‘Hope is the thing that kills you’

One year post-Roe is an as-told-to series led by Prism’s Editor-at-Large Tina Vásquez, marking the milestone by featuring new and veteran advocates and organizers, abortion storytellers, providers, clinic directors, abortion fund volunteers, and reproductive justice organizers. You can read the complete series here. 

Calla Hales has never been afraid to ruffle feathers or speak her curse-ridden mind, two facts that haven’t always made her a popular figure in the abortion rights movement. As the director of A Preferred Women’s Health Center for nearly a decade, she’s had to develop a tough exterior. Once a family business overseen by Hales’parents, A Preferred Women’s Health Center has four clinics across North Carolina and Georgia. Hales took over as director when she was still in her 20s—something that didn’t go over well with other directors many years her senior. Hales explained that the first time she went to a National Abortion Federation (NAF) conference, she introduced herself to another independent clinic operator from the Southeast, who mentioned the name of her parents and asked if she knew them. When Hales explained she was their child, the person said, “Oh, you’re that cunt’s daughter?” 

The 33-year-old said she finally began to find her footing with other clinic directors over the last couple of years—not that their acceptance is much of a priority. Hales often has more on her plate than she knows what to do with. Take for example the hundreds of anti-abortion protesters who have spent years harassing patients and staff outside of her Charlotte clinic each week or the thousands of additional patients her clinics have taken on since Roe was overturned. There’s also the matter of North Carolina’s new anti-abortion law, Senate Bill 20. The state was, until recently, an outlier in the Southeast, allowing for abortion care through 20 weeks gestation. SB 20 bans medication abortion after 10 weeks and procedural abortion after 12 weeks. SB 20 also comes with a host of new restrictions, including an additional in-person appointment for patients that is required at least 72 hours before they can access care. 

Many of Hales’ major life events have been overshadowed by the anti-abortion movement, including her wedding and the recent birth of her second child. Still, she says she’s in this work for the long haul. Hales recently spoke to Prism about her concerns regarding SB 20, the overwhelming challenges of running a high-volume clinic post-Roe, and how she’s feeling about the future of abortion rights. Here she is, in her own words: 

This has probably been the hardest year of my life. Not only do I have clinics in North Carolina, I also have them in Georgia, and when Georgia had its first round six-week ban, I was also pregnant for most of it. I gave birth in November, which is its own large-scale, stressful life event. But after my C-section, they rolled me into the recovery room, and immediately my phone rings. It was someone from Georgia telling me that an injunction for the six-week ban was on the table, and we could potentially start seeing patients over six weeks again. I literally felt numb, and I’m sitting there, frantically calling people and telling them not to send folks away and that they could schedule these patients again for the time being. The “time being” ended up being about a week. For me, that’s the story that comes to mind to illustrate the pure fucking chaos of this last year. 

I actually broke down and really lost my shit listening to other providers at the recent NAF conference. In this field, we all have it pretty rough. This is stressful work, and this is a very stressful time. I’m not saying this because it’s some sort of battle over who’s more traumatized; everyone’s struggles are valid. But I had this out-of-body rage experience listening to other independent providers talk about how miserable things have been for them because they saw 100 extra patients. At our Charlotte clinic alone, we took on an extra 4,500 patients. We usually have about 8,000 patients a year. We are a high-volume clinic, and last year, we saw just under 12,000 patients. With the laws constantly changing, who knows how many we’ll end up seeing this year? I left that meeting feeling spiteful, isolated, and like we were carrying this giant load on our own.

I still kind of feel that way. But I’m trying very hard to remind myself that this isn’t a competition of who’s the most miserable. This sucks for everybody across the board—for patients, for clinics, for providers, for everyone. I just have to acknowledge when I’ve hit my limit and go from there, but hopefully, the clinic doesn’t hit its limit any time soon.

The thing about the upcoming [12-week ban] is that there are a lot of gray areas in how the law is written, so we’re trying to think outside of the box while we wait on pins and needles for the North Carolina Department of Health and Human Services to tell us how it will implement the changes in the rules. What I can say is that the 72-hour in-person counseling requirement prior to a patient’s actual appointment is going to be the biggest problem. 

The new law also has a lot of emphasis on “qualified personnel.” I can absolutely see legislators trying to require all clinic staff—not just physicians or nurses—to have certain degrees, attend medical school, or have specific licenses or different certifications. Anything they can do to legislate abortion clinics out of existence. We can barely staff hospitals, let alone abortion clinics. Every time I talk about these kinds of requirements publicly, I feel obligated to point out that this in no way insinuates a low level of care in abortion clinics. What I mean is that academia and certification systems are their own fucking death traps of privilege, and the goal [of anti-abortion laws] is to place unnecessary burdens on clinics. Obviously, we need physicians and nurses who have medical degrees, but what happens when “qualified personnel” means that even your receptionist is required to have a college degree or be a certified nursing assistant or certified medical assistant? When I say I want our clinics to be accessible, I don’t just mean for patients. I want our clinics to be accessible to staff because people deserve the right to learn new skills and obtain new jobs, regardless of where they came from and what their background is.

