What Abortion Access Looks Like in Mississippi: One Woman at a Time06/13/2019
When Brandy found out she was pregnant for the fifth time, she was 25 and single and had given birth to her third child two months earlier. Soon after that, she lost her retail management job of six years. It was midwinter 2013, and she could barely pay her heating bill. “I knew I wasn’t going to keep it if I could do anything about it,” she says now of the pregnancy. A month later, once she could afford the cab fare, she called a taxi to drive her 20 minutes to Jackson Women’s Health Organization, the only abortion clinic in Mississippi.
But once she was in an exam room for her ultrasound, the doctor said there was nothing JWHO could do: The clinic did not perform abortions after 16 weeks of pregnancy, counted from the first day of a patient’s most recent period, because the state mandated that those take place at a hospital. The doctor estimated Brandy’s pregnancy at 17 weeks. The nearest place she could have the procedure done legally was a clinic in Tuscaloosa, Ala., about 200 miles away.
This presented a few problems. One was that Brandy (who asked to be identified by only her first name) did not own a car. Another was the cost — around $800, twice Brandy’s monthly Temporary Assistance for Needy Families check. She would also have to stay in Tuscaloosa overnight; like Mississippi, Alabama requires a waiting period before a patient goes through with an abortion. She would need money for the extra day of child care and for a hotel, too. As she dressed in the exam room, she ran through the numbers in her head. They added up to an error: She didn’t have the money to support another child, but she didn’t have the money for an abortion, either.
She left JWHO in a daze and was startled when a young woman — black, like Brandy and like a majority of Jackson residents — appeared beside her. Surely, she thought, this was an anti-abortion protester. “But then she asked me if I was O.K. and started talking to me, and I just knew that she wasn’t,” Brandy told me. The woman, who introduced herself as Yolanda, seemed uninterested in persuading Brandy of anything about her pregnancy. She said she just wanted to know if Brandy needed a ride. In the car, Brandy explained her predicament. Yolanda said she worked with a local black feminist activist who might be able to help; could she give the woman Brandy’s phone number?
The next day, Brandy received a call from this activist. Her name was Laurie Bertram Roberts. Within two days, Brandy had an appointment at the Tuscaloosa clinic. She would get there in Roberts’s car. She would stay with one of Roberts’s friends. Roberts would arrange and pay for everything through an organization she ran called the Mississippi Reproductive Freedom Fund.
A week later, Brandy stood outside her house around 6 a.m., waiting to be picked up. It was the first time she and Roberts met. Yolanda drove them straight to the Alabama clinic, where Brandy received a dose of misoprostol, which softens the cervix for a dilation-and-evacuation abortion. On the way to their lodgings, they stopped at a Piggly Wiggly for supplies to make Brandy a few heating pads. Sprawled on the couch with a rice-filled microwaved sock against her back, Brandy tried not to think about the reason she was spending the night at a stranger’s home.
She was the clinic’s first patient the next morning. With Roberts beside her, Brandy put her feet up in stirrups, took a deep breath and told the doctor to go ahead. Twenty minutes later, a nurse took her to a recovery room, where Roberts stayed with her until another patient entered. With no more time to spare from family obligations, they got back on the road.
Their only stop between Tuscaloosa and Jackson was at the Red Lobster in Meridian, Miss. Roberts has made many such stops at the chain restaurants and roadside cafes dotting Southern Interstates. It’s her responsibility, she says, to help her clients with far more than just medical bills. “I think sometimes people take me wrongly and think I’m trying to make abortion into a boutique experience, which is not true,” she says. “What I do want is for people not to have a shaming experience. And to have an experience that does not stigmatize. Why can’t you have Red Lobster on the way back from your abortion? She’s got to eat, and what am I supposed to do, throw her some cold fries and a crappy burger?”
