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Millions of Women Already Live in a Post-Roe America: A Journey Through the Anti-Abortion South

Currently, there are 20 states poised to outlaw abortion if given the opportunity, which would impact more than 25 million women of child-bearing age — and disproportionately poor and minority women.

Doctor walking in clinic
Dr. Stephanie Ho at the Planned Parenthood in Fayetteville, Ark. , Still from Reproductive Rights Road Trip

I met Danielle in the counseling room of the Jackson Women’s Health Organization in Jackson, Mississippi, which sits on a busy corner in the city’s arts district. Its vibrant pink paint job has earned it the name “the Pink House,” and it is the state’s only remaining abortion clinic.

Dressed in gray sweatpants and a T-shirt, Danielle looked pensive as she sat in a narrow room in the back of the building alongside 12 other women there for abortion care. Betty Thompson, a counselor who has worked at the clinic for 24 years, stood before the women, ready to walk them through the necessary paperwork and go over next steps.

Twenty four years old with two young children, Danielle had just found out she was pregnant again. She had a fling with a co-worker, only to learn that he had sabotaged the condom they used. She was now four weeks pregnant. After weighing her options, she decided to terminate her pregnancy. She’d become pregnant via deception, she thought, and that didn’t exactly suggest stability on the part of the man she would be bound to if she were to carry the pregnancy to term. But more importantly, she told me that she just wasn’t in a position to have another child. A single mom, she takes pains to ensure that her two kids, ages 4 and 2, have everything they need to thrive. It’s a struggle and a lot of responsibility, and she didn’t think it would be fair to anyone to bring another child into the mix. “I got my kids in a place where they can take piano lessons and they can take swimming lessons; they’re having a great life,” she said. “I would feel like a bad mom if I couldn’t do that for them. So I don’t regret doing this now. And every woman should have a choice with her body, what to do with her body.”

On August 7, Danielle boarded a Greyhound bus for the three-hour trip to Jackson. She left the kids with their grandmother, and she packed a duffle bag because she’d be gone at least three days — Mississippi law requires abortion patients to have an initial visit in which they’re counseled on the choice they’re making, and then a second appointment for the abortion itself. In between is a state-mandated 24-hour waiting period, allegedly necessary to allow the patient extra time to wrestle with the gravity of her decision.

This meant that in addition to the bus fare and the $450 she needed to pay for the abortion, she would also have to come up with money for a hotel, meals, and cab rides back and forth to the clinic, all of which posed a significant burden, especially since Danielle was between jobs. By the time she left Jackson three days later, Danielle estimated that she would have less than $30 to cover family expenses for the rest of the month.

Danielle’s story is familiar in substance and circumstance. Like Danielle, many women who seek abortion care are already mothers, and a majority cite economics or competing responsibilities as a factor in their decision to terminate. And like Danielle, in order to obtain an abortion, women in a number of states must also navigate a byzantine maze of regulations ostensibly meant to ensure their health and safety. But in reality, the rules are enacted solely to frustrate women’s ability to access constitutionally protected health care.

With the elevation of Judge Brett Kavanaugh to the U.S. Supreme Court, reproductive rights advocates fear that things will only get worse. Kavanaugh’s thin yet troubling record on abortion indicates that he is no fan of reproductive autonomy. And President Donald Trump long ago indicated that he has a litmus test for high court nominees: They must be “pro-life” judges, he said, who will vote to overturn the landmark Roe v. Wade case that legalized abortion.

So it was really no surprise that the hand-wringing began almost immediately after Justice Anthony Kennedy announced his retirement from the court last summer. A slew of headlines signaled that the demise of Roe was imminent. Despite the fact that Roe is settled law — and has been for nearly 46 years — I was worried too. But I also felt that a lot of the early coverage missed a crucial point: Millions of U.S. women already live in what amounts to a post-Roe America.

I wanted to write about the impact of Kennedy’s retirement and Kavanaugh’s nomination, but I wanted to do it in a different way: I wanted to show what it looks like on the ground for women who live in parts of the country where the right conferred by Roe — and reaffirmed in Planned Parenthood v. Casey and again in Whole Women’s Health v. Hellerstedt — has already been significantly eroded.

To do this, I rented a Toyota minivan and teamed up with award-winning documentarian Maisie Crow for a three-state, 1,400-mile road trip through Oklahoma, Arkansas, and Mississippi, contiguous states that have each enacted some of the strictest abortion laws in the country — and are surrounded by states that demonstrate similar, if not even more extreme, hostility to abortion rights. Together, they form a landscape encompassing a large swath of the country where millions of women live with a legal right to abortion, but often without meaningful access to exercise it.

Even if the Supreme Court does not overturn Roe outright and instead backs away from precedent in order to uphold the legality of the onerous restrictions passed by these states, the situation could quickly worsen. Currently, there are 20 states poised to outlaw abortion if given the opportunity, which would impact more than 25 million women of child-bearing age — and disproportionately poor and minority women. There are at least 16 abortion-related lawsuits just a step away from the Supreme Court, including one from Arkansas. In all, there are nearly 30 lawsuits related to reproductive rights that could make it to the court in the near future.

Oklahoma Goddamn

I first got to know some of the women who make up the all-volunteer advocacy group Oklahoma Call for Reproductive Justice in 2017 after reading one of their legislative alerts about a bill pending in the state House that would require a woman to get her sexual partner’s permission before seeking an abortion.

