While the rest of the South slowly whittled away at abortion access, Tennessee's clinics operated under less stringent restrictions.
That is about to change.
Voters on Tuesday approved altering the state constitution to make clear that it does not protect the right to an abortion — despite the U.S. Supreme Court's 1973 Roe v. Wade ruling establishing a nationwide right to abortion — and legislators are already talking about mandatory counselling and waiting periods to bring Tennessee in line with the eight surrounding states. The legislature meets again in January.
The amendment, approved by 53 percent of voters, was a slow motion response to a Tennessee Supreme Court ruling in 2000 that said abortion was protected by the state constitution. The amendment was brought before the legislature four months after that decision, but it took nearly 14 years to become law because of political opposition and the state's lengthy referendum process.
"Clearly, I think the legislature wants to put commonsense legislation in place to make sure that abortion is a safe procedure in Tennessee and to restore the state to being in-line with the states around us," said House Speaker Beth Harwell, a Nashville Republican.
Abortion rights supporters are worried that lawmakers will go too far. After the amendment passed, American Civil Liberties Union of Tennessee Executive Director Hedy Weinberg issued a statement warning politicians that "extreme, medically-irrelevant laws will be strongly opposed by voters."
The hard-fought campaign over Amendment 1 brought in more than $5.5 million, much of that raised by abortion rights advocates from Planned Parenthood affiliates across the country who fought it. The two sides spent nearly $4.5 million in October alone, much of that going toward television advertisements.
Opponents portrayed Tennessee as an "abortion destination," playing up that almost 23% of the women getting abortions in Tennessee are from out of state, according to the Tennessee Department of Health.
That statistic is a little misleading. Before the rules were relaxed by the state Supreme Court decision in 2000, 19 percent of abortions here were performed on women from other states.
Border states include Mississippi, where the only abortion clinic faces closure over a 2012 state law that is currently tied up in the courts, and Missouri, one of only three states that require women to wait 72 hours between when they seek an abortion and when they can obtain one.
Elizabeth Nash is a policy analyst with the Guttmacher Institute, a research organization that supports legal access to abortion. She said if Tennessee adopts laws like those in the surrounding states, abortion will become more difficult and expensive for women in the state. She doubted that lawmakers could cut off access entirely.
"If the goal here is to shut abortion clinics, I imagine they will be fairly successful," she said. "To go from eight clinics to zero probably won't happen."
Abortion rights advocates had better success Tuesday in Colorado and North Dakota, where voters decisively rejected measures that opponents feared could lead to bans on abortion.
The Colorado proposal would have added "unborn human beings" to the state's criminal code; the North Dakota measure would have declared in the state constitution that "the inalienable right to life of every human being at every stage of development must be recognized and protected."
Nationally, advocacy groups on opposite sides of the abortion debate drew different lessons from the election results.
Abortion rights supporters, though dismayed by the defeats of some of their Democratic allies in Congress, were heartened that some Republican candidates triumphed after softening previous stances on abortion and reproductive health.
Anti-abortion groups, meanwhile, were pleased by the infusion of more conservatives in both chambers of Congress, and said they now expect the Senate — under GOP control as of January — to take up a House-passed bill that would ban most abortions after 20 weeks.