Long Drives, Air Travel, Exhausting Waits: What Abortion Requires in the South

Yves here. Your humble blogger has pointed out repeatedly that one of the greatest acts of negligence of what was then called the women’s liberation movement was focusing nearly all of its energies on trying to pass an Equal Rights Amendment, and neglecting to nail down other key protections when they had strong political tailwinds and favorable press coverage. The biggest fail was not passing Federal legislation to protect abortion rights. This would have required reaching a compromise with religions interests…and then the Catholic Church had more sway than evangelicals. But in Europe, this very sort of bill passed in capital after capital, with the abortion advocates agreeing to limit a freely available abortion to the first trimester.

The other big fail in the US is the way middle and upper middle class urban and suburban women have taken almost no note of how abortion “rights” have been gutted in most of Flyover. So much for sisterhood

And it isn’t just legal protections that are at risk. US medical schools no longer teach how to perform abortions. So what happens when the current generation of practitioners retires?

By Sarah Varney, Kaiser Health News Senior Correspondent, who also reports regularly for NPR’s Morning Edition and All Things Considered, for print publications and, more recently, PBS NewsHour. Originally published at Kaiser Health News

Becca Turchanik, of Nashville, Tennessee, drove four hours to Atlanta for an abortion in 2019, and the emotions of the ordeal have stayed with her, she says. She’s angry that she had to call from state to state to find care, and that she couldn’t have her abortion close to home, with friends nearby. “We got an appointment in Georgia because that was the only place that had appointments,” she says. (Laura E. Partian for Kaiser Health News)

Just a quick walk through the parking lot of Choices-Memphis Center for Reproductive Health in this legendary music mecca speaks volumes about access to abortion in the American South. Parked alongside the polished SUVs and weathered sedans with Tennessee license plates are cars from Mississippi, Arkansas, Florida and, on many days, Alabama, Georgia and Texas.

Choices is one of two abortion clinics in the Memphis metro area, with a population of 1.3 million. While that might seem a surprisingly limited number of options for women seeking a commonplace medical procedure, it represents a wealth of access compared with Mississippi, which has one abortion clinic for the entire state of 3 million people.

A tsunami of restrictive abortion regulations enacted by Republican-led legislatures and governors across the South have sent women who want or need an early end to a pregnancy fleeing in all directions, making long drives or plane trips across state lines to find safe, professional services. For many women, that also requires taking time off work, arranging child care and finding transportation and lodging, sharply increasing the anxiety, expense and logistical complications of what is often a profoundly difficult moment in a woman’s life.

“Especially for women coming from long distances, child care is the biggest thing,” said Sue Burbano, a patient educator and financial assistance coordinator at Choices. “They’re coming all the way from Oxford, Mississippi, or Jackson. This is a three-day ordeal. I can just see how exhausted they are.”

The long drives and wait times could soon spread to other states, as the U.S. Supreme Court prepares this fall to consider a Mississippi ban on nearly all abortions after 15 weeks of pregnancy, with no allowances for cases of rape or incest. Under a law enacted in 2018 by the Republican-led legislature, a woman could obtain a legal abortion only if the pregnancy threatens her life or would cause an “irreversible impairment of a major bodily function.”

Mississippi’s ban was promptly challenged by abortion rights activists and put on hold as a series of lower courts have deemed it unconstitutional under the Supreme Court’s landmark Roe v. Wade decision. That 1973 ruling, in concert with subsequent federal case law, forbids states from banning abortions before “fetal viability,” the point at which a fetus can survive outside the womb, or about 24 weeks into pregnancy.

Tennessee, Texas, Mississippi and several other states have since passed laws that would ban abortions after six weeks. That legislation is also on hold pending legal review.

Groups opposed to abortion rights have cheered the court’s decision to hear the Mississippi case, believing the addition of Justice Amy Coney Barrett gives the court’s conservative bloc enough votes to overturn Roe, or at least vastly expand the authority of individual states to restrict abortion.

