Public and Private Transportation Initiatives Help Vulnerable Tennessee Mothers
Tennessee’s abortion ban heightens state responsibilities for helping with prenatal and postpartum care
Since the Supreme Court’s Dobbs v. Jackson decision overturning Roe v. Wade, state lawmakers have taken center stage with much greater authority in determining abortion policies across the United States. In some jurisdictions, such as California and New York, abortion remains readily available. However, other states like Tennessee now prohibit abortion throughout pregnancy with limited exceptions.
According to the abortion-rights organization Guttmacher Institute, women obtained 10,850 abortions in Tennessee in 2020, before the statewide ban was enacted. There are no figures for the state after the ban took effect. However, the organization reported that more than 10,000 women traveled from Tennessee to other states, primarily Illinois, to obtain abortions in 2023. So, it is not clear that the ban is serving as much of a deterrent, at least for those with access to transportation.
Transportation is thus crucial for those trying to circumvent Tennessee’s abortion ban, but it’s also a key issue for unwed or needy women who have unplanned pregnancies and for one reason or another want to keep their babies. Since Tennessee has curtailed access to abortion, it is not unreasonable to expect that the state should make an effort to provide assistance to those who need help getting prenatal and postpartum care. And that includes transportation assistance, especially in rural areas of the state where residents have few or no transportation options.
Pregnancy Is Not the Crisis
When pregnancy enters the national conversation, it is usually in the context of ending it. Abortion is what brings activists out into the street and apparently the voting booths. The nation is well supplied with organizations and networks (funded with public and private money) that enthusiastically offer material support for women seeking abortions, including those needing to travel from more restrictive states.
Counter to some of the loud public narratives surrounding the abortion issue, however, the nation is also home to organizations that enthusiastically offer tangible support and alternatives for women wrestling with an abortion decision. Rachel Preston, a regional director for a nonprofit organization called Her PLAN that provides pregnancy assistance and support, says that while abortion-rights organizations are focused solely on the termination of a woman’s pregnancy, anti-abortion organizations offer long-term help to both mother and child.
“Often, it’s not the pregnancy that’s the crisis for a woman,” she said. “It’s the circumstances that she’s in. So, if you end the pregnancy, you still have the life circumstances that were there before. The abortion doesn’t take care of the crises that brought the woman to your door.”
Ultimately, a vulnerable woman needs help to address those underlying roadblocks in order to carry her baby to term and care for him or her afterward. Many women in so-called crisis pregnancies feel unable to overcome the issues that created the crisis in the first place.
“These resources exist in most communities,” Preston said. “But what we also noticed is that they can be disjointed. Oftentimes, providers may not be aware of each other. Our role is to collectively bring those organizations and providers together so that they can collaborate and best meet a mother’s unique needs. We like to say that we connect and grow the pro-life safety net.”
Crossing the Maternity Care Desert
The complexities of transportation can end up being a significant factor in the integrity of this safety net. Tennessee is a state with wide swings in the range and density of its public transportation. “There have to be different transportation accommodations depending on urban or rural areas,” Preston says. “And then you have places like northwest Tennessee, which is a maternal health care desert. Their nearest hospitals and doctors are in the Memphis area, so they’re driving a couple of hours to get to health care providers even if they have vehicles and transportation, which is another issue.”
Nashville, to the contrary, has what Preston describes as a great pregnancy center in the downtown area with no real transportation issues for moms in need. Churches donate bus passes or Uber certificates so that their clients can reliably get to appointments. Telemedicine or other virtual options for appointments, which are less ideal for pregnancy care, are not required because physical transportation resources and community assistance are abundant.
Similarly, Knoxville has a downtown pregnancy center located near the University of Tennessee campus, which is well served by a transportation network that mothers can access.
“However, then you get out to places like more rural communities where they don’t have abundant regional transportation, just a city bus that runs a limited route in the downtown area,” Preston said. She explained that many families own at most one car, which is used for transportation for work and isn’t always available to get moms to doctor appointments during the day. For services like parenting education or birthing classes, women need virtual appointment options or group classes. Evening appointment times can be a huge benefit to moms without daytime access to a car, but these aren’t always an option.
The Government’s Role
Community support is not sufficient to provide services on a widespread and fair basis. Sometimes government intervention is needed to create infrastructure and provide legal frameworks for addressing problems such as pregnant women and new mothers being unable to easily reach health and support services.
A December 2024 report from the Charlotte Lozier Institute in Alexandria, Virginia, highlighted the importance of government policies at the federal and state level in strengthening the safety net for vulnerable mothers. Citing a 2022 study by the U.S. Department of Transportation, the report said public transit systems are “not designed to meet the travel patterns of pregnant women or caregivers,” who often need to take non-peak-hour trips. Also, pregnant women and caregivers often face a lack of accessible routes, inadequate amenities and higher costs due to safety concerns and other inefficiencies, the report said.
All this underscores the challenges faced by vulnerable pregnant women in general, and particularly those who need to navigate OB-GYN deserts like those found in Tennessee.
