How one quiet Illinois college town became the symbol of abortion rights in America

CARBONDALE, Ill. – The 26-year-old had never heard of the distant southern Illinois town, but it had become the closest option.

So she cobbled together money. Found child care. Asked her brother for a ride. And set off early one morning to drive north across state lines to 22,000-person Carbondale.

It was a nearly seven-hour round trip from her home in Tennessee. Long enough for the decision to rattle in her head as the flat Midwestern landscape slipped by the car windows.

No, she told herself. I thought it out. It's not the right moment to have a child.  

She was already raising two young children. She had split with her boyfriend. She was financially unstable from losing a job. And she could face health risks. 

She finally tried to go to sleep. 

They crossed into Illinois. 

From there it was another hour’s drive to the outskirts of Carbondale, a place often reached by a two-lane state highway that winds by farm fields and churches or a busier route dotted with fast food, strip malls and a building on which, for a time, hung a banner reading, “Pro Life. Pro God. Pro Gun. Pro Trump.”

Mostly rural, conservative southern Illinois was an unexpected place for an abortion clinic, the 26-year-old thought, even if the town’s welcome sign noted it was home to Southern Illinois University.

They parked outside a single-story office building, across from a Kroger, at the Choices Center for Reproductive Health. She walked in past a security guard to a waiting room, donning a green wristband.

at CHOICES Center for Reproductive Health  in Carbondale, IL., Wednesday, Dec. 21, 2022.
A security guard stands inside Choices Center for Reproductive Health in Carbondale, Illinois. April 2023.
The Choices Center for Reproductive Health in Carbondale, Illinois.
When it became c

Soon she sat on an exam table. 

Outside, a staffer put a mark on a whiteboard grid where the center kept track of its days, a row for each of six rooms, a column for each of the four people a patient would wait to see, including a nurse and a medical provider. Once each row was checked off, one patient was done; the next one could begin. Nearby, receptionists scheduled appointments for patients from as far away as Texas and Mississippi. 

After medical checks and an explanation of what to expect, the woman with the green wristband lifted a small water bottle and swallowed the first of two pills that would end her pregnancy. 

Similar scenes play out each day five miles away, a short drive past the city’s Amtrak station, downtown shops and neon-lit 1950s-era Dairy Queen, on the other side of town. There, at an anodyne medical office where a vinyl sign stuck in the grass reads “Alamo Women’s Clinic,” the parking lot is often filled with out-of-state license plates – women who drive as long as 10 hours from the Deep South for an abortion.

Carbondale, Illinois. April 2023.
A city street in Carbondale, Illinois. April 2023.
The road into Carbondale is dotted with signs of conservative rural America. At Illinois' far southern end, the city is closer to Mississippi than it is to Chicago. But inside city limits, where a university and a regional medical hub anchor a more left-leaning community, many people welcomed the new clinics.

Outside, on a spring morning, anti-abortion protesters wore orange vests and tote brochures, hoping to persuade arriving women to turn back. A woman drove past them and strode determinedly through the waiting room to the office window. "I have an appointment," she said. 

Not far away, just off State Highway 13 near a busy farm supply store, contractors were renovating what some locals expect will soon become Carbondale’s third abortion clinic.

A year ago, there were no clinics in this former coal-country railroad junction turned college town.

In Illinois, anchored by liberal Chicago far to the north, abortion rights were legally protected. But they weren't as much of a local concern.

Abortion clinics operated in towns just across from St. Louis. But elective abortions had not been provided in Carbondale since 1985, when opponents had persuaded the local hospital to halt them.

The Supreme Court’s dismantling of Roe v. Wade changed all that.

A woman stands at the window of the Alamo Women’s Clinic in Carbondale, Illinois, November 3, 2022.
The Alamo Women’s Clinic in Carbondale, Illinois, April 2023.
With the changi

In the year since Roe fell, few places in America have experienced the court’s radical redrawing of abortion access as intimately as some small, blue-state towns near red-state borders. States moved to restrict or ban abortions, and some clinics moved or opened anew in these border towns.