But, for supporters of reproductive rights, anything but a firm rejection of the Mississippi ban raises the specter of an even larger expanse of abortion service deserts. Abortion could quickly become illegal in 21 states — including nearly the entire South, the Dakotas and other stretches of the Midwest — should the court rescind the principle that a woman’s right to privacy protects pregnancy decisions.

“If we end up with any kind of decision that goes back to being a states’ rights issue, the entire South is in a very bad way,” said Jennifer Pepper, executive director of Choices in Memphis.

The decades-long strategy by conservative white evangelical Christians to chip away at abortion access state by state has flourished in the South, where hard-right Republicans hold a decisive advantage in state legislatures and nearly all executive chambers.

Though details vary by state, the rules governing abortion providers tend to hit similar notes. Among them are requirements that women seeking abortions, even via an abortion pill, submit to invasive vaginal ultrasounds; mandatory waiting periods of 48 hours between the initial consultation with a provider and the abortion; and complex rules for licensing physicians and technicians and disposing of fetal remains. Some states insist that abortion providers require women to listen to a fetal heartbeat; other providers have been unable to obtain admitting privileges at local hospitals.

“Everything is hard down here,” said Pepper.

The rules also have made some doctors reluctant to perform the procedure. While obstetricians and gynecologists in California, New York, Illinois and elsewhere routinely perform abortions at their medical offices — the same practices where they care for women through pregnancy and delivery — their peers in many Southern states who perform more than a small number of abortions a year must register their practices as abortion clinics. None has done so.

Texas offers an example of how targeted legislation can disrupt a patient’s search for medical care. In 2012, 762 Texans went out of state for abortions, according to researchers at the University of Texas-Austin. Two years later, after then-Gov. Rick Perry signed into law the nation’s most restrictive abortion bill, shuttering about half the state’s abortion facilities, 1,673 women left Texas to seek services. In 2016, 1,800 did so.

Similarly, in March 2020, as the coronavirus pandemic took hold, Gov. Greg Abbott issued an order prohibiting all abortions unless the woman’s life was in danger, deeming the procedure “not medically necessary.” The month before the order, about 150 Texans went out of state to seek abortion services. In March and April, with the order in effect, nearly 950 women sought care outside Texas.

There can also be an unsettling stigma in some parts of the South.

Vikki Brown, 33, who works in education in New Orleans, said she initially tried to end her pregnancy in Louisiana, calling her gynecologist for advice, and was told by a receptionist that she was “disgusted” by the request.

She sought out the lone abortion clinic operating in New Orleans but found it besieged with both protesters and patients. “I knew but didn’t understand how difficult it was to get care,” said Brown, who moved to Louisiana in 2010 from New York City. “The clinic was absolutely full. People were sitting on the floor. It was swamped.” It took her six hours to get an ultrasound, which cost $150, she said.

A friend in Washington, D.C., counseled Brown that “it didn’t have to be like that” and the pair researched clinics in the nation’s capital. She flew to Washington, where she was able to get an abortion the same day and for less than it would have cost her in New Orleans, even including airfare.

“No protesters, no waiting period,” she said. “It was a wildly different experience.”

Atlanta, a Southern transportation hub, has also become a key piece in the frayed quilt of abortion care in the region.

Kwajelyn Jackson, executive director of Feminist Women’s Health Center in Atlanta, said the clinic regularly sees patients from other states, including Alabama, Tennessee, Kentucky and the Carolinas.

These visits often involve long drives or flights, but rarely overnight stays because the state-mandated 24-hour waiting period can begin with a phone consultation rather than an in-person visit. Georgia has many of the same laws other states employ to make clinical operations more burdensome — requirements to cremate fetal remains, for instance, and that abortion providers adhere to the onerous building standards set for outpatient surgical centers — but its urban clinics so far have weathered the strategies.

