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TLANTA — 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.”

Carafem
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.
Carafem
Pamphlets with abortion and birth control information as well ibuprofen, antibiotics, and the abortion pill mifepristone are available at the clinic in Atlanta.

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.

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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  • Thank you so much for this article and I think the approach these clinics are taking is brilliant. I’ll be donating to this nonprofit and taking some ideas from them to promote abortion and birth control access where I’m from too. GO CARAFEM!

  • I never wanted an abortion and never had one despite getting pregnant the first time I had sex (on my 17th birthday.) I cannot make those decisions for other people; it is not my right to impose my values on others. I have always said, and I’m over 70 now, if you don’t think abortion is right, don’t have one. Period. End of discussion. My older son is now 53 and a great guy.

  • For the vast majority of pregnancies, there was first a decision by both parties to engage in sex. If we are really accountable stewards of our own bodies, that “choice” to abstain from sex until ready to accept the possibility of parenthood is the one that matters most. Sadly,our society generally no longer attributes much value or relevance to abstinence, or to traditional marriage, despite repeated studies that show that children who are raised by a father and a mother generally fare better than those who aren’t. By this I don’t mean to say that single parent families are inferior…real life often results in circumstances and trials, sometimes beyond our control, that create less than ideal outcomes. These, however, can be overcome through faith, love, and sustained effort. Living in an imperfect world is not an excuse to abandon morals or accountable behavior…it is actually part of our test. We all were and still are children of heavenly parents. I stand with those who value and protect life, beginning first with human life, and especially for those who are most vulnerable and innocent. Let’s do our best to save all the children, both born and unborn.

    • Why do men feel that they have a right to opine on the experience of a woman? You fail to recognize that in your scenario, females have a far greater responsibility and burden than males do. Why are females faced with such greater consequences than males in your world? Because that’s not fair or right.

      And leave your god out of it. He’s not mine, and even if he were, you have no right to impose your faith on anyone but you.

    • First, the only parents I had were the biological ones who gave me birth. Second, when does personhood commence? Anything that exists before this point is merely a potential person. Third, if you are so concerned about “…sav[ing] all the children…” I presume you have a complete plan for the care, feeding, clothing, education, shelter, etc. for all these children once they are born? Please cease trying to force your belief system onto others. Without indisputable proof, e.g. your Bible is not proof, your beliefs are no more legitimate than anyone else’s.

  • An abortion kills an innocent human life. It should be a profound decision and not celebrated like some… un-birthday.

  • Keep up the good work. You are providing a much needed service. Look out for the radicalized religious. They are dangerous to you and your patients. Bless you and your staff and the women who find their way to your open door.

  • Happy to see this normal, legal, extremely common part of reproductive healthcare being treated as such. Bravo to Carafem for giving patients a comfortable and supportive atmosphere in which to safely terminate a pregnancy.

  • I think it is great that woman have this choice. However, i strongly recommend mandatory discussion pre and post as I have seen several women become very depressed afterwards. I cannot judge why they choose to terminate. Only hope it does not become a habit as I have also heard in the past with some people. It is not a decision easy to make……

    • As long as we’re getting anecdotal, I have four friends who, for varied reasons, had abortions. None have exhibited or shared depression problems before or after. However, i gad serous depression following my first child’s birth. And, dear, I repeated that pattern with post-partum depression again when our third was born. Hmm.

    • I think it’s possible that depression following an abortion can be a result (at least in part) of the harsh judgement imposed upon women in our society who have abortions. I love that these clinics are working to change that.

  • It’s lovely to hear that they casually talk about having an abortion as though it’s equivalent to having a bad tooth extracted in their “subtle” advertising. Abortion ends a life, period. You can cover it up with flowery language, sophisticated advertising, any euphemism you choose (women’s healthcare for example), but it’s murder. Life starts at conception. Is a 4 week old baby the same as a 25 week old baby during the pregnancy? Of course not. But then again, neither is a 2 year old and a 75 year old. It’s amazing that the people that laud efforts such as transferring sea turtle eggs after an oil spill in the Gulf of Mexico are the same ones that believe killing the fertilized egg/baby in the mother’s womb is someone’s right. How is it that they recognize that an unborn sea turtle in its egg is just that; a sea turtle that isn’t fully ready to be born, but when it comes to an unborn child, it’s simply a clump of cells worthy of no more regard than having your tonsils removed. It’s reprehensible, and should be stopped. It sounds as though the people responsible for this murder clinic are very proud of themselves; they should be ashamed.

    • Good thing we don’t have to “cover it up” because abortion is still safe and legal in this country. I’m glad you aren’t my doctor. What a pompous, self-righteous person you seem to be.

    • May I suggest two points to consider? First, unlike the discussed sea turtles, humans are not (!) an endangered species.
      Additionally, while it’s true a two year old differs from a 75 year old, what does that have to do with abortion? Nothing. If you, doctor, can sustain an embryo or fetus until it is capable of full life outside of body, please do speak up. The truth is that an embryo or a 10 week fetus are both not able to exist in extended way beyond the one womb of they’ve implanted in.
      I cannot guess why you infer your opinion on what stands as a human is somehow more valid than many mine.
      It’s a medical fact that 1/5 of all known pregnancies result in natural abortions. ( Lay people call this miscarried, which is fine, but the medical term is a aborted.) For those who believe in some “god given spark of a soul” being granted at conception, I cannot imagine why those same believers would worship such a fickle god that then “kills” 20% of those “innocent babies”. A god who “throws away humans” so frequently is without any doubt the world’s great abortionist, no? A god who creates a precious soul and life one day, and sends it flushing down the toilet days or weeks later…?
      The answer is to teach birth control provide birth-control encourage abstinence and eliminate the need for most abortions. And for those who still wish to have an abortion, why don’t people start recognizing that it’s out of their hands.

    • It’s amazing that a doctor would be so judgmental. How many pregnancies end in miscarriage? Those pregnancies would never have resulted in a child. How many pregnancies end in stillbirth? Those pregnancies did not result in a child. Your position is therefore irrational and you should revise it at least to recognize these facts.

    • As a doctor, you know that life is all around us in various stages of becoming and decaying. As a scientist, you know that an acorn is not an oak tree but merely a potential tree. Billions of acorns drop to the ground; most never start to grow; some germinate, some grow a few years and then are killed or die off. So, yes, biological life starts at conception, but the point at which moral personhood is attained has never and can never be scientifically determined. People, including doctors and other scientists, can only state a belief about this. Incidentally, most of those sea turtle eggs which you (as a false equivalency) describe will never reach reproductive maturity. One last thought: Murder is recognized in out legal canon as the purposeful taking of a person’s life, so I ask again, when does personhood attach?

  • Well, if you kill humans for a living (and half of those killed are girls), I guess you have no choice but to hide it behind glossy photos of smiling faces, shiny pamphlets, and cute-looking billboards.

    This whole thing is sick.
    What these clinics are doing is simply demonic.

    • Well, sure, if your male skygod tells you it’s evil, sure it is.

      If men could get pregnant, there would be drive-thru abortion clinics, and they’d be able to watch sports while the procedure was being done.

    • You know what’s evil? Condemning a kid to a life of misery and struggle due to his or her mother’s inability to care for them just because folks have this theoretical view that a zygote is a life worth saving. I’m all for theory and belief and religion and all this fuzzy stuff but the reality is people are born with no survival skills whatsoever and if the mother doesn’t want the baby, then she is not going to be able to properly care for it. I’m all for life, but life without quality of life is pointless. As a society, we kill each other with abandon. If we had a movement advocating for the lives of people who are actually alive, then we might be onto something.

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