In places like Bristol, Virginia (straddling the Tennessee border), and Moorhead, Minnesota (just a bridge away from Fargo, North Dakota), tight-knit communities suddenly found themselves newly split by a post-Roe front line in the battle over abortion: their state line.

And as more states in the Midwest and the South put restrictions in place, abortion providers set their sights on Carbondale.

The city would become the closest abortion destination for more than 1.2 million women from states as far as Louisiana, according to an analysis by Caitlin Myers, an economics professor at Middlebury College who studies abortion access.

Carbondale had long been a blue-dot college town amid deep-red farm country. It had a history of activism dating back to Vietnam. But it had never planned on being the center of anybody’s abortion fight.

In some other year, the city council might have spent most of its time talking about potholes or police budgets.

“We never imagined we would be in the middle of this national, highly polarized policy issue,” city manager Gary Williams said. 

A year ago, the story of how Carbondale would grapple with its new place on the fault-lines of America’s post-Roe landscape was just beginning to unfold. 

Providers would have to move clinics and, in some cases, themselves. Could they serve the crush of women who had never heard of Carbondale – but soon would?  

Could opponents turn clients, or clinics, away?

Would their opening bring disruptive protests? A glaring national media spotlight?  Would tensions become a permanent presence? Would it change the area’s identity?

The stakes, for everyone, felt enormous.

“Everybody’s about to zone in on Carbondale,” Chastity Mays, a resident and mother of three, recalled thinking a year ago as she watched people she knew from her kids’ gymnastics and judo classes expressing clashing positions in a contentious meeting before any of the clinics had arrived.

“And I‘m just thinking, ‘Are people ready for this

Sitting at one of the tables was Jennifer Pepper, in her early 40s, with bangs, tattoos of a lightning bolt and a heart on her fingers and a shirt emblazoned with the logo of the clinic she leads – Choices Center for Reproductive Health.

A waiter came up to pour coffee, glancing at her shirt and around the cafe.

Jennifer Pepper of Choices Center for Reproductive Health began looking at Carbondale even before the Supreme Court overturned abortion rights. She brought her executive staff to visit the town. “I made everybody look me in the eye and said, ‘We're going to do this,'” she recalled.
Jennifer Pepper of Choices Center for Reproductive Health began looking at Carbondale even before the Supreme Court overturned abortion rights. She brought her executive staff 

“Are you working at the new place?” he asked, to which Pepper nodded and explained they were hoping to open later in the year.

“Well,” he said, “welcome.”

Pepper, the CEO of Choices in Memphis, Tennessee, had been eyeing Carbondale for a while.

Republican lawmakers in her state and others nearby such as Kentucky and Missouri had for years been passing more and more restrictions, regulations and measures to squeeze access.

In May 2021, when the U.S. Supreme Court decided to hear the case of a Mississippi ban on abortion after 15 weeks — and said it would rule on the constitutionality of all prohibitions on abortion before “viability,” when a fetus can survive outside the womb – Pepper concluded the clock was ticking.

She figured she had little more than a year before the conservative-majority court struck down Roe in the case known as Dobbs v. Jackson Women’s Health Organization. That, in turn, would lead Tennessee to enact its “trigger law,” designed to ban abortion as soon as any future Supreme Court ruling made it possible to do so.

While Choices would continue to provide a range of other women’s health services in Memphis, Pepper had to find a new place to provide abortions. Her clinic had performed roughly 4,000 a year.

But where? 

Illinois, whose Democratic-controlled legislature enshrined abortion rights in 2019, was already a destination for clients forced to seek care elsewhere because of restrictions in conservative states.

Pepper looked at a map, seeing clinics across the river from St. Louis, set up to maintain access amid growing restrictions in Missouri, that were already getting a crush of out-of-state patients.

