Laurie Bertram Roberts is working with a young woman who wants to end her pregnancy but can't afford to do so. If the Mississippi woman is somehow able to scrounge up the money, she knows she will have to travel to another state for the procedure.
With one abortion clinic left in the state, 99 percent of Mississippi counties do not have clinics that provide abortions. About 91 percent of Mississippi women live in those counties, according to the Guttmacher Institute, an organization that studies reproductive health rights.
"Mississippi is already in a post-Roe existence," said Bertram Roberts, co-founder of the Mississippi Reproductive Freedom Fund, which provides logistical and financial support to women seeking abortions.
"Most people do not have access to abortion care. If they do, they have to go through arduous hoops to get one," Bertram Roberts said, adding that her organization pays for up to seven abortions a week with more than half obtained outside of Mississippi.
Limited access to abortion services combined with multiple restrictions, such as state-mandated counseling and a 24-hour waiting period, often forces patients to cross state lines to get an abortion. Clinics in surrounding states, including Alabama and Tennessee, already see many Mississippi patients and said they could experience an uptick if access is further restricted.
On Dec. 1, the U.S. Supreme Court will consider the legality of the state's ban on most abortions after 15 weeks of pregnancy. Fetal viability is typically considered to begin between 24 and 26 weeks.
Mississippi's restrictive bill was the first to reach the high court from a wave of state laws intended to challenge the 1973 Roe v. Wade decision, which declared that access to abortion was a constitutional right.
"For decades, Mississippi has passed restriction after restriction, targeting every aspect of abortion care," said Hillary Schneller, senior staff attorney at the Center for Reproductive Rights and co-lead counsel for Jackson Women's Health Organization, the plaintiff in the Supreme Court's abortion case.
"This is the most direct challenge to Roe the court has seen in decades," Schneller said.
Abortion opponents say the Mississippi case offers an opportunity for the conservative-leaning court to roll back abortion rights. Laura Knight, president of Pro-Life Mississippi, said she is "encouraged" by the justices' decision to take up the case and said anti-abortion advocates "look forward to a future where Mississippi is free to further protect unborn children.”
State Sen. Joey Fillingane, a Republican who supports the law, said he is optimistic the court is “ready to make a change to the viability standard and move it closer to the point of conception.”
"There is a lot of momentum and excitement right now, and conservative states like Mississippi won't stop trying to pass pro-life laws," Fillingane said.
More than 93 percent of abortions in Mississippi in 2018 were performed before 14 weeks of gestations and 75 percent before 10 weeks, according to the Centers for Disease Control and Prevention. But abortion advocates say one less week to obtain an abortion in Mississippi would considerably impact patients.
Abortions later in pregnancy typically occur when medical concerns arise, like fetal anomalies or maternal life endangerment, and barriers to access could impede those procedures.
Robin Marty, operations director at West Alabama Women's Center, a clinic in Tuscaloosa, Alabama, said it could get an influx of Mississippi patients if the Supreme Court upholds Mississippi's law. For now, Alabama is a safe haven for abortions because "we are in a crisis where people do not have access in the South" and "more and more people are coming to our clinic every day," Marty said.
Currently, patients from all over Mississippi travel to West Alabama Women's Center for care. So far, in 2021, the clinic provided abortions to some 40 Mississippians a month, making up about 20 percent of its patients, according to Marty.
The average cost of an abortion at 10 weeks is around $550, and the cost goes up significantly later in pregnancy.
Greater distances to abortion clinics often lead to higher out-of-pocket costs, a delay in getting an abortion and challenges like taking time off work and securing child care, said Roxanne Sutocky, director of community engagement at The Women's Centers, which has a clinic in Atlanta.
She said the advocacy call center fields about 10 calls a week from Mississippi patients, who often think abortion is illegal or inaccessible in their state. The clinic provides abortion services to about six Mississippians a month, Sutocky said.
"The extension of reproductive control and oppression from states is very alarming," Sutocky said.
In Memphis, Tennessee, CHOICES Memphis has experienced a year-over-year increase in Mississippians seeking abortions at its clinic. In 2020, CHOICES Memphis saw over 500 Mississippi patients. So far this year, the clinic has provided abortions to over 700 Mississippians, nearly 70 patients a month, said Jennifer Pepper, executive director at CHOICES Memphis.
Even if the Supreme Court doesn’t overturn Roe v. Wade, it could potentially allow states to regulate the procedure more freely, making abortion largely inaccessible in the South, Pepper said. That could force patients in the region to travel hundreds of miles for care.
"The Supreme Court's decision doesn't just impact Mississippi, but it potentially impacts all of us in states where there isn't state protection for abortion access," Pepper said.
If Roe v. Wade were weakened or overturned, states surrounding Mississippi — including Tennessee, Alabama, Arkansas and Louisiana — as well as 21 other states would restrict abortion, according to the Guttmacher Institute. That would make Illinois, North Carolina and Kansas the closest states for Mississippians to obtain an abortion.
Ashley Coffield, president and CEO of Planned Parenthood of Tennessee and North Mississippi, which provides abortions to as many as 60 Mississippi patients a month, called Mississippi a "domino."
"When it falls, the surrounding states will fall also, and there will be an enormous health crisis that extends well beyond Mississippi," Coffield said.