Jackson said staffers at her clinic are aware of its role as a refuge. “We’ve had patients who were able to get a ride from Alabama, but they weren’t able to get a ride home,” she said. “We had to help them find a ride home. It is so much simpler to go 3 or 4 miles from your home and sleep in your bed at night. That is a luxury that so many of our patients can’t enjoy.”

Many women embarking on a search for a safe abortion are also confronting serious expenses. State Medicaid programs in the South do not pay for abortions, and many private insurers refuse to cover the procedure. In addition, the longer a woman’s abortion is delayed, the more expensive the procedure becomes.

Becca Turchanik, a 32-year-old account manager for a robotics company in Nashville, Tennessee, drove four hours to Atlanta for her abortion in 2019. “We got an appointment in Georgia because that was the only place that had appointments,” she said.

Turchanik said her employer’s health insurance would not cover abortion, and the cost of gas, food, medications and the procedure itself totaled $1,100. Her solution? Take on debt. “I took out a Speedy Cash loan,” she said.

Turchanik had a contraceptive implant when she learned she was six weeks pregnant. She said she was in an unhealthy relationship with a man she discovered to be dishonest, and she decided to end her pregnancy.

“I wish I had a child, but I’m glad it wasn’t his child,” she said. “I have accomplished so much since my abortion. I’m going to make my life better.”

But the emotions of the ordeal have stayed with her. She’s angry that she had to call around from state to state in a panic, and that she was unable to have her abortion close to home, with friends to comfort her.

Others turn to nonprofit groups for financial and logistical support for bus and plane tickets, hotels, child care and medical bills, including the National Abortion Federation, which operates a hotline to help women find providers. Last year, the federation received 100,000 calls from women seeking information, said its president, the Very Rev. Katherine Hancock Ragsdale.

Access Reproductive Care-Southeast, an abortion fund based in Atlanta, has trained over 130 volunteers who pick women up at bus stations, host them at their homes and provide child care. A study published this year in the International Journal of Environmental Research and Public Health examined 10,000 cases of women seeking assistance from ARC-Southeast: 81% were Black, 77% were uninsured or publicly insured, 77% had at least one child, and 58% identified as Christian.

“It’s amazing to see the scope of the people we work with,” said Oriaku Njoku, ARC-Southeast’s co-founder. “The post-Roe reality that y’all are afraid of is the lived reality for folks today in the South.”

A Texas law targets precisely this kind of help, allowing such organizations or individuals to be sued by anyone in the state for helping a woman get an abortion. It could go into effect Sept. 1, though abortion rights advocates are suing to stop the new law.

Despite the controversy surrounding abortion, Choices makes no effort to hide its mission. The modern lime-green building announces itself to its Memphis neighborhood, and the waiting room is artfully decorated, offering services beyond abortion, including delivery of babies and midwifery.

Like other clinics in the South, Choices has to abide by state laws that many abortion supporters find onerous and intrusive, including performing transvaginal ultrasounds and showing the women seeking abortions images from those ultrasounds.

Nonetheless, the clinic is booked full most days with patients from almost all of the eight states that touch Tennessee, a slender handsaw-shaped state that stretches across much of the Deep South. And Katy Deaton, a nurse at the facility, said few women change their minds.

“They’ve put a lot of thought into this hard decision already,” she said. “I don’t think it changes the fact that they’re getting an abortion. But it definitely makes their life harder.”

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  1. none

    Would legislation have helped? It was before my time but legislation comes and goes. If the Democrats passed something, the Republicans would try to repeal it. Would they be successful? They love issues like that, and they do win (some) elections with it.

