As soon as news broke that the Supreme Court would hear Dobbs v. Jackson Women’s Health Organization, the team at CHOICES Memphis Center for Reproductive Health began seriously considering a second location in a state where abortion would remain legal should the Court overturn Roe v. Wade. Tennessee’s “trigger” law meant that abortion would be banned in the state after Roe was overturned.

The plan for a second CHOICES location was solidifying in December 2021, by the time the Court heard oral arguments in Dobbs v. Jackson Women’s Health Organization.

“We had provided abortions for almost 4,000 people that year,” CHOICES President and CEO Jennifer Pepper said. “We knew those folks were going to need somewhere to go.”

That’s why, shortly after the majority draft opinion was leaked in early May, CHOICES was prepared to announce a new location in Carbondale, Illinois that will be state’s southernmost abortion provider. Carbondale is about three hours by car from both Memphis and Nashville, and it’s also accessible by Amtrak. In addition to its relative accessibility for abortion seekers traveling from the Southeast, the location is critical because Illinois is relatively protective of abortion access, but is surrounded by states that are expected to ban abortion (or, in the case of Missouri, already have).

CHOICES hopes to open its newest clinic in September. The Memphis center will continue to provide sexual and reproductive health services even after Tennessee’s “trigger” law goes into effect August 25, outlawing abortion.

Knowing this moment would eventually come, Pepper said she’s been communicating with staff about their options since January. Those who had been involved with providing abortion care may relocate to work in Carbondale, while others will stay in Memphis and be retrained in other services, like birthing.

Pepper said CHOICES delivered just under 100 babies last year after opening a birthing center in 2020.

“This year we’re on track to almost double that. Ultimately, we want to be doing about 450 births a year,” Pepper said. CHOICES also hopes to expand access to other services it already provides in Memphis, including gender-affirming care, gynecology, and general wellness.

CHOICES is in a unique position: adding a new location in a haven state and staying open in a state that currently bans abortion after six weeks, before most people even know they’re pregnant. The move to Carbondale is financially feasible because the Memphis center already provided other services in addition to abortion.

Pepper said CHOICES has been preparing for the eventual reality of abortion being illegal in Tennessee since the 2014 passage of Amendment 1, which declared there was no state constitutional right to abortion. In expanding its services to include midwifery, general gynecology and wellness, and LGBTQ health, CHOICES adopted electronic medical records and got set up to take insurance, major obstacles for many abortion providers due to cost and insurance coverage bans on abortion.

Not an isolated incident

For many abortion clinics in states that have banned or will ban abortion now that Roe is overturned—which, in addition to their limited ability to accept insurance, had been forced to invest heavily in meeting onerous facility and licensing requirements—it was impossible to pivot to providing other services quickly enough to keep their doors open.

Plus, abortion providers are experts at well, providing abortions.

“Saying to us, ‘You can stay open to provide gynecology services, but you can’t do abortion, is like saying to a heart surgeon, ‘You’re no longer allowed to provide heart surgery, but you can still screen people’s blood pressure,’” said Whole Woman’s Health CEO and President Amy Hagstrom Miller. Whole Woman’s Health is packing up its four Texas clinics and moving to a border city in New Mexico.

“New Mexico is the closest place where abortion is protected for many people from Texas, Oklahoma, and Arizona to travel,” Hagstrom Miller said. “But the closest we could get to Texas would still be a drive of nine hours from the Rio Grande Valley.”

Whole Woman’s Health has fought through numerous time periods in Texas where its clinics were forced to close temporarily. But with the elimination of the constitutional right to abortion, the abortion landscape has forced relocations.

“I bristle when someone says we’ve decided to close our clinics,” Hagstrom Miller said. “We didn’t decide—we were forced. We have been banned from providing abortion.”

Whole Woman’s Health clinics in Indiana, Maryland, Minnesota, and Virginia remain open, and Hagstrom Miller said she is considering further expansion to border areas in the future, such as Colorado, southern Illinois, and western Virginia.

Jackson Women’s Health Organization, the lone Mississippi clinic at the center of the case that overturned Roe, is also moving to New Mexico. Another independent provider, Red River Women’s Clinic, is relocating just across the state line from North Dakota to Minnesota.

A new approach for a new community

Abortion providers from states where abortion is banned are bringing their expertise to haven states at a critical time, Pepper said.

“The demand in these areas is going to outweigh the availability of services,” she said.

Pepper grew up in southern Illinois, and she was able to leverage personal connections to get to know the Carbondale community. She said CHOICES has been intentional about making itself a part of the community and has received a warm reception.

“Our plan in Carbondale is to eventually offer all the services we do in Memphis, but for practical reasons, we have to do it in a phased approach, so we started by asking people in Carbondale what they need,” Pepper said. “And what we heard is that they really need gender-affirming care.”

People in Carbondale, which is a college town, have been traveling hours away to St. Louis, Nashville, and Memphis to access gender-affirming care, so abortion and gender-affirming care will be the first services offered at CHOICES Carbondale.

“I hope that’s the approach everybody takes to opening new clinics, especially in rural areas,” Pepper said. “This is going to be a big change for a town of 26,000 people. There will be some economic benefit because people will be buying gas and food, and paying for hotel rooms. But we still need to come in and be an asset to the community.”