On the sidewalk of a four-lane, one-way street, a woman walks to EMW Surgical Center in Louisville, Kentucky for her appointment. It’s a Saturday morning in the fall and the sun is just about the peek through the almost leafless trees.
She is accompanied by a male companion and a clinic escort. A woman with an open Bible in her hand tries to keep up with the group.
The woman walking to get to her appointment keeps her head slightly down but occasionally looks to the escort on her right. She passes through a group of about 20 people standing on both sides of the sidewalk. They hold prayer beads while softly singing Ave Maria.
As the woman gets closer to the clinic’s entrance, she passes a petite woman with red hair who tries to hand her a pamphlet. A man who’s hooked up to a wireless microphone system also approaches her.
“Please don’t murder your baby,” the man says as he holds a large poster board with the phrase “CHOOSE LIFE” on top of a photo of a baby.
Without making eye contact with the protesters, the woman passes through the line of clinic escorts who block protesters from the entrance. The protesters stop following once they reach the wide, white line that indicates the clinic’s private property.
“We provide a very necessary service,” EMW’s director Anne Ahola said. “It’s a health issue; it’s not a political issue to have an abortion.”
This woman isn’t the only one who has experienced this while getting an abortion at EMW. Some have experienced worse. This is the reality of Kentucky’s last abortion clinic.
Kentucky is one facility away from being the first state in the country without an abortion clinic. The state has attempted to shut it down by claiming the clinic’s transfer agreements are inadequate. Depending on how the federal district judge rules in the case, the clinic could close early next year.
For the past several months the clinic has been in the spotlight as individuals, groups and news organizations wait to see what the outcome could be for abortion services in Kentucky.
Back in March, EMW received a letter from the Cabinet for Health and Family Services notifying it that the clinic’s transfer and ambulance transportation agreements didn’t comply with state regulations.
The transfer agreements are written agreements between the clinic, local hospital and ambulance system indicating that a patient can be transported by ambulance to the local hospital if complications occur at the clinic.
According to the court complaint filed by the clinic, the facility has had the same hospital agreement and ambulance agreement on file with the Cabinet both for several years with no complaints from the inspector. Last year, the inspector found the agreements acceptable and renewed the clinic’s license through May 31, 2017.
But in its March letter, the Cabinet deemed the signature from the Chair of the OB/GYN Department as deficient and instead said it needs to be from the owner of the hospital. The Cabinet also claimed the ambulance agreement lacks certainty of whether the patient would be transported to the hospital.
The letter informed the clinic that its license would be revoked within 10 days unless the transfer and transportation agreements were fixed before then. Shortly after the notice, the clinic sued the Cabinet in a fight to stay open.
The crowded sidewalk
Anti-abortion protesters at EMW will get to the clinic as early as 7 a.m. They wait about an hour for the patients to arrive and walk to the clinic for their appointments.
Joseph Spurgeon, the lead pastor at Sovereign King Church in Sellersburg, Indiana, is one of the regulars who tries to come out every Saturday morning.
He distinctly remembers the first time coming to EMW four years ago after a friend from seminary school invited him to join to protest.
“I had just left from holding my little newborn daughter in my arms and now I’m here watching people walk in…cussing and basically going in to murder their child and saying they don’t care that’s what they’re doing,” Spurgeon recalled.
Spurgeon is also the local leader of Operation Save America, a national organization that advocates to end abortion.
Back in July of 2017 a national event was held in Louisville for a week. According to Spurgeon, several hundreds of protesters came to the clinic each morning. One day he said there were up to 400 or 500 protesters outside.
The group didn’t just stay on the clinic’s sidewalk. Throughout the city, pastors were preaching the Gospel. Someone drove around town a truck the size of a U-Haul called a “Truth Truck” with images across it of aborted fetuses.
Downtown, outside of City Hall, a portable jumbotron displayed an abortion procedure. Group members also handed out flyers with some of the clinic employees’ names on them in the neighborhoods where they lived. (Anne Ahola, EMW’s director, was among those on the list.)
