ATLANTA — The bright pink signs popped up around the city last spring, advertising a new clinic offering abortion and birth control. “Doors open in Atlanta,” the billboards proclaimed. “Because you matter.”

A new abortion clinic in the region would be notable enough: Across the Bible Belt, the swath of spiritual states stretching from Texas to North Carolina, the number of abortion clinics has dropped nearly two-thirds over the past three decades, in part due to restrictive laws, constant protests, and sporadic violence.

But the activists behind the nonprofit Carafem didn’t just want to quietly open their doors. Despite protests outside the clinic, the most recent a few weeks ago, they embrace an unapologetic brand of women’s health care, and they launched it with an in-your-face advertising campaign — in a conservative state where 4 out of 5 adults identify as Christian.


“We want to be really out loud about what we do,” said Melissa Grant, Carafem’s vice president of health services, as she sat inside one of the clinic’s exam rooms. Then she echoed the slogan on another of Carafem’s provocative pink ads: “Abortion. Yeah, we do that.”

In recent years, abortion rights activists have embraced a mantra of openness to erase the stigma of ending pregnancies, through initiatives such as “Shout Your Abortion,” the Sea Change project, and the “1 in 3 campaign.” Abortion providers like Whole Woman’s Health, whose clinics are in five states including Texas, have plastered the words of famous feminists on the walls of exam rooms.

Even against that backdrop, Carafem stands out. One of its ads touts medication abortions, used in the first trimester, as “the 10-week-after pill” — and even has turned that slogan into a Twitter hashtag. Another ad depicts a text exchange in which one friend casually suggests abortion to another. All the ads grab attention with that eye-popping shade of Carafem pink.

Such promotions, combined with Carafem’s vision for upscale, even chic, abortion clinics, have stirred outrage among anti-abortion advocates.

Brash ads stir a backlash

Carafem’s promotion of abortion pills has “crossed the boundaries of honesty and decency,” said Jody Duffy, the executive director of Post Abortion Treatment and Healing, which offers women — including some former Carafem patients — Christian counseling following abortions.

Elizabeth Greenwald, the leader of a local Georgia Right to Life chapter, said Carafem deceives women “by marketing a spa-like environment to hide the ugly truth that they’re killing an innocent child.” Mike Griffin, a pastor who lobbies for the Georgia Baptist Convention, said the fact that Carafem “creates a luxurious environment” in its clinic amounts to putting “a positive spin on a wicked act.”

Abortion opponents are already fired up by the prospect of more action on the federal level, including the Republican proposal to strip federal funding from Planned Parenthood and President Trump’s pledge to appoint pro-life justices to the Supreme Court. The backlash against Carafem could be sharp enough to stir more anti-abortion action at the state level, too, said Charles Bullock, a political science professor at the University of Georgia.

“This is the Bible Belt,” Bullock said. “Some people out in the suburbs, and the further out you get, see Atlanta as evil as New York — like Sodom and Gomorrah inside the perimeter.”

Despite the risks of a legislative crackdown, Carafem officials insist the only way forward is to talk about abortion in an “open and honest” manner that’s no different from conversation about other kinds of health care. To mute that communication, Grant said, would give women the impression their care isn’t as acceptable.

“People who don’t agree with our message, our pink signs, are going to disagree regardless,” Grant said. “What it can do is point out the difference in the way this service is talked about, in the way this division of health is handled. It can speak to the people who agree with us.”

Kat Boyd, regional director of health services, checks a bag filled with information about abortion and birth control that is given to patients at Carafem’s clinic in Atlanta. Tami Chappell for STAT
Pamphlets with abortion and birth control information as well ibuprofen, antibiotics, and the abortion pill mifepristone are available at the clinic in Atlanta. Tami Chappell for STAT

Developing a Southern strategy

Carafem launched its first clinic two years ago just outside Washington, D.C. The nonprofit sparked some controversy there, too.

When the clinic sought to promote its abortion services on public transportation this winter with the “10-week-after-pill” slogan, the D.C. Metro rejected the ad. So Carafem put the same ad on a billboard truck and had it driven around the city.

By then, the nonprofit had already expanded to its second clinic, in Atlanta. Originally, Carafem had no Southern strategy. But its executives soon realized a tenth of their D.C. patients had traveled more than 100 miles for an abortion — including from states as far away as Ohio and Texas.

