With the recent confirmation of Justice Brett Kavanaugh to the U.S. Supreme Court, activists on all sides of the abortion issue across the country are gearing up for battle over the fate of the 1973 landmark abortion decision Roe v. Wade.

Mississippi, which has passed a series of laws over the years limiting abortion access and now has just one clinic where abortions are performed, has long been considered the easiest target for pro-life advocates working to create an abortion-free state.  

While parts of the country see the newly aligned court as a fresh federal threat to abortion access, Mississippi advocates who have fought against reproductive restrictions for decades are preparing for a two-pronged fight – protecting existing abortion providers and fighting new legislative efforts to further erode abortion rights.

“Our main objective right now is staying open because that’s what we are constantly dealing with,” said Shannon Brewer, director of Jackson Women’s Health Organization, the only abortion clinic in the state. “But, we’ve always tried to focus on taking away the stigma with abortion, that’s just something we’ve always done.”

The courts have been the primary tool the Jackson Women’s Health Organization, the only abortion clinic in the state for over a decade and the focus of repeated targeted regulation, has wielded to keep its doors open.

In 2018, the Center for Reproductive Rights filed a lawsuit on the clinic’s behalf challenging the constitutionality of Mississippi’s 15-week abortion ban, which also includes complaints against five other abortion regulations in the state—including a telemedicine ban, mandatory 24-hour waiting period and requirement for providers to state a medically unfounded connection between abortion and breast cancer. The ban on abortions after 15 weeks was blocked from going into effect while the case moves through the courts.

Lawyers for the Jackson clinic argue Mississippi’s abortion laws – which proponents for expanded abortion access call Targeted Regulations of Abortion Providers, or TRAP, laws — were invalidated by the 2016 Whole Woman’s Health v. Hellerstedt decision that said states cannot restrict clinics in a way that creates an undue burden on women seeking abortion.

The Jackson Women’s Health Organization also sued the state after the Legislature passed a measure in 2012 to require doctors at freestanding abortion facilities to have admitting privileges at a local hospital. The clinic sued in federal court arguing the law was an unconstitutional barrier to abortion access, as protected by the Roe decision.  

But Mississippi is one of four states that has a law on the books to immediately ban abortion if Roe is overturned.

Planned Parenthood recently announced their new “Care for All” plan that promises to protect and expand abortion access across the country through policy initiatives, regional access networks — essentially, helping transport women across state lines if needed — and cultural change to reduce the stigma of abortion. The organization notes that although public discourse has shifted to hypothetical plans for Roe’s reversal, most Americans consistently support abortion access, according to a recent Pew poll.

Most of the specifics of the Care for All plan — including expanding telemedicine abortion access — are either impossible or unlikely in Mississippi currently, where powerful anti-abortion groups have the ear of top state officials.

“What’s happening around the country right now is that people in other states are suddenly faced with the reality of what we’ve been dealing with here for a decade,” says Felicia Brown-Williams, state director for Planned Parenthood Southeast. “And what that means in practice is that we may as well have a ban on abortion for Mississippians outside the city of Jackson.”

During the recent midterm elections, for example, Alabama and Georgia sought to pass tough abortion restrictions and Republican leaders in those states are vowing to do more. As a result groups like Planned Parenthood’s political arm poured resources into political mobilization.   

Mississippi’s 15-week ban was the most restrictive ban in the country at the time of its passing, but is now seen as the standard for other conservative state legislatures hoping to pass similar legislation. In Georgia, Republican gubernatorial candidate Brian Kemp, who resigned as secretary of state this week, vowed to pass legislation similar to Mississippi’s should he be successful in his bid against Stacey Abrams, a former Georgia state House minority leader. Alabama passed a ballot initiative that gives rights to unborn children.

“The bottom line is it’s veiled in this health and safety of women and they don’t trust women. They don’t trust women to make their own private, personal decisions. They don’t care about women’s health,” says Staci Fox, President and CEO of Planned Parenthood Southeast.

“If they did they would make it a priority instead of trying to enact barriers through the legislation—it’s just rhetoric.”

Mississippi’s one Planned Parenthood location, in Hattiesburg, does not offer abortions because of building restriction TRAP laws, says local director Brown-Williams. Even though they don’t offer abortions, they are often squarely in the crossfires of Mississippi lawmakers who promise to “defund” the organization.

While federal funds don’t pay for abortions, the sentiment is rampant among lawmakers who oppose Medicaid reimbursement payments for services, even preventive health services such as annual pelvic and breast exams, infection tests or contraception. The Mississippi Legislature successfully blocked state reimbursements in 2016, but the law was blocked by a federal judge.

Chris McDaniel speaks to a crowd gathered at Mississippi’s sole abortion clinic in Jackson on October 24.

U.S. Senate candidate Chris McDaniel recently rallied in front of Jackson Women’s Health promising to defund Planned Parenthood, which is not affiliated with the abortion clinic.

To effectively lobby in Mississippi, Brown-Williams, said it’s important for legislators to know your face.

“You employ them,” she said. “Your taxes pay their salary and like any good employer, it’s incumbent upon you to let them know what your expectations are. And frankly until we have more people in the halls who care about these issues and are comfortable in the halls, we won’t have people in the seats who can represent those values.”

Others doing reproductive health work in Mississippi say culture change has been their priority for years, and want more collaboration on-the-ground with community networks.

