drastically curbed abortion rights in the past few months. Alabama banned nearly all abortions, including in cases of rape or incest.
In Tennessee, conservative lawmakers are pushing a so-called heartbeat bill, which would ban abortion weeks into a pregnancy.
But in this eastern part of the state, a rural and conservative region of cherished religious values, the abortion debates in Washington, in state houses and on cable news can seem distant.
Here, the front line of the anti-abortion movement is a woman working out of a church basement.
‘My heart is for women’
Options is one of more than 2,700 anti-abortion pregnancy centers across the country. It is affiliated with Care Net, one of the three largest networks of such centers in the United States, whose home page calls for action against “the pro-choice Left,” which it says “publicly defends infanticide.”
NARAL Pro-Choice America calls pregnancy center activists “anti-choice extremists” that “lie to and mislead women to prevent them from considering abortion.” Planned Parenthood clinics, like one in Memphis, report that pregnancy center volunteers try to lure women away from their doors with gift bags or protest vigils.
“All of that is directed at shaming patients who come for abortions, and stigmatizing abortion, which is a part of health care,” said Aimee Lewis, a vice president for Planned Parenthood of Tennessee and North Mississippi. “They are fake clinics.”
Options, like many independent anti-abortion pregnancy centers, is not a licensed medical clinic. But unlike some centers, it does not pretend to be. Volunteers do not force women to hear fetal heartbeats or show them gruesome photos of aborted fetuses. Women are informed that the volunteers are not professional counselors. The vast majority who come have already decided to have their babies.
Instead the mission is to assure women they can handle the challenges to come, no matter the obstacles; the center helps them find jobs, emotional support or even a place to shower.
“The job is to not just say, ‘Hey, this is a real life inside of you, you need to save it.’ That’s not going to accomplish anything,” Ms. Ramsey, 31, said. “It is to get her to see that whatever she thinks is too big for her to handle, she can actually handle it.”
A third of people in Cocke County, which includes Newport, are below the poverty line. The Tennessee Department of Health says that it ranks 94th out of 95 counties in health outcomes, which measure length and quality of life, and that nearly half of children under 5 do not live in two-parent homes. The nearest abortion clinic is 50 miles away.
Nationwide, about a quarter of women who had abortions said their main reason was that they could not afford to have a baby, according to a 2005 study by the Guttmacher Institute. Half of the women who had abortions in 2014 lived in poverty.
“Circumstances don’t make a woman what she is,” Ms. Ramsey said. “My heart is for women to know their worth,” she said, “that they have a purpose, and that life is not too hard or extreme for them to meet the purpose that they want to do.”
“I just don’t know this is a war we are going to win politically,” she went on. “I wish people could just think people, not power. What is the good for the people?”
‘How can we help them’
Ms. Ramsey’s first client arrived, almost eight months pregnant. She was 19 and worried about being a first-time mother. Ms. Ramsey asked what success looked like to her, and popped in a breastfeeding DVD to go over ways to hold a baby.
The videos are part of a Christian curriculum designed for anti-abortion pregnancy centers. When a client comes to Options, she watches a short video, does some homework reflecting on the day’s topic and then earns “Baby Bucks,” points she can trade for clothes, supplies, cribs — anything in their donation stockpile.
“We have to do a pregnancy test to start giving her stuff,” Ms. Ramsey explained between clients, otherwise “things get traded and sold.”
Down the hall, Brier Smart, 22, and her boyfriend finished a Bible study session. She dragged a pile of free infant clothes to the couch and began to fold each onesie while he played with their 7-month-old.
They had been coming since she was 30 weeks pregnant. When the Health Department reduced their son’s formula allotment with the Women, Infants and Children supplemental nutritional assistance program, they were grateful Options could help out.
Newport, a city of about 6,800, was getting a little better, Ms. Smart said. There was the updated movie theater and pool at the park. But many people they knew from school were now addicted to drugs — particularly methamphetamine. Grandparents were left raising children.