“[W]omen are traveling further distances and incurring sizable expenses to access abortion care when they need it,” Carafem President Chris Purdy wrote in a Huffington Post op-ed last year. “… because of state-specific, restrictive laws, they may have to stay in hotels, miss days of work, and pay for childcare while being forced to adhere to a ‘mandatory waiting period.’ There has to be a better way.”

Purdy has long experience in the field: He’s also the president and CEO of DKT International, a global nonprofit that promotes family planning and HIV prevention, in part through aggressive marketing of birth control in countries across Asia, Africa, and the Middle East.

Carafem - Melissa Grant
Melissa Grant, vice president of health services at Carafem in Atlanta. Tami Chappell for STAT

As Carafem eyed expansion, Grant looked for cities with looser abortion regulations near states with restrictive laws.

Atlanta fit the bill. Nearby states such as South Carolina, Mississippi, and Alabama had been making it tougher for clinics to operate, though some of the laws enacted in those states remain hung up in courts.

Georgia has its own restrictions, including a law banning most abortion after 20 weeks gestation and a 24-hour waiting period for women seeking to terminate pregnancies. And the state, like many others across the nation, has had a history of abortion violence. In 1997, two bombs exploded at a clinic just outside Atlanta, in Sandy Springs, Ga., injuring several people.

But Grant saw potential.

Plush pink chairs and cups of tea

The Atlanta clinic is inside an aging office building on Peachtree Street, tucked between two Mexican restaurants. Located on the eighth floor — past a security guard, up an elevator, and past a locked entrance — Carafem’s clinic has a chic aesthetic that includes pink plush chairs in exam rooms and framed photos of smiling millennials fit for a magazine spread. Clinic staffers offer patients tea and snacks.

“We want this to be the best health experience you’ve ever had,” Grant said. “Not just the best women’s experience you’ve ever had.”

Doctors, on site three days a week, see patients in exam rooms that are as “de-medicalized as possible” to reduce anxiety, Grant said.

Carafem does screening for sexually transmitted diseases and sells a variety of birth control, advertised in the same cheeky style. One pink poster promises “5 star protection… for 5 star sex” and features peach and eggplant emojis. Ads on college campuses around Atlanta last fall used blushing and winking emojis to market birth control and abortion services to students experiencing “new sights… new sounds… new experiences.”

But while most clients leave with some form of contraception, 90 percent of the roughly 1,000 patients Carafem has seen so far in Atlanta come in for abortions. For $550, there’s “the Carafem procedure,” a surgical abortion that usually lasts less than seven minutes and is available to women in their first 90 days of pregnancy. If a woman is fewer than 10 weeks pregnant, she can opt for a medication abortion, taking series of five pills for $475.

Before women leave the clinic, staffers encourage them to jot down notes about their care, either on #MyCarafemExperience cards that are shared on social media or in pamphlets passed on to future clients.

They say things like: “A safe environment without judgment,” “I wish all doctor offices were like this one,” and “You’re angels.”

A travesty — or a beacon?

The picketers outside on Peachtree Street hope those “angels” hear their prayers.

They pray for the unborn babies. They pray for the expectant mothers. They pray for the Carafem staffers to pack their bags.

“They’re trying to de-stigmatize [abortion],” said state Senator Renee Unterman, a Republican, who chairs the health committee and has long been a staunch opponent of abortion. “I don’t think they’re being effective. You can’t put lipstick on a pig.”

Abortion rights advocates, however, see the pink billboards over Atlanta’s interstates as a beacon for women seeking treatment without judgment. Diane Derzis, the owner of the only abortion clinic in Mississippi (known as the “Pink House” for its bold exterior paint), said Carafem’s approach “takes away the shame” often associated with abortions by talking about them frankly and openly.

“This is putting abortion rights on the offensive,” said Elizabeth Nash, senior states issues manager of the Guttmacher Institute, which researches issues surrounding reproductive health.

Carafem officials say the tactic works — and it’s one they think will resonate throughout the South. Earlier this month, the nonprofit opened a third location in Augusta, Ga., about 10 miles from the South Carolina border. They hope the new clinic, like the first two, will make it easier for more pregnant women to say, “Abortion. Yeah, we do that.”

