Forget abortion: What women in Appalachian Kentucky really want

Stacie Sexton oversees a project determined to bring comprehensive birth-control access to southeastern Kentucky.

Story highlights

  • A court battle about Kentucky's only abortion clinic is in progress
  • Women in Central Appalachia, hours away from the clinic, worry about other matters
  • They are stepping up to fight for basics, like birth control and sex ed access

Pikeville, Kentucky (CNN)Perhaps it was the abstinence pledge she felt forced to sign or the promise ring she was told to slip on her finger. But from the moment Cheryl became sexually active, she felt dirty.

Then, three boys raped her, reducing her self-image to mud.
She didn't dare tell anyone or seek help. Growing up in rural eastern Kentucky, she'd been raised by drug addicts who'd lost the family home and lived in a place, she says, where there was "nothing left to do but do each other."
    Shame kept Cheryl, who wants to be identified only by a pseudonym, from even stepping foot into her hometown's health department. A year of untreated chlamydia stole her fertility.
    "I wish I hadn't been so scared," says Cheryl, now 20 and a University of Pikeville student who hopes to be an attorney someday. "I will never be able to have a family. I wish the way I'd learned about my own body and sex in general had been different."
    Here, where the Bible Belt cinches tight around Central Appalachia and small-town living means everyone knows your business, matters of sexuality and reproductive health are traditionally talked about in whispers -- if they're talked about at all.
    But pull back the kudzu, and you'll hear voices crying out for change, even as the political winds howl against them.
    Arwen Donahue, an artist and writer, is working on a graphic novel about choices, reproduction and motherhood because she wants to give voice to rural women who are often isolated.
    Gov. Matt Bevin, they say, is hell-bent on outlawing abortion. Under him, state officials are threatening to close Kentucky's only abortion clinic. And though a pre-abortion ultrasound requirement was recently struck down, Bevin signed into law a ban on abortions after 20 weeks. Meantime, the Trump administration has rolled back Obamacare's contraceptive coverage requirement and proposed a budget that would cut programs to prevent teen pregnancy -- while sinking millions more into abstinence-only education.
    In the face of all of this, there are women in eastern Kentucky rising up to do what others won't do for them. Through activism and art, radio shows and bootleg sex ed classes, they are taking a stand for their communities and families, and for every young Cheryl out there.

    As deep as the 'hollers'

    Near a stone bridge that crosses the North Fork of the Kentucky River in the quaint town of Whitesburg, a group gathers in a space usually reserved for youth programs and punk rock shows. They are here to embark on a bold mission, one that is so new, they ask me to leave before they get to work.
    The dozen or so who stream in are from Whitesburg and nearby towns, the big city of Lexington and even the nation's capital.
    Their goal? To launch a comprehensive birth-control access campaign in southeastern Kentucky, where teen birth rates outpace the national average.
    In walks a woman who remembers classmates who got pregnant before they reached high school. Here comes another who likes to say it's easier to get pain pills in these parts than some forms of birth control. A third works on the front lines to ensure abortion access.
    Abortion has put Kentucky in the national spotlight. If its last abortion clinic, based in Louisville, closes, the Bluegrass State would be the first in the nation to effectively ban the procedure since it was legalized in 1973.
    But here in this easternmost part of the state, hundreds of miles from Louisville, a court battle over the clinic's fate is hardly top of mind. Many people I meet while traversing the region aren't even aware this fight is happening.
    Medical professionals can count on one hand the times they've been asked about abortions. Women who've had abortions rarely, if ever, mention it. For many, the clinic might as well be in Las Vegas. If you don't have the means to get to Louisville -- let alone pay for the procedure, lodging and child care -- what difference does it make if there's no abortion clinic in the state?
    What can make a difference in tackling unplanned and unwanted pregnancies are more conversations about -- and more access to -- birth control, reproductive health care and sex ed. But the challenges in opening up these discussions run as deep as the "hollers," or valleys, that cut through these green hills.

    'The whole town knew'

    Outsiders often imagine this area in black and white, a place where poverty blankets the land much like the fog that hangs in the morning air. But the reality bursts with color -- and people who defy expectations.
    "Women in this area are not encouraged to be forceful," says Zelma Forbes, who goes by "Sweet Tater" when she's on the radio.
    Tattooed on Stacie Sexton's left shoulder are the longitude and latitude of Whitesburg, where she was born and raised until she moved to nearby Hazard as a tween. She lives in Lexington now but never forgets where she's from. She recalls the abstinence-only education she got in grade school and how two of the seven girls in her class got pregnant before the end of eighth grade. One miscarried; the other married.
    She'd just turned 20 when a nurse at the health department confirmed that she was pregnant and insisted that she make a prenatal care appointment. With the start of college around the bend, she had other plans: She traveled more than 150 miles to Knoxville, Tennessee, for an abortion.
    When someone from the health department called because she'd missed her appointment, Sexton was honest about what she'd done. "The whole town knew within a few days," she says, privacy laws "be damned."
    Today, at 32, she's a force for change. She recently organized the first "Abortion Monologues" in Lexington, providing a stage for women and men to share their stories while trying to increase empathy and erase stigma.
    But it's her full-time job at the Kentucky Health Justice Network that brings her back to Whitesburg this evening to steer the group committed to promoting birth control access.
    She directs the new project, All Access EKY, which is loosely modeled after a successful Colorado initiative. Between 2009 and 2014, with the help of a private funder, Colorado managed to cut births and abortions by about 50% among teens and 20% among women between 20 and 24, while saving the state nearly $70 million in public assistance.
    With funding from the Educational Foundation of America, All Access EKY aims to increase access to and demand for birth control, including long-acting reversible options like IUDs and implants -- the sorts of contraceptives that can be hard to come by here.
    We're "still having to fight all these negative stereotypes of being barefoot and pregnant," Sexton says. "We do have a problem, but people would be receptive to these options if they had them."
    Across Kentucky, 47% of pregnancies are unplanned, costing the state $75 million and the federal government nearly $303 million a year. This is according to the latest figures culled by the Guttmacher Institute, a leading research and policy organization focused on sexual and reproductive health.
    In Appalachian Kentucky, the teen birth rate is 68% higher than the country and 34% higher than the rest of the state, according to a report by several groups, including the Appalachian Regional Commission.
    All Access EKY wants to shape a new reality through coalition building, education, legislation and storytelling.

    A hardscrabble history

    Signs pointing to churches dot the roadways. So do alerts for blasting zones and fallen rock, where the long-dying coal industry gasps for breath.
    To understand how women have experienced this region, it helps to know a bit about the hardscrabble history of where they're from.
    The area has long been defined by coal. But the truth is, since automation took hold after World War II, mining has been on its way out. The "boom and bust" business that displaced millions of people has been dying for decades, says Dee Davis, founder and president of Whitesburg's Center for Rural Strategies, who has lived in and studied this area for most of his 66 years.
    "I don't think anyone thinks that the coal indu