Whether the clinic closes or not, Spurgeon said he thinks the anti-abortion side will still win in the long term: “If we’re not able to win the pro-life argument right now, we can win by attrition because as they murder their children and they stop having children we’re gonna have bunches of children,” Spurgeon said.
Not all protesters use the same tactics to reach out to the women.
Laura Grijalba, a mother of seven, patiently waits outside EMW on Saturdays to meet women who might need help. She said she knows of six children whose mothers she has helped. All five of the mothers she met at EMW, she said. One mother was 19 years old. Grijalba said she asked how she was doing after exiting the clinic.
“She was like ‘I have to do this,’”Grijalba recalled. “And I said, ‘Why?’ She goes, ‘I don’t even have my driver’s license. I don’t even know how to take care of myself.’”
Without hesitation, Grijalba said she offered to throw the woman a baby shower. The woman was surprised by the kindness, Grijalba said, and the baby shower was later held in Lexington.
Grijalba said she thinks protesters who display images of aborted fetuses and tell the patients they’re going to hell are doing it wrong.
“It’s not effective,”Grijalba said. “I don’t know what they’re thinking.”
Grijalba and her husband are local leaders of 40 Days for Life group, an international organization whose mission is to end abortion through prayer and fasting, constant vigil and community outreach. From Sept. 27 to Nov. 5, there was always at least one person praying for 24 hours outside of EMW.
Grijalba sees herself as a mentor to other women. She said she can see that the women who go to the clinic under difficult circumstances need help.
“I can see the pain in the women’s eyes when they’re walking into the abortion clinic,” Grijalba said.
Helping the patients get inside
Clinic escorts aren’t new to EMW.
According to “Standing Up For Reproductive Rights: The Struggle for Legal Abortion in Kentucky,” a book on the history of Kentucky’s reproductive rights, EMW has had escorts since 1986 for safety reasons given the amount of protesters who show up on certain days.
One Saturday a few months back, Kate Lafferty-Danner, a University of Louisville graduate student, escorted a woman from a parking garage a couple blocks away from the clinic. EMW does not have a designated parking lot. As a result, patients must park at a meter, various lots near by or the parking garage farther away.
The woman, who came by herself, had earphones. Lafferty-Danner suggested she keep them in to block out the noise of protesters.
As they walked on Second Street toward the clinic, a protester started to follow them. Lafferty-Danner noticed the woman getting upset. She leaned over near the woman’s ear and offered her hand to hold.
The woman held tightly onto Lafferty-Danner’s hand while putting her hood up with her free hand as the two walked the rest of the way to the clinic.
“Having somebody that you have just met….feeling comfortable enough to grab my hand or take a hold of my arm so I can get them through the doors is incredibly moving,” Lafferty-Danner said.
Lafferty-Danner grew up in New Jersey where there are 41 abortion clinics. Being an escort has made her realize the challenges women face to get an abortion in Kentucky.
“For me it was kind of eye opening to be exposed to that world where you know you have one option when it comes to your reproductive health if you do want an abortion,” Lafferty-Danner said.
Clinic escorts are stationed by the front of the clinic as well as by the parking lots. The escorts who stand by the entrance face the brunt of the protesters.
Emory Williamson, a nonprofit worker in education, usually guards and monitors the front entrance with several other escorts.
Several times in the past protesters have gotten within a foot of him and either yelled directly at him or at patients inside the clinic. When this happens, Williamson will ignore them and turn his head to monitor the sidewalk.
This is a technique he and all the escorts are trained to do.
“If I get distracted in any way [or] capacity you know the antis win because they know I’m not focused on the clients,” Williamson said.
When Operation Save America came to EMW in July, a protester got up close to Williamson’s face and yelled at him then stepped back and spat on the ground near his feet.
“I thought it was disturbing, but I also remembered that I needed to maintain focus,” Williamson recalled.
Williamson said he started advocating for a woman’s right to access abortion as early as 16 years old.
He said he started volunteering as an escort after friends confided in him about their abortions. The “horrific, unsettling experience” his friends encountered from the protesters upset him. Although he knows this is an experience he will never face, he wants to be involved in some way.
