in March 2018, Trump announced tariffs of 25 percent on steel imports and 10 percent on aluminum imports. Ostensibly, the tariffs were intended to punish other countries (namely China) for unfair trade practices and revitalize the U.S. steel industry, but few experts believe the policy will accomplish those goals.

Ken Simonson, chief economist of the Associated General Contractors of America, said in an email that the tariffs have driven up steel and aluminum prices in the United States, with new construction projects reflecting these higher costs.  

Sara Jane Goodman, president of the CHOICES board and a major donor, said she knew immediately that the project would be affected by the tariffs. Goodman spent part of her career working as a facilities manager for a banking corporation and remembers the impact trade tariffs had on construction projects in the 1980s. She joined the CHOICES board nine years ago, volunteers as an abortion doula at the clinic, and has helped with fundraising efforts. When news broke about the tariffs, Goodman was mad because the organization had worked hard to reach its fundraising goal, only to have to raise more.

“Without the tariffs, we would be that much closer to making healthier women here in our city,” Goodman said. “But one way or another, we’ll get the money and defy Trump and lead the nation in what reproductive health care can be. I may be Susie Sunshine, but I feel confident we can do it.”