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Inside an Alabama abortion clinic: the potential impact of greater restrictions

To understand the potential impact of restrictive new legislation, we visited one of three clinics in the southern state that still offers safe abortions. A law signed by Governor Kay Ivey in May prohibits abortion even in the case of rape or incest.
5 Sep 2019 – 05:02 PM EDT
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HUNTSVILLE, Alabama.– “It was very hard for me to make the decision to come here to do this,” Jazmine*, a patient at the Alabama Women’s Center, says in late May. The center is one of just three abortion clinics left in the state, and Jazmine is here seeking to end her pregnancy of nearly six weeks. Two days ago, an ultrasound — required by the state before an abortion — revealed she was carrying not one, but two fertilized embryos.

“I’m not even able to tell my mother,” she says. “I was raised in a Christian household, she wouldn't approve.”

Jazmine, the single mother of a 7-year-old boy who suffers from sickle cell anemia, is accompanied by a distant cousin. Law requires that patients do not undergo the procedure alone. "If not, I would have come without telling anyone,” she says.

She is nervous, but relieved, and wants to talk as long as we agree to protect her identity. “Things will be okay simply because I have this option, but if I didn't... just to think about what would happen if I didn't have it,” she says. “I'm not in a position to take care of my only child, much less three. I've gone through this alone before and I can't mentally, physically, emotionally, financially do this again. Not twice, not alone.”

The director of the clinic, Dr. Yashica Robinson, is in charge of performing the procedure. An obstetrician-gynecologist with 14 years of experience, Robinson also delivers an average of 20 babies a month at a hospital. She has become an activist, raising her voice in support of the services she provides, which she calls “necessary.” Her argument is the same as that declared by human rights organizations, lawyers and other reproductive health experts: “abortion bans do not prevent [abortions]. All they do is make them less safe,” she says. “If someone needs one, for whatever reason, they will look for one, even outside the health system.”

The strictest law in the country

Robinson says she is "infuriated" by legislation passed recently in Alabama. As a doctor, she sees firsthand how patients often grapple with the decision to seek an abortion.

“It is something that takes time to think through, and everyone needs to make that decision on their own, without any political influence,” she says. “These are decisions being made for the general health of women and their families. Not only physical health, but also mental and financial. Neither laws nor politics can play a role there.”

“There is no other area of medicine where this occurs,” she adds.

News about the law has generated confusion since it was approved and signed by the governor in May. Many wrongly believe it already took effect. Although originally scheduled to go into effect in January 2020, the legislation remains in the courts after lawsuits were filed by the American Civil Liberties Union (ACLU) of Alabama and Planned Parenthood. Both organizations have declared that the law is unconstitutional.

Under the law, doctors who perform abortions may be charged as criminals and face sentences of up to 99 years in jail. The text does not include exceptions for cases in which pregnancy is the product of rape or incest. When asked whether she would have preferred to include the two exceptions, Governor Ivey replied that "all human life is precious."

“The lawmakers who voted for it should be ashamed of themselves for politicizing our health and lives, and, once again, wasting taxpayers’ dollars on dystopic policies only fit for nightmarish fictional worlds — not Alabama in the 21st century,” the ACLU wrote in a statement.

In testimony before Congress on June 6, Robinson recalled how a patient told her about “nightmares she had prior to coming to the clinic about being turned away and denied services because of these restrictive laws.”

If the law goes into effect, abortion would be illegal except if the life and health of the mother are in danger.

That concerns Robinson, who says the law appears loaded with subjectivity. She is unclear how it will work in practice. "Exactly at what point is it that they would agree that her life is at significant enough risk for me to proceed?”

Access is already limited

When Jazmine decided to have an abortion, she thought she simply had to show up at the clinic. Instead, she found a slate of obstacles already in place.

"In the state of Alabama, there is a 48-hour waiting period for those who need access to the procedure," explains nurse Lashonda Clemons-Pinchon. The law requires nurses like Clemons-Pinchon to offer a counseling session to patients who make a first appointment at the clinic. During the session, she informs patients of their options and gives them a brochure with information about resources (such as food stamps) in case they decide not to terminate the pregnancy.

"To hear that I had to wait another 48 hours to go through with something that I had already decided I needed was nerve-racking," Jazmine says. “Between that and the hormones, I hesitated, I thought maybe I wasn't going to be able to do it. It took a lot of nerve for me to come the first time and now I had to come back."

Clemons-Pinchon says that a woman has already made a decision by the time she arrives at the clinic. “I am not dealing with a bunch of uneducated people who can't make decisions for themselves,” she says. “This is probably one of the hardest life changing decisions that they’ll ever have to make. So, once they reach my chair they pretty much know what they need to do.”

When she started working at the Alabama Women’s Center in Huntsville in 2006, the clinic was one of 11 in the state. Now there are only three; the remaining two are in Montgomery and Tuscaloosa.

And clinics that provide abortions are not the only health providers that have been disappearing. According to Dr. Robinson's calculations, at least 10 rural health centers have closed in the last decade.

“There is already a shortage of services,” she says. “There’s not even enough prenatal care.”

That has contributed to the worsening of already high rates of maternal and infant mortality in the state.

And Robinson says she sees patients from outside the state as well. "I am consistently serving people from Louisiana, Georgia, Florida, Mississippi and Tennessee," the gynecologist says.

The procedure is not cheap: it costs some $500 if done during the first weeks of pregnancy. The amount increases if surgery is required.

“I had to get the $502 out of nowhere,” Jazmine says. “And now I'm going to have to find a way to survive until my next paycheck, because that was all I have.”

“They want to make you feel like a monster”

At each of the three clinics in the state, patients face insults from protesters who surround the entranceways. Some protestors show up with cameras and broadcast via Facebook live as women arrive at the clinic. They have even recorded patients’ license plate numbers to ridicule them.

“This is abuse that is unprecedented in other areas of medicine,” Robinson says. “They have nothing better to do? I don't understand how and why someone would want to make someone feel worse than they already feel.”

Those in the waiting room confirm that coming here is tough. "The protesters outside are making it worse. They want to make you feel like a monster," Jazmine says.

She says she is simply exercising the power to make choices about her own body, a right that is defended even by the United Nations:

The ability for a woman or girl to make her own decisions about pregnancy “is at the very core of [her] fundamental right to equality, privacy and physical and mental integrity and is a precondition for the enjoyment of other rights and freedoms,” the organization said last September, on International Safe Abortion Day. “Legal frameworks for abortion have typically been designed to control women's decision-making through the use of criminal law.”

Jazmine* is not her real name.

This story was produced thanks to the support of the International Women's Media Foundation (IWMF) and the Women's Equality Center (WEC).

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