The flashing sign outside the Sumter County Health Department advertises family planning services every Wednesday. That means birth control and STD testing. It’s one of the few places in rural Sumter County where women can get birth control, and it’s available for free.

But the lines there can be long and the wait time can take two hours or more, said KiErra Bailey, 22. Earlier this month she graduated from the University of West Alabama, just down the road from the health department.

“People in the cities don’t know what it’s like to drive 45 minutes to get the healthcare you want,” she said.

The nearest OBGYN is about an hour north, in Tuscaloosa, or 45 minutes west over the state line, in Meridian, Miss.

Tuscaloosa is also home to one of the state’s three remaining abortion clinics.

A look at the data shows that families in Black Belt counties like Sumter will likely be the ones most impacted by the nation’s strictest abortion law. It was signed last week by Gov. Kay Ivey, herself a Black Belt native. The law bans nearly all abortion and makes no exceptions for cases of rape or incest.

Alabama counties with the highest abortion rates, like Sumter, are in the Black Belt. It’s a region once known for its rich soil, but is now home to some of Alabama’s poorest, and often majority-black counties.

When you’re trying to make ends meet, an unplanned pregnancy can threaten your entire family, said Bailey. In Sumter County, the median household income is not quite $22,000 a year, according to the U.S. Census Bureau. That’s less than half the state average of $46,000.

“I don’t think people understand that when we say we’re struggling, we’re struggling,” said Bailey. She recently moved back to her hometown in nearby Hale County and is looking for work.

“You have to make a decision. Do I eat today, or take my kid to the doctor?”

The abortion law was designed as a legal challenge to Roe v. Wade and championed by Alabama’s Republican legislators. It was sponsored in the House by Rep. Terri Collins, R-Decatur, and in the Senate by Sen. Clyde Chambliss, R-Prattville. Both represent districts where the abortion rates are below the state average.

It’s a distinction not lost on some in the Black Belt.

“When you’re affluent and making decisions for the poor, you can’t possibly see where we’re coming from,” said Bailey.

“You want us to conform to your way of living and we don’t have the means. You have access and we don’t.”

KiErra Bailey, a resident of Hale County, Ala. is a recent graduate of the University of West Alabama.

Hit the hardest

A few years ago, Adley Joyce thought she was pregnant. At the time, she was a college student and wasn’t sure what to do or where to go.

She eventually learned her pregnancy test had been a false positive. It was a huge relief.

“But in that situation where I thought I was pregnant, I wanted to have a choice,” said Joyce, now 26. She works in Sumter County at a packaging company and is in school to earn a master’s degree in business.

“Now that women can’t have a choice, it’s a big deal.”

Adley Joyce lives in Demopolis and is working on a master's degree in business.

In Alabama, 65 percent of abortions are performed on black women and women of color, though they account for only one-third of all pregnancies.

And while the Alabama Department of Public Health doesn’t report socioeconomic status of women who get abortions, nationwide nearly half of women who get abortions live in poverty.

Greene and Sumter Counties – two of Alabama’s poorest counties, according to the 2017 median household income reported by the U.S. Census – have the second- and third-highest rates of abortion according to 2016 data, the most recent available from the Alabama Department of Public Health. The highest rate is over in Macon, near the Georgia state line. There, about 20 percent of all pregnancies end in abortion. The state average is about 9 percent.

Alabama Abortions as a percent of all pregnancies by county.

“Where we are is a big Bible Belt area,” said Joyce. “But I’ve actually been really surprised to see people I thought would be so against (abortion) say this law is too extreme, that they’re taking it too far.”

Hard to access

One of the reasons women in places like Sumter County seek abortions is the lack of healthcare options, said Candace O’Brien, vice president of health care access at the Yellowhammer Fund, a Tuscaloosa-based organization that provides financial assistance to women seeking abortions.

“There’s a lack of reproductive and sexual healthcare access in the area,” said O’Brien. “Or they don’t have transportation to get to a medical care facility.”

That lack extends to women who choose to have their babies.

Half of all births to Greene County mothers get less than adequate prenatal care, according to ADPH numbers. Statewide, just one-quarter of mothers receive less than adequate prenatal care.

And about 47 percent of children in Greene and Sumter Counties live in poverty, according to the U.S. Census Bureau

Because Alabama did not expand Medicaid, only the poorest Alabamians are eligible. That leaves many women without insurance.

“When I stopped being eligible for Medicaid, it was hard,” said Bailey. She’s now on her father’s insurance for a few more years, she said, but still has high co-pays and deductibles.

“I started not going to the doctor. Do I risk not going, and getting sick? Or having these bill collectors calling?”

More of a say

Tandreka Holloway, 23, is a student at the University of West Alabama and plans to graduate in December with a degree in criminal justice. She’s from Chambers County, which also has an abortion rate much higher than the state average.

While she said she personally is against abortion, she doesn’t like the way the law was passed.

“I feel like all women should be able to decide if they want to keep their child or not, especially if they may not be financially stable,” she said.

“I just feel that more people who are affected, who might need to have abortions, should have had more of a say-so in this. If they had asked people in the state, it may not have passed.”

Tandreka Holloway is a student at the University of West Alabama.

Leaving

About 10 years ago, Bailey said, her mother had to have an abortion because an ectopic pregnancy threatened her life.

“She already had three children,” she said. “My mom said it was the hardest decisions to make. It’s something that changes you on the inside.

“These women aren’t heartless. They made a decision and chose themselves.”

Bailey said she hopes eventually to leave Alabama. So does Joyce.

“Nothing’s changing around here,” said Joyce. “I’ve always said I wanted to be the change, and to try to make change in this area and the state. But we’re only going backwards. I don’t feel the need to stay where we’re not moving forward.”