Once an Abortion Clinic, It Now Offers Midwives, Formula and Housing Help

The Washington Post

13:12 JST, April 28, 2025

TUSCALOOSA, Ala. – Once, it was the sole abortion clinic in this half of the state. Then Roe v. Wade fell, the legislature’s near-total ban on the procedure took effect, and the protesters who would mass in the parking lot vanished. Nowadays, the crowd that gathers when word goes out follows the handwritten signs for “FREE STUFF.”

Under towering pines, the front lawn of the West Alabama Women’s Center turns into a rummage bonanza – with baby formula, children’s clothes and shoes, toys and other donations spread out on blankets.

“It’s hard to live paycheck to paycheck,” said Keilani Camara, a mother of three from rural Knoxville, as she perused the offerings at the most recent giveaway. Camara works at a trucking company; her husband is unemployed. “We can’t afford to buy all our kids’ clothes at Wal-Mart. Diapers, wipes, food: The economy of it! It’s so expensive to afford children.”

In the post-Roe world, the clinic has become an unlikely safety-net provider in one of the reddest states – which has some of the country’s lowest rankings for maternal and infant health. With billions of federal dollars for Medicaid and related programs threatened in Washington, staff are bracing for a cascade of cuts that would make their work even more challenging.

“What happens when we have a government that decides it doesn’t need to take care of its poor?” Director Robin Marty said as she sat in the heart of the clinic, where donated baby dolls from a recently closed maternity home were stacked. “We are a great net and we are very strong, but we can only hold so much.”

Abortion clinics in the Deep South were once bastions of resistance and reproductive health care, especially in smaller cities like Tuscaloosa. The West Alabama Women’s Center opened in 1992, hired 16 staff members and planned to become a full-service operation, Marty recounted. “But there was so much need for abortion that we were never able to really expand.”

When the U.S. Supreme Court ended a constitutional right to abortion in 2022, the several hundred patients whom the clinic scheduled monthly evaporated overnight and staffing was cut to just a few positions. Other abortion clinics went further. Reproductive Health Services of Montgomery, the longest-standing abortion facility in Alabama, shut its doors. Whole Woman’s Health closed all of its Texas locations. A clinic in Jackson, Mississippi, was sold, while a few elsewhere relocated to blue states such as Illinois and New Mexico.

In Tuscaloosa, Marty committed to remaining open and serving the most vulnerable female and LGBTQ+ patients, slowly rehiring and expanding services to meet their needs.

The clinic employs eight people, including a community outreach coordinator, a mental health counselor, doulas and midwives – who later this year will be able to deliver babies in a birthing center converted from what was once an abortion recovery room. Many of the 150 patients seen monthly have multiple needs, and the staff test for HIV and other sexually transmitted diseases, counsel on substance abuse and even fund care for dental needs, a leading cause of miscarriages.

They also keep gas cards on hand, since transportation issues often mean patients miss appointments, and help find emergency housing for those in need. A makeshift food pantry started in January is filled with boxes of macaroni and cheese, canned goods and baby food.

“We get a lot of unhoused population who come through here. How are you going to raise a child if you don’t have stable housing?” Marty said. “You can’t take a baby home from a hospital if you don’t have a car seat. What are you going to do? That’s one of the reasons we make sure everybody has car seats.”

Outside Alabama’s major cities, low-income women have relatively few options. Local health departments often have small staffs, and the wait for basic care can last months. Tuscaloosa is home to a federally qualified health center, with satellite locations serving parts of western Alabama. Another FQHC serves central Alabama. The state’s only Planned Parenthood clinic is nearly an hour away in Birmingham.

Across much of the South, in fact, reproductive health care has contracted. “The whole region is strained,” said Usha Ranji, associate director of women’s health policy at the research nonprofit KFF.

Marty and her staff regularly hold pop-up events offering blood pressure checks, ultrasounds and pregnancy tests to outlying rural towns such as Aliceville, Gainesville and Moundville. Depending on the season, they hand out holiday hams and turkeys. They appear at local health fairs and visit colleges, bringing emergency contraception where allowed. Last month, some clinic staffers were at the main campus of the University of Alabama, which is minutes away.