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  • To Margarita: While I appreciate your logic, there is a vast difference between a toddler and a fetus. In fact, there is a difference between a baby that is viable and one that still relies entirely on the mother in the same manner as that of a parasite relying on its host. When discussing abortion, it’s important to remember that carrying and birthing a child is still sometimes a dangerous, expensive, and possibly even fatal decision. Nobody should get to make that decision for a person but the person in question.

    If I have a baby and it requires immediate blood transfusions and I were the only match, I would still be allowed to refuse the use of my body, even if it means the baby might die. Please explain to me why an unborn baby has more rights than my already-existing children. Or me. (I realize this sounds confrontational, but I don’t intend it to be)

  • a couple of years ago I saw Jada Pinkett Smith report on CNN of sex trafficking and Atlanta. Perhaps this also influences choice of location of this clinic? and please watch 2014 Key & Peele skit: Mother Majesty– I will share that with my 12 year old when she is older — great understanding of power. Which does not mean I want unsafe abortions or limited birth control; it means I want abortion to be a serious decision and the gravity not “pinked” over. Patricia Monge-Meberg, MD

  • I applaud these women for letting their lives at risk to provide other women with control over their reproductive rights.

    To the author: please do not use the right-wing term ‘unborn baby’. Before it’s born, the correct term is ‘fetus’.

    • Please, you are entitled to your opinion regarding whether an unborn baby is a person or not. Personally, I don’t think that is debatable; however, to try to coerce someone to use the term fetus rather than unborn baby is ridiculous. And to use the term right wing when describing a person who uses the term unborn baby is ridiculous as well. That’s like arguing over whether you can use the term human or person when describing an infant, toddler, adolescent, prepubescent, elderly, middle aged, etc…, which are simply stages of development.

      Ted Jones M.D.

  • To Margarita: I can’t say I would like to invest time in dialogue with you as I see clearly your position and, as a 70-something retired social worker with a masters degree, I am not ambivalent on mine. May your heart remain open to things you cannot yet imagine. I wish you would invest some of your passion into the cause of ending war or capital punishment as they are the pro-life causes we can all agree on.

    To sflenore: I see you sensitive nature and would just caution you not to allow yourself to be used by Margarita in furthering her sense of mission to make all abortions illegal. Be at peace.

    • Thanks for your reply, Sue. The reason I want to dialogue is so that I have an opportunity to share things that you otherwise wouldn’t know about me: for example, I am very much against war and capital punishment unless there is absolutely no other way to defend oneself or others. It’s true that I hold my views strongly because I value truth & have researched the issues thoroughly. However, because I value truth, if I am wrong in any area about anything, I want to know it, and that’s another reason I value dialogue. I don’t like debate just for the sake of proving I can “win” an argument or just to “further my mission”. Being pro-life means that genuine personal connection with people is my priority. But of course I would want to gain support for protecting all human life through my dialogue with others; if I didn’t, it would mean my convictions are pretty lame, and there’d be no real connecting. I think we can be passionate about our dreams though and be passionate about real connecting at the same time.

  • I think of abortion as a tragedy in the same way that divorce is a tragedy – one that may become necessary. I am not attracted to the approach taken by this new clinic and find it distasteful. But I understand it in the context of the culture it is resisting. It overcompensates to make a point I suppose.

    I hold in my heart all those girls and women facing this tragic choice and I will continue to believe in your right to choose just as I will support the right to choose divorce even as our forebears were denied this option (and not all that long ago.)

    • Hi Sue Fraser Frankewicz! Do you mind to see my conversation with Sflenore below? I would really value a similar conversation with you as well. Thanks!

  • I struggle with this. I’m working on a project studying miscarriage and to many of these women a 10-week old was a very wanted child and life they mourn losing. To other women who don’t want the baby I imagine it is a zygote taken care of with a 10-week after-pill. It seems so incredibly subjective and short sighted to be so firmly in one camp or the other as one can’t really delegitimize either perception. As for me when I heard my sons heartbeat at 8 weeks, I think a clinic like this sets an unethical precedent for the reality that you are indeed ending a life that could be viable. Some decisions just are difficult no matter how much pink you ad and clever ads you create. I do believe in choice but I struggle.

