Abortion in Mississippi is already limited to a single clinic. If Roe v Wade falls, it could soon be outlawed entirely
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The sun is still rising when Derenda Hancock arrives at the only remaining abortion clinic in Mississippi.
Marked by a battered black-and-white sign on the state capital’s main drag, the Jackson Women’s Health Organization is better known as the “Pink House” for its distinctive bubblegum-coloured paint.
For nine years, Ms Hancock has been organising the volunteers who escort patients from the car park to the front door.
One of her team is already lining the fence with black tarps to block the view of the anti-abortion protesters who will soon arrive.
Ms Hancock often calls them the “antis” but she greets the first two men by name.
“I know them better than I know my neighbours and half my family,” she says.
If Roe v Wade, the landmark 1973 ruling enshrining Americans’ constitutional right to abortion, is overturned by the US Supreme Court, this uneasy morning ritual will end.
The Pink House is at the centre of the case, which is expected to trigger Roe’s downfall, after challenging a state law that restricts abortion to within 15 weeks.
Under Roe v Wade, a pregnant American is allowed to access abortion care until 24 weeks, when a fetus is considered viable.
A leaked draft ruling, published by Politico, shows the court is poised to back Mississippi authorities, clearing the way for even tighter restrictions and bans on abortion to roll out across the country.
One abortion clinic for millions in the Deep South
Ms Hancock estimates between 300 and 350 patients attend the clinic each month, with many travelling hundreds of kilometres from neighbouring states Louisiana and Alabama.
Some come from as far as Texas and Tennessee.
“We’ve dealt with the fact that there’s not abortion access in the state,” she says.
“When you’ve got one clinic for three million people, it’s really a reach to call that access.
“And so, we’ve always said, ‘as Mississippi goes, so goes the nation’. And now here it is.”
By the time counselling appointments start at 7.30am, at least a dozen protesters, including children dressed in matching “abortion is murder” T-shirts, have set up on the footpath.
To enter the Pink House, patients must drive the length of the building to the gate, often with protesters clamouring around their cars.
Some are more subdued, however, silently praying at a distance.
“For every woman, it’s different,” Ms Hancock says.
“We have a few that are really bold and hold their head up high and basically flip the antis off on their way in the door. But… Mississippi is the most Christian state in the nation.
“Half these people are afraid that their grandma goes to church with one of the protesters on the sidewalk.”
Ms Hancock and her fellow volunteers, who call themselves the Pink House Defenders, band together in rainbow-striped vests but are regularly outnumbered.
“Somebody has to do it,” Ms Hancock says.
“I feel like women have the right to make their own medical decisions without all this harassment.”
Coleman Boyd, a vocal anti-abortion street preacher, sets up a PA to blast his message through the fence.
At around 9am, a woman dressed in business attire, armed with a whistle, storms up to spray him with a foul-smelling liquid.
“If you are going to make it uncomfortable for them to be here, then I will make it uncomfortable for you,” she says.
Mr Boyd says he welcomes the Supreme Court draft but wants it to go further.
“That doesn’t take away the task or the responsibility of the church and, ultimately, the governing authorities to establish justice,” he says.
“And that is to call murder ‘murder’, to treat it like murder, to penalise it like murder.”
He is against exemptions from abortion bans for pregnant survivors of rape and incest, as well as destroying embryos created for IVF.
In some states, his vision is already playing out.
A post-Roe America
Louisiana recently floated, then scrapped, a plan to classify abortion as homicide in order to prosecute women for ending pregnancies.
In 2021, Texas passed a law skirting Roe by allowing residents to collect $10,000 rewards for suing women for having abortions beyond six weeks.
If, as expected, the Supreme Court acts to undermine nearly 50 years of precedent, some 26 states are likely to ban abortion using pre-Roe laws and “trigger” laws, which will kick in shortly after the judgement lands.
The ruling could be softened or reversed but many experts believe the end of Roe is nigh.
Vara Lyons, a senior counsel for ACLU Mississippi, says she was gutted when she read the draft opinion penned by conservative justice Samuel Alito.