In explaining to me the purpose of his proposal, state Rep. Justin Humphrey lamented that one of the “breakdowns in our society” is that men have been excluded from “these types of decisions.” He said he understood that women feel like they should be able to do what they want with their own bodies, but we needed to recognize that where pregnancy is concerned, we’re actually just a “host.” If you have sex and get pregnant, that’s your fault, he told me. “Your body is your body and be responsible with it. But after you’re irresponsible, then don’t claim, well, I can just go and do this with another body, when you’re the host and you invited that in.”

The bill didn’t go anywhere and hasn’t been filed again, almost certainly because it is blatantly unconstitutional, at least by current standards. But dubious legality doesn’t appear to concern many Oklahoma lawmakers. Currently, the state is in court over several abortion restrictions it has passed in recent years — including one that seeks to ban the most common method of later-term abortion, one that would force doctors to use an outdated protocol for administering medication abortion (available in the earliest weeks of pregnancy), and one that has replaced the state’s 24-hour waiting period with a 72-hour “reflection” period, the longest waiting time required by any state.

If there were a three-day waiting period in Mississippi, Danielle would have had to stay in Jackson for at least a week in order to obtain her abortion — provided that she could get her two appointments to align — or make two six-hour round-trip bus rides to the city to obtain care.

In a quiet neighborhood northwest of downtown Oklahoma City, we met with Priya Desai and Danielle Williams, current co-chairs of OCRJ. Desai handed me a 10-page spreadsheet listing all the bills — good, bad, and terrible — that OCRJ has tracked through the capitol over the years. Among them are at least 128 bills related to abortion. It may sound like a lot, but it is fairly par for the course in states like Oklahoma, where grandstanding over abortion is an every-session affair.

Keeping on top of what legislators are doing to try to restrict access can be challenging, Williams told us, in part because lawmakers often file shell bills, legislation with a number and title, but without text. “So we could have a shell bill that is filed in February, and then all of a sudden, they fill it in April,” just a month before the end of the annual session, “and it’s an anti-abortion bill that we had no way of knowing what it would be.” Such a move seems designed, at least in part, to gin up support for a proposal behind closed doors without giving advocates time to organize in opposition.

Still, OCRJ has dedicated supporters in the capitol who help to keep them as in the loop as possible, and when they haven’t been able to stave off a particular bill, they’ve taken their fight to court, serving as a plaintiff in five lawsuits challenging various restrictions. They’ve won four times. The fifth is still in litigation.

 

Whether they pass or not, the extreme measures proposed by Oklahoma lawmakers over the years have helped to sow confusion. Williams and Desai say they’ve heard from women who are confused about whether it is even legal to get an abortion in the state, or under what circumstances they’re allowed to do so. In response, OCRJ has published a guide (aptly titled “How to Get an Abortion in Oklahoma”) to help women navigate the hurdles.

This is a largely rural state, and not a particularly prosperous one, where the main population centers — Oklahoma City and Tulsa — are in its eastern half. This is also where the state’s abortion clinics are located, meaning that women in communities throughout Oklahoma must travel long distances, even hundreds of miles, for in-state access. They face a 72-hour waiting period, a 20-week gestational ban, medically inaccurate informed consent materials — which include the debunked warning that abortion could be linked to breast cancer — restrictions on access to medication abortion, a mandatory ultrasound law, and a ban on insurance coverage for abortion.

Restrictions like these do not make women safer. They force women to spend more money, travel greater distances, and carry their unwanted pregnancies far longer than necessary, if they don’t simply conscript them into parenthood.

When women can’t find services in-state and must cross state lines, they have to navigate a whole other regime of restrictions. In Arkansas and Mississippi — and, really, across the entire region, including Nebraska, Kansas, Iowa, Missouri, Texas, Louisiana, and Alabama — lawmakers have essentially adopted the same goal: Legislate legal abortion out of existence.

Abortion restrictions fall into two basic categories. The first includes laws that supposedly aim at protecting the state’s interest in fetal life — things like mandatory ultrasounds, multiday waiting periods, and gestational bans. Some states have required a woman to view the ultrasound image and listen to the fetal heartbeat if one can be found, regardless of whether she wants to or not. Iowa and North Dakota have each passed a six-week gestational ban, before many women even know they’re pregnant. These laws have been blocked by the courts, for now. In December, Ohio lawmakers passed their own version of the law.

The second category includes what are known as targeted restrictions on abortion providers, or more commonly, TRAP laws. These are things that allegedly protect the health and safety of women seeking abortion care, but are medically useless, practically speaking. This category includes facility requirements — like mandating that abortion clinics be transformed into expensive, hospital-like surgical centers — as well as restrictions that attach to the abortion doctors themselves, like a requirement that abortionists have hospital-admitting privileges. This requirement is particularly dishonest: Doctors don’t get admitting privileges unless they regularly admit patients. Abortion is one of the safest medical procedures there is, so it is almost impossible for an abortion doctor to obtain admitting privileges — and the lawmakers who advocate for this restriction know that.

As a whole, these laws are based on junk science.

