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Cleek writes: "With more than a million residents, Birmingham is Alabama's largest metro area. Now it’s also one of the largest cities in America with no abortion clinic — Birmingham's only clinic quietly closed in January."

Planned Parenthood of Alabama. (photo: Ashley Cleek/Al Jazeera America)
Planned Parenthood of Alabama. (photo: Ashley Cleek/Al Jazeera America)

Abortion Clinics Scarce in Deep South

By Ashley Cleek, Al Jazeera America

13 July 14


As termination providers in Mississippi, Alabama and Louisiana rapidly dwindle, women labor to access services

hen Kew found out she was pregnant, she knew immediately that she wanted to have an abortion. So she did a web search for “abortion clinic in Birmingham Alabama.”

“I tried to call two numbers. They were disconnected,” Kew explained. “And then I started seeing different news articles. They were all from January and they said, “Abortion clinic closed in Birmingham,’ and I was like, seriously?'”

With more than a million residents, Birmingham is Alabama's largest metro area. Now it’s also one of the largest cities in America with no abortion clinic — Birmingham's only clinic quietly closed in January. Planned Parenthood, who operated the clinic, declined to comment for this article.

Kew, who did not want her full name published due to the sensitivity of the subject, is 22 and heading into her senior year of college. She works at Wal-Mart, where she makes a little over $8 an hour. Kew's mom supported her decision to have an abortion, but Kew decided not to tell friends and family, many of whom say that women who have an abortion will go to hell.

“They make you feel like you should keep it. You should struggle. You should be on welfare, and you should stay in the projects if that’s what it takes for you to keep your baby. And that’s not the life that I want to live,” Kew said. “The cycle has to end somewhere. My mom told me this morning that she doesn’t want any of her kids to struggle through what she had to struggle through.”

But for Kew and many women like her throughout Alabama and much of the Deep South, following through on the decision to have an abortion is getting harder and harder. Over the past two decades, the number of abortion clinics in many southern states (Tennessee, Arkansas, Louisiana, North Carolina, South Carolina, Alabama and Mississippi) has shrunk to single digits, requiring women to travel farther, pay more and receive later-term abortions. Currently, there is one abortion clinic in Mississippi, three in Alabama, and five in Louisiana, though three of those in Louisiana are expected to close within the next six months due to inability to comply with the new regulations.

Laws regarding abortions in each state differ slightly and are constantly in flux. Laws in Alabama, Arkansas, Mississippi, and Louisiana ban abortion after 20 weeks. However, the lone clinic in Mississippi only performs abortions up to 16 weeks, while the clinics in Louisiana only go as far as 16 and a half weeks. Clinics in Mississippi and Louisiana have a 24-hour waiting period between an initial appointment and the procedure. During the course of reporting this article, Alabama passed a law increasing the waiting period to 48 hours.

Access to transportation is another barrier to abortion.

All three states have little to no public transportation connecting major cities, making it difficult for women to travel to get an abortion. Laurie Bertram Roberts, president of the Mississippi chapter of National Organization for Women (NOW), recounted how she recently helped a Mississippi woman get to Alabama for an abortion. The woman was 17 weeks pregnant, had little money, no car, and three kids.

“Even though [abortion's] not illegal, you have to know people,” Roberts said, comparing the current situation in the South to Jane, an underground group in Chicago pre-Roe v. Wade that connected women with safe, affordable abortions.

Kew had to travel too. A hotline referred her to a clinic in Columbus, Georgia, a 3-hour drive across the state line. She made an appointment, asked two friends to accompany her, and cleared out her bank account to pay for gas ($40) and the abortion ($420).

“All the way from Birmingham to Georgia just to get an abortion,” Kew said. “In a way you are trying to control someone’s life when you take away those options.”

Her situation is far from unique.

“We get 100 calls a week from women looking for an abortion clinic in Birmingham,” explained Diane Derzis, sitting in a counseling room of her closed clinic in downtown Birmingham. Derzis has been working as “an abortionist” — a term she uses freely — since shortly after the Roe v. Wade decision in 1973.

Her clinic in Mississippi is currently in court over a state law that would require doctors have admitting privileges at a local hospital. Out-of-state doctors who fly in to perform abortions at clinics across the South are unable to get admitting privileges at local hospitals. Derzis and other providers argue that local doctors are often unwilling to perform abortions for fear of being attacked or their practices picketed.

The same law has been passed in Alabama and Louisiana, where they are tied up in similar court battles.

In 2013, Alabama passed a series of laws to more strictly regulate abortion providers. One new requirement is that clinics meet the surgical standards of an ambulatory surgery center, meaning, among other things, that hallways would need to be widened to allow gurneys to pass, sprinkler systems installed, and additional exits created. The deadline for compliance was July 1.

The bills were introduced by Representative Mary Sue McClurkin, a Republican whose district includes a portion of Birmingham. In 2014, McClurkin also introduced a “fetal heartbeat bill” that would ban abortions at around four to six weeks after conception, when a heartbeat can be detected. McClurkin agrees the bill, if passed, would have effectively made abortion illegal in Alabama.

“It’s only right. My goodness, that’s a life,” she said. “We do so many things in our society to defend life, but we turn our backs on abortion, where we have killed millions of babies in the United States since Roe v. Wade.”

A “fetal heartbeat” bill was passed in Arkansas where it is currently under court injunction pending litigation. McClurkin believes there is great support for the law in the Alabama legislature, and that it will be reintroduced next year.

