When Jules Edwards was a teenager, they say being able to access an abortion was life-saving health care. 

“I was somebody who had an abortion as a teenager and didn’t tell my family and got support through a family friend,” Edwards said recently. “And that saved my life and gave me my future.”

Now, as executive director of Abortion Care Tennessee (ACT) and Mountain Access Brigade (MAB), independent organizations funding Appalachians who need to seek abortion care out of state, Edwards spends every day fighting to provide that same life-saving care for others. 

It’s increasingly difficult. Edwards says they’ve been threatened and doxxed doing this work. Their home state of Tennessee enacted a trigger ban when the U.S. Supreme Court first overturned Roe v. Wade; abortion remains banned across the state, as well as in the bordering states of Kentucky, Missouri, Arkansas, Mississippi and Alabama. Tennessee’s abortion laws are so strict that the state is currently entangled in two court cases over them. 

With the government enacting ever-tightening bans across Southern Appalachia, nationwide organizations like Planned Parenthood are no longer able to provide life-saving abortion care in Tennessee, and have faced intense operational threats. It’s left to grassroots organizations in Appalachia — usually founded, funded and run entirely by and for their communities — to continue fighting to provide care and helping each other when no one else will or can, despite funding challenges, tightening restrictions and risks of persecution. 

Edwards’s organizations, ACT and MAB, are among the grassroots funds filling a reproductive health gap by operating statewide to service Tennesseans going out of state for abortion care. Among community work and educational measures, ACT funds procedural costs for Tennesseans traveling for abortion access, and MAB is an abortion fund and doula collective.

Now, New York and Maryland are the only Appalachian states who have permanently legally protected abortion, without six- or twelve-week bans. (At six weeks, many individuals do not even yet know they are pregnant). 

The ulterior motive of the state’s injunctions against abortion, Edwards said, is taking away the ability of young people to have power and autonomy, as well as to “make it impossible for the Planned Parenthoods, the abortion funds, or support groups to do their jobs.” Both abortion providers in Appalachia — and individuals who need abortions in the region — are left grappling with a landscape that’s nearly impossible to navigate. 

Organizers work through an ‘access crisis’ 

Tennessee was sued over its abortion law, a ban with virtually non-existent exemptions, in a case led by the Center for Reproductive Rights and three Tennessee women, Katy Dulong, Allie Phillips and Nicole Blackmon,who faced near-deadly barriers in accessing abortions for life-threatening pregnancies and/or fetuses that were virtually non-viable. In a temporary injunction in late October 2024, judges ruled that doctors in Tennessee who provide abortions to patients facing certain medical conditions can do so without facing disciplinary action. As of December 2024, the case is still active. 

Meanwhile, back in September 2024, a judge temporarily blocked enforcement of Tennessee’s ban criminalizing any non-parent from helping a minor to obtain an abortion, according to reporting from Tennessee Lookout. For organizations like ACT and MAB, bans not only impact them providing aid, including to minors, but also complicate elements of their work.

Before Roe’s overturn, “Tennessee was actually a safe haven for abortion in the South,” Edwards said, noting Tennessee’s central location to other Southern states and previously higher number of abortion clinics. As of 2012,  more than one in four abortions in Tennessee were being obtained by someone traveling from out of state, an outcome of the 2000 Tennessee Supreme Court decision that struck down abortion restrictions.

“We received quite an influx of out-of-state patients,” Edwards said. “So when Tennessee lost abortion access, it sent the entire South into an access crisis.” Doing this work in the South, Edwards said, “feels like a microcosm of the fascism that we’re facing on a national level.”

‘The need is significant’

That “access crisis,” driven by Tennnesee’s trigger ban, was compounded by violent blowback against providers. For MAB and ACT, the uptick in work kicked off before Roe’s overturn when, on New Years Eve of 2021, Knoxville’s Planned Parenthood clinic was destroyed. Mark Reno, a Jan. 6 insurrectionist and member of a Catholic Orthodox militant group, allegedly arsoned the $2 million yet-to-be-opened facility, but died in jail before he could be convicted. The year before, he had allegedly fired shots at the same clinic. 

The day of the arson, Noé Monárrez, an East Tennessee Community Health Educator who has worked at the Knoxville Planned Parenthood since June of 2021, recalled opening their phone and scrolling through Twitter. Monárrez immediately saw that a Planned Parenthood was on fire – and realized where it was. 

“I had an inkling that somebody had burned it down, because it is Knoxville, it is East Tennessee, that’s just one of those things you have to expect potentially,” Monárrez said. 

“The day it burned, I remember the first thing I thought was, ‘Did that person have my address? Did they find me online?’ said Tory Mills, who was Director of Community Engagement at Planned Parenthood for 11 years. Mills recalled fear that she — along with her friends and colleagues — were in danger. 

