Jenna King-Shepherd had an abortion nearly a decade ago at a clinic in Birmingham that no longer exists.

“I was getting ready to go off to college and my parents really wanted me to get married and live in the hometown I always had been in and be a housewife,” King-Shepherd said. “I just knew that’s not what I needed to do.

“So after I found out I was pregnant, even though I didn’t really know about abortion, there was never really a doubt in my mind what I needed to do for myself.”

Full coverage of the abortion debate in Alabama

Today she would find her options limited. Alabama now has just three abortion clinics that regularly provide care, down from 13 in 2000.

Alabama last fall cemented state opposition to abortion. Voters in November added language to the state Constitution opposing abortion. It is a mostly symbolic move, although it would set the stage for quickly restricting access in Alabama should the Supreme Court overturn Roe v. Wade. The vote was the latest in a long line of state legislation that has chipped away at access or added new obstacles for Alabama women seeking an abortion.

King-Shepherd grew up in Guntersville in a conservative, religious home. Her parents did not approve of her decision to have an abortion so her sister drove her an hour and a half to Birmingham twice, one for mandatory counseling and again two days later for the procedure.

She bonded with the two other women in the waiting room over their shared experience, but has not since talked about her experience with anyone besides her husband.

“It’s really sad that more people in Alabama don’t talk about [abortion] because women tend to feel alone or that they’re the only ones going through this,” she said. “One in four women are going to have an abortion for whatever reason, and when I was going through mine, that’s not something that I understood.”

The National Abortion Federation lists three clinics statewide that regularly provide surgical and medical abortions. They are located in Huntsville, Tuscaloosa and Montgomery.

According to a 2011 study by the Guttmacher Institute, a research organization focusing on reproductive health, 59 percent of women in Alabama do not have access to a women’s clinic in their county.

Those limited options, combined with demanding state hurdles and waiting periods, force some Alabama women to travel long distances or across state lines and take extended time off work, at times pushing the procedure later into pregnancy.

Planned Parenthood tends to attract attention in abortion debates, but the organization only has two clinics in Alabama and none that provide surgical abortions on a regular basis.

Planned Parenthood has two clinics in Alabama, but can only perform abortion based on doctor availability from out of state.Kalamazoo Gazette

Staci Fox, president of Planned Parenthood Southeast Advocates, said Birmingham’s Planned Parenthood abortion services depend on the availability of providers in the area. Doctors are flown in from out of state to perform abortions at the Planned Parenthood clinics in Alabama.

Fox said despite Planned Parenthood Southeast’s long-standing relationship with the University of Alabama at Birmingham Medical Center, she believes doctors at UAB are not allowed to provide abortion services at Planned Parenthood or other abortion clinics around the state.

“They’re afraid of things like funding because here we have a state that wants to amend its state constitution to ban abortion, and UAB gets its funding from the state,” Fox said. “So UAB makes decisions like not allowing their staff to work for [Planned Parenthood] or other abortion providers to help provide access to women’s healthcare.”

A spokesperson from UAB said the medical center “does not have [such] a policy – official or unofficial.”

According to a 2016 study by the Department of Health Care Organization & Policy at UAB, it is difficult for women in Alabama to find an abortion provider in Alabama in a timely manner.

“Two-thirds of the women were unable to schedule their abortion 48 hours later owing to work schedules or because appointments were offered only once a week,” researchers found, “and four women were delayed until their second trimester even though they sought services earlier in pregnancy.”

Finding a clinic with openings, getting together enough money to pay for the procedure, which can amount to $600 in some cases, taking off work, and finding transportation all combine to create a nearly insurmountable barrier for many women facing an unwanted pregnancy.

King-Shepherd became pregnant during the summer and did not have to take off work or school. Her sister didn’t have to take off work because of her flexible schedule. She was able to pay for the abortion by using the monthly allowance her parents provided. But she said she knows things are not that easy for many women in her situation.

Amanda Reyes, president of the Yellowhammer Fund, helps procure funding, travel and lodging for women seeking abortion care in Alabama.

She most often sees women who live in Montgomery, South Alabama and the Florida panhandle asking for assistance, she said. “Those folks have the most problems physically accessing the clinics and that’s where do a lot of our help.”

Reyes said one case that sticks out to her is a woman whose partner was not supportive of her decision to have an abortion despite the woman being disabled. Reyes and her team helped the woman find transportation, childcare and funds to travel to Atlanta, where clinics provide general anesthesia for patients. She estimates they spent close to $1,500 to help the woman.

“Where we are now, it’s really bad and it’s been that way for a while,” she said. “Some of the different elements have changed, but I’d say the access landscape in general has not changed. It’s still extremely hard for people to access abortion care.”

Fox said the lack of access primarily affects poor women and poor women of color.

“When you look at our history [of Planned Parenthood] from 1930 to 2018,” she said, “it’s not like another provider has stepped up to fill that gap for access to healthcare.”

Fox pointed to Alabama’s high rates of cervical cancer in the Black Belt as another effect of women’s clinics, like Planned Parenthood, closing. She said clinics began closing because of Alabama’s political stance on abortion.

In November, 60 percent of Alabamians voted to add Amendment 2 to the state constitution, essentially codifying Alabama as a “pro-life” state.

Alabama has attempted to institute so-called TRAP laws, or Targeted Regulation of Abortion Providers, in the past, such as revoking clinic licenses when clinics are within 2000 feet of a school.

Summit Medical Center in Birmingham closed in 2006 after a physician’s assistant gave a patient medicine for a medical abortion. Lack of funding caused Huntsville’s Planned Parenthood’s closure in 2008. Beacon Women’s Center in Montgomery closed in 2010 because of health code violations.

Many others, Fox said, closed because of building code violations and the extra scrutiny abortion clinics are put under by the health department.

King-Shepherd, now a mother of a 2-year-old boy, said she kept her abortion secret until Amendment 2 passed in November. She invited women in her community in Guntersville to come to her house, to talk about the possible repercussions of the amendment. But almost all 25 canceled because they didn’t want to be associated with abortion rights, she said. Some said their husbands did not want them go.

“A lot of people in the South may choose to think of themselves as ‘good people’ who are loving and accepting people, especially because of their faith, but when it comes down to pressure and it’s something that affects you or someone you know and love, it’s what do you do under those circumstances that dictates who we are.”

After the amendment passed, King-Shepherd quit her job at her family’s company and started studying for the LSAT so she could apply for law school. She hopes to travel out of state with her family for school and eventually return to Alabama to fight for women’s reproductive rights.

“I had an abortion and I never regretted it, and that doesn’t make me a bad person,” King-Shepherd said. “I just did what’s right for me and I can’t imagine what my life would be like had I not had that right.”