  2. Amfortas the hippie

    thanks to mom’s influence…one of the few instances where she was subtle in that influence…i was more feminist than most of the girls at my high school(late 80’s).
    and i ran a sort of underground railroad to planned parenthood, some 50 miles sounth in houston.
    so this stuff infuriates me…not least, because it’s a perfect example of an engineered fight…few in right-leaning-christian-land gave a damn about abortion until Weyrich, et al ginned it up as a call to arms.
    it was a masterful campaign, and led directly to the Reagan Counterrevolution that we still toil under.

    as far as what’s to be done, mom keeps things like pennyroyal and chaiste trees growing…haven’t tried slippery elm lately.
    there are several other herbs she keeps around, just in case.
    (note: all of these plants are quite dangerous, and should NOT be used for abortions unless at the uttermost end of need)

  3. The Rev Kev

    I wonder how big a market there is in some of these States for ‘morning-after’ pills. Pretty big I would imagine. If some of these States had their way, you would have to apply to have an abortion – with a ten month waiting list. And the funny thing is that their sisters who live in States that are more reasonable about abortions do not really try to help these girls in these southern States from what I can see. I suppose they imagine that things like this will never blow back on them where they live. I guess that people are entitled to their delusions.

    1. d w

      well some of maybe financial, as not every one has much if any excess income to provide support, even if they were so inclined. i can see a day when there could be a lot of folks traveling just for this. and i could actually see some states trying to out law that too.

      if some are so against abortion, then stand up, and help unwilling mothers to put their babies up for adoption, and support that child until they are 18. with the possibility of providing college education. and health care, etc

      1. James Simpson

        So is it possible to be broadly uncomfortable with abortion as contraception while being a socialist? I suspect it is but it certainly isn’t possible to admit it.

  4. MK

    What percentage of woman use abortion as a form of birth control?

    If a man can’t be bothered with using condoms and a woman does not require its use, and a woman not looking to get pregnant that won’t use pills or other forms of control such as an IUD – all of them – men and women – have no personal responsibility. You need a license to drive – but to procreate? crickets . . .

    1. tegnost

      I’d say it’s a very small percentage.
      What’s your view on vaccine mandates?
      Is it “irresponsible” to not get vaccinated?

    2. Yves Smith Post author

      You must not get laid much. Seriously.

      Big foot in mouth and chew with admission that you are so inexperienced that you’ve never heard of condoms tearing or breaking and other birth control methods also not being 100% effective.

      The failure rate is about 3% with a couple that has been having sex with each other regularly. When you include more casual relationships, the failure rate is estimated at 14%.


      And are you kidding regarding IUDs? I know a woman who nearly died from an IUD infection. She had to spend over a month in the hospital, she was that debilitated, and it was months before she could work at her former level. She was a measurable percentage of McKinsey’s total medical expenses the year she was treated.

      See here for other issues:


  5. Arizona Slim

    During the depths of the Great Depression, my grandmother saved a neighbor’s life. She had a back alley abortion, there were complications, and Grandma nursed her back to health.

    My mother never forgot what she saw. She became very pro-choice.

    Makes me wonder if this is what the anti-abortion forces want this country to go back to.

  6. Irrational

    Never ceases to amaze me how (mostly male) politicians think it is OK to dictate what a woman can or cannot do with her body when they are the potential perpetrators. It’s a very Islamic way of thinking and judging.

    1. James Simpson

      Is it as simple as your argument makes it to be? If there is a (potential) other life involved, then it’s not the same as other medical procedures. I find it interesting here in the free-abortion UK that, if a pregnant mother states to doctors she will continue the pregnancy to term, they refer to the new life as a baby; if she decides to abort, they call it a foetus. As to your comment about Islam, that might be true but how many feminists will admit it? And it applies to other faiths just as much.

  7. marieann

    “I do not believe that just because you are opposed to abortion, that that makes you pro-life. In fact, I think in many cases, your morality is deeply lacking if all you want is a child born but not a child fed, a child educated, a child housed. And why would I think that you don’t? Because you don’t want any tax money to go there. That’s not pro-life. That’s pro-birth. We need a much broader conversation on what the morality of pro-life is.”
    This is my favourite quote from Sister Joan Chittister

    1. James Simpson

      Not all anti-abortion advocates are right-wing, woman-hating Republicans. I’m ambivalent on the topic and find the arguments from both sides to be lacking in depth, logic, compassion and reason.

