MONTGOMERY, Ala.—June Ayers does not ignore calls.
It was after 4 p.m., and Reproductive Health Services, the clinic she has owned and operated for the last 30 years, was closed for the day. Ayers, in periwinkle scrubs dotted with purple butterflies, was seated behind a front desk covered with patient charts. A muted television played HGTV to an empty waiting room. The silent feed from the security cameras revealed a deserted parking lot.
But the phone kept ringing, so Ayers kept answering.
“Reproductive Health, may I help you?” Ayers, 61, has been repeating this line for decades. And her voice—Alabama drawl, all heavy vowels, sugar-sweet with a little rasp—is very likely one of the first things you will hear if you need an abortion within 100 miles of Montgomery.
The clinic is one of just five left in Alabama, which means that a majority of women in the state live in a county without an abortion provider. So in Alabama—like in Texas, like in Mississippi, like in a growing number of states across the country—to have an abortion means to travel.
It also means state-directed counseling intended to discourage abortion, a mandatory ultrasound, two separate clinic visits, and a 48-hour waiting period between them. For women who live outside of Montgomery, the waiting period requires time off work, traveling hundreds of miles for repeat trips, or finding somewhere to stay in the area overnight. And because 60% of women who have abortions are already mothers, the travel required means, in some cases, two full days of childcare. None of it comes cheap.
“And right now the state Legislature has seven other bills ready to go,” Ayers told me as we talked that afternoon, gliding her hand in the air like a conveyor belt.
Minors in the state must overcome another potential barrier: parental consent. Alabama is one of 21 states in the country that require minors to obtain the permission of at least one parent before terminating a pregnancy. If they can’t get that, whether because their parent is incarcerated or estranged, abusive, or strictly anti-abortion, then the law says they have to go to court.
For people under the age of 18, getting an abortion in Alabama is a little like that line about Ginger Rogers and Fred Astaire: all the same steps, except backward and in heels.
The caller on the line with Ayers that afternoon was 17. On the verge of graduating high school and, quite unexpectedly, pregnant.
“OK, baby,” Ayers cooed into the phone. “When can you come in?”
Alabama passed its parental consent law in 1987, not long after Ayers took over the clinic.
Legislators at the time wrote that the law was intended to “further the important and compelling state interests of protecting minors against their own immaturity.” But, as required by the United States Supreme Court, there is also an escape valve: judicial bypass, the process by which minors who can’t obtain parental consent can petition a court for the right to have an abortion anyway.
Judicial bypass is meant to be confidential and relatively quick. (Pregnant people only become more pregnant as time passes.) The Supreme Court requires the process be “completed with anonymity and sufficient expedition to provide an effective opportunity for an abortion to be obtained.” It is, the high court concluded in 1979, a stopgap against an “absolute, and possibly arbitrary” veto on a minor’s access to abortion.
And while the process has never been easy in Alabama, it was manageable, Ayers told me. She learned over the years how to work with court officials who didn't know the law, how to help teens navigate the courts when a parent was incarcerated or too ill to offer consent, how to make discreet phone calls when a minor needed to reschedule an appointment.
But things changed in 2014. Republican lawmakers came together, just a few blocks down the road from the clinic, to remake the bypass system in Alabama. More hurdles were coming.
Ayers started at Reproductive Health Services as a receptionist in 1977. It was her second job out of college after a brief detour hawking souvenirs at Disney World for minimum wage.
“It was just one of those things that fell onto my lap,” Ayers said of the decision. “I was 24, I had no job, and I got a call in the middle of the summer about an opening at the front desk.”
It may not have started as a religious calling, but Ayers quickly immersed herself in the work. She had a B.A. in psychology, and was promoted to counselor not long after she started at the front desk. From counselor she moved to assistant clinic director. By 1982, just five years after she started answering the phones, Ayers was named director.
That was also the year that the former owners called her with the news that they were closing the clinic. Faced with the possibility that Reproductive Health Services would be shuttered, one of the physicians at the clinic suggested that he and Ayers take it over.
It sounded like a ridiculous idea at the time. Ayers was young, the work of owning a clinic can be chaotic. She had already experienced threats, and had witnessed her colleagues endure the same.
She agreed anyway. At age 19, she had crossed state lines to have an abortion herself. She had counseled patients coming through the clinic in unimaginably difficult situations. She might have been in over her head, she said, but she wasn't ready to turn anyone away: “I was committed to making sure that the clinic doors stayed open."
