A Model of True CHOICES: Learnings from a Comprehensive Sexual and Reproductive Health Clinic in Tennessee that Provides Abortions and Opened the City's First Birth Center

Abstract

CHOICES: Memphis Center for Reproductive Health staff is passionate about ensuring that everyone has access to the full continuum of comprehensive reproductive health care (including abortion, gender-affirming care, miscarriage management, and community birth) regardless of race, gender identity, sexual orientation, HIV status, economic status, or religious beliefs. Memphis, Tennessee, has a history of limited community birth options (birthing outside of hospital walls). In 2017, when home birth services were added to CHOICES and plans for opening Memphis’ first freestanding birth center were being imagined, it was intentional to create a model in which midwifery care could be accessible for patients who may be eligible for state-funded health care services, those considered at higher health risk than traditional low-risk midwifery patients, or both. In fact, individuals and their families with limited out-of-pocket funds and those historically marginalized would purposely receive holistic, individualized care based on their unique health care needs and personal desires, driven by a reproductive justice framework. In this article, we outline the success and challenges of addressing the reproductive health needs of marginalized communities, including the benefits of a nonprofit business model, operationalizing reproductive justice concepts, and the reclamation of Black midwifery. We also discuss the challenges of caring for Black birthing people and providing abortion and gender-affirming care in a politically hostile environment. Although individuals have complex needs, at its core, CHOICES believes that every person must be seen as whole human beings and that each can be cared for by a midwife. The CHOICES approach is informed by evidence-based information, clinical judgment, and an intentional partnership with and investment in a people who have historically been and are presently pushed to the margins, neglected, and blamed for poor health outcomes and demise. Striving to adapt the CHOICES model of care in other parts of the country is important now more than ever following the Supreme Court decision to overturn Roe v. Wade.