The Washington PostDemocracy Dies in Darkness

Opinion Access to contraception will be all the more vital in a post-Roe world

A one-month dosage of hormonal birth control pills. (Rich Pedroncelli/AP)
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Rachel Schulson is a writer in Chattanooga, Tenn.

In 2004, I flew to Washington for the March for Women’s Lives. It was exciting to march with others for a cause I believed in. But watching the marchers and counterdemonstrators verbally clash over the right to abortion access, I felt far from my home in Chattanooga, Tenn., and the desperate need for essential services there.

The solution I struck on a few years later seems like one that, in the post-Roe world we seem soon to be entering, could be useful far beyond the abortion-services desert of southeast Tennessee.

When it comes to basic reproductive health, the situation in southeast Tennessee is about as stark now as it was in 2004. The only approved sex-education program in public schools is abstinence-based. In rural counties close to me, women may need to wait up to a month for appointments for long-term, reversible contraceptive devices, such as IUDs.

There hasn’t been an abortion provider in Chattanooga since 1993; a nonprofit called the National Memorial for the Unborn now stands where that clinic once offered services. Women seeking abortions often drive two hours to Atlanta or Nashville, or an hour and a half to Knoxville (where abortion services are still available, even though a Planned Parenthood clinic was torched in December).

Back in 2004, the abortion rights advocates on the streets in Washington and antiabortion protesters shouting at them from the sidewalk were never going to agree on abortion policy. Meanwhile, women in my community were getting pregnant when they didn’t want to be. I started thinking about practical solutions.

It took almost a decade, but I founded a contraception-access nonprofit in southeast Tennessee, based on an organization in Memphis. That kind of pragmatic, prevention-only work appealed to me because I respect those who don’t feel as I do — and because I don’t believe there will ever be a consensus.

The goal of the organization, A Step Ahead Chattanooga, was to offer comprehensive sex education (you’d be surprised by how many women don’t know why they get periods); provide free contraception, including the insertion or removal of IUDs and implants; and supply free transportation to appointments if needed. ASAC today offers its services in 18 counties in the southeast corner of Tennessee, rural north Georgia and northeast Alabama. (I retired from the organization in 2019 and no longer speak for it.) Contraceptives are relevant to almost everyone, regardless of personal politics or beliefs about abortion access. What ASAC doesn’t do is offer abortions or referrals for them.

Such models are rare in the South, and in other places where people struggle to gain access to basic reproductive care.

Whenever I spoke publicly about ASAC at churches, civic organizations, homeless shelters and elsewhere, I could sense people’s tense shoulders relaxing as they realized that the organization wasn’t involved in abortions — beyond trying to make them unnecessary. The dozens of ASAC referral partners include many Christian nonprofits that recognize the importance of making contraceptives available but wouldn’t have associated with a mission that facilitated abortions.

To this day, I don’t know where many of the people I worked with inside and outside the organization stand on abortion, and until now I have never publicly shared my own views. It didn’t matter. You can advocate for contraceptive access because you want to prevent abortions from being performed; you can advocate for contraception access because you believe that all reproductive decisions — from abstinence to abortion — should be solely a woman’s prerogative. Either way, you’re supporting contraception.

I hope efforts like the current one in Missouri to pull Medicaid funding from some methods of birth control don’t begin to erode this middle ground.

To date, ASAC has connected almost 5,500 women with free contraception, mostly IUDs and implants, and offered sex education to thousands more. Most clients are in their early 20s, in committed relationships and have completed some college courses. Almost half have no insurance, and more than a third were not using any method of contraception before receiving one through ASAC. Some in the reproductive justice movement may find the organization’s willingness to make compromises unacceptable. But that sort of rigidity strikes me as all too similar to the inflexibility of those who oppose contraception itself.

As far as my views are concerned, I wish Roe v. Wade would remain intact and abortion was available to anyone who sought one, anywhere. But I also live in one of the many parts of the United States where abortion is already unavailable. Helping women who do not feel prepared for parenthood to avoid getting pregnant seems essential.

As activists prepare for a post-Roe future, shouldn’t a prevention-oriented model, with its big tent and ability to appeal across partisan lines, be part of the plan?