In addition to the more familiar anti-abortion lawmakers who soapbox for these kinds of restrictions, Oklahoma is also ground zero for the Abolish Human Abortion movement — “Our sincerest apologies to the rest of the world,” Williams told us — which was founded in Norman, a college town roughly 20 miles south of Oklahoma City. Where most anti-abortion lawmakers have taken the familiar, death-by-a-thousand-cuts approach to restricting the right to abortion, AHA is more direct: They disdain the incremental and champion only measures that seek to eliminate legal abortion immediately and altogether.

For the most part, AHA’s adherents are young and look, as Williams put it, “like your standard hipster.” They wear GoPro cameras affixed to their chests to record their public evangelizing to crowds gathered wherever and for whatever reason, including outside concert venues, sporting events, or as Desai noted, Norman High School. They fancy themselves the moral equivalent of 19th century abolitionists, and they believe that women who have abortions should be charged with murder.

The AHA has found some friends among the Oklahoma legislature. In 2016, one lawmaker filed a bill that would categorize abortion as first-degree murder, and a similar bill is already teed up for the 2019 session. Another lawmaker sought to pass a ballot measure that would amend the state constitution to outlaw all abortion (including the destruction of fertilized embryos created during in vitro fertilization) and to ban the use of certain contraceptives. Both measures were unsuccessful. In 2018, a former state lawmaker, Dan Fisher, ran for governor with the explicit promise of making abortion illegal in the state.

As it is across the country, the anti-abortion movement in Oklahoma has cloaked itself in religiosity and righteousness. Though what they seem to have forgotten is that the move to legalize abortion was also deeply tied to faith. Even in Oklahoma.

A Whole Different World

Without traffic, it takes roughly two hours to drive from Oklahoma City north to Tulsa, a city known for its wealth of well-preserved art deco architecture. In a small theater on the edge of downtown, we met Cecilia Wessinger. She’s lived in Oklahoma for about a decade. Growing up in New York, Wessinger said that she didn’t think much about the politics of reproductive choice. “It’s very different being pro-choice and a feminist on the coasts than it is to be one in the middle of the country,” she said. “Oklahoma, it’s a whole different world.”

Wessinger didn’t grow up in a particularly religious family, but in Oklahoma, she joined the Unitarian church. Tulsa has one of the largest Unitarian congregations in the world. It was through the church that she got more deeply involved in reproductive rights and with the Oklahoma Religious Coalition for Reproductive Choice. “I can tell you that when I lived in New York, there were women that I respected,” she told me. “But when I moved to Oklahoma, I met women I wanted to be like.”

The women she met through the coalition encouraged her to start advocating for Planned Parenthood and work as a volunteer patient escort at Tulsa’s abortion clinic. She recalls manning a booth for Planned Parenthood at the state fair and being heckled by middle-aged white men, “who shouted some incredibly horrible things” while their kids stood by, “eating turkey legs.”

They also got her thinking more about the role of the church in reproductive choice. “I thought it was such an oxymoron, right? Where it’s religious, but it’s choice. And how does that work?”

In fact, there is a long history of faith leaders advocating for reproductive rights. In the pre-Roe years, a network of clergy helped hundreds of thousands of women access services because they saw the damage and death caused by illicit and self-induced abortions. What came to be known as the Clergy Consultation Service on Abortion officially formed in New York in 1967, at a time when 42 percent of the city’s maternal deaths were due to unsafe abortions. At the center of the movement was the Rev. Howard Moody of the Judson Memorial Church. He brought together area ministers and rabbis to advocate for safe abortion, and they announced their intentions on the front page of the New York Times. In short order, the CCS grew to a network of more than 2,000 clergy members across the U.S. and Canada helping women to access safe abortion care.

The CCS opened one of the first free-standing abortion clinics in 1970, and after Roe legalized the procedure nationwide, the group continued to advocate for access, calling not only for equity in care for all women regardless of race or means, but also pushing for services to be provided in the least restrictive setting. In other words, the opposite of what many U.S. women currently experience in trying to access care.

The group eventually disbanded, but its work was carried forward by the Religious Coalition for Reproductive Choice — of which the Oklahoma Coalition is a part. “As faith leaders, we all feel literally called — and supported by spirit on a daily basis — to model something different,” the Rev. Harry Knox, former president of the RCRC, told ThinkProgress. “Our message is that you are loved, loved, loved. God loves women who have abortions.”

In Tulsa, the faithful were equally active in helping to arrange pre-Roe abortion care. They met in the basement of the Unitarian church and put together a sort of “underground railroad,” Wessinger told us, to fund and facilitate abortion. One of the only women on staff at the University of Tulsa acted as a go-between, working in concert with the head of the school’s theology department, she said. Women would wait in a parking lot at the corner of Harvard Avenue and 30th Street, just southeast of downtown. After being picked up, they would lie face down on the car’s floor with a blanket over them, so they didn’t know where they were going, and would be driven to a doctor’s home to receive care. “That’s what abortion was like,” she said. “And those were the lucky ones, right?”

Watch here
 

Arkansas’s Bad Medicine

Fayetteville is a leafy college town nestled in the Ozark Mountains in the northwest corner of Arkansas. It’s about two hours east of Tulsa and roughly three hours northwest of the state’s capital, Little Rock.

The Planned Parenthood clinic here is in a mixed-use development on a main thoroughfare at the edge of town. There are apartments on the second floor above the clinic and a CPA office next door. It is one of only three abortion providers in the state (the others are in Little Rock), and it provides only medication abortion.