While the schools have their own health services, “we recognize that not every student is an affluent student who can afford all of that,” Marty said. Plus, with birth control, “there are a lot of students who do not want to use the health center because that notification will go back to their parents.”

Since its start more than three decades ago, the clinic has been tucked away in a sprawling, brown-brick office park. Inside, the waiting room for patients features a life-size cardboard cutout of a Black couple, with the reassurance that “Breastfeeding is normal.” On another wall hangs a rainbow-colored painting of a woman’s profile, captioned: “To the world, you are a mother, but to your family, you are the world.”

The only vestige of the past is a small sticker on the front-desk window: “Need to be unpregnant?”

“We can’t get it off,” Marty said.

Midwife Nancy Megginson began working here last fall after seeking permission from the elders of her evangelical church.

“Is it in line with our values?” they asked.

Yes, she told them.

“Would you be providing any abortions?”

No, she assured them.

Megginson, who had just had her fourth child, ended maternity leave a month early to join the clinic and at first brought her infant son with her. She relishes “being able to problem-solve and address people being underserved.” A quarter of pregnant women in Alabama receive no prenatal care. As a former labor and delivery nurse, Megginson is well aware of the complications that can result.

“This job meant so much, to meet a greater need,” she said.

One patient that day had come two hours from her home in rural Thomasville.

“There’s nowhere else for me to go,” said Tawney Thurston, 28, and three months pregnant, as she sat in an exam room after getting an ultrasound. “If this place wasn’t open, I probably wouldn’t have had an appointment.”

Thurston, who will be a single mother, is living with her sister’s family and supporting herself with a new retail job. She hadn’t yet qualified for private insurance so was relying on Medicaid.

Yet, what if federal cuts to the program affect her prenatal care?

“I am terrified. What am I going to do if I lose my insurance?” she said.

Clinic staff are also bracing themselves for the future.

Medicaid is the primary funder of women’s reproductive health care nationwide, and a sharp decrease in Medicaid resources – as advocacy groups worry lies ahead during the Trump administration – would take a big toll on already overwhelmed county health departments. Food banks and other safety-net groups could face steep losses, too.

In Tuscaloosa, all of it could send more patients to the West Alabama Women’s Center, taxing its nearly $1.2 million annual budget. Twenty percent of its funding comes from services, according to its director, with the rest from private donors and grants.

“If there are cuts, that does have a domino effect on other providers and that can lead to more demand for a clinic like this,” Ranji of KFF noted.

With every Medicaid patient it sees, the clinic takes a hit. Federal regulations require a facility seeking reimbursement for services through the program to have a physician with admitting privileges at a Medicaid-covered hospital. The clinic does not – because, Marty says, doctors and hospitals in the area refuse to work with it.

“We’re still being punished for providing abortion services,” she added.

Doula Crystina Hughes, who had brought friends to the clinic for abortions before the Supreme Court overturned Roe, is now its community outreach director. She started organizing mothers groups and food giveaways after one patient mentioned having nothing to eat but her children’s leftovers.

“I’m creating all these events so people don’t feel shame and come and get help,” Hughes said. “If we’re doing a visit and you’re like, ‘My lights might get cut off this month’ or ‘I don’t have food to feed my kids,’ those needs have to get met first.”

The latest rummage event was a success, she thought. It drew several dozen people, most of them women of color. There were Black women – one was eight months pregnant – but also migrants from Guatemala and Mexico, some documented, some not. In the wake of federal immigration raids across the country, many said they had almost been afraid to come. But they heard clinic staff were trustworthy.

Mariana Maldonado, 32, and four months pregnant, was at the event to look for items for her daughters, who are 11 and 14, and her 6-year-old son.

“We need clothes,” said Maldonado, a legal resident from Mexico who works as a house cleaner in Tuscaloosa. Her husband works in construction, but as she put it in Spanish, “There’s not a lot of work right now.”

It’s been hard finding nearby clinics that will accept her Medicaid coverage and have Spanish-speaking staff, she said. She worries about federal lawmakers cutting Medicaid.

Her only alternative if they do? “Work more.”