Increase in abortion capacity for sure, up to five year wait for “birthing center”
By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
Choices – Memphis Center for Reproductive Health, Tennessee’s oldest free standing abortion clinic, has purchased a vacant medical building in the midtown Memphis area, near the intersection of I-40 and I-240, with plans to move there and make additions to its new property that will create a more than 15,000 square feet mega-facility.
Abortion will continue to be a prominent feature at Choices, as it has been since the mid 70s, but the latest twist is that the group plans to offer a birthing center. This supposedly makes it the first non-profit clinic to offer abortions, births, and other “sexual and reproductive health care” under one roof.
A number of legal and financial obstacles stand in the way, but It is hard not to wonder whether the carrot of the birthing center is being dangled in front of the boards and courts and donors as an incentive to accept the stick of the abortion clinic.
Birthing centers are popular in the U.S. right now, offering a sort of middle ground between the more high tech hospital birth with a doctor and home births overseen by midwives with minimal equipment. Kate Bauer, executive director of the American Association of Birth Centers tells the Memphis Commercial Appeal that the number of birthing centers in the U.S. has grown by 60 percent in the past five years, so that there are now 320 nationwide (MCP, 10/8/16)
Birthing centers offer women with low-risk pregnancies a more home like birthing experience with a midwife, but at a facility with better equipment than would be found at regular home, in case there are special complications. Choices has hired a board-certified obstetrician-gynecologist to oversee the midwives at the new center.
However, for Choices – Memphis Center for Reproductive Health, all that may be a number of years away. A lot remains to be done before the new clinic opens.
Choices is mounting a $3 million campaign to come up with the funds needed for renovations and operating costs. Moreover, it needs to get some zoning variances from the city’s Board of Adjustment for its new location.
Choices is scheduled to go before the zoning board on October 26 to get zoning variances. Part of their new building is in a residential, rather than medical area, and isn’t set back an appropriate distance from the property line. And Choices is asking that the variances stay in place for up to five years in case it takes that long for them to raise the $3 million it needs to finance the construction.
One of the biggest obstacles is a Tennessee law requiring that abortion clinics be licensed as ambulatory surgical centers (ASCs), similar to the Texas law the U.S. Supreme Court considered this past summer in Whole Woman’s Health v. Hellerstedt. Rebecca Terrell, the clinic’s administrator, says that while the current clinic already meets those standards, it would have to get a “certificate of need” to offer abortions at the new site, a process she says would be prohibitively expensive.
Choices is counting on the courts striking down the Tennessee law in light of the Supreme Court’s rejection of the ASC requirement in Texas. The clinic has challenged the Tennessee law on ASCs with its current certificate of need requirements and is waiting for a ruling.
Choices claims that there is a shortage of gynecological care in Midtown Memphis, and a real need for this sort of service. But five years is a long time to wait for a new birthing center.
Note that meanwhile, there is no indication of any planned pause in Choices’ abortion business while they wait for those approvals.
But there is another intriguing question. Is all that additional space really needed for a birthing center?
Other birthing centers offer spacious labor, delivery and recovery rooms of about 400-500 square feet that can accommodate staff, equipment, furniture and numerous visitors (e.g., healthcare design magazine, 7/31/15). By contrast the 9,000 additional square feet that the new center would offer over the current Choices location seems a bit much for the three birthing suites the groups says it plans on adding. 
To be sure, Choices says that it also intends to add pre and post natal care, mental health services, and other “reproductive health care.” But it is unclear why those services, some already offered at their current location, would require the significant, expensive new additions Choices has planned.
Abortion, on the other hand, has been a part of Choices since its beginning in the mid-1970s, when it was said to be the first abortion clinic in the Mid-South region (the parts of Tennessee, Mississippi, Missouri, Kentucky, Arkansas, and Alabama surrounding Memphis).
Choices was started as and technically remains a non-profit, though its abortions are pricier than most. A 2014 Guttmacher publication puts the average first-trimester surgical abortion at $480, a “medical”(chemical, drug induced) abortion at $504. Choices medical and surgical abortions both start at $700, with sedation optional at $280. Surgical abortions from 12-15 weeks go for $800.
Because Tennessee has a 48-hour waiting period, every abortion at Choices involves at least two visits. Choices requires that patients pay $200 of that fee up front at their first visit, in which they receive their counseling, ultrasound, lab work and schedule their next visit for the abortion.
Why the deposit at the first visit?
Donna Randolph, medical director for Choices, told the Commercial Appeal that she can count on one hand the number of women who backed out of having the abortion, but Rebecca Terrell, Choices executive director told the same paper that it was standard for any clinic for just over half to come back for the abortion after the counseling.
The deposit would guarantee the clinic income even if the woman changes her mind.
Choices also offers a special $2,000 “private surgical abortion” (sedation $500 extra), with a $300 non refundable deposit. This cachet service offers a private appointment with “compete privacy, a more flexible schedule,” and it “reduces the amount of time you are in the clinic,” according to the Choices website [https://memphischoices.org/medical-services/abortion-services/private-abortion-services].
Otherwise, it is unclear what the extra $1,300 over the standard $700 fee buys the patient. A RhoGAM injection, for which regular patients are charged $80, is included, if needed. The patient will still be charged an additional $50 if they schedule a PAP Smear and STD/STI Screening with their visit (it is $55 extra for the non-private patients), but the private experience does apparently come with routine HIV testing.
We do not know precisely how many abortions Choices performs each year, but it is obviously a featured service and likely a significant money maker for the “non-profit.”
There were 4,595 abortions performed in Shelby County, Tennessee in 2011, the county where Choices is located. The only other abortion clinic advertising in the area is Planned Parenthood, which said it performed 2,370 abortions in its annual report for fiscal 2011.
Even if Choices performed only 2,000 of the abortions in Shelby County and charged its lowest rate, that alone would represent $1.4 million in income for the group.
Medical Director Randolph previously handled the abortion cases at Choices, but a new doctor, Susan Lacy, has been brought it run the birthing center. What Lacy, who was on the board of Planned Parenthood’s Memphis affiliate board of directors as recently as 2014, will do in the meantime for Choices while she waits for the birthing center to be built, is not specified, but she has been named as Choices director of obstetrics and ambulatory gynecology.
The current timeline on the Choices website has the obstetrics and midwifery services department coming into being sometime in 2017/2018.
Putting all the pieces together, the opening of the birthing center is far from settled, but the expansion of Choices abortion services seems a near certainty. Together, Choices and Planned Parenthood have helped to make Shelby County responsible for more abortions than any other county in Tennessee (more than twice that of Davidson Country, which includes Nashville).
The folks at Choices are clearly proud to become the first freestanding non-profit center with offering both birth and abortion services. They apparently believe it opens a whole new service area and revenue stream. Perhaps they even believe this will provide the community with a valuable and needed service.
But at least publicly they do not seem to have considered how a pregnant mother will feel about giving birth to a baby in a room, no matter how homey and pleasant, just down the hall from a room where one of the clinic doctors is taking the life of a child.
 There is a new free standing birthing center in Baton Rogue that fits three birth suites into a 4,300 square foot building – half the size of Choices new footage – but this space also includes birth tubs, large private bathrooms, a spacious classroom, and a family style kitchen.)