Debra Choat stood in the National Memorial for the Unborn in Chattanooga, Tenn., a space that used to be an abortion clinic.
Granite slabs cover the wall. Each plate is inscribed with the name of a “baby lost to abortion,” said Choat. Some of the plates have full names inscribed on them while others have a first name. Some have a last name or just “Our Little Angel.”
On a mantel below the wall rest dozens of stuffed animals, letters and toys left by visitors.
The National Memorial for the Unborn celebrated 25 years in May. It is an early example of an abortion clinic that was turned into something else by antiabortion activists. These are commonly referred to as “flipped” abortion clinics or “born-again” clinics.
A number of former clinics have been turned into memorials. There’s Hope Park in Toledo, Ohio and the American Holocaust Memorial in Baton Rouge, La., which refers to exam rooms as “holocaust chambers” and “blood rooms.” In Wichita, Kan., Central Women’s Services was converted into the headquarters of the antiabortion group Operation Rescue. In Bryan, Tex., a Planned Parenthood that closed in 2013 is now the headquarters of the Catholic antiabortion group 40 Days for Life.
The most common reincarnation of former abortion clinics are crisis pregnancy centers, which offer free pregnancy tests and ultrasounds to attract “abortion-minded” women and attempt to dissuade them from that choice.
While examples stretch back to the early ’90s, flipping has accelerated since 2011 as the closing of abortion clinics across the country has surged. Following the 2010 midterm elections, many states passed a wave of stringent abortion restrictions that made it impossible for many abortion providers to continue their work. About 200 providers have closed or stopped offering the procedure since then and the latest numbers estimate 750 or so abortion clinics are left in the United States. There are around 3,000 crisis pregnancy centers.
The phenomenon of flipped clinics illuminates how the battle over abortion isn’t just political or ideological. It’s also physical: a turf war, a land grab, a fight over real estate.
In June, I visited five flipped clinics, starting in Germantown, Md., and working my way down to Miami. I wanted to understand how these transactions unfolded and what they reveal about the state of reproductive rights in America.
The building where Germantown Reproductive Health Services used to be now sits vacant. It’s located in a large suburban complex with long rows of office suites laid out townhouse style with tan colored brick and tidy lawns. LeRoy Carhart, who practiced here, is one of the only doctors in the country who performs late-term abortions.
Just 1.3 percent of abortions occur at or after 21 weeks, according to the CDC, and are almost always pursued due to concerns of fetal and/or maternal health. Accessing abortion after the 20-week mark is not easy, however. Twenty-one states have 20-week bans in place and similar proposals regularly come up in Congress. Carhart is one of only four physicians left in the U.S. who will provide an abortion in the third trimester.
The arrival of Carhart from Nebraska, where he practiced until the state passed a 20-week abortion ban, riled up local antiabortion activists. Their protests extended to the family of the owner, Todd Stave. Stave, who is also a physician, says they waved “the requisite bloody fetus pictures” and a banner displaying his photo and phone number to pressure him to close the clinic at his daughter’s middle school. At the time, they were unsuccessful.
A few years later, Reverend Charlie Baile of the Maryland Coalition for Life, took a shot in the dark. He sent Stave an email:
“This is a crazy idea, but just thought I would mention it. If you are ever interested in selling your abortion clinic in G’town or would like to talk about getting out of the abortion industry or would just like to talk at all - I would be interested in meeting with you.”
Baile went on to say that he “was appalled” by the demonstration at the middle school, which he had not been involved with. His church, along with other members of the Maryland Coalition for Life, had, however, regularly protested and prayed outside the clinic.
To Baile’s surprise, Stave responded the next day: “I would consider talking with you about selling.”
Baile swung into action and with the help of an “anonymous pro-life Christian businessman,” the group was able to make an offer on the property.
As part of the sale, Stave had to agree not to be involved in the abortion business for five years. The buyers, however, could not put the same restriction on Carhart as an independent contractor.
Within seven weeks Carhart opened a new practice in nearby Bethesda, Md.
I asked Baile if he thought the $1.2 million the group spent on buying the Germantown clinic was worth it, given that Carhart continues to practice in the area.
“What’s a life worth?” he said. “We tried through peaceful, prayerful protest ... [buying the property] felt like a viable option.”
As for Stave, he said he’s satisfied with how it all played out. He had taken heat from antiabortion activists for years, so criticism from the abortion rights community didn’t bother him.
“I highly support women’s rights, but it’s not close to a defining cause for me,” Stave said during a phone interview. “I also support the Baltimore Ravens. It’s one of other things in my life. When an offer like this comes along, it’s very difficult to say no.”
Flipped clinics sell under a variety of circumstances. In Stave’s case, it was a financial decision — the offer was too good to pass up. In some cases, however, antiabortion buyers may be the only option. It’s not easy to sell an abortion clinic, as the longtime owner of Amethyst Health Center in Manassas, Va., discovered.
