A Post-Roe Postcard
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Thirty-two years ago the right to have an abortion was affirmed by the Supreme Court. Gov. Haley Barbour of Mississippi is marking the anniversary of Roe v. Wade with an official proclamation declaring the seven days leading up to the anniversary "a week of prayer regarding the sanctity of human life." Barbour also authorized the placement of tiny white crosses on the lawn of the state Capitol "in memory of the unborn children who die each day in America," according to the decree. The crosses have been planted for the past three years, though this year Barbour will be at President Bush's inauguration during the official anniversary event, and the display was moved to a nearby churchyard. Barbour is a Republican, but it should be noted that the tradition of transforming the Capitol lawn into a symbolic mini-graveyard was begun by the previous governor of Mississippi, who was a Democrat.
With eight of nine U.S. Supreme Court Justices over 65 and one seriously ill with cancer, much of the country is understandably focused on the possibility that their soon-to-be-appointed replacements will overturn the decision upholding the right to abortion. But in Mississippi, in many ways, Roe has already fallen. Abortion is legal here, of course, as it must be throughout the country while the landmark ruling stands. Yet, for many women, the ability to terminate a pregnancy is out of reach, buried under state laws that make the process unnecessarily difficult, discouraged by a sense of shame enforced by practically every public authority, and inaccessible for many who lack money to pay for it.
How Mississippi all but outlawed abortion is a story people on both sides of the abortion debate are still struggling to understand. Few would expect this famously conservative Southern state to be prochoice. And Texas, Louisiana and a few other states have been competing for the dubious distinction of being the worst place to be if you want or need to end a pregnancy. But Mississippi has gone further in its hostility to abortion even than other Bible Belt states. A small, mostly rural population and the absence of local prochoice organizations have helped turn Mississippi into the perfect laboratory for antiabortion strategists.
Virtually every possible restriction on the procedure exists here, from a mandatory 24-hour waiting period after counseling, to a requirement that minors obtain the consent of both parents to have an abortion, to 35 pages of regulations dealing with such physical characteristics as the width of a clinic's hallways and the size of its parking lot. The mounting restrictions (Mississippi passed six anti-abortion laws last year alone) have delighted anti-abortion activists all over the country, who have hailed – and copied – the state's innovations.
Meanwhile, pro-choice activists see Mississippi as a glimpse of what might become the norm in a possible post- Roe future. "It's the canary dying in the mine," says Nancy Northrup, president of the Center for Reproductive Rights. If the Supreme Court were to reverse the decision, abortion would likely become illegal in 30 states, including Mississippi, according to a 2004 report by the center. Across what can seem like a great divide, the 20 other states have laws, constitutions or court decisions that would protect the basic right to abortion even if Roe falls. While some of these, including New York and Washington State, which both decriminalized abortion before 1973, will likely remain strongly pro-choice, others may pass restrictive laws like Mississippi's.
Even while Roe stands, Mississippi is a cautionary tale for the rest of the country. "It's what can happen if the constant strategy of chipping away at Roe is not met with sufficient push-back from the pro-choice movement," says Northrup. So in order to preserve the right to abortion, prochoice Americans would do well to learn how Mississippi all but eliminated it.
Jackson Women's Health Organization occupies a small stucco building on a quiet, tree-lined street. If not for a handful of people holding "I'll Pray for You" and "Don't Kill Your Baby" signs, you'd hardly know it was Mississippi's only remaining abortion provider. There used to be others. In 1996, there were six medical facilities providing abortions in Mississippi. But since last August, there has been only the Jackson clinic, which is staffed by three part-time physicians, only one of whom lives in Mississippi. (Two others fly in from other states to work for a few days at a time.)
Many of the chairs in the clinic's waiting room are full on the four days a week that abortions are done, but the Jackson Women's Health Organization is not overly busy. That's because the number of abortions performed in the state has plummeted as restrictions have mounted. While there were 21.3 abortions for every thousand women of reproductive age nationwide in 2000, in Mississippi there were only six, down from more than thirteen in 1991.
With the third-highest teen pregnancy rate in the country, Mississippi's low number of abortions is not an illustration of the "safe, legal and rare" ideal that many talk about, in which a decline in unwanted pregnancies creates a corresponding drop in abortions. Rather, it is the direct consequence of concerted opposition to abortion from the grassroots to all levels of government.
Such concern for the rights of fetuses does not appear to translate into a commitment to promoting the well-being of the children they may become. The uncomfortable irony for an opposition movement purportedly concerned with saving "innocent babies" is that restrictions on abortion are associated with worse outcomes for actual babies. Indeed, children fare terribly in Mississippi. The state with arguably the least access to abortion also has the second-highest rate of child poverty in the country, according to the Children's Defense Fund. Mississippi's infant mortality rate – a good indication of the health of both women and children – is the highest in the country. For every 1,000 live births, 10.5 infants under age 1 die in Mississippi. In parts of the impoverished Delta region, that number ranges up to 18. (The national infant mortality rate, by comparison, is 6.8.) Interestingly, a post-election comparison found that "red" states had higher infant mortality rates than "blue" ones. In general, states that restrict abortion spend far less money per child than prochoice states on services such as foster care, education, welfare and the adoption of children who have physical and mental disabilities, according to a 2000 book by political scientist Jean Reith Schroedel.