Many people in Jackson will not say the word “abortion” in public. They prefer euphemisms, like “taking care of a problem” or “women’s health care”; even in their own homes, they lower their voices before uttering the word itself. Roberts has responded to this secrecy with a bullhorn. She openly helps people obtain abortions. She takes them to dinner afterward. She provides them with whatever else she thinks might help them and their families go on with their lives: birth control, books, money for groceries or child care or Christmas presents. She gives the volunteers who help her money to keep their cellphones on and their gas tanks full, because most of them are as poor as her clients.
Hers is not the work of a traditional nonprofit, limited in scope and precise in budget. This is by design. Roberts feels she has more in common with her clients than the charity organizations that typically serve them, and having previously sought help from charities herself, she loathes what she sees as their paternalism. “When we say we trust black women, we mean that,” she says. “We give them cash to do what they need to do, because they know their lives better than anybody else.”
Planned Parenthood, the A.C.L.U. and the Center for Reproductive Rights are the legal heavyweights of the reproductive rights movement, spending millions between them on courtroom challenges to anti-abortion legislation. Abortion funds concentrate on direct aid, averaging around $300 per case, to clients who face a financial gap between legality and access. There are now 76 such independently run funds, across 41 states, recognized by the National Network of Abortion Funds.
The more hard-line a state’s opposition to abortion, the fewer funds are typically there to ferry clients across expanding provider deserts. M.R.F.F. has long been the sole fund based in Mississippi and one of only a few supporting clients there. (Access Reproductive Care-Southeast, a regional fund in Georgia, began supporting clients in Mississippi in 2016.) Donations usually arrive in single and double digits, and they rarely total more than $50,000 annually. “We’re run by and for poor folks,” Roberts says, “so we treat our money like poor folks do. As soon as we get it, we spend it.” In an average week, she says, she receives 60 calls. There are frequent stretches — lasting anywhere from a few weeks to several months — when she says she has to turn down all of them.
Four decades ago, in the years following the 1973 Supreme Court decision Roe v. Wade, access to abortion looked very different. Clinics opened, and within a decade an abortion was rarely over an hour’s drive away, other than in America’s more remote corners. The procedure was also, initially, covered by Medicaid. That changed in 1976, when Representative Henry Hyde, a Catholic Republican, attached an amendment to that year’s Department of Labor and Health, Education and Welfare Appropriations Act barring any federal Medicaid funding of abortion outside of narrow exceptions. “I certainly would like to prevent, if I could legally, anybody having an abortion — a rich woman, a middle-class woman or a poor woman,” he said in a floor speech. “Unfortunately, the only vehicle available is the HEW Medicaid bill.” The Supreme Court ultimately upheld what’s now known as the Hyde Amendment, confirming that Roe established a negative right: Patients couldn’t legally be denied an abortion, but whether they could actually receive one was their problem.
In the years between Roe and Hyde, around 300,000 patients annually used Medicaid for abortions. Some of the earliest abortion funds “formed in direct response to the Hyde Amendment,” says Yamani Hernandez, executive director of the National Network of Abortion Funds. Hyde’s oblique angle of attack also reinvigorated the anti-abortion movement, which had until that point foundered amid failed attempts to overturn Roe. “I would call it pivotal,” says Catherine Glenn Foster, the president of Americans United for Life. “The movement as a whole realized we could push back in a very real way.”
That movement spent the next two decades introducing workaround constraints that steadily reduced access to abortion. By 1992, the nation’s abortion laws were a patchwork that included funding bans, waiting periods and parental and spousal notification requirements. The Supreme Court’s ruling in a case that year, Planned Parenthood of Southeastern Pennsylvania v. Casey, tried to standardize which restrictions could be permitted: They would be allowed if they did not place an “undue burden” on patients, a phrase the justices left vaguely defined. So anti-abortion activists set about testing its limits state by state.