“I need to at least try to understand and to at least listen and to at least get involved in some capacity otherwise I’m just, you know, promoting the status quo, and the status quo benefits white straight men,” he said.
The legal showdown
The state and the clinic presented their arguments in a three-day trial in early September. Both sides attempted to answer the question of whether the state’s requirements impose an undue burden on a woman’s right to an abortion.
In the trial, EMW, along with Planned Parenthood of Indiana and Kentucky, argued that the transfer agreements at question were unnecessary, stating that abortion is an extremely safe procedure and that in the very rare case of an emergency, a hospital is already required by law to accept the clinic’s patients.
The Cabinet defended their requirements by claiming they serve to protect the health of women who seek abortions. They also argued that women in Kentucky could still go to a neighboring state to seek a legal abortion, which doesn’t make the potential closing of EMW an “undue burden.”
Don Cox, the attorney who has defended EMW in the lawsuit, said he thought the defense’s evidence was a joke.
“They didn’t have the proof, and we had all the proof,” Cox said.
EMW has been a regular client of Cox’s law firm for 30 years. Cox said he felt comfortable taking on a case that he said is “based upon these phony arguments raised by the governor who’s rabidly anti-abortion.” However, Gov. Matt Bevin’s attorney Steve Pitt, said the clinic didn’t come close to proving to the judge how the agreements posed an undue burden, according to a news brief by the Associated Press.
This isn’t the first time Bevin’s administration has attempted to block a Kentucky abortion provider from obtaining a license. According to a Facebook post from the executive director of the EMW Women’s Clinic in Lexington, the clinic closed in January of this year after the inspector general denied the facility a license. The landlord also did not renew the clinic’s lease after almost 30 years occupying the space.
Later that July, the state denied a license to Planned Parenthood of Indiana and Kentucky’s facility in Louisville for a final time after a year and a half battle, according to the clinic’s trial brief.
Tamarra Wieder, the Director of External affairs at PPINK, said she believed the clinic’s presented a compelling case, but she tries to not get too hopeful.
“I’m also realistic in that I know that it’s not going to be the end,” Wieder said. “I feel that the state will appeal.”
In late November, the attorneys submitted their final written arguments to U.S. District Judge Greg Stivers for the Western District of Kentucky. Cox and Wieder said they don’t expect a ruling until next year.
The clinic next door
It’s no coincidence that EMW’s building is right next to a crisis pregnancy center. Clinic escorts will stand near the organization’s parking lot to make sure EMW patients don’t mistake it for the clinic.
“The board of directors believed it was important to have a pro-life alternative for women on their way to the abortion clinic to have a safe place to consider their pregnancy options, even at the last minute, on their way to their abortion appointment,” Monica Henderson, the executive director of BsidesU, said via email.
BsideU for Life, previously known as A Woman’s Choice and Necole’s Place, is a organization that offers alternative options to an abortion. The services they offer range from free pregnancy testing to parenting classes.
Henderson said the organization helps about 160 women per month, and approximately 70 percent of their clients come from the 10 poorest zip codes in the Louisville metro area.
April Hickman was homeless when she walked through their doors after discovering she was pregnant almost five years ago. Hickman said she lost her job as an emergency medical technician due to her severe mental illness.
She was offered an abortion pill at the hospital where she had her pregnancy test done. At first Hickman wanted to abort, but later that night she had a dream that changed her mind.
“God showed me this little girl, not a baby, but a little girl and I knew what her name was supposed to be,” Hickman said.
The next day Hickman went to BsideU for Life. She remembers feeling scared and hopeless the day she walked in, but she said the organization has offered her compassion, love and understanding.
Hickman is now the mother of two little girls: Marlee, 3, and Michilee, 2. Hickman has eight children total, the oldest is 23 years old.
Hickman has taken parenting classes and anger management classes from BsideU for Life. She’s still currently attending their Bible study and counseling.
If she didn’t go to BsideU for Life for help , Hickman said she thinks she would’ve committed suicide.
“I think I probably would’ve ended my life,” Hickman said.
From a broader perspective
Kentucky isn’t the only state in the country with one abortion clinic. Five other states could be the first without a clinic: Mississippi, Wyoming, North Dakota, South Dakota and West Virginia.