Schroedel also found that women in anti-abortion states are worse off than their counterparts in pro-choice states. They suffer from lower levels of education, higher levels of poverty and a larger gender gap in earnings. They are also less likely to enjoy mandated insurance coverage for minimum hospital stays after childbirth. Together, the conditions make for an abysmal reality for women in Mississippi, which came in 51st in a 2004 ranking of the status of women in the 50 states and Washington, DC, published by the Institute for Women's Policy Research.
The poverty of women in Mississippi both increases their need for abortions and their difficulty in obtaining them. In the poorest state in the country, where more than one in five women lack health insurance and live below the poverty line, girls and women are often unable to get birth control. Only about two in five women and teens in Mississippi who need publicly financed contraception receive it, according to the Alan Guttmacher Institute, which does research on reproductive issues. Though the inability to prevent unwanted pregnancies makes women only more likely to want abortions, many of the forces behind the anti-abortion movement here also oppose contraception. Pro-Life Mississippi, for instance, regularly protests the only Planned Parenthood office in Mississippi, which is in Hattiesburg, even though it provides only birth control, not abortion.
Because of the intensely hostile climate toward abortion, 60 percent of Mississippi women who want to end their pregnancies go out of state to do it, according to the Guttmacher Institute. Some others may even resort to illegal abortions. In the Delta, the poorest region in the state, parts of which are four hours from Mississippi's one clinic, "lay midwives" minister to unwanted pregnancies, according to several sources. Many others want the procedure but simply cannot afford to pay for it.
Betty Thompson hears from these women regularly. Thompson, who worked as counselor and then director of the Jackson Women's Health Organization for years and is now a consultant to the clinic, says women often call saying they want abortions but don't have the money to pay for them, and delay the procedure because they lack the funds. (The clinic charges from $380 to $615 for an abortion, depending on the stage of pregnancy.) About once or twice a week, she says, the clinic gets calls from women who, while trying to gather money or arrange to travel to Jackson, have passed the sixteen-week gestation point, beyond which the clinic can't provide abortions. "There's nothing we can do then," she says.
Thompson, a stately grandmother who had her first child when she was 16, says the National Women's Health Foundation used to provide money to help women who couldn't afford abortions at the clinic. But since the funds dried up last year, she often finds herself encouraging resourcefulness among women desperate for abortions. "I have to play the social worker," she explains. But hers is an unusual sort of social work. "I say to them, have you tried to borrow money from everyone you could? Have you tried to sell your jewelry yet?"
Mississippi forbids facilities that receive public money from performing abortions and bans Medicaid funding for them. Though the law officially makes exceptions for cases of rape, incest, fetal anomaly and danger to the woman's life, clinic staff say they have not once succeeded in collecting Medicaid reimbursement in these cases. "We've filed for it and we've never been paid for them, and so we don't even file anymore," says Susan Hill, the Jackson Women's Health Organization's president. Hill, who was a social worker before Roe, says, "Mississippi is like the rest of the country was before 1973." Women who arrive at her clinic "have that same look in the eye now," she explains. "They have to go through the same kind of struggles."
Some, for instance, end up spending the night in their cars after driving to the Jackson clinic. Mississippi requires that everyone seeking an abortion wait at least 24 hours after an informational session before having the procedure. Because 98 percent of women here live in a county without an abortion provider and some live several hours away, getting an abortion can turn into a two-day ordeal, and many patients struggle to find childcare and a place to stay while they're away.
The mandatory delay has also lowered the number of abortions and caused many to be performed later in pregnancy. The abortion rate in the state declined from 11.3 percent to 9.9 percent in the six years after the law was enacted in 1992, according to a study published in Family Planning Perspectives in 2000. (Another study compared Mississippi's abortion rates to those of South Carolina and Georgia during the same period and found the drop to be specific to the state, suggesting that the policy change was responsible.) The study also showed that after the law went into effect, the proportion of second-trimester abortions increased by 53 percent among women whose closest provider was in Mississippi.
In case the waiting period and the cost aren't enough to discourage teens from ending unwanted pregnancies, Mississippi also has a well-enforced requirement that minors get the permission of both parents before having an abortion. The only way a girl can get around the law – one of only two in the country – is to go before a judge and explain why she wants an abortion and can't tell her parents. One attorney, who has represented minors in such judicial reviews and did not want to be identified, said her clients, who have included an 11-year-old whose mother was a crack addict, were "scared to death" by the process. "It's a huge deterrent," she said.
