Working Through the End Days of Roe

The staff at the Jackson Women’s Health Organization is too busy to dread what’s very likely to come.

Photo: GABRIELA BHASKAR/The New York ​Times/Redux
Photo: GABRIELA BHASKAR/The New York ​Times/Redux
Photo: GABRIELA BHASKAR/The New York ​Times/Redux

The first day of December was relatively quiet inside the pale-Pepto-colored building nicknamed the Pink House, shorthand for Jackson Women’s Health Organization, the last abortion clinic in the state of Mississippi. Dr. Cheryl Hamlin, one of the Pink House’s several out-of-state doctors, was in the middle of her shift. Hamlin flies into Jackson once a month from Massachusetts to work for three days (doctors cannot live in the state for fear of harassment and intimidation by anti-choice activists). She typically sees over a dozen patients a day, but things happened to be a bit slow.

Outside was a different story. The anti-choice protesters who maintain a constant presence at the front of the clinic — attempting to dissuade patients, chanting and waving signs — were even bolder than usual. Over the course of the day, Hamlin had three patients complain to her about being recorded without their consent as they approached the clinic’s doors. That afternoon, after the last patient had been brought inside and the Pink House Defenders (volunteers who escort patients through the parking lot and past the protesters) had gone home, something strange happened. The protesters, who usually go home then, too, stayed behind to form a ring around three sides of the building. Hamlin noticed them on the clinic’s many security cameras, standing there silently with tape over their mouths. She couldn’t send her final patient off to face the bizarre gauntlet alone, so she escorted the woman out to her car herself, something she had never had to do before.

According to Hamlin, it was the only real sign that there was anything out of the ordinary — the only thing that might indicate that, a thousand miles away, the justices of the United States Supreme Court were hearing oral arguments regarding the very care she and the staff at Jackson Women’s were providing. The Pink House is at the center of Dobbs, the SCOTUS case that will determine the constitutionality of Mississippi’s 15-week abortion ban, enacted in 2018, and which activists believe will very likely be used to roll back Roe v. Wade entirely. With the clinic’s director, Shannon Brewer, away in Washington, D.C., on the Supreme Court steps and the eyes of the country on Jackson, the protesters seemed emboldened, anticipating changes in their favor.

By the time Hamlin went home that evening, it was looking like they were right. The conservative majority on the court is almost certainly poised to uphold the 15-week ban. During the oral arguments, the conservative justices signaled that they were swayed by several of the state’s positions, despite their lack of grounding in reality — for example, that adoption remains a viable alternative to abortion care, requiring women to carry unwanted pregnancies to term, and that this would not cause irrevocable harm. If they do uphold the ban, they will invalidate the viability threshold that has enshrined the right to choose in the Constitution since 1973. What happens next will be predictable: Other states will file their own bans, and 26, according to the Guttmacher Institute, will likely move to ban abortion altogether. While lawyers at the Center for Reproductive Rights say they will continue to fight abortion restrictions in state and federal courts, the worst-case scenario is looking likelier and realer than before. It appears ever more probable that come June, when the Court will likely decide on Dobbs, millions more Americans will soon find themselves without safe, accessible abortion care.

Talking to Hamlin over the phone a week later, I was expecting her to be shaken. Instead she was straightforward, good-natured, and calm, with a slight Midwestern accent (she is originally from Chicago). “I don’t think about that day very much,” she says of the moment the SCOTUS decision will be handed down this summer. Until then, “we are just trying to help as many women as possible,” she says.

Working under seemingly impossible circumstances isn’t new to Hamlin. Since she began providing medical care at the Pink House in 2017, after being moved by Donald Trump’s 2016 victory and his promise to support Republicans in limiting abortion rights, she has seen the state pass numerous restrictions, including the three “heartbeat bills” that became the six-week ban. “I have had patients referred from local doctors with letters and paperwork in hand,” she says, “and we have to say, ‘Well, we can’t do it,’ and we have to refer them to Alabama.” But Alabama is a three-hour drive away, and not all patients can make it.