“I’m a woman within the age to have kids and I’ve made the choice to focus on my career,” she says.
“I have friends who have decided to have children — who decided to have children and careers, or who decided to be stay-at-home mothers — and I believe we should have that decision.”
This is not the first time Mississippi has tried to restrict abortion access, she says.
In 2013, the Republican state legislature used a Targeted Regulation of Abortion Providers law, or TRAP law, to force most of the state’s abortion providers to stop operating via onerous rules and licensing requirements.
The Pink House was the only clinic in the state to survive the red-tape assault.
It also fought off the 15-week abortion ban in federal court in 2018, arguing successfully the law violated the protections established by Roe and affirmed by the Supreme Court in the 1990s.
Mississippi appealed that decision, however, and Dobbs v Jackson Women’s Health Organization made its way to the top of the US court system.
“The problem with this case is the Supreme Court didn’t have to take it,” Ms Lyons says.
“The 15-week ban is outside of the viability framework, and it’s unconstitutional. Leave it at that.”
Young people feel left out of the conversation
Omarr Peters, the regional coordinator of anti-abortion organisation Students for Life, hopes the end of Roe will herald a return to an earlier era.
He identifies as a former pro-choice Democrat who changed his view during university after learning a close family member was pressured to have an abortion she didn’t want.
“You can listen to statistics, you can listen to other people’s stories — and that can impact you, don’t get me wrong,” he says.
“But when you hear about it from your own family, it tends to change your perspective a whole lot.”
He agrees with Justice Alito’s conservative reading of the US constitution, saying the implied right to privacy, which Roe hinges upon, is an illusion.
“We believe we’re on the right side of history.”
Mr Peters’s organisation has no formal position on the use of contraceptives but he supports “natural family planning”, an unreliable method of avoiding pregnancy by tracking women’s menstrual cycles.
It offers no protection from sexually transmitted diseases.
He thinks women should not be punished for seeking abortions but wants other options, such as adoption, to be pursued instead.
Delia Wilder, a public health master’s student at Jackson State University, is concerned young women are being left out of the conversation.
“You should have the option to do what you want to do,” she says.
“It shouldn’t be anyone else’s choice.”
Ms Wilder fears losing access to birth control and wants Mississippi to improve sex education for young people, focusing on safe sex and respectful relationships.
From either side of the ideological spectrum, the pair say voting is key to shaping Mississippi for the next generation.
“If you don’t like something, you can change it,” Mr Peters says.
“You have the free speech to change it.”
For Ms Wilder, it’s not so simple: “This is a democracy. And we live in it. And we’re supposed to be able to have our input on it.
“We’re the land of the free but nothing’s free here.”
America’s abortion fight is only just beginning
The Jackson Women’s Health Organization is still operating but its future is uncertain beyond late June, when the Supreme Court is expected to publish its final decision.
“It’s devastating, not unsurprising, but devastating,” says Cheryl Hamlin, one of six abortion providers who works at the clinic.
“I spend all my time thinking like, ‘well, what are we going to do?'”
The clinic is in the process of opening a second outpost in New Mexico, which has been dubbed “Pink House West”, according to NBC News.
“We don’t obviously want to forget about the women of Mississippi,” says Dr Hamlin, who lives in Massachusetts.
Mississippi has the highest poverty rate in United States, according to census data, and interstate travel is out of reach for many women, particularly with the added costs of accommodation, childcare and time off work.
Even those with the means to travel interstate for abortions face risks returning home.
“Complications happen. Pills don’t always work,” Dr Hamlin says.
“And what are they going to do? Are they going to go to the emergency room? Probably not. Or seek care from their doctor? Probably not.
Mississippi already has a high maternal mortality rate and Ms Hancock cautions banning abortion will lead to a spike in deaths.
“[Women] are going to resort to any measures unnecessary if they don’t want to have children,” she says.
“And they’ll drink bleach, that already happens here in Mississippi, they will throw themselves down a flight of stairs.
“Abortion is not going away. It’s just going to be unsafe, and possibly deadly.”
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