KNOXVILLE, Tenn. -- Sarah, a 26-year-old with blue eyes and pink nails, wakes up before sunrise on the outskirts of Knoxville, Tennessee. Normally, she'd head to her outpatient rehab program, which she attends voluntarily every day for an addiction to prescription painkillers. But this Monday, she won't make it: She's got a doctor's appointment. She climbs into her weathered Nissan Maxima, drops her 3-year-old daughter Laela off at her mother's house, and makes the 45-minute drive to the Knoxville Center for Reproductive Health, which is located so close to the University of Tennessee campus that appointments aren't scheduled during home football games. Sarah parks her car and walks briskly past a group of pro-life protesters, which includes a couple of devoted regulars: two middle-aged men who've been protesting on this spot for over a decade.
Thirty-four women like Sarah have appointments today. It's a typical day for the clinic, but a not-so-typical one for the patients, who have to drive as long as eight hours from as far away as Kentucky and Mississippi to get there. When Sarah arrives, the waiting room is half-full of women fiddling with their phones or watching Rachael Ray on a TV screen. A couple speaks in Spanish. A toddler sleeps in the hallway. One young woman leans on her boyfriend and wipes away tears.
Sarah got pregnant during a drug relapse and is eight weeks along. She's no longer in touch with the father. Sober for only about four weeks now, she wants to focus on getting clean before having another child. But when she called the clinic to make her appointment, she learned she would not be able to get the procedure right away—Tennessee is one of 28 states that now requires women to undergo a waiting period before having an abortion. Here, the mandatory wait is 48 hours. And here, as in about half the states with waiting periods, Sarah is also required to attend an in-person counseling session, meaning she has to make two separate trips to the clinic.
Those two days play out like this:
Sarah's first appointment takes over four hours, most of which she spends, coincidentally, waiting. There's only one doctor at the clinic today, who has to split her time between this, another clinic, and another private practice. The staff is stretched thin.
First, Sarah undergoes a lab test verifying she is pregnant, along with an ultrasound. A staffer takes her medical history and checks in on how she's feeling emotionally. Under Tennessee law, a woman cannot be coerced into an abortion, so the staffer ensures that she is not. Sarah then watches a 15-minute video that details the risks associated with abortion and the aftercare. And as part of new legislation that took effect last July, a board-certified doctor conducts "counseling," which entails reading Sarah a state-approved script that informs her that abortion "constitutes a major surgical procedure." Further still, the state requires the doctor to inform her that a fetus can survive outside the womb 24 weeks after conception (despite the fact that there aren't any clinics in Tennessee that will perform abortions after 16 weeks). The doctor then must legally add that should Sarah decide to proceed with her pregnancy, there are services available to support her.
Only after all this can Sarah provide informed consent.