In a state already notorious for poor birth and maternal health outcomes and stringent abortion laws, legal and policy experts and abortion advocates say Dobbs v. Jackson Women’s Health Organization could be the proverbial match to the tinderbox that is abortion access and reproductive health in Mississippi.
For over a decade, Jackson Women’s Health Organization has stood as Mississippi’s lone abortion clinic, a pink-painted building in the Capitol City. Now, it sits at the height of controversy in the U.S. Supreme Court court case challenging the 1973 Roe v. Wade decision granting the constitutional right to abortion.
Mississippi’s case centers on viability, intending to uphold a state law making abortion illegal after 15 weeks of pregnancy. There’s a handful of ways the conservatively stacked court could rule, said Matt Steffey, constitutional law professor at Mississippi College School of Law.
It could overturn Roe entirely. Apply restrictions. Strike down the Mississippi law. Or in what he called death by a thousand cuts, the court could whittle away at abortion rights in the Magnolia State and Mississippi legislators, instead of health care providers, would call the shots. That is more likely, he purported.
But regardless of the outcome, abortion is a personal decision that will always remain out of the court's purview.
“As a practical matter, nothing the court does is going to stop abortions,” Steffey said.
People seeking abortion access have long-preceded the Roe decision. It’s a landscape the country knows well: the risks a person will take to terminate a pregnancy and the disproportionate effect it has on those who are low-income, already parents and people of color. The health and financial implications are enormous,
'Putting women in difficult situations'
“Bleak” is the one-word answer Steffey offered if abortion access were legally snuffed in Mississippi.
For people who have the financial means to travel outside the state to get a medically safe abortion and the independence and time to do so, the outcome is less dismal, he said. But, based on socio-demographic research of abortion fund cases across the Southeast, 86% of Mississippians seeking financial help to pay for pregnancy termination are on public insurance or are uninsured and the majority are already taking on the financial burden of parenting.
Young people, too, are particularly at risk.
Kari White, an associate professor at the University of Texas at Austin’s school of social work and sociology, has researched people’s access to contraception and abortion services in the South for about a decade. Her 2019 research showed in Mississippi, people aged 18-24 made up 35% of abortions performed at the Jackson clinic that year.
Mississippi is one of the 12 states that have not expanded Medicaid. This leaves low-income Mississippians who make too much money to qualify for the state's Medicaid insurance coverage, but not enough for marketplace health insurance plans, in limbo. And, largely, without adequate health care.
Cost can be an ultimate roadblock for the one in every five people living below the poverty line in Mississippi.
For people seeking a medical abortion through medication up to 11 weeks into their pregnancy, the cost is about $600. The highest cost at Mississippi’s clinic is $800 for a surgical abortion between 14-16 weeks.
“We speak to folks who are having to make the choice between being able to pay for rent or pay for their health care in the form of abortion,” said Quita Tinsley Peterson, Access Reproductive Care-Southeast co-director. “This just further pushes health care out of reach for the people who need it, and the folks and the same states that have some of the strictest anti-abortion policies also have some of the highest maternal and infant mortality rates.”
In 2019, Mississippi ranked 50th in the nation in infant mortality and 49th in the mortality rate among women of childbearing age — from ages 20-44, according to the Centers for Disease Control and Prevention.
Black mothers in the Magnolia State are particularly vulnerable, with three times as many dying from pregnancy-related causes than white mothers in 2019.
“Childbirth has far more health risks to women than abortion,” said Alina Salganicoff, Kaiser Family Foundation senior vice president and director of women’s health policy. “We know that abortion is a very safe and effective procedure. Too many of these barriers to abortion place greater jeopardies on women's health and the quality of their health.”
Labor can pose a risk of hemorrhage. Infection. Pre-eclampsia.
And for people who are pregnant and battling cancer or have a high-risk pregnancy due to carrying multiple fetuses, the risks increase.
For 10 years, researchers at the University of California San Francisco looked at the effects of unwanted pregnancy on 1,000 women’s lives in what they would call The Turnaway Study. It found people denied abortion access were more likely to have serious complications toward the end of their pregnancy, suffer anxiety and loss of self-esteem, stay with abusive partners and experienced poor physical health years postpartum.
If abortion access is further restricted in Mississippi, Salganicoff believes many people will seek medication to terminate a pregnancy from unreliable, unknown sources. Best case scenario? The medication is effective. But other cases could lead to health risks that go unmonitored by a medical professional.