Doctors who perform abortions, meanwhile, bear the brunt of the organized anti-choice movement's wrath. Consider what happened to Donald Whitaker, a young doctor who until January 2004 was part of an OB-GYN practice in Hattiesburg and also provided abortions on a volunteer basis at the Planned Parenthood clinic in Mobile, Ala. Last winter, protesters in Mobile identified the doctor, tracked down the address of his Hattiesburg office and began protesting in front of it – even though neither Whitaker nor his colleagues performed abortions there. The protests were led by anti-abortion activist Father Edward Markley, who spent time in federal prison after attacking clinic employees and taking a sledgehammer to a clinic in Alabama. Weeks after these protests began, the doctor resigned from his job and left the state.
An unmistakable undercurrent of violence runs through the anti-abortion movement in Mississippi. Roy McMillan, for instance, who can be found most afternoons in a lawn chair across from the clinic in Jackson, has been arrested 62 times in his 25-year career as an activist. He has threatened clinic staff, and put his fingers in the shape of a gun and "shot" them, earning himself a federal injunction that requires him to remain at least 25 feet from the building. McMillan also signed a declaration calling the murder of abortion providers justifiable and was a longtime friend of Paul Hill, the anti-abortion activist who was executed for murdering Florida abortion provider Dr. Bayard Britton and his clinic escort, 74-year-old Jim Barrett.
McMillan, who was dressed in a Santa outfit when I met him on a 50-degree day in December ("This is a time for peace on earth, not war in the womb," he explained), seems happy to play the part of extremist. He shouts "For shame!" at women heading toward the clinic, carries a plastic baby doll with him and hasn't held a job in 19 years. Yet, nutty and dangerous as he may seem to many, McMillan enjoys a certain legitimacy in Jackson. He is married to a prominent local physician, who after providing the first abortions in the state had a religious conversion (and married McMillan) and is now one of several OB-GYNs in the area who refuse to prescribe birth control. And though McMillan says he would like the state to move more quickly to become the first to be "abortion-free," he says he feels his state government is on his side.
This is not McMillan's imagination. The governor has made his anti-abortion passions perfectly clear. The local circuit courts have repeatedly shown themselves to be negatively inclined toward abortion. And I was unable to find any Mississippi legislators who openly identify themselves as pro-choice. "Either you say you're pro-life or you don't say anything," explains Erik Fleming. A Democratic state representative who was described to me as the most likely state legislator to call himself pro-choice, Fleming bristled at the term. "I don't like to be put into that label thing, because when you put a moniker saying you're against life, that's pretty strong," says Fleming, who supports limiting abortion and has sponsored legislation that would ban abortions after the first trimester of pregnancy.
The equivocation of folks like Fleming, who works as an abstinence educator when the legislature is not in session, is still better than the outright terror of the issue some other Mississippi politicians display. In the November election for state lieutenant governor, the incumbent, Republican Amy Tuck, accused the Democratic candidate, State Sen. Barbara Blackmon, of being pro-choice. Blackmon, who does support abortion rights, might have said, "One in three American women has an abortion by age 45. I support keeping it safe and legal for them." Or maybe even simply, "Yes, I'm pro-choice. Next question?" Instead, she responded by accusing Tuck of having had an abortion herself, and challenged her to sign an affidavit swearing she hadn't. Tuck signed the affidavit and won the election.
The fear of being associated with the issue extends beyond government officials. Even Mississippians who are outraged about how their state has handled abortion were afraid to be named in an article about it. ("I'm a Catholic, my priest would kill me," is how one explained it.) And the issue is "too divisive" for the Mississippi Coalition on Women to address, according to one of the group's founders. Meanwhile, the few willing to work openly on the issue are overwhelmed. Susan Hill, who runs clinics in Wisconsin, Indiana, Delaware, Georgia and North Carolina, in addition to Mississippi, says she saves her energy for the big fights. Currently she's leading the battle against a renewed push to ban abortions after the first trimester of pregnancy, which ends around the twelfth week. Already, the state limit is 16 weeks, though Roe allows abortions until the point of fetal viability, at least 20 weeks into pregnancy. Sixteen weeks is a significant cutoff, since amniocentesis and other tests for fetal abnormalities are performed at that point. As a result, women cannot get abortions in the state because of problems discovered through these tests.
Operating in triage mode has meant that no one in Mississippi has found the time to sue over highly questionable state policies. So, by law, clinic doctors must give the scientifically unfounded warning that having an abortion might increase the risk of breast cancer. The state issues "Choose Life" license plates despite the fact that the practice has been found unconstitutional in other states. And the governor's proclamation, which declares that "the time has come" to overturn Roe v. Wade in addition to authorizing the display of the crosses, has gone unchallenged.
Mississippi, the proclamation tells you, lives by a different law from the rest of the land – for now, anyway. And even while they challenge it simply by running Mississippi's last remaining abortion facility, Susan Hill and Betty Thompson have been forced to accept that reality. In his lawn chair outside the clinic, Roy McMillan rejoices in it. And the women of Mississippi, who sleep in their cars, shuttle out of state and bear unwanted children in poverty, live it.
Sharon Lerner is a senior fellow at the Center for New York City Affairs at Milano Graduate School, New School University.