“How much farther south could I get?” she asked.

Pepper knew the area. She grew up in the Rust Belt Mississippi River town of Alton, Illinois. Her eyes quickly fell on Carbondale, founded as a railroad junction in the 1850s. The presence of Southern Illinois University’s campus had long made it a Democratic-leaning outlier in the region – a blue college town inside a red rural swath inside a blue state.

The town, dotted with churches, hadn’t provided abortions for a generation. Still, it was home to a thriving LGBTQ community center, and voters there – unlike in many counties in the area – chose Joe Biden over Donald Trump in 2020.

In Texas, even before Roe was overturned, more than 40 towns prohibited abortion services inside city limits, an approach that spread to other politically conservative towns in states such as Iowa, New Mexico and Ohio.

But she figured Carbondale would be a welcoming place with support from leaders and volunteers. And unlike other smaller options even closer to the Illinois border, it had a local police force to quickly respond to trouble and was already a regional medical hub.

Most important, though, was the location. Wedged between states likely to limit or ban abortion, it was in a spot where the Ohio and Mississippi rivers dipped the Illinois border toward the American south. Carbondale was closer to Tupelo, Mississippi, and Huntsville, Alabama, than it was to Chicago.

That could make it a key outpost for abortion rights in a part of the country where an “abortion desert” was about to spread. 

In November 2021, six months before word of the impending Supreme Court ruling first leaked out, Pepper visited Carbondale to meet with advocates, civic leaders and others.

Soon she pitched the location to supporters and donors – some of whom were initially skeptical that five decades of the federal right to abortion would just disappear. “Don't you think this is ‘Chicken Little, the sky is falling?’” they would ask her. “And I was like, no.” 

Many also hadn’t heard of Carbondale. 

“How far is that?” they would ask, as Pepper heard the clack-clack-clack of keyboards typing in the name to look it up on a map.

It’s only three hours from Memphis, she’d reply. It was even on an Amtrak line that ran to New Orleans. 

In January, she brought her executive staff to town. “It was like the exit row of an airplane,” she said. “I made everybody look me in the eye and said, ‘We're going to do this.’”

Pepper knew things were about to get so stressful and time-consuming that she and her husband “preemptively started couples therapy, just like, to be sure that this would not ruin our marriage,” she said. Pepper's mother worried that photos of her in online news stories about abortion rights could put her at risk. 

In the months that followed, Pepper clocked thousands of miles in her Honda Accord between Memphis and Carbondale, quietly identifying a former dermatologist’s office they would later buy. It sat on a busy commercial strip, across from a large grocery store, next to a burger restaurant and a half-mile from Carbondale Community High School.

In what often felt like blind dates, she met with supporters who might help with housing or volunteer as clinic escorts. Grassroots abortion funds could help women pay for travel and other expenses.

By early March, she was meeting with local government and law enforcement. 

Police officials peppered them with questions: How many protesters would there be? How many officers would it take? Would there be safety concerns for staff, patients and the community? FBI agents came and toured their site. 

Many asked: Why Carbondale? 

“We would take an iPad and show people the map: ‘You’re this blue in the middle of all of this,” she said, showing the red states expected to enact post-Roe abortion bans and restrictions: Missouri. Arkansas. Kentucky. Tennessee. Mississippi. Louisiana. Texas.

And southern Illinois was farther south than practically the entire state of Kentucky.

“‘This is why you’re going to be important,’” she would say to people in Carbondale.  

And she’d hear the response: “Oh, that’s going to be a lot of people.” 

Carbondale City Council member Adam Loos, a lawyer whose father worked in coal before the industry dried up, had watched the region outside the city, like other parts of rural America, turn from union blue to Trump-country red.

Sitting in a Mexican restaurant, near the railroad tracks that shoot through on their way from New Orleans to Chicago, Loos noted that polls showed a majority of Americans favored some level ostretched health system deals with thousands more births after abort

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