Clinic facilities

With illegal abortion, Memphis clinic opens new chapter

MEMPHIS, Tenn. – Jennifer Pepper, CEO of a reproductive health clinic in Memphis, has done her best to prepare her staff for the painful pivot to come in a post-Roe world.

For 48 years, the Choices Clinic in the heart of Memphis has provided abortion services. But that ended Wednesday, Pepper said, the day before Tennessee’s abortion ban went into effect, making performing the procedure a felony punishable by up to 15 years in prison.

For months Pepper, the CEO of Choices, worked with the center’s board of directors to do two things simultaneously: protect Memphis staff from layoffs and open a new clinic about three hours away in a state different.

That meant laying the groundwork for the new clinic in Carbondale, Illinois, where abortion rights seem safer. It also meant cross-training former Memphis abortion care staff to provide other services, including Medicaid billing and to become birth attendants.

Choices has been providing abortions in Memphis, TN for 48 years. The center is currently retraining its staff to provide other types of patient care.Andrea Morales for NBC News

“We will definitely continue to help our community figure out how to access abortion services,” Pepper said. “We will advertise and people will be able to find our clinic in Carbondale very easily.”

Less than a month after the U.S. Supreme Court’s decision to overturn Roe v. Wade, more than 40 clinics has stopped providing abortions in trigger-ban states, according to the latest available data from the Guttmacher Institute. In Tennessee, at least one clinic, located in Knoxville, has firm since the rollback of the right to abortion this summer.

The reality of the post-Roe v. Wade slowly settled into Choices, where the once-busy clinic’s waiting room often has more empty seats than clients.

After the Supreme Court’s decision, a ban on abortions after detection of fetal heart activity (usually at around six weeks) went into effect, the clinic began seeing more patients than it had to turn away.

“Are you ready for this?” Roxy Vazquez, a medical assistant, was asking patients. “Just know we’re here.”

With that window closed on Wednesday, Vazquez said she was starting a new chapter. After spending most of her career in abortion care — at Planned Parenthood before Choices — Vazquez is training to become a birth attendant with the clinic’s midwifery services.

Memphis CHOICE
Since the cancellation of Roe v. Wade, the once bustling clinic often has more empty chairs than clients.Ariel Cobbert for NBC News

“We’re going to be here,” Vazquez said. “We are still standing.”

Funded by a mix of patient revenue and more than $1.5 million in donations last year, Choices remains afloat financially — for now, Pepper said. Last year, the clinic performed nearly 4,000 abortions, according to its annual report.

Even without abortion services, the clinic still offers a wide range of reproductive care, including a birthing center that offers midwifery services, HIV prevention, contraceptives, and gender-affirming care. But her birth center is relatively new and opened in 2020. Last year, the centre’s midwifery practice attended around 90 births.

Choices Clinic in Carbondale is scheduled to open Sept. 19, Pepper said.

Pepper said she’s concerned that Tennessee and other abortion-banning states “are creating systems that take care of pregnant women and parents and really turn their backs on them.”

Pregnant women in Tennessee are among the most vulnerable in the nation, according to data from the Centers for Disease Control and Prevention. The state has one of the highest maternal mortality rates in the country with nearly 35 maternal deaths per 100,000 live births between 2018 and 2020. Black women were almost three times more likely to die than white women, according to the Tennessee Department of Health.

Dr. Terry 'Keith' Grebe at the CHOICES Memphis Center for Reproductive Health in Memphis, Tennessee on August 10, 2022.
Dr. Terry “Keith” Grebe, who began practicing medicine before Roe v. Wade, said he was concerned for women who might feel hopeless as the ban takes effect. Ariel Cobbert for NBC News

Dr. Terry Grebe, 76, president of the clinic’s medical services, remembers being in training before Roe v. Wade and seeing a patient with a life-threatening complication after undergoing an illegal abortion. He recently saw a story about a Louisiana mother whose fetus was diagnosed with a life-threatening illness but said her hospital refused to terminate her pregnancy. He fears leaving women with so few options will lead to despair, he said.

“Anything you can imagine is going to happen to somebody,” Grebe said.