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'We're still standing': With abortion illegal, a Memphis clinic starts a new chapter

For months, the leadership of a Memphis abortion clinic has been working protect the staff from layoffs and open a new clinic three hours away in Illinois.
Jennifer Pepper, the executive director at CHOICES, on June 14, 2022 in Memphis, Tenn.
Jennifer Pepper, the executive director at Choices, an independent reproductive health care clinic in Memphis, Tenn., has spent the past few months strategizing for a post-Roe future.Andrea Morales for NBC News

MEMPHIS, Tenn. — Jennifer Pepper, CEO of a reproductive health clinic in Memphis, tried her best to prepare her staff for the painful pivot coming in a post-Roe world. 

For 48 years, the Choices clinic in the heart of Memphis provided abortion services. But that ended on Wednesday, Pepper said, the day before Tennessee’s abortion ban took effect — making performing the procedure a crime punishable by up to 15 years in prison. 

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

That’s meant laying the groundwork for the new clinic in Carbondale, Illinois, where abortion rights appear more secure. It’s also meant cross-training former abortion care staff in Memphis to provide other services, including billing Medicaid and becoming birth assistants.

CHOICES in Memphis, Tenn., on June 17, 2022.
Choices has provided abortions in Memphis, Tenn., for 48 years. The center is now retraining its staff to provide other types of patient care.Andrea Morales for NBC News

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

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

The reality of the post-Roe v. Wade world has set in slowly at Choices, where the once-bustling clinic’s waiting room often has more empty seats than clients. 

After the Supreme Court’s decision, a ban on abortions after the detection of fetal cardiac activity (typically at about six weeks) took effect, the clinic started seeing more patients that they had to turn away.

“Are you prepared for that?” Roxy Vazquez, a medical assistant, would ask patients. “Just know that we’re here.”

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

Since Roe v. Wade was overturned, 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’re still standing.”

Funded by a mix of patient revenue and more than $1.5 million in donations last year, Choices is staying afloat financially — for now, Pepper said. Last year the clinic provided 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 its birthing center is relatively new, opening its doors in 2020. Last year, the center’s midwifery practice assisted in about 90 births. 

Choices’ clinic in Carbondale is expected to open on Sept. 19, Pepper said.

Pepper said she’s concerned that Tennessee and other states banning abortion are “not creating systems that care for pregnant and parenting people and really turning their back on them.”

Pregnant people 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 country’s highest maternal mortality rates with nearly 35 maternal deaths for every 100,000 live births between 2018 and 2020. Black women were almost three times as likely to die than white women, according to the Tennessee Department of Health. 

Dr. Terry ‘Keith’ Grebe at CHOICES Memphis center for reproductive health in Memphis, Tenn., on Aug. 10, 2022.
Dr. Terry "Keith" Grebe, who started practicing medicine pre-Roe v. Wade, said he's worried about women who may feel desperate as the ban takes effect. Ariel Cobbert for NBC News

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

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