Medication abortion is a two-drug cocktail available to women up to the 10th week of pregnancy. It is highly effective and extremely safe — just .16 percent of women experience any complications — and is growing in popularity, not only because it allows for the earliest of terminations, but also because, unlike a common procedural abortion, it is noninvasive, and a woman can manage the process in the privacy of her own home.

In the simplest of terms, this is how it works: A woman first takes a drug called mifepristone, which blocks progesterone, a hormone needed to maintain pregnancy. Then 24 to 48 hours later, she takes a second drug called misoprostol, which causes the uterus to contract and expel the pregnancy. Medication abortion has been available in the U.S. since 2000. It has been used by more than 2 million women.

Because it can only be used in the earliest stages of pregnancy, the introduction of medication abortion was something of a game-changer, in part because it would seem to address many of the concerns held by anti-abortion activists chagrined by the termination of pregnancy later in gestation. It has not worked out that way. Instead, lawmakers in a number of states have pushed back against medication abortion, attempting to saddle providers with restrictions that they claim are necessary to protect women against its alleged harms. Nowhere have they done so more aggressively than in Arkansas.

In 2015, the state passed a law requiring medication abortion providers to contract with a doctor with admitting privileges. Theoretically this would create an extension of care, in case a patient were to develop a complication needing emergency medical treatment. Akin to the admitting privileges requirement that states like Texas had already imposed (before they were struck down by the U.S. Supreme Court), it was sold as a way to demonstrate the state’s desire to ensure the health and safety of women.

But for that purpose, the law doesn’t make sense. For starters, it mandates only that a provider have a contract with a physician that has admitting privileges somewhere in the state, which encompasses some 53,000 square miles, meaning that there’s no requirement that the hospital in question be near the state’s abortion clinics or any particular abortion patient, many of whom have to travel hours to access services. Remember, medication abortion is self-administered by a woman at home (or wherever she chooses to be). In Arkansas, the first pill is taken at the clinic, but the pills that actually force expulsion of the pregnancy are taken days later. So if a patient were to face some sort of medical emergency while at home, there is literally no reason to think that they would drive hundreds of miles to a hospital somewhere else in the state. Instead, as with any other medical emergency, it is far more likely that they would seek care locally. And that isn’t even likely to happen: Just .06 percent of medication abortions result in a complication requiring hospitalization.

While pro-choice leaders scoffed at the law, the clinics nonetheless sought to comply with it — the problem is, they couldn’t. The clinic in Fayetteville sent out letters to doctors all over the state seeking a provider willing to help, but got no takers, in large part because anti-abortion rhetoric here has created a toxic situation, including for the hospitals that would have to agree to the arrangement.

Planned Parenthood and its Fayetteville doctor, Stephanie Ho, sued to block the measure from taking effect: The law was medically unnecessary, they argued, and would leave women across the state without meaningful access to abortion. If the law took effect, there would be just one provider in the entire state, Little Rock Family Planning Services — the only clinic that provides procedural as well as medication abortion — left to care for thousands of women each year. And it would force women who would otherwise opt for medication to undergo procedural (often called “surgical”) abortion.

Although a judge agreed to block the law temporarily, pending a full hearing, the state balked and appealed to the 8th U.S. Circuit Court of Appeals.

While the case was pending, however, the Supreme Court issued its landmark 2016 ruling in the Whole Woman’s Health case, striking down Texas’s admitting privileges requirement on the basis that the actual medical benefit of such a restriction must outweigh the burden it places on abortion access. With that, it appeared that the 8th Circuit would have the logic needed to decide the Arkansas case. But then a twist: Instead of rejecting the law, the court upheld it, claiming that the district judge hadn’t made specific findings on how many women would be negatively impacted by the law. And when the Supreme Court subsequently declined to intervene (without explanation or dissent), the law took effect.

The impact was immediate. Ho remembers clinic employees scrambling to try to contact all the patients who’d already scheduled their appointments. Some of them simply couldn’t be reached. “So they didn’t find out until they actually arrived at the clinic,” Ho told us. They “just had to be turned away,” she said. “It was incredibly stressful for the patients.”

The clinic tried to find providers in other states that might be able to help its patients. “But there were some women who, because of this, the state forced them to carry the pregnancy to term against their will because that’s not what their plan was.” Ho remembers one of the patients who hadn’t heard the news before arriving at the clinic. “When she walked in the room and saw me, she just immediately burst into tears,” she recalled. “She didn’t know what was going on because you can tell somebody that this is the law; this is what’s happening. But they’re not thinking that. They’re like, ‘This is my life. Now what am I going to do?’”

There was another related problem: The women had gone through the state’s mandated consent process for medication abortion, but not for a procedural abortion. That meant that even if they were able to get an appointment in Little Rock, they would have to start the process all over again — go in for an initial appointment, undergo another mandatory ultrasound, be provided the state-approved (and largely medically inaccurate) information on abortion, and then abide by the state’s required 48-hour waiting period before returning for the actual procedure. “Not one single woman was safer” because of the law, says Ho. “Not one single woman was more informed, and not one single woman was happy with the fact that her government decided … to make that decision for her.”