“All you do is end up putting women in very difficult situations,” Salganicoff said. “Either in terms of having to secure funds, deal with childcare, travel, work, as well as choices that affect their economic well-being. We know, already, the history of what happens when abortion is banned. In many cases, they take a lot of risks to assure that they don't have children when they don't want to have children.”
Kristi Hamrick, chief media strategist for Students for Life, a national anti-abortion nonprofit, said rather than eliminate the suffering she says terminating a pregnancy causes people, the nonprofit provides resources to pregnant people so they can carry to term.
“We're coming into communities saying here are the people in your community available to help, here's the access to food through food stamps, here's access to organizations that want to help you here to access to your legal rights,” Hamrick said. “We need to help women be prepared for that and rather than just abandoning them to whatever situation they're in. So what will a post-Roe world look like? We're gonna have to be more proactive.”
Restrictions on abortion across the South tightening
While abortion may be legal, Tinsley Peterson said it’s never been accessible to everyone.
“Black folks, people of color, parents, folks who are living with low wages, right? Those are the same people who always had a lack of access to care,” Tinsley Peterson said. “But it's only becoming even more restrictive, and it's expanding out from there.”
Cazembe Jackson knows the financial and emotional strains of seeking an abortion in the South.
When Jackson, a transgender man, was a junior at Sam Houston State University in Huntsville, Texas, in 2001, he was sexually assaulted one night a week before finals. Studying at the library, he was walking home alone and was raped by four men.
“They left me where I was, in between two buildings,” the now-Atlanta resident said. “And you know, the whole time. They told me that God wanted me to know what it felt like to be a real woman, because I was presenting as trans masculine. I wasn’t identifying as a trans person yet, but I definitely dressed like a boy.”
His mother didn’t support him and he fell deeper into a depression. He returned home to Austin where he went to the Planned Parenthood when he found he was pregnant.
“I went to Planned Parenthood the first night and they gave me information and stuff but couldn't do the abortion the same day and I also found out how much it was going to cost,” Jackson said.
The price tag on an abortion back then was $300. He had two days to find the money, getting a payday loan with a sky-high interest rate. Jackson estimated, adding up the payday loan, he paid closer to $1,000 for the abortion.
Now 41 and a community organizer with the Rising Majority, Jackson finds solace in sharing his story with the We Testify Project, especially as a trans man shedding light on the fact that abortion rights aren’t solely for straight, cisgender women.
“I think if more queer and trans people speak up about their abortion experiences, it gives other queer and trans people an opportunity to see that it's not just them that’s going through this thing. It lets them know that they are a part of a larger movement," he said.
‘Even if we win, we lose’
Despite a looming landmark abortion case, Mississippi has one of the most restrictive abortion policy environments in the nation. In Laurie Bertram Roberts’ eyes, even if Jackson Women’s Health Organization prevails, it’s an uphill battle.
"The landscape now is so restrictive and so oppressive. Even if we win, we lose,” said Roberts, the co-founder of the Mississippi Reproductive Freedom Fund and the executive director of the Yellowhammer Fund in Alabama. “Because the state of access right now is no access for a whole lot of people.”
In Mississippi, there are bans on using insurance to pay for an abortion. Restrictions on telemedicine use. Parental consent is required for minors. A single clinic in the state creates long travel times for residents.
Then there’s state-directed counseling 24 hours before the procedure that stops people in their tracks. It’s not uncommon in the South. People in Alabama and Tennessee have to wait 48 hours. In Arkansas, it’s 72 hours.
State-directed counseling with subsequent wait periods in Mississippi left less than half of patients returning after 24 hours, White's 2019 research showed. And about 43% had more than a 50-mile trip one way.
Some people have to make the trip twice because next-day appointments aren’t available, she said.
“But in many instances, they have other obligations and they can't afford to stay overnight for another 24 or 48 hours to get the next appointment, they can't afford to take additional time off work, they have child care or other caregiving responsibilities,” White said. “And most of the people seeking abortion care are people who already live on low incomes.”
Many people reported missing work to return and putting off utility and car expenses to pay for their abortion. Without health insurance covering abortion costs, the procedure and travel add up.
“Everyday folks who are working class, who have families, who do not have access to this type of wealth or resources, are having to take day long trips, sometimes a week long trip out of state for care, and they're willing to do it because they're sure of their decision,” Tinsley Peterson said.
Tinsley Peterson is clear: “They should never be forced to do all of this.”
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This article originally appeared on Mississippi Clarion Ledger: Experts discuss numerous health implications in Mississippi abortion case