Tennessee state Senator Becky Massey said telemedicine can play an important role in prenatal and postpartum care, particularly for women in remote areas. She sponsored a 2023 law that expands insurance coverage of telemedicine appointments in part because of the issue with OB-GYN deserts.
“It’s so important that we get people to their doctor’s appointments in a timely manner,” Massey said. “And we tried to do a little more with telemedicine and remote monitoring, have it covered because a doctor is reading it and prescribes it to people that are more high risk and have issues.”
Chair of Tennessee’s Transportation and Safety Committee and a member of its Health and Welfare Committee, Massey acknowledges that technology is not always the best solution for overcoming distance in providing healthcare, especially for high-risk pregnancies. With the eastern counties located in the Appalachians, Tennessee is among those states with higher-than-average incidences of neonatal abstinence syndrome, where babies are born dependent on opioids because of their mothers’ substance use. These cases are best handled through regular office visits rather than telemedicine.
“Tennessee kind of had to be at the forefront of looking for solutions, and we are,” Massey said. “It is getting better; those numbers are going down. But even if expecting mothers weren’t addicted, but in some economic distress, if they can’t get to their prenatal events and appointments, then those babies might have other issues. Because whether it’s help quitting smoking or whatever, they need those visits to help to make sure the baby’s born healthy.”
Learning While Moving Forward
Tennessee offers transportation benefits to state Medicaid recipients, although these must be scheduled 72 hours in advance. More urgent rides can also be scheduled through this benefit. Massey points out, though, that it isn’t like an Uber or Lyft, where the car is going to be there in 10 minutes. It’s not always the most reliable in terms of scheduling, she admits, and therefore missed appointments are a real possibility. Furthermore, in many instances a woman may live in one county and have a doctor in another, yet the transportation provider won’t cross county lines due to company policy.
A more comprehensive framework for assisting pregnant women and new mothers might be found in Tennessee’s Accessible Transportation and Mobility Act of 2020, which provides services for people who are disabled, elderly or otherwise in need of assistance in accessing healthcare, employment and education. The law established an office at the Tennessee Department of Transportation “to provide resources and expertise for expanding and improving accessible transportation and mobility across the state.”
Rather like Her PLAN, the goal of the new office is not necessarily to own and operate new services but to coordinate existing services so that providers are more aware of each other and clients are more aware of available transportation options. Massey thinks this same approach would work to improve access to transportation resources for moms in need.
“When we studied what was necessary for the disabled and elderly, we looked at what we had available and where the gaps were,” she said. “These gaps actually would be the same for not just pregnant and parenting mothers, but mothers who have lower income and don’t have their own transportation. The same type of services they could access would be similar for those covered in the Accessible Transportation and Mobility Act.”
The state would have to decide whether to make mothers in need eligible for services under the existing program or whether some new provisions would have to be made to accommodate the particular needs of pregnant women and mothers with young children. The previously referenced Lozier study similarly suggests that existing federal programs for improving mobility for seniors and people with disabilities in rural areas could be modified to prioritize projects that provide accommodations for pregnant women and new mothers in need.
Her PLAN’s Preston says that regardless of how comprehensive federal and state support programs can be, community-centered assistance remains indispensable. One of the limitations of government programs is that a person has to qualify for them. In some cases, eligibility might be set at 200% of the poverty level, which is still a high enough bar to leave many women in the lurch.
“Let’s say that you’re not poor necessarily, but you’re not surrounded by resources, either,” Preston said. “You’re at that level, which I think a lot of people are. So, you don’t necessarily qualify for something like state Medicaid, but you’re in a challenging situation. You still need help. This is where communities of support come in, including pregnancy centers, auto mechanics, food pantries, churches, Chambers of Commerce, whatever can point vulnerable mothers to other services when they need additional support.”
As an example, she cites an organization just outside Nashville that began as a source of food and clothing for people experiencing homelessness. Organizers perceived that more than basic and emergency supplies, people needed financial education and job training. From these efforts, they realized people were also struggling with transportation. They pooled their resources and bought a van that helps get people to and from work. Each individual pays a weekly, low-cost fee and the fees are used for upkeep and fuel. Through partnerships with local businesses, people are able to buy their own cars and afford their upkeep.
“This is actually a common model that we’ve shared with many different organizations and churches,” Preston said. “Sometimes it’s not that a mom doesn’t have a car. It’s that to get an oil change costs $75 she doesn’t have.”
In Preston’s view, anti-abortion organizations, like the more than 400 organizations in Her PLAN’s Tennessee Directory, are especially interested in helping both the baby and his or her mother struggling to secure healthcare. In 2022, pregnancy centers in Tennessee provided an estimated $7.1 million in goods and services at virtually no cost to moms and families, according to a study co-produced by the Lozier Institute and Care Net, in Lansdowne, Virginia.
On the government side, the Strong Families grant program from the Tennessee governor’s office and state General Assembly has spent $20 million for pregnancy and medical support, job and housing assistance and other guidance, including navigating the adoption process.
It’s private initiatives and models in concert with well-crafted public policies that will help women access the resources needed to create a roadmap for their and their babies’ future.
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