So at age 29, Ayers became a clinic owner, working with a lean, dedicated staff to keep the doors open and the lights on: “At the time I thought it was the last thing I wanted to do, but in retrospect, it’s one of the better decisions I ever made.”
Ayers has spent half her life at the clinic, and, as we talk about those years, she marks the time passed with patient stories, birthdays with the team that has become a kind of family to her, the sleepless nights she spent in nursing school and raising her daughter as a single mother. But it’s also a timeline of terror, witnessed up close and at a distance: the killings of doctors she’s known, the anthrax threats that have brought the FBI to her door, the protesters who film her as she comes and goes, the laws that regularly threaten to close her down and cut off access to the women she serves.
But it hasn’t moved her from that front desk, she said: “I still answer the phone, I still make the appointments, I still check people in, I still do nursing care. What I do is incredibly personal. It's what gives me the incentive to get up and do it again tomorrow.”
The Alabama Capitol building—stately and domed, with white Greek Revival columns framing the entrance—is vestigial in terms of the actual functioning of state government. There are tours for those who want to wander its historic hallways, but the state Legislature actually works in a less aesthetically commanding building just across the street.
I met Kerry Rich in his office there, a modest room off a maze of gray carpet and beige hallways. Rich, a Republican from the city of Albertville with a deep, gentlemanly accent, was one of the 18 members of the state legislature to co-sponsor the bill to amend Alabama’s judicial bypass process. (The law’s lead sponsor, a Republican from Andalusia named Mike Jones, did not respond to my requests for an interview.)
Rich had a small cup printed with the words “Sweet Home Alabama” on his desk, which he used for chew spit. “Tell you the truth,” he said politely, pausing to spit discreetly when I asked him about judicial bypass, “that was two years ago, and I don't remember any details on that.”
But the changes were significant. The revisions in the law turned what was once a hearing that involved the minor and a judge into a full-on trial process. It dictated that district attorneys be given notice when a person under the age of 18 applies for judicial bypass, and empowered the court to call witnesses—teachers, friends, even parents—into the trial.
And, in arguably its most striking feature, HB 494 allowed judges to appoint a lawyer for the fetus.
The American Civil Liberties Union of Alabama challenged the law soon after it passed. The case went to court, with Ayers as the sole plaintiff, in 2015. More than a year later, a decision is still pending because of a backlog of cases in the district’s federal courts.
“Let me just give you what little I know,” Rich said, pausing to spit again, after I listed core changes enacted under the law. “There were, I believe, a lot of judges that were making exceptions to allow a young person to have an abortion and that was deemed to be unnecessary. Or they were taking the law as it was too far.” He declined to offer examples.
But bringing the adversarial trial process to judicial bypass wasn’t actually a new concept in Alabama. The revisions to the law formalized a precedent that already existed in the state that allowed judges to appoint lawyers to represent fetuses.
In her 2007 book Girls on the Stand: How Courts Fail Pregnant Minors, Helena Silverstein, a professor of law and government at Lafayette College in Easton, Penn., documented how, in several cases throughout the 1990s and early 2000s, Judge Walter Mark Anderson III—one of just three judges who heard bypass requests in Montgomery—appointed fetuses legal representation.
In a 1998 case involving a 17-year-old high school honors student who was seeking bypass because her father had been “known to point a gun at boys who looked at her provocatively,” Anderson appointed a Montgomery lawyer—and a high-profile abortion rights opponent—named Julian McPhillips to represent the fetus.
McPhillips called witnesses, named the fetus “Ashley,” and aggressively cross-examined the 17-year-old Jane Doe.
His questioning included ruminations on eternal judgment (“You say that you are aware that God instructed you not to kill your own baby, but you want to do it anyway?”) and accused Jane Doe of making a decision to “snuff out the life of your own baby."
After four hours, Anderson granted the request. But not before making his disapproval clear, writing that it “was not in the best interest of this young woman” and “certainly not in the best interest of this unborn child.”
In 2014, the circus atmosphere of Anderson’s courtroom became the law of the land in Alabama, for reasons that Rich couldn’t quite recall with any specificity.
“I hesitate to even comment on it,” he told me in a tone of sober professionalism when I asked again about the newly enacted trial process. He was stern but polite in ending this particular line of questioning. “You get yourself in trouble talking about something that you don't remember.”