“That’s what that building being burned down was [for], was to scare people, to scare them away from getting care [and] from doing this work,” said Mills, now a member of Knoxville Abortion Justice Alliance (KAJA), a community organization advocating for stigmatization and education around reproductive care.

For a year after the arson, Knoxville, the third largest city in the state, was left without a Planned Parenthood. After that, Knoxville’s Planned Parenthood had a brief tenure of offering limited services out of a bus until the provider went on maternity leave. Even when the mobile unit was offering services, many community members didn’t know; Planned Parenthood was reluctant to advertise given the violence and threats they’d previously faced, and struggled with zoning issues, according to Monárrez. 

Because it was still a functional clinic, the bus had to be in a location zoned for health care. It couldn’t remain on the site of the previous Planned Parenthood due to construction starting, and had to be moved overnight due to safety concerns. 

“At the time, we also didn’t publish [the location of the bus] anywhere publicly except social media and maybe [the Planned Parenthood] website,” Monárrez said. “We tried to keep the announcement of it very quiet just because of safety and security reasons.” 

In anticipation of Roe’s overturn, the mobile health unit’s offerings were kept fairly simple. They focused primarily on basic birth control services, pregnancy testing and limited UTI treatment, with the hope of being able to offer ultrasounds, gender-affirming care and more extensive STI/UTI testing and treatment in time. 

“[For many of the patients,] the only times they were seeing any kind of medical care was when they were coming into Planned Parenthood,” Monárrez said.

The Dobbs decision left the entire state without abortion care. Now, the Knoxville Planned Parenthood facility has been rebuilt with tightened security measures and reopened in November 2024. But it still legally can’t offer abortion care within the state, though it will help navigate patients to the closest clinic that offers the services they need. The Knoxville Planned Parenthood also has an internal patient navigation assistance fund, which can be applied to travel costs such as flights and hotels as well as procedure costs, and partners with abortion assistance mutual aid funds such as MAB, according to Monárrez.  

In Appalachia, the stigma against abortion, as well as systemic barriers like lack of access to transportation and failure to expand Medicaid, directly impact community members. There are gaps in the narrative around what attacks on Planned Parenthood mean and how they impact people, particularly how they potentially leave “the everyday person who needs an abortion feeling terrified for their life,” according to Edwards. Whereas Planned Parenthood is a national organization, most local abortion organizations — the ones stepping in to fill health care gaps and save lives — are funded by the community and often lack capital. 

Multiple organizers with MAB and KAJA previously worked for Planned Parenthood, and noted the importance of the organizing work they learned there; Planned Parenthood is the first stepping stone for many people, some said. But Planned Parenthood doesn’t share the same funding burden with the funds, some organizers said.

One MAB member mentioned that the fund’s anonymous support line sometimes has to be closed for a week or so out of a month due to lack of funding. In late September, the fund posted a message to Instagram: the support line was closed because they’d spent double their weekly budget the week prior, supporting appointments.

The need is significant. A study from The Guttmacher Institute detailed that more than 10,000 Tennesseans crossed state lines to access an abortion in the last year. While Tennessee is already classified as a “maternity care desert,” experts have stated that maternal and infant mortality rates could rise in states with abortion restrictions, according to reporting from The Tennessee Lookout. Because Tennessee is out of Title X compliance due to a policy of refusing to allow clinics to share information on elective abortions, the state is also ineligible for vital federal Title X funding. 

Mills also noted that many abortion funds and national organizations deem the climate in Appalachia too difficult to navigate and too hostile, and simply give up on providing care here.  “This country as a whole has painted Appalachia as a throwaway place,” said Mills. 

The organizers in Tennessee see this as another social justice battle that Appalachia is being thrown to the frontline of.  “And now we’re experiencing that around abortion,” Edwards said, noting that many of the most brilliant social justice activists come from the South, particularly Appalachia.

The lack of resources, rights, wealth and more that Appalachians often face is discussed and widely known – but rarely are Appalachians celebrated for the “grittiness, resourcefulness and tenacity” they show in the face of oppression and injustice, Edwards said, pointing out that Appalachians rarely fail to rise up and provide for each other. 

People in Tennessee and East Tennessee will always need abortion, Mills said, and regardless of what entities or organizations hold the work, there will always be workers ensuring people get the care they need.

“Even as tired as I am 20 years into this fight, I will never leave this region,” Mills said. “I will never leave Appalachia, and I will never let the bastards win.”

Contact Mountain Access Brigade’s Support Line at 855888MAB8.

Kacie Faith Kress is an investigative journalist, with an MS in Journalism from Northwestern University’s Medill School, specializing in Social Justice & Solutions Journalism.  Born and raised in East Tennessee, she now lives in Chicago.