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Today marks the 47th anniversary of Roe v. Wade, the landmark Supreme Court ruling that legalized abortion nationwide, and it has never been more at risk. We live under an administration that is hellbent on ending access to legal abortion, and many state legislatures are dominated by fanatics who have been swiftly eroding that basic right for a decade now. Abortion clinics are reporting escalating rates of harassment and violence outside their doors. Just four years ago, three people were murdered by an anti-abortion terrorist at a Planned Parenthood clinic in Colorado Springs, Colorado. This March, with Brett Kavanaugh now on the bench, the Supreme Court is poised to hear a case that could close clinics across the country, and perhaps, if Republicans get their wish, even overturn Roe v. Wade altogether.

How do you celebrate an anniversary if you know it might be the last? If you’re a grassroots abortion-rights supporter, you’re doing more than that: You’re organizing.

Quita Tinsley is co-director of Access Reproductive Care (ARC) Southeast, an organization that provides financial and practical support to people who need abortions across six Southeastern states, including some of the most restrictive states for abortion in the country: Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee. Originally founded in 2015, the organization began providing financial and legal support in July 2016, just a few short months before Donald Trump took the presidency.

ARC Southeast was started by four Black women who were working in a clinic in Atlanta who saw firsthand that pregnant people were coming from all over to access care. As clinics across the southeast have been forced to close, Georgia has become a major hub for abortion care. The state now has more abortion clinics than Mississippi, Alabama, South Carolina, and Tennessee combined.

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ARC Southeast’s regional model reflects a shift that is happening beyond just abortion funds. As entire regions become inundated with abortion restrictions and bans, it becomes even more important to have a regional view, particularly if a state only has a handful of clinics, or even just one clinic left. According to the Guttmacher Institute, six states, including Mississippi, currently have only one abortion clinic to service the entire state. ARC Southeast’s approach doesn’t shy away from the scary reality that abortion rights are facing—it acknowledges it and then develops a solution to address the problem. And they’re already thinking about what they will do if and when Roe is overturned.

“For us, we know that no matter what happens legally,” says Tinsley, “we want to continue funding abortions, providing practical support, and being here for folks.”

Marginalized communities are already organizing for a potentially post-Roe world because, while Roe has technically been the law of the land, its promise hasn’t been extended to them.

Of course, the need for abortions won’t end if Roe v. Wade is overturned. But what do we do then? How will people who need abortions get them?



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One answer is regional hubs for abortion. Clinics that exist on the border of two or more states can help ensure access if one state becomes overtly hostile or even bans abortion outright. ARC Southeast provides financial assistance for an entire region. Some clinics, like Hope Clinic for Women in Granite City, Illinois, serve as regional hubs for abortion care.

Hope Clinic opened its doors in 1974, a year after Roe v. Wade was decided. Right on the border of Illinois and Missouri—two states with diametrically opposed abortion laws— Hope was established on the border specifically to meet the needs of people from both states. The divide has grown even starker in recent years. Last summer, Illinois signed into law the Reproductive Health Act, which protects abortion in the state and removes it from the state’s criminal code, an outdated and unenforced law that could pose trouble if Roe were ever overturned. Meanwhile, across the river, Missouri officials have been trying feverishly to close the state’s last remaining abortion clinic, a Planned Parenthood in Missouri.

As a result of the increasingly restrictive environment in Missouri and other neighboring states, including Indiana and Tennessee, Hope Clinic has been a de facto regional hub for abortion for years.

“About 58 percent of our patients in 2019 were Missourians, and another five percent were from other states outside of Illinois, so an overwhelming majority of our patients are coming from these really restrictive states,” Alison Dreith, deputy director of Hope Clinic, told DAME. “I think we need to see a lot more clinics like ours open in border cities across the country to make sure that patient sat still going to be able to access the care that they need, want, and deserve.”

Hope Clinic, which has already begun expanding the number of patients it can serve in the past few years, now has company. Last fall, Planned Parenthood of the St. Louis Region and Southwest Missouri, which is fighting to keep its doors open in St. Louis, opened a new, state-of-the-art clinic in Fairview Heights, Illinois, just a few miles from Hope Clinic. “The idea is that we are creating a regional abortion access hub,” Yamelsie Rodriguez, president of Planned Parenthood of the St. Louis Region and Southwest Missouri, told the New York Times when it opened. “In a post-Roe world, this is crucial to our mission.”

Another answer is to take abortion out of the clinic and give it back to the people. Self-managed abortion, when a person chooses to perform their own abortion outside of a medical facility, most often through medication abortion, can actually be a safe and effective option for folks, particularly those who are unable to access an abortion clinic. The World Health Organization has its own guidelines for self-managed abortion with misoprostol, and hotlines in countries where abortion is either highly restricted or outright illegal covertly share this information with callers. Research shows that when used on its own, misoprostol is up to 85 percent effective at ending a pregnancy. In states where abortion is heavily restricted (or may even become illegal), or even for those in states where abortion is legally protected but difficult to access, self-managed abortion can be a solid option.

While on the surface, self-managed abortion appears to be a solitary activity, in reality, it requires a community of support. Yes, patients need accurate medical information. But they also may need legal support if they face unjust criminalization for terminating their own pregnancies.

Farah Diaz-Tello, senior counsel at If/When/How, has been working for years to ensure legal protection for self-managed abortion and those who choose it. From working with grassroots activists and policymakers to ensure that the law clearly protects these patients to litigating in defense of those who have been criminalized for their pregnancy outcomes, Diaz-Tello brings her legal knowledge to the aid of what might, at first glance, seem beyond its purview.

“Self-managed abortion is something that holds a lot of potential because it really addresses the lacuna that exists in Roe itself,” Diaz-Tello told DAME. “Roe was really about the relationship between physicians and people who need abortions … It fails to address the fact that abortion isn’t like a product or a transaction that people contract with their physician. It’s a part of people’s reproductive lives that they’ve always had ownership of. Self-managed abortion has always been a part of people taking control of their reproductive lives.”

Diaz-Tello helped create the ReproLegalHelpline.org, a free, confidential helpline that provides information about legal rights regarding self-managed abortion. The helpline, staffed by advocates who can provide detailed information about laws regarding abortion and pregnancy, can also help connect callers to a defense counsel, if needed. It’s a simple and connective solution to a problem of isolation and misinformation. And, in a potentially post-Roe world, it could serve as a critical lifeline to those facing criminalization.

No one knows what the Supreme Court will do, and yes, it would be absolutely awful if Roe v. Wade were indeed to be overturned. But even if it’s not, the Court will continue to gut it in ways that will make access more and more difficult, and that will continue to impact marginalized folks first and foremost. Those communities are already taking the lead in terms of organizing for a potentially post-Roe world because, while Roe has technically been the law of the land, its promise hasn’t been extended to them. There is heartening, holistic work happening right now—beyond states, beyond borders, beyond legal and political advocacy.

If the unthinkable does happen, if Roe v. Wade is overturned, it will then be up to all of us to follow the lead of the grassroots activists who have been preparing for this moment. Patients will have to travel further and wait longer, or they may need help managing their own abortion. Regardless, the work will remain, and those who are doing it now will continue to do it.

When asked about what would happen in a post-Roe world, if abortion would become illegal in a swath of states across the southeast, Tinsley was emphatic about ARC Southeast’s future.

“We’re not going anywhere,” they said. “As long as there are barriers to abortion care, ARC Southeast is going to be here, making sure that southerners are being taken care of.”