Finally, two-and-a-half weeks after the de facto ban on medication abortion began in Arkansas, the law was again blocked after a district judge issued a 148-page ruling laying out in detail how many women would be burdened by the restriction. After enumerating several strategies for getting at a hard number, the judge stepped back, observing that “every woman” seeking medication abortion (in 2017, there were 653 in Fayetteville alone) “faces a burden due to the contracted physician requirement.”

The state again vowed to appeal, but then in late November, Planned Parenthood told the court that it had found a doctor with admitting privileges to contract with the clinic, which made the lawsuit moot — at least for now. Planned Parenthood has asked the court to allow them to revive the suit if necessary.

The Defense Line

It was noisy outside the Little Rock Family Planning Services clinic, located in a nondescript office park on the city’s west side, when we arrived one morning in early August. Across the street, a crew was using heavy machinery to clear land where the Arkansas Pregnancy Resource Center, a crisis pregnancy center, once stood.

CPCs like the one that used to be here are not clinics. They rarely provide any medical services — save for pregnancy tests and ultrasounds — and are mostly staffed by laypeople whose mission is to encourage women to carry unwanted pregnancies to term. CPCs are often located close to abortion clinics, and have facades and signage that mimic an actual clinic. They collect lots of personal information about the women who come through their doors, but since they are not regulated like medical facilities, in Arkansas and elsewhere, they are not required to follow medical privacy laws. According to a directory of “helpful services” published by the Arkansas Department of Health, there are some 46 CPCs across the state. Their operations are subsidized by public money, and in many states, that includes money siphoned from federal welfare funds. In Texas, for example, millions in welfare dollars, as well as money earmarked for actual health care (including the provision of birth control for low-income residents), have been diverted to fund CPCs, most of which deliver an explicitly religious message.

In Little Rock, protesters used to gather outside the Arkansas Pregnancy Resource Center in an effort to divert traffic to the CPC. In May 2018, a fire tore through the building that housed the CPC, leveling it. The group recently resurfaced in an office building right next door to the clinic.

Still, in August, it was clear that the fire hadn’t deterred the protesters. As the clean-up crew worked to scrape the land across the street, a handful gathered at the clinic’s property line — including several men apparently affiliated with Abolish Human Abortion. One was wearing a GoPro on his chest pointed at women as they arrived at the clinic; another was sporting a “Dan Fisher for Oklahoma” T-shirt. The man with the GoPro wore dark sunglasses and held a small orange cone to his mouth to amplify his voice over the construction noise. “We’d love to help you!” he yelled to someone in the clinic parking lot. “Whatever you need!” No one in the parking lot was taking him up on the offer. He changed his approach: “Please don’t go in there! We’ve seen many women leave that place hurting,” he said. “I’ve … seen people leave that place in ambulances!”

Karen Musick and Leeann Bennett were there too. Musick is one of the founders of the Arkansas Abortion Support Network, and Bennett is the group’s membership director. Among the things that AASN does is provide an escort service for patients coming to the Little Rock clinic. They wear brightly colored, pullover vests and carry rainbow-striped umbrellas, which they use to provide privacy for women and their loved ones on their way in and out of the clinic, or to form a visual barrier against shouting protesters at the edge of the clinic’s driveway, an area Musick calls “the defense line.”

“We get two main groups here,” Bennett told me after lowering her umbrella and nodding to an older white man standing with a sign outside the clinic’s fence. That man and a few others across the street are part of what she calls “the Catholic cabal.” They mostly stand around quietly, holding signs and praying. On the other side though, she says, looking toward GoPro and his group, are the more confrontational ones. “They say horrible things to people as they’re coming through. Some are straight-up lies,” she says. “They’re the ones that are hard to take. Extremely hard sometimes.”

Scenes like this play out every day in front of clinics across the U.S. Some clinics like the one in Little Rock are fairly fortunate, in that they have a decent buffer between the property line and the actual entrance to the clinic. Others aren’t as lucky; the clinic in Louisville, Kentucky, for example, is on a busy downtown street with virtually no buffer, making it a favorite target of all kinds of anti-abortion protesters. Escorts there have seen hundreds of people descend on the clinic to harass patients as they come and go.

Generally, things are fairly under control in Little Rock — perhaps because AASN has a strict policy of nonengagement for its volunteer escorts. They go over this at length during their trainings: Ignore the cajoling protesters, volunteers are told. But occasionally things have gone sideways.

Musick first met Scott Skarda not long after she had started escorting at the clinic. He came up to her while she was in an overflow parking area and got in her face, she told us. He said she was the “face of evil.” The clinic’s security guard, a no-nonsense czar of order, later told her that Skarda was a pastor at a church in Hazen, a town about an hour east of Little Rock. At times wearing motorcycle chaps, he soon became a regular protester at the clinic.

The November 2015 shooting at a Planned Parenthood clinic in Colorado Springs, Colorado, had the Little Rock clinic, and escorts like Musick, on edge. Musick began regularly using her phone to record the protesters. Skarda apparently did not like it; after telling her to stop, he ripped her phone from her hand. In another incident a few months later, as Musick was using her umbrella to shield a clinic patient from a female protester, Skarda grabbed it and broke it over his knee, later claiming that Musick had hit the woman with it. Both incidents were caught by the clinic’s surveillance cameras. In each instance, Musick called police. Skarda was ordered to stay away from her. After the umbrella incident, he was hauled into court on a harassment charge. He was acquitted of that but was found guilty of violating the no-contact order. Skarda denied any wrongdoing.