Ms. Ramsey stood in her office, reflecting on her mission. She could remember only three times when a client said she came to Options thinking about abortion.
“I don’t ever look at a baby and think, ‘This is going to make this girl’s life way worse,’” she said. “When I see people that are living in poverty, I don’t look at it like, those people shouldn’t have a kid because they aren’t going to take care of it. I look at it as, those people aren’t in a good situation, how can we help them be in a better situation, with or without a kid.”
She finds truth in the critique by many who support abortion access that their opponents do not care about life beyond birth. “All we want is the baby to be born, and then we are not going to give the parents any kind of tools to take care of it,” she said of many others in the anti-abortion movement. “We are not going to come alongside them, we are just going to feel like we won.”
‘A sense of pride in family’
The last client left for the day, and Ms. Ramsey drove toward Cocke County High School, which she graduated from in 2006 before attending Bible college in Knoxville. There, she dreamed of moving to India to fight human trafficking, and even refused to wear shoes for a month to protest global poverty.
Last summer, a leadership club at the high school volunteered to serve dinner at the annual Options fund-raising banquet. It seemed that the whole town showed up: the local judge, the dentist, nurses, a pediatrician, the state representative. Together they raised $35,000 to refurbish a donated house so Options could move out of the church basement, a move set for later this summer.
This night, Ms. Ramsey met with teachers, health care providers, law enforcement and other community leaders to brainstorm how to get all the county’s children ready for kindergarten.
She sat down next to Alicia Dalton, who runs Newport Pediatrics.
“We are all pretty much in the same room together all the time,” Ms. Dalton said, “all working together to meet the same needs.”
Together the group discussed how to increase day care opportunities, make transportation accessible for people without cars and educate parents about nutrition. They had a refrain: “The community owns the problem, the community solves the problem.”
“People take pride in being able to provide for their families,” the county mayor, Crystal Ottinger, said a few days later. “They can’t always do that for whatever reason: unemployment, disability, it may be drugs. I’m not going to sugarcoat it, we are rural Appalachia. But they still have a sense of pride in family here.”
It is a reason she thinks Options works — people have to earn points and take classes, not simply take free stuff. “The more people that Options can help, the more likely they are to give back,” she said.
Ms. Ramsey said her work was about helping women and their babies, but she also had an underlying hope: that they would commit their lives to Jesus. She offers extra points for Baby Bucks if they go to church. “I can’t lie,” she said. “Ultimately I just don’t think that there can be an abundant life without Jesus. If they say that’s manipulative and a secret tactic, then I will not apologize for it.”
“I will tell you,” she went on. “We have girls that don’t go to church, that don’t do the Bible studies. I give them as much as anybody else. And I love them as much.”
‘He will set a path for me’
The morning after the meeting, Ms. Ramsey set out in a white minivan. Many of her clients do not have cars, so she picks them up.
She knows Newport’s streets by heart: past the Food City Gas ’N Go, along the railroad tracks, by the women’s jail where she volunteers every other Thursday, to the bridge dotted with baskets of fuchsia-colored blossoms. She crossed.
This was the side where she grew up, first in the gray trailer, and then in the house where her mother lives.
She looked out at the dark clouds growing over the Smoky Mountains in the distance, and pulled into a driveway. She prayed silently, and then knocked on the door.
A young woman stepped out, about five months pregnant. Jennifer Campbell, 30, was born here too. Her parents divorced when she was 8, she moved in with her grandparents and then her father died in a motorcycle accident. Things spiraled, from an abusive relationship to opiates and meth. Her two children were taken into state custody. She spent time in jail, and without a home.
And then, she said, she prayed to God.
“I got pregnant during the time that I prayed,” she said. “He blessed me with another chance of being a mom, and I did not want to mess this up.”
Now, she is sober. She goes to the doctor for prenatal care. She met Ms. Ramsey when she was in jail, and heard she offered baby supplies. She said she had never considered having an abortion.
“I know that since God has blessed me with this child, he will set a path for me,” she said.
They pulled up to the church’s back door, and went in.