    • Hi Sflenore! I really appreciate and respect your honest and thoughtful comment. I think it’s so important for people in our society to be able to have calm, respect-filled conversations about the hard stuff like this. Do you mind to share more about the thoughts that are causing your struggle with this issue? I advocate for pre-born babies to be fully protected by law like any other person is, but I truly value dialogue on this subject.

    • Hi Margarita! What a thoughtful comment back. Thank you. My struggle comes into play with the respect for choice and privacy because I think there are many medical situations where tough decisions have to be made for the safety of the mother or psychological issues must be considered. I can’t put myself in the shoes of someone with severe post-partum depression who just can’t go through that again, but I do empathize and think the choice to abort comes from a place of trying to do what is best for the woman and family. It is really difficult to decide what is more humane – abortion or a child growing up in an environment the mother knows will not be good and possibly full of pain/neglect/lack of socioeconomic support/addiction, etc. That decision seems so significant to me, and a cute pink ad does not seem appropriate! I think others would argue that I am placing far too much value in the “life of a few cells.” And this is probably true because my experience with being pregnant completely and utterly changed my perception of the connection between mother and child and where my rights begin and his end. This clinic, in my perception, is marketing abortion like another form of birth control and completely dehumanizing the fetus. Personally, I think this crosses an ethical line, and it’s where I lose my agreement with the pro-choice movement when there is a complete denial that this is indeed a living being. Many arguments I’ve read on comment threads devolve into semantics of what you even call a child/fetus/zygote/lump of cells/soul growing. I think there is great power in the decision to abort, or at least I think it is more ethically sound to put my tent in the camp of taking that decision seriously. In an ideal world, I would wish us to live in a society where as few living things are harmed as possible. This type of marketing of abortion turns my stomach in a way that I can’t explain, but I know I feel it, if that makes sense!

    • Thanks so much for being willing to have this sensitive conversation with me, Sflenore. I too have deep empathy for women who are facing difficult circumstances with their pregnancy, and I believe we as a society need to be there for them way more than we are. A big part of my ministry is facilitating a larger network of support in our area for women/couples in this situation. Many are actually in an emotional state of crisis and really need help in clearly knowing all their options. Thank God the only medical situation which may truly require ending the life of the newly conceived person is an ectopic pregnancy, but even with that there’s a case where a 40-day-old unborn child was successfully transplanted from the fallopian tube to the uterus, and more research needs to be done to standardize that procedure. Ectopic pregnancies are also very rare. In other very difficult circumstances such as rape, incest, financial hardship, bad environment, or health challenges for the new person, as hard/painful as all these things truly are, killing a human being never makes it better – it only adds excruciating shame & regret. I often invite people to think about ending the life of a toddler in order to spare that child or the parents from some great hardship. Regardless of one’s religious beliefs, everyone just knows in their heart this would be wrong. We also know in our hearts that it’s wrong for a society not to make more of an effort to make help available & make that help widely known. I personally know 2 women who were brutally raped and became pregnant (which is also very rare), and who say their child is the best thing that ever happened to them. Others who have had their babies aborted following a rape testify that the abortion was worse than the rape. This makes sense because they (without realizing at the time) chose to punish the child with death for something he/she did not do; the mom became the aggressor in that case (although she could not see that clearly at the time due to emotions). With bad environment concerns, again, killing is far worse – we all just know that in our hearts. Circumstances can change – maybe the child is the one to help bring about change. Also, adoption, as painful as it can be emotionally for the mom & dad, is available in many different ways these days (such as open adoptions) and gives the child a chance at a good life instead of killing the child. It also blesses another couple. But there’s a growing movement now of free mentors and support for birth mothers to be empowered to keep their babies even in hard circumstances. This is too long, so I’ll stop here and let you reply if you’d like to. 🙂

    • Thank you again Margarita for the response. I see and acknowledge the hard work you do in this area! Much to think about. I apologize I won’t be able to continue this conversation as I just can’t agree with taking away the choice, particularly and especially in situations like rape or incest, and I’m not sure over the Internet we could ever come a conclusion on that. However, I think we both can agree that this form of marketing of abortion strikes a discomfort for some of us for a similar reason. I really appreciate your thoughtful dialogue.

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