On a muggy evening at a public library not far from the clinic, a handful of people attended AASN’s August escort training. Roz Creed, who with her daughter and Musick founded AASN, stood before the group with a pointed question: How would they deal with heckling from protesters? From the audience, people called out to the newcomers: You should be ashamed of yourself! How do you sleep at night?

Creed, who is a retired transplant from upstate New York, offered up one of her favorite heckles. “I have heard, ‘You have so much gray hair, lady, you have one foot in the grave; you’re going to be meeting your maker pretty soon. I can’t believe you’re doing this. You need to repent.’”

The answer to dealing with the heckling and harassment is that you don’t respond, Creed told the group. You come up with a mantra to distract yourself, and you make small talk with the patients in order to distract them from the onslaught. Talking about the weather or a person’s shoes will usually do the trick.

Creed knows that the work is hard and can be upsetting. But she also knows it’s necessary — infuriatingly so. Part of AASN’s work is managing an abortion fund that provides financial assistance to women struggling to afford care. A loose network of such groups operates across the U.S., with the National Network of Abortion Funds and the National Abortion Federation, a professional association for abortion providers, acting as points of contact for assistance. Creed manages AASN’s donor-supported fund and since 2016, has granted $23,000 to help roughly 200 women access abortion.

The calls she gets can be heartbreaking — like the one from a woman whose 15-year-old granddaughter was pregnant. The girl’s mother had died, and her father was in prison. There wasn’t enough money to pay for the abortion. “‘I can help you out with that,’” Creed told the woman. “She just exploded to me: You have saved my life!” she recalls the grandmother telling her. “I mean, I’m sitting there crying. I’m like, It’s OK, it’s OK. I’m glad I was able to help.” Over the last two years, Creed has amassed dozens of similar stories — of young mothers who, like Danielle in Mississippi, are pregnant and aren’t ready for another child; of women who are in school and not ready for motherhood; of broken relationships and fathers who have split; of women who are homeless.

Shame and Fear

The Arkansas state Capitol sits just west of Woodlane Street, where it crosses West Capitol Avenue, just blocks from the Arkansas River. While it seems clear that West Capitol Avenue is meant to facilitate an unobstructed view of the capitol, it actually accentuates the fact that the capitol is offset from the avenue. It wasn’t planned this way; the capitol was built atop a state penitentiary that occupied the land before the statehouse took over its foundation. It was built with prison labor.

Inside, the building features all the gilt and grandeur of many state capitols — lots of golden lighting and wide marble stairways. Before we left Little Rock, Musick had arranged for us to come here to meet with state Sen. Joyce Elliott, one of Arkansas’s most ardent supporters of women’s reproductive rights.

Elliott spent 30 years as a teacher before entering politics — though she knew early on, during the John F. Kennedy years, that it was something she wanted to do. She was a state representative before transitioning to the state Senate, where she has represented part of Little Rock for the last nine years. During her time under the dome, she has been a tireless voice for equal rights, including for women’s reproductive autonomy, a cause that she sees as increasingly difficult and necessary to take on. She grew up in the pre-Roe years and saw the damage caused by illegal abortion, and she’s deeply concerned about her state (and the country) retreating into that past.

Arkansas is a relatively poor state with poor health outcomes, particularly in its most rural areas, like the fertile Arkansas Delta that runs along the Mississippi River in the eastern half of the state. And the state of affairs for women seeking to control their reproductive lives is especially grim, she says, defined by men making policy decisions about abortion while refusing to address other issues, like the statewide provision of high-quality health care and education, including comprehensive sex education.

“That kind of burden falls very disproportionately on poor women, on poor families. Because, I guarantee, if it’s a family of means, if they choose to have an abortion, it will happen. It always has. It will continue to be the case. And we will continue to punish that young woman … who could not make the same choice,” she said. “It is not serving our state well.”

It was hard not to think about our conversation with Elliott as we drove several hours east from Little Rock into the Delta. The land feels vast but haunted; there are few signs of vibrancy. The town of Helena, which abuts the Mississippi state line, is a perfect example. Kudzu has taken over the landscape. Downtown, there’s a crumbling brick building that still sports a faded, painted mural of country music singer Conway Twitty with his guitar, a Tweety Bird with a cowboy hat standing on its neck. A woman in Helena seeking abortion care would have to travel roughly two hours to the clinic in Little Rock; an hour and a half to the clinic in Memphis, Tennessee; or three hours to Jackson.

Just over the Mississippi River is the Isle of Capri Casino, which one Helena local told us is part of the reason her town has lost so much of its wealth — people like to gamble, and the slots there are tight. There really wasn’t anywhere else to stay, so we stopped at the casino for the night. Before going to sleep, I dumped a pile of papers on the bed. They were various pieces of anti-abortion propaganda that we’d picked up along the way. They each take a slightly different approach, but lean heavily on shame and fear to express the message that abortion is bad. And wrong. One, titled “This is Not Your Only Choice,” reminds women that “even though medical and surgical abortions carry different risks for the mother, both are EQUALLY FATAL to the baby.”