Most of the legislation regulating abortion in Alabama has been the work of Eric Johnston, a civil rights lawyer and pro-life advocate.

“[Abortion] is something that is legal right now, but that does not mean that it is right,” Johnston said. “I don’t believe in a woman’s right to choose. I think [that’s] a mistake, and I would hope that someday the Supreme Court would reverse itself and recognize that it was wrong to do what they did.”

Johnston said the recent wave of laws are not intended to close clinics, but keep women safe. However, studies have long shown that abortion is one of the safest outpatient procedures. Less than 0.3 percent of women in the U.S. who have an abortion have a complication that requires hospitalization. In addition, a paper by the Guttmacher Institute notes that the Supreme Court ruled in 1983 that there was no health or safety reason to require second trimester abortions to be performed in a hospital.

However, Alabama, Johnston noted, never voted to legalize abortion. Prior to Roe v. Wade, abortion was a crime in Alabama except when the woman's life was threatened.

“That law has never been repealed by the Alabama legislature. It was repealed by the Supreme Court in Roe v. Wade, so it is unenforceable,” Johnston said. “I think the majority of people in Alabama would say that abortion is wrong, and I think the Alabama legislature would pass a law [making abortion illegal] in a minute if the Supreme Court opened the door to do that.”

While abortion clinics have closed in Birmingham, another type of medical office has taken their place.

In Vestavia, a suburb of Birmingham that fans out from the highways in small hives of strip malls and gated communities, a large billboard advertised the Pregnancy Test Center. In the center’s waiting room, two teenage girls filled out paperwork.

Pregnancy Test Centers are pro-life clinics that provide free pregnancy and STD testing for women and men as well as parenting classes and financial incentives for couples who agree to keep the pregnancy. There are now seven such centers in the city and 57 in the state.

“We want to be a safe haven, a nonjudgmental environment, for anyone who is experiencing a crisis or unintended pregnancy,” said Lisa Hogan, executive director of the Sav-A-Life “crisis pregnancy” franchise.

The Pregnancy Test Center is a licensed medical facility and provides ultrasounds as well. They do not provide information about birth control, including condoms, or offer abortion referrals.

Down a quiet hall are two rooms with ultrasound machines. A big screen is angled toward a hospital bed “so that the client can see the ultrasound from where they are laying,” Hogan said. (Women in Alabama are required to have the option to view an ultrasound before consenting to an abortion.) Posters of fetuses at every week of development adorn the walls: “6 weeks – I have finger nails,” “Week 10 – The baby can turn its head and frown,” “17 weeks – I just had a dream.”

Women are sometimes handed small rubber replicas of fetuses at 7, 8 or 10 weeks so that, Hogan explained, “they can get an idea of what the baby might look like.” According to Hogan, the Pregnancy Test Center prevented 81 abortions in 2013.

April (not her real name) visited this same Pregnancy Test Center in 2005 when she was 16 and worried she was pregnant. It was down the street from her boyfriend's house. She wasn't considering abortion, she said, she just wanted a free pregnancy test.

She explained over email what happened while she waited for the results.

“The lady took me back to a room to talk. I remember her asking me if I was religious, and if I went to church and how involved I was. She also asked what religion my boyfriend was and how often he went to church. It was about an hour of questioning. Basically, I had to agree to be saved before she would read me my test results.”

April wasn’t pregnant.

“It's especially unnerving when you're already a terrified 16-year-old that thinks they are pregnant,” she said, “to then also be preached to for what feels like forever when you already know you've made a mistake or else you wouldn't be there in the first place.”

The federal government issued a 2006 report about the false information provided by federally funded pregnancy resource centers. (The Pregnancy Test Center is not federally funded). The report details cases of centers telling women that abortion can cause Post Traumatic Stress Syndrome (PTSS), breast cancer and infertility — all of which have been repeatedly proven false.

It concluded: “The vast majority of pregnancy centers contacted in this investigation misrepresented the medical consequences of abortion, often grossly exaggerating the risks. This tactic may be effective in frightening pregnant teenagers and women and discouraging abortion. But it denies the teenagers and women vital health information, prevents them from making an informed decision, and is not an acceptable public health practice.”

Dalton Johnson has owned and operated an abortion clinic in downtown Huntsville, a city in North Alabama, since 2001, when there were three clinics in town. He closed his clinic earlier this month because it was unable to comply with the state's new ambulatory standards. Since January, the number of clinics in Alabama has decreased from five to three.

Johnson, whose clinic saw women from Alabama and neighboring states, fears the desperation that will result from more clinics closing.

“It's been so long since they have seen what can happen from an illegal abortion, with a woman losing her ability to reproduce, infection, dying at a higher rate, everything else … that they forgot about that part of it,” he said. “If someone wants a termination, they are going to seek it out, whether it be legal or illegal.”

Derzis believes she will lose the court battle to keep her Mississippi clinic open, but plans to appeal the case to the Supreme Court. She said she remembers being a teenager prior to Roe v. Wade, when abortion was illegal.

“I am from a small town of about 100 people,” she said. “A mile from my house, someone was doing illegal abortions on University of Virginia coeds. They started digging up the yard, and they found bones.”

Derzis said the fact that it’s become practically impossible for many women across the Deep South to access abortion — despite it being legal — is an injustice.

“You can’t continue to have women in Mississippi not have the same rights as women in New York,” she said. “Or women who are poor not have the same rights as women who have resources.”

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