Patients at A Woman’s Choice ─ an abortion provider in Danville, Virginia ─ can leave messages in a journal for the people who come after them.
"I can tell you this much, you will get through this," reads one anonymous handwritten note. "You have made the best choice for you in your circumstances, and you have a whole lot of life left to experience and enjoy."
The messages are a way to build community among women who may not have a great deal of outside support, said clinic manager Danielle Floyd.
"It lets them know that you are not alone, and that’s a really big thing for us here," she said.
The clinic opened in February in reaction to shifting state laws. It is just minutes from the border with North Carolina, which restricted access to abortion last year. The new North Carolina law limits most abortions after 12 weeks of pregnancy and requires two in-person appointments to obtain the procedure.
"We already knew that people were traveling hundreds, sometimes thousands of miles to access abortion care, and the Danville clinic is only 45 minutes from our Greensboro, North Carolina, clinic," said A Woman's Choice spokesperson Amber Gavin.
Gavin said a Florida clinic, just minutes from the Jacksonville Naval Air Station, had been their busiest. In May, Florida banned most abortions after six weeks of pregnancy, joining Georgia and South Carolina, which have similar laws. Several other Southern states ban virtually all abortions.
"In Danville, about 50 to 75 percent of our patients are traveling from out of state," Gavin said. "Some are from Georgia, many are from Florida and just the South. Basically, all the states that are beneath Virginia, folks are traveling here."
That includes military personnel, she said.
Women in the military are largely left to navigate this changing system on their own. A federal provision known as the Hyde Amendment bans the use of federal funds for abortion, except in cases of rape, incest or when the mother's life is in danger. It applies to military personnel, as well as other groups such as federal employees, veterans and Medicaid recipients. Congress has continually renewed the Hyde Amendment since the 1970s.
In the five years leading up to the Dobbs decision in 2022, military doctors performed a total of 91 abortions for service members or dependents, according to the Pentagon. Some military doctors won't even discuss the subject with their patients, said Dr. Toni Marengo, a former Navy lieutenant commander.
"There was some lapse, I believe, in their family planning training, because they had mentors who were told, 'Oh, we can't even talk about abortion.' And so you're not able to counsel your patients on the full scope of medical care because of misunderstanding and stigma," Marengo said.
Marengo was the first family planning OB-GYN in the military, as a civilian doctor at the Naval Medical Center in San Diego. She left the naval hospital in 2018 to become the chief medical officer for Planned Parenthood of the Pacific Southwest.
"I felt very stifled, even as a civilian working in a military organization," Marengo said. "I could not speak freely, I could not write op-eds, I could not advocate as much as I wanted to for the patients I was taking care of."
With military doctors performing so few abortions, the task falls on providers in states like Virginia, which haven’t imposed more restrictive laws. Clinics are straining to keep up with the influx of new patients.
"We have all of these military personnel coming over to seek health care. No, this isn't sustainable," said Air Force Lt. Col. Sharon Arana.
Based at Joint Base Langley Eustis near Newport News, Virginia, Arana leads Sword Athena, a group that looks at barriers women face in the Air Force, including access to abortion.
Its work led to some of the Pentagon policy changes after the Dobbs decision, including the policy that allows women to take leave to find care on their own.
"Right now, they're saying the best we can do is get you to an outside clinic," Arana said. "They have basically washed their hands of us, of women like me, saying go find it yourself. And here's the train ticket."
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans.
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