At her home in Little Rock, Musick had brought out her own propaganda collection, much of it collected from the windshields of cars in the clinic’s overflow parking lot. It included a number of black-and-white comic books, including one titled “Who Murdered Clarice?” that tells the story of an abortion doctor — “the butcher” — who “dismembered” little Clarice. He blows his brains out and meets God, who, needless to say, is super pissed off, but not about the suicide. “I performed that abortion at the mother’s request,” the dead doctor tells God. “It was perfectly legal. I worked within the law.”

“Not within My law … you committed murder and sold Clarice’s body parts,” God replies. “You devil … you sold her baby ears for $75 and I damn you to hell.”

Old Mississippi

The roads in Jackson are riddled with potholes too large to avoid. Someone told me that a promising dancer who was a day shy of high school graduation died when she drove into a pothole that flipped her car. Someone else said that Jackson won a contest run by Domino’s Pizza, looking for cities with the worst potholes. The company offered to fix the holes to aid its drivers and protect the pies.

The stretch of North State Street that runs alongside the Jackson Women’s Health Organization is a mess. On the day we first drove up, there was a crew in the middle of the road cutting into the dilapidated asphalt using hand tools, as cars whizzed by in a dance of barely controlled chaos.

Along the sidewalk and in the street in front of the Pink House’s entrance, there was a similar chaos — and that’s typical, say clinic escorts Derenda Hancock and Kim Gibson. Gibson is a master of recording the “circus” on her phone, and regularly posts videos or livestreams to the Facebook page of the Pinkhouse Defenders. Unlike in Little Rock, the escorts here regularly engage with the protesters; they certainly don’t like one another, and the whole exercise has an odd quality of hostile politeness. “We’re polite because we’re Southern,” Gibson reminds me.

Many of the protesters here are older white men, which is pretty typical. But there is also a gaggle of children who are regulars, brought by Boyd Coleman, an area doctor. He and his wife ferry their home-schooled children to protest at the clinic — it’s part of their education, he told me, so they can grow up to be like their parents. The family brings a ladder, which they set up on the sidewalk, so they can see over the fence and watch the women as they come and go. Sometimes the kids, who range in age from toddlers to teenagers, stand on the ladder holding anti-abortion signage. They also work the sidewalk and the street, trying to get the attention of clinic patients, “counseling” them about their reproductive choices.

Coleman is adamant that his brand of Christianity is the correct one. I actually got into a bit of an argument with him about this — though I don’t know why I bothered. The point of having secular law, I said, was to protect against the imposition of rules informed by a particular religious view. That was wrong, he told me; his interpretation of God’s law was the only one that mattered, and we would all be judged by it.

Shannon Brewer, who has worked at the Pink House for 17 years and has been its director for nine years, keeps an eye on all of this from her cluttered desk inside. The wall behind her is covered with Post-It notes and letters from clients and supporters praising the clinic. When you talk to Brewer here, her eyes constantly dart to her right, where a computer screen displays an array of video feeds from various security cameras around the property. She doesn’t usually engage with the protesters, she said. “Nothing you say is going to matter. Once you learn that, it’s like you’re talking to a brick wall. So you either stand there and listen to it, or you walk away. To keep my sanity, I just walk away. Sometimes I cuss them a few times, just to get my day going. Otherwise I walk away.”

Frankly, she’s got way too much work to do.

Mississippi lawmakers have been relentless in their efforts to shut down the Pink House. The state is one of four that has a trigger law on the books, meaning that if Roe v. Wade is overturned, abortion will immediately become illegal. There’s a 24-hour waiting period, mandatory ultrasound, and requirement that medically inaccurate information on abortion be provided to each patient. Then there’s the requirement that the Pink House follow complicated surgical center regulations in order to be allowed to perform second-trimester abortions, and a requirement that only ob-gyns provide abortion care.

Although there is ample evidence that other medical professionals, like nurse practitioners, can ably provide care, a number of states have implemented such a ban, which is a strategic move. There are a discrete number of abortion doctors across the country, which means that in many states, including Mississippi, doctors must be brought in to provide care. This in turn reduces the number of days that a clinic can provide services and creates a bottleneck in the system that increases waiting times. The Pink House has a doctor in house only a select number of days per month. The doctor was present for both of the days that we were there in August; over those two days, there were more than 100 appointments scheduled.

And then there is the state law passed last March that would ban abortion at 15 weeks, well below the point of fetal viability, which is generally considered to begin at roughly 24 weeks. Brewer wryly pointed out that during the debate on the bill, lawmakers asserted that the ban was needed to protect the humanity of the unborn child who, at this point in gestation, would already have teeth. “I had six kids,” she said. “Nine months, none of them had teeth when they came out.” Once the bill passed, the state had to rush to reprint its informed consent booklets, she noted, because the description of fetal development in the old books contradicted the assertions made by lawmakers.

The rush resulted in further mistakes: The pages in the book are out of order so that the description of fetal development jumps from 18 weeks to 32 weeks. Notably, the state cribbed the information in its new booklet from one created by the state of Alabama, which itself was already plagued by medical inaccuracies.

The clinic had been living under the specter of the ban until only recently. In late November, federal district Judge Carlton Reeves issued a blistering opinion blocking the law. He wrote that lawmakers’ “professed interest in ‘women’s health’ is pure gaslighting.” While they’ve taken a great interest in abortion, he noted, they’ve done nothing to address the state’s crippling maternal mortality rate, the highest in the country. “Leaders are proud to challenge Roe but choose not to lift a finger to address the tragedies lurking on the other side of the delivery room,” he wrote. “No, legislation like HB 1510 is closer to the old Mississippi — the Mississippi bent on controlling women and minorities.”

