Jackson, Mississippi — The Pink House wasn’t Tiara’s first choice. It wasn’t even her second. It was the only place that could help her.
Tiara, who kept her full name secret for privacy, lives near Beaumont, Texas. She and her husband have twins, aged 1 and 2, who are both 2 years old. She is employed and is responsible for the majority of her parenting duties.
Soon after the Texas law SB 8 was in effect, Tiara discovered she was pregnant. Her home state had banned abortions for anyone further along than six weeks in a pregnancy, a point at which most people, Tiara included, don’t realize they’ve conceived. Oh, no, She thought.
“It’s my first time doing something like this,” she said.
At 3 a.m. on Tuesday October 10, Tiara set out for Jackson, six hours away. Tiara left her husband to look after the children and headed to the Pink House for an abortion. She didn’t know how much the procedure would cost. $600? $650? She knew it was necessary to make it work.
The access to abortion has become more difficult across the country over the past decade. This year, the battle for undo has begun. Roe v. Wade — the 1973 Supreme Court case that guaranteed the right to an abortion — may finally reach a crescendo. The Pink House, which is the nickname for Jackson Women’s Health Organization, is at the center of the case, which is widely seen as a chance to undo 50 years of abortion rights.
On December 1, the Supreme Court will hear a case initiated by Jackson Women’s Health, the only abortion clinic in Mississippi. The clinic challenged a Mississippi law that would prohibit abortions after 15 weeks of gestation. It argued that it violated the Constitution. Roe v. Wade’s precedent of guaranteeing the right to an abortion until after a fetus can live independently outside of the womb.
In some ways, a 15-week ban on its own could mean relatively little — Jackson Women’s Health does not perform abortions after 16 weeks of pregnancy, and nationally, most abortions occur before 13 weeks. But abortions after 15 weeks are usually those performed for people who discover health concerns later in the pregnancy, or who haven’t been able to pull together the money, time and resources to access an abortion earlier. Even a loss of one week is devastating for them.
Tiara walked by the anti-abortion protesters, who often shout Bible verses outside the Pink House. She was greeted by the facility’s clinic escorts — volunteers whose job it is to help patients safely enter and exit the facility. They were wearing brightly striped vests and had placed speakers blasting Journey and Prince songs in an attempt to drown the protesters.
Inside the clinic, Tiara sat through Mississippi’s state-mandated counseling, which includes a false claim that abortions can increase the risk of breast cancer. A sonogram showed she was 11 weeks pregnant — late enough that she would need a minor surgery to end the pregnancy.
Mississippi is one of several states that requires patients to come in for two visits to get an abortion: There’s the initial counseling and then, 24 hours later, the abortion itself. But Tiara’s first appointment was Tuesday, and Jackson Women’s Health wouldn’t be open the next day.
Tiara drove six hours to Beaumont that night. She’d see her kids and her husband. She would return the trip two days later.
“I already have kids. They’re too close in age,” Tiara said from the clinic waiting room. “I really don’t think it’s right, taking abortion away.”
If the Supreme Court upholds Mississippi’s 15-week ban, the decision would almost certainly weaken Roe v. Wade. Much will depend on the details of the court’s decision. But if the court takes the case a step further, suggesting that the Constitution does not protect abortion rights and states are free to regulate the procedure as they please, Mississippi’s governor has indicated he would pursue a total state ban. Many observers believe this outcome is possible.
The impact on Jackson and the surrounding areas would be immense.
“It’s going to be detrimental to women in Mississippi. It’s going to be detrimental to women in the South,” said Shannon Brewer, the clinic director for Jackson Women’s Health. “Eventually, it’s going to be detrimental to women everywhere.”
Abortion access in Mississippi — one of the poorest states in the country, and with one of the highest rates of pregnancy-related deaths — was already tenuous at best. Jackson Women’s Health is the only clinic in the state. For many patients, both in Mississippi and from neighboring states, it’s a lifeline.
“The patients here are the ones who can’t afford to fly to another state,” Brewer said. “These are the ones who can’t afford to take time off work because they’ll lose their jobs, or who can’t find someone to watch their kids.”
Brewer said that this year the clinic is under unprecedented pressure. She glancing between sentences at a series of security camera feeds on her desk, Brewer said. Jackson Women’s Health is under constant scrutiny, thanks to the national interest in the upcoming Supreme Court case. However, physicians have seen a dramatic increase in their workload over the past few months.
Mississippi is neighbor both to Louisiana — where abortion infrastructure was devastated by Hurricane Ida this summer — and to Texas, where the six-week ban has effectively ended access to most abortions. Perhaps half of the patients who arrive in Mississippi are from these two states. Clinics in Oklahoma are calling Jackson Women’s Health asking if its doctors can help schedule appointments for Texans seeking out-of-state care.