The specific reasons vary behind why clinics have been dwindling down one by one in the other states, but all have one overarching reason in common: restrictions.
According to a 2016 article by the Guttmacher Institute, a research and policy organization that focuses on sexual and reproductive health and rights, 288 abortion restrictions have been enacted from 2010 to 2015. That makes up 27 percent of the 1,074 restrictions that have been enacted since the Roe v. Wade ruling in 1971 that guaranteed access to abortion.
Some of these restrictions are considered “TRAP” laws, short for targeted regulation of abortion providers, that abortion rights advocates say are designed to close clinics.
For instance, Mississippi’s last clinic, was almost closed due to being unable to gain hospital admitting privileges. Gov. Phil Bryant enacted the law back in 2012. In March of this year, a federal district court permanently blocked the law, according to an article by the Jackson Free Press.
Another state, South Dakota enforced a law back in 2011 that requires clinic patients to receive counseling at a “pregnancy help center” 72 hours prior to appointments, according to CBS News. Women in some areas of South Dakota also have to travel hundreds of miles to get to a clinic, according to a CNN article.
What is happening in these six states is just a microcosm of what is happening nationwide as clinics across the country are decreasing in numbers. According to a report by the Guttmacher Institute, there were 272 clinics nationwide in 2014, down from 329 three years earlier.
The impact for one patient
Elizabeth R. was upset and angry at herself that she accidentally got pregnant for the second time while working and going to school part time to earn her graduate degree.
“It was not the time,” Elizabeth said. “I just don’t see how possibly we could’ve financed it.”
The decision to get an abortion wasn’t difficult for her to make, she said. Elizabeth thinks carrying the pregnancy and having the baby would’ve been a bad decision.
“I would’ve felt more guilt raising a child in a household where both their parents weren’t satisfied,” Elizabeth said.
This past March she went to EMW for a second time to get an abortion. The first time she went was in 2011.
Elizabeth doesn’t recall encountering any protesters the first time she went. But the second time was on a Thursday, and she remembers more protesters than usual were there.
She, her partner and the clinic escort walked together to the clinic. Elizabeth started getting nervous so out of habit she started smiling. She recalls mainly white male protesters yelling at her to stop smiling, saying “murder” isn’t funny. One of them called her partner a coward.
Elizabeth remembers feeling anger as she walked through the protesters. She wished they weren’t there. She wished the clinic wasn’t in such a public spot in downtown Louisville on the sidewalk of a busy street. She wished that there was parking for patients. However, she doesn’t know what she would’ve done for both of her unplanned pregnancies if EMW wasn’t there.
“I wish we had more than one clinic here. I wish we had like five clinics,” said Elizabeth, who asked to be identified by her middle name.
Business as usual
While people on both sides of the abortion debate wait for Judge Stivers’ ruling on the case, the Louisville clinic continues to operate as usual.
Beyond the dark tinted front doors of the clinic’s building is a small entrance area where patients check in for their appointment. One overhead fluorescent light is turned off while the other is dimmed, which makes it harder for people to see in from the outside of the clinic.
Through a box office-looking window, the clinic’s director, Anne Ahola, greets patients and asks for their photo ID and their payment. She hands them neon green clipboards with medical paperwork to fill out before unlocking the door that leads to the waiting room.
Ahola describes the clinic’s atmosphere as calm. In the waiting room, patients sit quietly in burgundy red and forest green chairs. The generic abstract art of the walls complements the neutral color scheme of the building. Calm jazz music plays over the intercom.
Ahola has been the clinic’s director since 2006. She said she can deal with the protesters day in and day out because she is “so convinced in that what we do is the right thing.”
With a background in marriage and family therapy, Ahola started at EMW as a counselor in 2000. She still counsels the women to make sure this is the right thing for them.
For Ahola, the clinic staying open is crucial for a woman’s health and safety because it can prevent women from getting an illegal abortion or trying to do the abortion themselves, both of which can put them in danger.
“It’s a choice that absolutely has to be there because if they didn’t have this option, they might…resort to trying to abort themselves,” Ahola said.