I don’t think supporting clinic staff get enough credit, and I don’t think we talk enough about how fucking overwhelming it is for them to have to constantly talk to patients about every aspect of their care—because anti-abortion laws and restrictions make everything so complicated. Misinformation is also getting very, very difficult to manage. We see crisis pregnancy centers and anti-choice groups actively going out of their way to promote misinformation and falsehoods, so people traveling very long distances for care don’t really know what to expect.  

In April, more than 70% of our patients were from out of state. I don’t think that’s just a function of other state’s laws and restrictions. I think Roe combined with SB 20 has really confused North Carolinians; they’re massively confused by what’s going on, and they’re scared. We constantly get calls from people asking about how our clinics are still open if abortion is illegal in North Carolina, and we have to explain that abortion is not illegal here. 

People have been misled about abortion, and there’s also a lot of stigma around abortion. They have a lot of internalized shame. They have assumptions about how things are supposed to go, but we are a high-volume clinic where people have a block of time with us so that we can accommodate our patient volume while ensuring safe and accessible care. This takes time, and can mean long appointments for patients who have already had to navigate a lot of bullshit to get here. They get here, and there’s a line to check in. They’re around this group of strangers also waiting for abortion care—either for themselves or for a loved one they’ve accompanied to the clinic. For some people, it stirs up a lot of feelings and internal conflict because, even though they still struggle with the idea that abortion is “wrong” or “shameful,” they’re sitting there waiting for their abortion, surrounded by a lot of other people who are there for the same reason.

If I’m being honest, all of this can lead to a toxic situation. Sometimes it makes patients angry or hostile. They also don’t understand why all of these hoops are necessary. It’s traumatizing for them. Sometimes that means they lash out at us. It can all feel very overwhelming, and all you need is one really pissed-off patient to turn the tides inside a clinic—especially one as busy as ours. But it’s all understandable. Abortion can bring up a lot of emotions, especially for people who were raised to believe abortion is wrong. The clinic becomes the place where they are processing all of this information and internalized stuff, and at the same time, they’re a pregnant person who doesn’t want to be in the situation they’re in. They’d rather be literally anywhere else—especially when they’re being yelled at by protesters and made to feel worse.

Charlotte is my home base, and it’s where I first notice certain trends. There have definitely been changes to the composition of clinic protesters we see. We’ve always had hundreds of protesters on Saturdays here in Charlotte, but as more folks travel to North Carolina for care, we also see protesters from those states showing up. To me, it looks like more fringe folks are integrating with the usual players from [anti-abortion] groups like Love Life—and there’s definitely an uptick in white nationalism. I’m very grateful for our clinic volunteers—both escorts and defenders. There’s a group that organizes in tandem with Charlotte for Choice called the Black Abortion Defense League. They’re fucking amazing, and I always want people to know about them because Black people are often left out of conversations around clinic volunteering and clinic defense because, quite frankly, it’s usually privileged white women who have the ability to give this much time, effort, and money to volunteering. So, it’s incredible that this space was created by Tina Marshall [founder of the Black Abortion Defense League]. I just feel this push and pull because, of course, I’m grateful for our clinic defenders, but I also feel guilty they are in this position where there are white nationalists outside our clinic, and I know the clinic defenders hear racist shit all the time. I certainly hear antisemitic shit all the time. 

I was raised in this field. This is the career I chose, and I knew what I was getting into. Plus, I know what it is to be a target. I already know what it’s like to be attacked. I already know what it’s like to feel like the end of the world is here, and you would rather die. I don’t think about my safety as much as the safety of my kids and people I love, who can be targets just because of their proximity to me. I worry about the safety and security of my staff and volunteers. But I can’t obsess over it because then I wouldn’t get out of bed in the morning. The weight of the work outweighs the risk. If I don’t do this work across four clinics, about 40,000 people seeking abortion care aren’t going to get it. You honestly just can’t get in the weeds about it. I panic about a ton of stuff, and I get into my head about so many things. Safety isn’t one of them.

I actually worry about elections a lot. I know that voting isn’t the answer to everything, but elections have serious consequences for us, and every two years, I have to assess if we’re decently safe, moderately safe, or if we’re totally fucked. I can only think in these two-year chunks—that’s as far as I dare to go. It’s hard to think of the future long term. 

I feel like there’s a lot of collective trauma in the abortion rights movement. This should be a time when we’re really banding together and supporting each other, but this is not that kind of field, unfortunately. It’s really shitty to have to not only fight antis, but also fight against folks in our own movement. There’s a lot of ego and a lot of people who want to center themselves instead of focusing on patient care. That’s been really hard for me—the fact that we’re in the middle of this massive fucking catastrophe, and we are fighting each other. I guess that’s part of why I struggle with feeling hopeful. 

I’m a queer Jewish abortion provider in the South. Hope is the thing that kills you. I think there is something really lovely and radical about people’s ability to be wholly optimistic about the future of abortion rights. I’m just not there.