The state has appealed the ruling.

I’ll Keep Walking

If it had taken effect, the 15-week ban would have been one Mississippi abortion law Danielle would not have had to contend with. She’d caught her pregnancy very early, and had acted with deliberation and determination to have it terminated.

Still, when she arrived in Jackson, she would be forced to navigate a handful of the state’s other abortion restrictions, as well as the protesters who were gathered around the clinic. She was baffled by their presence, she told us later, and frankly, pissed off by it. “I thought I was seeing some regular guy on the street. He said good morning to me. When I said good morning to him, he kinda ran me down and tried to force his religious views on me. And then he tried to force me, saying, ‘What if the baby has your eyes? What if the baby has your pinky toe?’” she recalled. “Crazy stuff.”

Once she’d been through counseling and set up her appointment for the following day, a process that took several hours, she walked across the street to a taco joint before catching a cab back to the nearby Red Roof Inn. A lot of women stay there when traveling to Jackson for care, the clinic counselor, Betty Thompson, told me. It’s relatively inexpensive — roughly $50 a night — and the rooms are serviceable, save for the water pressure, which just sucks. In the room, Danielle had a blanket from home sitting on the bed, and the TV was tuned to a channel showing a marathon of “Law and Order Special Victims Unit.” She’s a fan of the show; it’s formulaic and predictable in a way that, despite the subject matter, is comforting when you’re away from home but wish you weren’t.

Danielle was frustrated by just about everything in Jackson. It wasn’t just the protesters whose attitudes she found dismissive and ignorant. “They don’t have no business doing that. They don’t have no business walking up on women, being aggressive, you know? They make them feel like they’re ashamed of themselves for the decision that they’re making. But at the end of the day, how they feel shouldn’t have nothing to do with you.” It was also the state, which had imposed this totally arbitrary waiting period. “The 24-hour thing really does get you,” she said. “If I’m ready, I’m ready.”

There was also the money she was spending — the bus ticket, the cab rides, the meals, and motel room, not to mention the cost of the procedure itself, since the state bans the use of public or private insurance to cover care, unless the life of the mother is at stake. Back at the clinic, Thompson had given the women the telephone numbers for several organizations that help to fund abortion care, including the National Abortion Federation. That afternoon, Danielle tried to call NAF. Numerous times. The lines were busy. The best time to call, the recording announced, was early in the morning and especially on weekends.

Before bed, she got on the phone with her younger brother, Walter. The two would often talk for hours. Tonight was one of those nights. They lamented the situation that Danielle found herself in, and both were frustrated by the obstacles she faced in trying to exercise her right to control her reproductive future. It was all about politics, they concluded. And it was time for those lawmakers to retire, Walter said. “My thing is, it’s 2018, some of the older people need to just sit down, retire, go sip some tea on your porch or something, and let the younger generation take control. Their time is up.”

When we arrived at the motel the following morning to meet Danielle for the trip back to the clinic, she had some good news: She’d gotten up early and had gotten through to NAF. They only take the first six callers, she said she had been told, and she was No. 6. They would be providing $150 toward her abortion. The paperwork would be faxed to the clinic, and that amount would be deducted from her final bill. Now she would have a bit more money left in her pocket to take care of family expenses.

Before leaving, she packed up her duffle bag because she was heading to the Greyhound station as soon as she could get her pills. She missed her kids and really wanted to get home, where she could finish her abortion. When she arrived back at the clinic for her second appointment, the protesters were already offering platitudes while Gibson and Hancock had turned the volume to high on a large boombox playing a local radio station in an effort to drown them out. It was pretty much business as usual.

Inside, the clinic was bustling and women, some with their partners, family, or friends, packed the waiting room. Finally, Danielle was called into the doctor’s office. They sat across a desk from each other while the doctor went over the final paperwork. Danielle would be given a prescription for an antibiotic, which she would need to take, and a mild pain pill, which she could take if she wanted. The cramping could be pretty intense as the muscles worked to expel the pregnancy. She was handed a dose of mifepristone, which she was required to swallow in the doctor’s presence. She was also handed a small envelope and asked to open it, to make sure that there were four small misoprostol pills inside. Those she would take 24 to 48 hours later.

In the cab on the way to the Greyhound station, Danielle wondered aloud what would come next and if she’d get the “baby blues” — if her hormones would drop after the abortion and leave her feeling a bit down. Mostly, she said she felt relieved. “Everything was just backwards,” she observed. “But I feel stronger. I had a choice. I handled my business,” she said. “Everyone has an opinion, but I don’t live for them. I live for me.”

Now it was just about the next steps. “That’s life,” she said. “I’ll keep walking.”

[Jordan Smith is a state and national award-winning investigative journalist based in Austin, Texas. She has covered criminal justice for 20 years and, during that time, has developed a reputation as a resourceful and dogged reporter with a talent for analyzing complex social and legal issues. She is regarded as one of the best investigative reporters in Texas. A long time staff writer for the Austin Chronicle, her work has also appeared in The Nation, the Crime Report, and Salon, among other places.]