Audience conversation hushed at Savannah’s Front Porch Theatre last Wednesday night when six people took the stage.
An older white woman recalled her 1957 abortion in which she was blindfolded in the back of a truck and asked to lie on a kitchen table. A young Black mother of six, who had faced racism in birthing care, explained that she had never expected to have an abortion until illness made it clear that one of her pregnancies would cost her her life. A Black veteran discussed how medical neglect in the military prompted her complicated decision to terminate her pregnancy.
After each testimony, the audience would snap or, more often, burst into applause.
Planned Parenthood Southeast sponsored the event hoping that the stories would reduce the stigma surrounding abortions, something that the organization’s Georgia Campaigns Director Vivienne Kerley-de la Cruz says “contributes to misinformation that is weaponized” — despite the fact that nearly one in four American women get an abortion before the age of 45.
Conversations about abortion have been brewing across Georgia in anticipation of the Supreme Court’s decision to overturn Roe v. Wade, the landmark 1973 decision that made abortion a constitutional right, the morning of June 24.
In May, candidates for statewide office put their views of abortion at the center of their campaigns. Hours after Roe was overturned, Georgia Attorney General Chris Carr petitioned the U.S. Court of Appeals for the 11th District to reverse its injunction against the state’s so-called heartbeat law banning abortion after six weeks of pregnancy.
Meanwhile, pro-abortion advocates have been preparing alternative options for Georgia women who need to terminate a pregnancy. They worry about returning to a pre-Roe era in which cultures of silence made illegal abortions taboo and unsafe. They are also concerned that restricting abortion access will exacerbate the inequitable patchwork of women’s healthcare that already poses risks to mothers’ lives.
Georgia has the second-highest maternal mortality rate in the nation, with 48.4 deaths per 100,000 live births, compared to the national average of 17.4. And Black women in Georgia are nearly three times more likely to die during childbirth than their white counterparts.
State of reproductive healthcare
Until Georgia’s six-week ban goes into effect, abortion is legal in the state up to 21 weeks and 6 days. In reality, however, abortion access has been complicated.
In 2017, 26 facilities provided abortion services in Georgia, according to the Guttmacher Institute, and only 15 of those were specialized clinics. That is a steady decline from years past. Roughly half of Georgian women lived in counties without any abortion providers.
Savannah and Coastal Georgia currently have two functional abortion providers: the Savannah Medical Clinic, which offers surgical abortions up to 16 weeks and medication abortions by pill up to 8 weeks; and Planned Parenthood’s Savannah Health Center, where medication abortion is available up to 11 weeks. The state’s other providers are largely concentrated in greater Atlanta.
Roula AbiSamra, the state campaign manager at reproductive justice collaborative Amplify Georgia, says rural Georgians face drives up to five hours for abortion access in state.
In some cases, those seeking abortions are actually closer to clinics in other states — for example, the Planned Parenthood Health Center in Charleston, South Carolina. But restrictions like multiple-day waiting periods in North Carolina and Alabama and Florida’s currently in-litigation 15-week ban are making even that option more complicated.
Pregnant women seeking any care in Georgia also face a dearth of options. Only 79 out of Georgia’s 159 counties have an Obstetrics and Gynecology (OBGYN) provider.
Longtime lawyer, former legislative assistant, and candidate for Georgia General Assembly Anne Allen Westbrook attributed this gap — as well as the higher maternal mortality rates — to a lack of Medicaid expansion and a trend of rural hospital closures. “Abortion is a safe procedure. Childbirth is not always,” says Westbrook. “If we love babies, and if we care about babies, we would be doing different things than what we’re doing in states like Georgia.”
‘Pregnant? We can help.’
While reproductive health care access has declined in Georgia, the number of crisis pregnancy centers, known as CPCs, has grown.
These facilities, which often operate under the umbrella of religious or other nonprofits, aim to dissuade women from choosing abortion. They also provide a limited selection of reproductive health services like pregnancy tests, STD/STI tests and limited obstetric ultrasounds. CPCs will not provide contraception or refer clients for abortions.
In Savannah, you can find colorfully advertised CPCs just across the street from both of the two abortion providers. The entrance to one, ThriVe Express Savannah, is visible in Planned Parenthood’s mirrored door. On East 34th Street, across from Savannah Medical Center’s understated brick building is the Savannah Care Center, a CPC in a stately house with a banner reading “Limited Ultrasound No Cost.”
In FY 2021, the Georgia Department of Public Health paid $1,806,783 in taxpayer money to CPCs, according to its annual report.
CPCs have come under criticism from advocates, lawmakers, and those in the medical community for misleading messaging. The groups advertise with highway billboard ads with messages like “Pregnant? We can help.,” and often appear in Google searches related to abortion clinics. A 2018 Women’s Health Issues study found that 58% of Georgia CPC websites omit the fact that they do not refer for abortion.
One local CPC, ThriVe Express Savannah, describes itself on its website and in videos as “no cost healthcare to women in need” with a “team of Medical Staff and Advocates.” However ThriVe’s parent nonprofit, United for Life to His Glory (ULHG), states their aim in their 2020 nonprofit IRS form: “Encourage […] the recognition of human life from the moment of conception and to minister in the name of Jesus Christ to women and men.”