      1. PlutoniumKun

        I’ve noted in a few European countries there are stirrings of what might be called a ‘conservative on social, radical/left on economic’ platform political parties. In Ireland, a new party, an off-shoot of Sinn Fein has had some modest success on a platform of what would by US standards be considered a very left wing (with a strong orientation towards rural communities) platform along with a fairly right/reactionary stance on issues like abortion. There are several similar parties around Europe, especially in Eastern Europe.

        I think it includes a fairly substantial group of people in many countries who are generally overlooked. A lot of these are the people who swing from right to left wing parties and vice versa apparently randomly, but this is really a reflection of those people having views which appear contradictory to cosmpolitan political observers, but are entirely consistent from their own perspective.

  8. PlutoniumKun

    Just as a general topic on this, the Irish example I think shows that it is possible – with a lot of sweat and pain – to depoliticise abortion and take the toxicity out of the debate. The main way was the use of what are known in Ireland as ‘constitutional conventions’, which are really citizens juries, charged with coming up with sensible changes to the constitutions with related legislation. Its fair to say I think that most of the Irish population are still generally anti-abortion, but the constitutional amendment allowed enough wriggle room for all but the extremes on either side to be isolated.

    Previously, judicial intervention had created an almighty mess, where the blanket anti-abortion legislation had been declared unconstitutional, but the political system proved incapable of coming up with a sensible alternative, leaving a very ambituous legal situation for several decades (contrary to general reporting around the world, Ireland did not ban abortion, it was neither banned nor permitted, in reality hospitals simply sent women requiring one to get the ferry to Liverpool to get one). Abortions were regularly carried out in hospitals, they were just called something else. But this, of course, left women at the mercy of their obstetricians personal views.

  9. Eclair

    Recently, in the midst of an afternoon spent with a couple of the myriad cousins in my husband’s family, here in western New York/Pennsylvania, all of whom are conservative Trump voters, one woman made a surprising confession. I can’t remember what we were discussing, but it was nothing political, because I am known as that radical commie feminist their cousin married, but accepted because we connect on more basic levels and I genuinely like them all.

    She, the 86 year old cousin, confided to me that her mother had had an abortion. This must have been back in the 1930’s. After her mom’s fifth or sixth birth, she became pregnant once again and her doctor told her that there was a high probability that neither she nor the baby would survive. So he advised an abortion and performed it. The cousin whispered to me that she really believed this was a woman’s right. I agreed. And we began to discuss the upcoming annual county fair, where one branch of the family cooks hamburgers and bakes pies at the Pomona Grange Hall, to feed the hungry fair-goers and exhibitors.

    Why do the, mostly, male legislators have a bee in their bonnet about abortion? Is it a control issue? “No woman is gonna walk away with my sperm inside her, and then dump my DNA!” How can we, as a species, raise pigs and cows and chickens in horrendous concentration camp-like conditions, purely to be slaughtered in an assembly line of death, and then piously proclaim that ‘every little (human) sperm is sacred?’ Or hunt down male deer, not for food, but for the number of ‘points’ on it’s head gear? What’s so special about us humans? Other than the fact that we have totally fooked up the planet’s water and air and destroyed entire ecosystems.

  10. drumlin woodchuckles

    If some of the non-Conservative-ruled States can armor-plate and permanentise their right-to-legal-abortion society against the anti-abortion conspiracy and the RTL ( Right To Life) terrorists, they can then begin advertising themselves as “woman friendly” places to live. If they could encourage enough women to move from the anti-womanitic states to the womaneutral states to begin shrinking and attriting the population of the anti-womanitic states, they might be able to weaken and then break the power of the anti-womanitic states to dictate policy and culture to the womaneutral states.

    America could begin the Last Biggest Sort in preparation for dividing itself into a United States of Modernia and a United States of Shit Headistan. Once the Modernians were all in our own separate country, we would no longer have to worry so much about the Shit Headistanis polluting our culture and society.

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