Nestled between cafes and restaurants in Jackson’s gentrifying Fondren neighborhood, the clinic would be easy to miss if not for the daily stream of protesters who wait outside with posters, offering anti-abortion pamphlets. It isn’t a big building. There are two rooms where surgical abortions can be performed. There is also office space for staff and doctors. The building has patient waiting areas at both the front and the back. Visitors can buy snacks — a bag of chips, or a bottled water – from the front waiting room.
The cheapest procedure — a medication abortion before someone is 11 weeks pregnant — costs $600. An ultrasound, which is mandatory is an additional $100. Those aren’t small amounts, particularly in a state where 1 in 5 working women live below the poverty line, and health insurance in Mississippi is generally prohibited from covering abortions.
Sarah, a 29-year-old patient, drove two and a half hours to come here, borrowing a friend’s car to make the drive. (Sarah is a pseudonym. She requested that her first and last names be withheld. In an effort to avoid daily protesters, she arrived early.
Sarah hadn’t told a single person she was pregnant — about four and a half weeks along — or that she was seeking an abortion. She stated that her family is deeply religious. They wouldn’t understand.
Having a child just isn’t feasible right now, she said. Her job was lost when the coronavirus crisis hit Mississippi. She and her fiancé had to sell their house so that they could pay the bills. She’s living with her parents until she gets married.
“My life at this point doesn’t allow me to have children,” she said from the small waiting area in the back of the building. “I didn’t mean to get pregnant.”
But if the clinic hadn’t been here, Sarah said, she isn’t sure what she would have done. She doesn’t think she could have feasibly driven more than four hours each way to get an abortion.
Already, almost half of Mississippians who opt for an abortion are leaving the state. According to data from the state health division, approximately 4,700 Mississippians had an abortion in 2018. According to the Centers for Disease Control and Prevention, only 3,000 abortions were performed in Mississippi that year.
This means that close to 2,000 Mississippians have left Mississippi to get an abortion. They often travel to clinics in Tennessee or Alabama, according to CDC data.
If Roe v. Wade were to be overturned, every single one of Mississippi’s neighbors — Texas, Tennessee, Alabama and Arkansas — has laws on the books to outlaw the procedure. Florida, North Carolina Kansas, Illinois and Illinois are the next closest options.
The week of October 18, 104 patients got abortions at Jackson Women’s Health — more than double the norm.
The clinic has upped its hours: Before the Texas ban took effect, Jackson Women’s Health was open three days a week. Now it’s open five days, sometimes six. They hired two more doctors — now five different physicians fly in from out of state to provide abortions. The clinic covers their airfare, their rental cars, and their lodging.
“When patients call and we’re able to get them in the following week, they’re willing to drive that far, instead of having to wait two, three, four weeks,” Brewer said. “So many states are limited with their doctors, to where it fills up your schedule so quickly. Patients don’t have a choice but to wait. That’s why we brought in these doctors. We’re thankful to have these doctors, but that’s the only reason we’re able to see the patients.”
Still, many here believe it’s a matter of when — not if — abortion rights disappear. It’s been a transition years in the making.
“Mississippi has always been on the chopping block,” said Michelle Colon, a long-time abortion rights organizer in the state. What’s different now, she said, is how widespread restrictions have become.
Activists are trying conceive a future without Roe v. WadeMississippi and its neighboring states no longer have protections for abortion rights.
Part of that means training people in how to use Plan B, the so-called “morning-after pill” that can prevent pregnancy if taken within three days of unprotected sex. Colon’s organization, known as Sisters Helping Every Woman Rise and Organize (SHERo), is even working with local churches to help distribute the pill.
Also, there are efforts made to establish abortion networks.
Organizers and funds for abortion are trying to build relationships with clinics in other states so that, in the unlikely event Mississippi bans abortion, they can help people travel elsewhere to have an abortion.
And they are trying to spread awareness of what is called “self-managed abortion” — taking medication abortion pills at home, which, if done correctly, can be a safe option for people who are earlier than 10 weeks in a pregnancy. (Safe self-managed medication abort in the first trimester is supported by the World Health Organization.)
Legally, a person other than a doctor cannot prescribe a treatment plan. Talking about the possibility for self-managed abortion is permissible. Self-managing abortions are illegal in five states. Mississippi is not one.
To find pills, however, you will need to know someone who can help you locate them or have access to an online retailer. This assumes that the pill is still available to someone who is not yet pregnant. Even in states that do not criminalize the practice, self-managed abortion is possible. still risk prosecution.
“It’s going to be challenging,” Colon said. “But how do you say no? How do you not help someone?”