Reflecting the demographics of Mississippi at large, many of Hamlin’s patients are low-income women of color, for whom obtaining an abortion is already incredibly burdensome even while the ban remains contested. For instance, Hamlin legally must repeat misleading talking points from the state’s anti-choice materials, like the fact that abortion is connected to breast cancer (it isn’t), when first sitting down with a patient seeking the procedure. Hamlin and her fellow doctors must also adhere to the state’s two-visit rule, which means patients must show up to the clinic for a consultation, no matter how close they are to the current 18-week limit, and then wait a full 24 hours before they can get an abortion, whether surgical or medical. Many women learn of this waiting period at the clinic, after driving hours from other parts of the state, or from Texas, where there is currently an active six-week ban on abortions. When they get there and find out they have to wait a whole day away from home, many cannot afford an overnight hotel room or to leave work or their families for that long. “Some of their regular doctors don’t even realize it,” Hamlin says, and have called in shocked that their patients cannot receive the treatment they need when they are ready for it.

If conservatives really wanted to curb late-stage abortions, Hamlin says, they would do away with this hellish web of restrictions that leaves the most vulnerable women scrambling to terminate their unwanted pregnancies later and later. Same goes for their stance on Mifeprex, she says, the abortion pill the FDA just finally made fully available by mail — but only in states where administering the medication without a doctor is legal. (Seventeen states passed some kind of restriction last year alone in anticipation of the FDA’s expansion of the law.) “If there was wider availability, they could hand it out,” Hamlin says. But even the state’s Planned Parenthood is barred from providing safe, effective medication abortion.

Once she got home from work on that early December evening, reading the news of the oral arguments inside that marble courthouse, Hamlin was outraged by the way conservative justices waved away the grim realities of what a United States without Roe might look like. Their logic was predictably galling: Instead of protecting the constitutional right to choice, the decision to enshrine that right would simply be turned over to the states, Brett Kavanaugh explained. It was a blithe dismissal of what Hamlin knew with painful certainty — that millions of people already can’t get abortions, and that even more won’t be able to if Roe is overturned.

The looming Supreme Court decision is a cap on a few difficult years for the Pink House. Beyond the right-wing encroachment on abortion rights, the pandemic has made access even trickier, with patients suffering financially even more than they already were, making an often overnight trip even less realistic. On top of that, with more people in need streaming in from Texas, the clinic has gotten busier, and hours are longer. And due to a statewide nursing shortage, Hamlin says Jackson Women’s can only perform around six surgical abortions a day when it used to do 12.

If the Supreme Court does uphold the ban, Hamlin predicts having to physically turn some of her patients away — undoubtedly, she says, due to so much confusion around legality in the state, some of them will still show up. Many will not be able to get to another clinic in time under the law. “Some of the women could go somewhere else,” clinic director Brewer said in a livestream with the Center for Reproductive Rights following the oral arguments. “But the majority of the patients we see are barely making it here, and they live in the state. They can’t afford to hop on a plane and fly somewhere; they can’t afford to spend two or three thousand dollars to go to another state and get lodging, child care, and all of these things.” The implication: Many of these women will be forced to go through with their pregnancies or seek potentially unsafe alternatives outside of doctors’ offices.

Abortion funds, doulas, and mutual-aid organizations in the state have been preparing for this eventuality, hoping to spread knowledge about how to manage at-home abortion safely and other ways to obtain abortions even if Roe is overturned. Making medication abortion more widely available, even in states where it is illegal, is imperative, according to Hamlin. She is considering getting her OB/GYN license in her home state of Illinois in order to treat patients in the southern tip of the state, closer to regions where abortion will likely be banned. Some of the doomsday preparations sound fantastical; Hamlin has even heard activists talk about mooring some kind of abortion ship off the coast of Mississippi, as far out as you would need to be beyond state lines, to administer care.

“People have asked me, ‘How long are you gonna do this?’” Hamlin says. “But it’s not all drudgery, and, you know, I love the people in the clinic and the patients.”

“It’s not Doctors Without Borders,” she adds with a laugh. Hamlin wants outsiders to understand that abortion isn’t always a “calamity.” “I hate that narrative,” she says. “The narrative that people always say, the heart-wrenching decision — I mean, it often is, but it’s not always. Some people, they miss their period, they get their pregnancy test. They’re at the clinic by five-plus weeks, they have their abortion, and they leave happy that they’re not pregnant anymore. Not everybody comes in sobbing. And they don’t have to. They’re just making a decision based on their circumstances.”

Before getting on the phone, I assumed Hamlin would describe the atmosphere at Jackson Women’s as some kind of bunker inside a war zone in the heat of battle. But it was more like a wonderfully mundane oasis. She was adamant that once you get past the protesters, Jackson Women’s is a normal health-care center providing normal health care. Even at the center of a constitutional fight, it is a pleasant, even happy place, with laughter and joy. “Once you walk through the door, it’s just a health center. And we have to treat the patients we have today.”

Working Through the End Days of Roe