Mondays, Tuesdays, Wednesdays, and Fridays are “first visits” at Reproductive Health Services. Women arrive at the clinic, starting around 8 a.m., in sweats, in nursing scrubs, with briefcases or children in hand. They receive ultrasounds and counseling booklets—”A Woman’s Right to Know”—drafted and mandated by the state.
Most of the women leave these booklets behind at the clinic, but that transaction—the moment a nurse hands it to them—starts the clock on the 48-hour waiting period required of all patients.
When I arrived at the clinic that Wednesday morning, Ayers, coffee in hand, was in her usual spot at the front desk. The quiet bustle of the clinic unfolded around her perch at reception.
The last appointments are usually about 11 a.m., but Ayers had made arranged for a later visit for Lindsay and John, the teenagers who had called her—and called her, and called her—earlier that week. (Both requested that I not use their real names to protect their privacy.)
Despite the late appointment, the couple had to cut out of school a little early to make the drive from their small Alabama town to the clinic. Just after 2 p.m., their figures appeared on the feed from the security camera, casting long shadows on the pavement.
Lindsay, quiet and polite, wearing a University of Alabama “Roll Tide” T-shirt and running shorts, introduced herself first. After a quick exchange at the front desk in the near-empty clinic, Ayers invited them back to fill out paperwork: “All right, sweethearts, this way.”
It was the first visit, and Lindsay would be getting an ultrasound. She was on the cusp of turning 18—her birthday was just a month away. But one month shy of 18 doesn’t mean anything under state law. She would still need parental consent—or a court bypass—to have the abortion. And Ayers had been preparing for the possibility all day.
Intake at Montgomery’s juvenile courts is about 10 minutes from the clinic, over on the west side of town. It’s less daunting than going through the adult court system, Ayers said, but heading to the same complex as “juvie jail" can still intimidating for many of her young patients.
“I am a clinic director. I see patients. My priority is their health and well-being. I don't want to see a 15-year-old without an adult, I want to see somebody who has all the support around them,” she told me earlier that day as she waited for Lindsay and John to arrive. “But that's the ideal situation. It's not always the world that I deal with.”
Lindsay’s, it turned out, was not an ideal situation.
She had searched “abortion, Alabama” after she found out she was pregnant because it seemed like the most obvious thing to do. "I'm 17 and he's 16, so there's really no way to support a child right now," she told me during her appointment, shaking her head to drive home the point.
John, quiet in a T-shirt and jeans, whispered a correction, “I’m 17.” Lindsay laughed, raised her eyes to the ceiling. “Oh, yeah, he’s 17 now.”
Lindsay is one of six kids and grew up in a strictly anti-abortion household. When she found out she was pregnant, she knew there was no question about how her parents would respond: “My parents never have—it’s just something they don’t agree with."
Judicial bypass exists for teens like Lindsay and John. The question, now, was whether they would need it.
About 20 minutes after they arrived at the clinic, the teens re-emerged from the ultrasound room, faces soft and unreadable. But the news was positive, if complicated: She was early enough in her pregnancy—eight weeks—that she could wait until she turned 18 and bypass the courts.
“She’s about to start college, and she has a goal in life to do something,” John told me afterwards, voice low, eyes at the floor. “We were worried that if we did have to go through the court thing—”
He trailed off. “It was a relief,” Lindsay offered.
The appointment behind them, Lindsay thanked Ayers again and asked her to be in the room during the procedure. “I’ll drop what I’m doing, baby,” Ayers told her at the front desk. “I’ll be in there holding your hand.”
Lindsay threw open the door, the late afternoon sun flashed into the clinic, and, just like that, they were gone. It felt cinematic. The prospect of going to court had been a frightening one, and then it wasn’t anymore.
As Ayers began filing their paperwork, I asked her when Lindsay would come in for the procedure. “Her birthday is a month from now, so we made the appointment for that week,” she told me. It hadn’t occurred to me until that point that Lindsay would have to remain pregnant for another month. Four more weeks of hiding it from her parents, teachers, and classmates. Four more weeks of the physical symptoms of pregnancy.
“I wrote down what she’ll need in her diet,” Ayers said, counting on her fingers what she'd told Lindsay: “I want to make sure she’s hydrated—ice chips from Sonic, Pedialyte popsicles, however she can sneak water in. I want to make sure she’s monitoring and aware of what’s happening in her body. We talked about dealing with the nausea, which can be debilitating.”
It was a lot for a 17-year-old, I said.
“She needed me,” Ayers said, still at the front desk, already organizing charts for the next day. “Tomorrow, I have 30 more patients who will, too.”