Contraceptive providers in Chattanooga are seeing a heightened interest in pregnancy prevention as well as concern that contraception access in Tennessee could be restricted since the U.S. Supreme Court overturned Roe v. Wade two weeks ago.
A Step Ahead Chattanooga, a local nonprofit group that provides no-cost birth control to anyone who lives or goes to school in one of 18 regional counties, has seen a significant spike in calls since the landmark decision establishing the constitutional right to abortion was reversed, Executive Director Mandy Cowley said.
"We've had more calls to our appointment line than we sometimes get in an entire month," Cowley said in an email six days after the June 24 ruling, noting that 11% of this year's calls to A Step Ahead have come during that period.
Callers range from people wanting to be connected to free birth control to those with private insurance struggling to find open appointments and even men or women interested in permanent surgical sterilization, which the organization doesn't cover.
"I think our community is concerned about whether there will be restrictions to contraception here, so we are getting a lot of questions about that, as well," Cowley said in an interview, pointing to states like Missouri, where last year legislation aimed to stop the state's Medicaid program from funding emergency contraceptives, such as Plan B, or intrauterine devices, a category of long-acting, reversible contraception commonly called IUDs.
Lawmakers in Idaho and Louisiana are also eyeing bills that could restrict Plan B, IUDs and potentially other forms of birth control.
For nearly 50 years, the landmark Roe case established the constitutional right to abortion based on the principle of privacy founded in the 14th Amendment. But with that case now overturned, many reproductive rights advocates and health care providers fear conservative lawmakers in states that have banned or heavily restricted abortions - such as Tennessee, Alabama and Georgia - will target other precedents.
"It scares me the road that we're on, especially because that specific topic (contraception) was alluded to in the Supreme Court filing," Dr. Heather Urrego, an obstetrician-gynecologist at Erlanger Medical Center, said in a phone interview.
Though Justice Samuel Alito, who wrote the majority opinion in the recent ruling, said "nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion," Justice Clarence Thomas wrote in a concurring opinion that other precedents, including cases allowing contraception and same-sex marriage, should be reconsidered.
The Chattanooga region hasn't had an abortion provider since 1993, and many in the region struggle to access basic reproductive care like birth control and testing for sexually transmitted infections, particularly in rural areas.
Urrego said a large part of her practice involves prescribing or administering various forms of birth control to her patients, who are primarily low-income and face barriers to basic health care. Many of her patients drive between one and two hours to Chattanooga to obtain reproductive health services because there are few or no providers where they live.
"It has huge implications for women's health care if women's access to birth control were to be limited, and I'm worried that it could be in the future," she said.
Unplanned pregnancies can limit education attainment, career mobility, cause financial strain and trap women in unhealthy relationships, Urrego said. They can also pose a safety risk to the mother depending on her medical conditions and the timing of the pregnancy.
In May, after a leaked draft opinion suggested the right to abortion would soon be overturned, Republican leaders in Tennessee told The Associated Press they had no plans to ban contraceptives if the draft opinion materialized.
"I can't promise what members may or may not file next year, but I don't have an issue with oral contraceptives," House Speaker Cameron Sexton, R-Crossville, told AP.
Gov. Bill Lee, who has signed some of the most restrictive abortion laws in the country, told the AP that "there is no law in our books that deals with emergency contraception and there are no plans for such," while a spokesperson for Senate Speaker Randy McNally said in an AP story the Oak Ridge Republican "would not support additional restrictions on contraceptives."
Despite those assurances, Rebecca Reingold, associate director of the Health and Human Rights Initiative at Georgetown University's O'Neill Institute, recently told STAT news that there is a serious legal risk of the right to contraception being reversed.
"Advocates of restrictions on access to contraception may argue that the right to contraception similarly 'destroys a potential life,'" Reingold said, meaning contraception is especially vulnerable even if other privacy-based rights remain intact, according to STAT.
Brooke Dillard, Marketing Communications Manager for A Step Ahead, said in an interview that some callers who already use a form of long-acting, reversible contraception - an overarching term for contraceptives that includes IUDs or arm implants that prevent pregnancy for up to three to 10 years, depending on the method - are now wanting to get those devices replaced early.
"Their IUDs may not be expired yet, but their concern is they don't know how much longer it may be accessible to them, so they're trying to expedite getting their IUDs replaced so they'll have coverage for the next three to 10 years," Dillard said.
Along with the pill, Urrego said IUDs are the most common form of birth control she provides. Because so many patients already came to her seeking contraception, Urrego said it's hard to suss out if demand has increased since the Supreme Court decision.
"Plus, our appointments are booked out so far ahead of time, even if people are calling up front to try to get in, I don't know that I would necessarily get that information," she said, noting that the clinic's next available patient appointment is in late September.
But Urrego said she has had two patients so far specifically request tubal ligation, a surgical procedure that results in female sterilization, as a result of overturning of Roe v. Wade.
"I never anticipated having people requesting sterilizations for that reason," she said.
With no immediate changes on the horizon, Cowley said A Step Ahead is "trying not to operate from a place of fear" and focused on connecting as many people as they can to contraception today.
"We are keeping our eye on legislation that's being drafted across the country, and, of course, in the three states that we cover, so it's something we're hyper aware of and really trying to keep a pulse on," she said.
Last year, the organization connected more than 1,100 people with access to free birth control - a significant increase from 2020.
"We are on trend to exceed that this year, and certainly in the past week, the demand has exponentially increased. So we'll see if that sustains," Cowley said.
Since its founding in 2014, A Step Ahead has connected 5,500 people with access to free birth control. Nearly half of those clients were uninsured, and more than half were between the ages of 20 and 29, according to Cowley.
Many medical providers favor long-acting, reversible contraception over other birth control methods because they are safe and the most effective form of contraception that isn't permanent.
But their high price tag can make them out-of-reach for patients, particularly those without health insurance. The devices, along with the exam, insertion and potential follow-up visits, can cost more than $1,000.
In addition to paying for the contraceptive, A Step Ahead foots the bill for all related medical costs, including the exam, any needed testing, insertion and removal of a device if a woman decides later she wants children. The organization also provides transportation if needed.
The program doesn't perform medical procedures but refers patients to a partner provider through its appointment line. It reimburses providers for services not covered by insurance using donations from individuals and private grants.
In the past, A Step Ahead focused on offering such contraception but this year added a telehealth partner that provides access to the hormonal birth control pills that are delivered directly to people's homes.
"We really added that because we know that IUDs and implants are not right for everybody, but we also know that in our rural counties and in the rural communities that we serve, there isn't always a provider really close by who does IUDs or implants," Cowley said.
So far, the organization hasn't had to turn anyone away, and Cowley said she's hopeful the group can continue to meet demand thanks to donations.
"Basic reproductive health care is sometimes hard to access in parts of our region," she said. "I encourage people if they need help accessing effective contraception, we're here. Please reach out. Please call us."