States have enacted around 400 new abortion restrictions since 2011, including building code requirements and regulations around hospital admitting privileges. Many clinics are unable to meet these rules and are forced to close.
Many of the independent clinics in the United States have been around for decades. The owners and providers opened facilities shortly after Roe v. Wade passed and are now nearing retirement. Given how hard it is to run a clinic and to have a “normal” life as a clinic owner, there’s a limited pool of young buyers out there willing and able to take over a practice.
Amethyst Health Center for Women opened in 1980 and served around 1,200 women a year until it closed in 2015. The owner had been looking to retire for years and eventually chose to sell to an organization called BVM Foundation.
BVM stands for “Blessed Virgin Mary.” The foundation was formed by members of the local Catholic community who had actively protested Amethyst for years. This is where things get a bit murky. In an interview with The Washington Post in 2016, the owner said she didn’t know who the buyers were and was under the impression the practice would continue as an abortion clinic.
Jim Koehr, the treasurer and secretary of the BVM Foundation and an architect of the deal, disagrees with that account. He says he assembled a group of Catholic entrepreneurs to raise an initial investment, establish BVM, and quietly bring the owner an offer for the real estate and the assets of the business.
“I was a party to the contract and there is no way she was deceived,” Koehr said. “But it puts her in a very difficult position.”
Flipped clinics don’t always change hands through a direct sale. The Chattanooga Women’s Clinic opened in 1975 and remained open until 1993, when the two owners reportedly died from cancer in close succession. The memorial’s written history on their website implies this was an act of divine retribution:
“A handful of men began to pray on the CWC parking lot every Sunday morning. They specifically implored God to act by either saving or removing the people who worked at CWC. Almost immediately, clinic co-owner Sue Crawley contracted a fast-spreading cancer which ravaged her body and hospitalized her ... Some twenty-one months later, the other clinic co-owner Fran Muzzoco, likewise contracted cancer and died abruptly.”
Around the same time, the owner of the building went into bankruptcy and the property was put up for auction. At the time, the clinic’s attending physician put in a bid, as did the Prolife Majority Coalition of Chattanooga. The latter won the bidding war, paying $70,000 more than a recent appraisal said the building was worth. Shortly thereafter, the clinic was razed to make way for the National Memorial for the Unborn.
The memorial is open 24 hours a day and always left unlocked with the lights on. There’s a cross-shaped support beam wrapped in fake white flowers, a lectern with a fetus drawing that says “In the image of God,” and a dozen chairs for people who want to sit or hold a service.
Choat said the memorial has 3,600 brass name plates, which those who are interested can buy online for $45 — one plate is shipped to them and the other is placed on the wall. Choat herself put a plate on the wall for an abortion she had in the ’70s. She said she had her first child as a teenager and when she got pregnant again, she felt pressure to “fix the problem.” She said working at the memorial has helped her heal.
“There’s something about placing a plate for your son or daughter that honors them,” she said. “It’s not a secret anymore. You are forgiven and set free.”
For some purchasers of flipped clinics, the chance to intercept patients seeking abortion can be part of the appeal. The last two stops on my journey were Ocala, Fla., where the owner of Ocala Women’s Center (who was also its doctor) sold to Interfaith Emergency Services, a charitable organization that offers food, shelter and medical care to the homeless, and Miami, where Top Gyn Ladies Center was taken over by a crisis pregnancy center.
Top Gyn closed in October 2015. An hour later, Heartbeat of Miami — an affiliate of Heartbeat International, which calls itself as “the first network of pro-life pregnancy resource centers in the U.S. and the largest and most expansive in the world” — signed the lease for the building. It would become Heartbeat of Miami’s fourth location, and the second one to open in a former abortion clinic.
Heartbeat of Miami did not respond to multiple requests for comment sent through email and over the phone.
The faded coral building it’s housed in has a large sign facing the road that says ’“Pregnancy Tests: Free and Confidential.” There were cars parked on the grass in front of the door and the blinds were drawn. In person, too, I was denied interviews.
I traveled 1,500 miles to visit these flipped clinics because they epitomize a web of larger forces at work: sustained harassment, burdensome regulations, the lack of insurance coverage and a wave of retiring providers who can’t keep going much longer.
While the centers I visited in Virginia and Ocala, Fla., provide valuable medical services, they still reflect the systematic erosion of abortion access.
While touring the Center for Life in Ocala, I asked the manager, Joan Truby, a friendly retiree from Kentucky, what she would do if a woman showed up seeking an abortion. She said that right after the center opened in 2016, she encountered a few people a month who came by or called to make an appointment for an abortion. That has slowed, she said, but it still happens. The most recent case was just two weeks before I visited.