United for Life measures statistical success of its pregnancy center as 707 “saves” — the number of people they describe as “abortion-minded” women who choose not to have the procedure after coming to the ThriVe Savannah office. The nonprofit also says it has gotten 755 commitments to Christ, given out 924 Bibles, and provided one “abortion pill reversal.”
ThriVe referred all questions to its executive director Paula Kinard, who did not respond to multiple requests for information about the organization’s services.
Some centers exempt from business, medical regulation
While its marketing suggests the CPC offers a full range of reproductive healthcare, ThriVe and other such centers provide very limited medical service in addition to counseling.
In addition, ThriVe is not a licensed medical facility. Under Georgia law, the center can perform medical services like limited ultrasounds, as long as the volunteer nurses and doctors have medical licenses. However, since the centers like ThriVe do not bill for their services, they are exempt from business and medical regulations. The only oversight comes from their parent nonprofit.
The same 2018 study found that “53% [of Georgia CPC websites] included false or misleading statements” regarding the medical realities of abortion.
Additionally, since CPCs do not charge, and therefore do not electronically transmit patient information for billing, they are not covered under national privacy laws that protect patients. That includes ThriVe.
Prominent CPC conglomerate Care Net is more forthcoming about the aims of its work. On its website, Care Net asks visitors to sign a pledge of support in overturning Roe.
Realities of abortion pre-Roe
In the eclectic living room of her Ardsley Park home, 95-year-old Miriam Center worried that the decline of abortion rights would mean a return to the risky days where women sought out illegal and dangerous options to terminate a pregnancy.
Center herself had an illegal abortion in the late 1950s. She became pregnant after her 16-year-old eldest son’s death. She was in mourning, and didn’t want to have two children who never got the chance to know each other. But no providers were offering the procedure legally in Savannah.
Center had a friend cover for her and say that she was going to a conference — at the time, she was working at a real estate firm. She traveled to Atlanta, where a nurse administered the procedure in her own kitchen. The abortion would not complete, and Center had to be driven to the office of a doctor, who finished it. “It was horrible,” Center remembers. “There wasn’t any kindness.”
She emphasizes that those involved in her then-illegal abortion were all prominent in Atlanta society — working at leading hospitals and law firms. “They knew, all right,” she says, “I knew a lot of girls that went out of town.” This element of the culture still went unacknowledged. “It was always secretive,” she says.
“[Abortion], it’s discussed politically,” she says about Savannah. “But I don’t think it’s openly discussed.”
The cost of man-made laws
Westbrook believes abortion’s complexities are obscured by how it is currently being negotiated in majority-male legislatures. Referring to Georgia’s six-week ban, she points out that people who have experienced irregular menstrual cycles in their lives know how difficult it is to determine pregnancy by the six-week mark.
Georgia’s Republican-led legislature has signaled that more restrictions may be coming — looking to ban medication abortion via telehealth visits and require doctors to give women medically inaccurate information on abortion reversal, for example.
Following the SCOTUS decision, the national access landscape will continue to become more restricted, notably in areas around Georgia. Looking to cut off alternative channels for access, Missouri has discussed laws that would penalize women who travel to another state for an abortion — even as clinics in pro-abortion states like New York are preparing to be overwhelmed with out-of-state travelers.
In this climate, younger Georgians are discussing invasive surgical steps to prevent pregnancy, including tubal ligations, according to Westbrook, referring to discussions on her neighborhood Facebook group. “They're having to really think about ways to control that aspect of their bodies and their lives that don't expose them to criminal prosecution,” Westbrook says.
Advocates gear up for chaotic future
Data suggests that despite more restrictive laws, people still find ways to get abortions. The procedures just tend to become less equitable and safe. A New York Times report found that Texas’ six-week ban on abortion halved legal abortions, but only decreased the total number of abortions in the state by less than 10 percent. That difference was accounted for by spikes in out-of-state travel and orders for overseas abortion pills. Meanwhile, poor women were the most likely to be unable to access abortion at all.
Planned Parenthood and Amplify Georgia haven't been waiting for the Supreme Court ruling on Roe to plan how to navigate what is expected to be a thorny and complex legal and medical terrain for their clients.
According to Kerley-de la Cruz, Planned Parenthood has been preparing systems to ensure continued access, including providing opportunities for those seeking care to contact local health centers to find out their options.
AbiSamra identifies websites such as ineedanabortion.com, a search mechanism for available abortion providers in every area, as key resources for women seeking care post-decision. She also says that donating or giving time to organizations like ARC Southeast — which provide funding and logistical support to individuals seeking abortion care — is "the best thing that you can do to prepare."
Coco Papy, a Savannahian organizer who serves on Planned Parenthood’s Southeast C4 policy board, says the organization If/When/How is currently training lawyers to know how to handle cases where self-managed abortions and miscarriages are being criminally prosecuted.
“You likely know someone who has had an abortion. They probably sit in your church, they’re maybe on your board, you probably work with them. They might be in your family,” says Papy.
“I think it's really easy for people to exist in hypotheticals without considering how complicated people's lives can be.”