“Cultural shift doesn’t happen without movement building. So, to me, to have a cultural shift plan without a movement-building plan is incomplete … that’s not how organizing in the South works,” said Laurie Bertram Roberts, co-founder and executive director of Mississippi Reproductive Freedom Fund, which raises money to help expand access to reproductive health care and fund abortions.

As part of the National Network of Abortion Funds, Roberts says part of the problem—both with legislative restrictions and among those fighting to protect the current limited abortion access—is Mississippi’s unique position in the reproductive health conversation because it can carry a stigma here.

“To us, there is no choice unless you fully can exercise all of your options,” she said. “Most of our clients don’t have access to all of their options since Day One: They didn’t get adequate sex education, they don’t have adequate access to family planning, they don’t have adequate access to prenatal care or support if they want to parent, they don’t have adequate access to health care before they’re pregnant—so all of these things impact whether or not they need an abortion or whether or not they want to stay pregnant,” Roberts said.

Public health research often points to the state’s lack of preventive and maternal care as dangerous for mothers and children, and the disproportionate effect on African Americans. Mississippi ranks last for child and mother well-being, with the highest infant mortality rate in the country and one of the highest maternal mortality rates, according to United Health Foundation. African American babies are 70 percent more likely to die at birth than white babies. Also, maternal mortality among African American moms is almost two times higher than white moms.

More than 40 Mississippi counties across the state qualify as “maternity care deserts,” meaning they do not have access to OB-GYN providers, according to a recent March of Dimes report.

While five rural hospitals have closed in the state since 2010 and others face uncertain futures, access to prenatal care should be at the forefront of lawmakers’ minds, instead of further restricting abortion, says Planned Parenthood’s Brown-Williams.

“It’s simply a matter of whether or not lawmakers have the political will to make the changes that need to happen to prevent (high infant and maternal mortality rates)—whether or not their intent is to significantly harm women of color in the state, that’s the impact of their inaction,” she said.

Terri Herring, an anti-abortion activist, in the Mississippi Legislature, Tuesday, April 3, 2012 at the Capitol in Jackson. Credit: Rogelio V. Solis, Associated Press

Groups opposing abortion have also been ramping up efforts to influence their own cultural change. Terri Herring, president of the non-profit Choose Life Advisory Committee, says the organization wants to focus on reducing the stigma of adoption, and better promote it as an option for women facing unintended pregnancies. Herring also lobbies the Legislature for a group called Americans United for Life.

Herring wants to expand a conversation that she says usually focuses on just two options.

“We only look at two choices,” she says. “Either you keep your baby or you abort your baby, and adoption is almost never a part of that scenario.”

Unintended pregnancies in Mississippi are commonplace. Fifty-six percent of pregnancies were unintended in 2011, compared with the national 45 percent, according to the Mississippi Center for Health Policy.

Herring’s organization is behind the “Choose Life” car tags, which have raised over $3 million for crisis pregnancy centers across Mississippi since 2002, according to tax records.

“Our hopes were to provide every option that we could across the state for women to choose life, as long as [centers] are helping identify women who are vulnerable to abortion and we encourage adoption,” she said of the centers the tags help fund.

Herring acknowledges some of the push back on crisis pregnancy centers, mostly from critics who point out they are unregulated and don’t provide medical care beyond an ultrasound exam to confirm pregnancy. “They’re not providing medical care, they are providing moral support,” she said.

Izzy Pellegrine, a sociologist and doctoral candidate at Mississippi State University studying sex education and how it affects decision-making and health outcomes, echoes the importance of cultural shifts before policy change.

She says more work is needed to ensure women have all the support to make their own reproductive decisions. She also researched the disenfranchising effect on Mississippi women who are left out of the conversation.

“We know that if Roe falls there are a lot of women (in Mississippi) for whom their access to abortion services wouldn’t change at all because they already don’t have access to those services,” she said. “It’s not a function of Supreme Court legislation in those cases.”

Data and on-the-ground organizing, she says, “really backs up this idea that abortion is a means-tested privilege and for folks that have the resources to do so they will be able to overcome the state by state barriers to access, and folks that don’t are effectively living under a ban at present.”

Her research found that white, affluent women in Mississippi tended to cross state lines to get abortion care, while African American and low-income women tended to rely on the highly limited access available in Jackson.

“If you knew exactly nothing about Mississippi and you landed in the middle of the state one day, it wouldn’t take you long to pick up on the idea that there is a lot of movement in anti-choice organizing activity—billboards, car plates, bumper stickers, the whole nine—but you would probably be less likely to see immediate signs of the work that the pro-choice movement is doing on the ground in Mississippi,” Pellegrine said.

“And that’s because the already-strained resources of pro-choice work on the ground in Mississippi are going into direct service provision or are going into high level advocacy work just to keep the doors open and keep the lights on.”

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Erica Hensley, a native of Atlanta, has been working as an investigative reporter focusing on public health for Mississippi Today since May 2018. She is a Knight Foundation fellow for our newsroom’s collaboration with local TV station WLBT and curates The Inform[H]er, our monthly women and girls’ newsletter. She is the 2019 recipient of the Doris O'Donnell Innovations in Investigative Journalism Fellowship. Erica received a bachelor’s in print journalism and political science from the University of Southern California Annenberg School for Communication and Journalism and a master’s in health and medical journalism from the University of Georgia Grady College for Journalism and Mass Communication.