Mississippi proved a model for their experiments. Since 1991, its legislators have, among other restrictions, passed a 24-hour waiting period; mandated that doctors perform an ultrasound and offer the results before an abortion; and required that abortion clinics meet the same structural standards as ambulatory surgical centers. According to Izzy Pellegrine, a Mississippi State University Ph.D. candidate who has studied abortion access in the state, Mississippi once had four abortion clinics open concurrently; now there is only JWHO. Foster would not say whether Americans United for Life wants to close clinics, but an annual report from 2012 describes how her organization “has worked with Mississippi to enact numerous life-affirming laws” and says that “as a result, only one abortion clinic remains in the entire state.” It is one of 16 states that have lost at least 50 percent of their abortion providers since Casey.
[Inside the network of anti-abortion activists winning across the country.]
Abortion funds grew in tandem with these restrictions and with welfare cuts that unraveled their clients’ safety nets. N.N.A.F. formed in 1993, when 22 individual groups recognized a need to coordinate their efforts. Hurdles like waiting periods and notification laws had turned a 20-minute procedure into a weekslong logistical challenge; laws targeting providers had shuttered clinics, adding drives and flights. “Funds will never meet the actual need of people who need help,” Hernandez says. “We can only support about a fifth of the calls we get.” Most of those calls, in line with America’s poverty trends, come from people of color.
It took the Supreme Court over 20 years to further clarify which burdens were acceptable to continue placing on patients. In the 2016 case Whole Woman’s Health v. Hellerstedt, a 5-3 majority decided that to be upheld, a law must have “medical benefits sufficient to justify the burdens upon access.” Requiring abortion providers to obtain admitting privileges from often-hostile local hospitals, for instance, doesn’t make abortion safer, so those sorts of requirements were struck down. Earlier this year, the Supreme Court granted a stay to a Louisiana admitting-privileges law — passed in 2014, before Hellerstedt — that could have left the state with only one doctor authorized to perform abortions. In a dissent, Justice Brett Kavanaugh argued that as long as all four of the plaintiff doctors obtained admitting privileges, the law would not create an undue burden in Louisiana specifically; he did not mention medical benefits. Mary Ziegler, a legal historian at Florida State University who has written two books on abortion law, says that this sort of parsing granular state-level facts “illuminates a way to hollow out precedents without any need for the court to explicitly undo Roe.”
But many states are now moving away from this incrementalist approach. Recently passed bills in Georgia, Kentucky, Louisiana, Mississippi and Ohio ban abortion at six weeks, which is usually the point when an internal ultrasound can detect activity in cells that will later become a fetus’s heart. This is before most people know they’re pregnant. Alabama passed a near-total ban. None of the laws are yet in effect, but many panicked patients will read a headline about abortion being banned and call a clinic to cancel their appointment. “Every abortion fund in the South,” Roberts says, “now has to start our voice mail with, ‘Abortion is still legal.’ ”
Jackson Women’s Health Organization doesn’t publicize which three days each week its doctors perform abortions, but it’s easy to tell driving by: If there are protesters outside, then there are abortion patients inside. On a Wednesday last January, a rare snowfall had thinned the vigil to a trio of beaming young white women. As I approached, one offered me a full-color, four-page pamphlet with arguments about the sanctity of life and the dangers of abortion. Aimed at the clinic’s majority-black clientele, it argued that abortion was “the leading cause of death among African-Americans.” (According to the C.D.C., it’s heart disease.)
Every few minutes, a volunteer walked a patient to the mirrored facade of the clinic, waiting a few moments before being buzzed inside. The clinic’s director, Shannon Brewer, worked in an office to the right of its waiting room. A grid of business cards was taped to the wall behind her desk, many of them for staff members at the Mississippi State Department of Health; protesters often called in fake complaints, she said, that had to be investigated. She gestured at the other cards behind her — F.B.I. agents, federal marshals, local police officers. Brewer talks to them about once a month to keep tabs on the protesters, who she says enlist a nationwide network of activists to harass the clinic’s doctors. “They call their homes” — all of which are out of state — “they put stuff in their mailbox, the neighbors’ mailboxes, put up signs saying, ‘Do you know a murderer lives on this street?’ ” she told me. (Pro-Life Mississippi, which helps to organize many of the clinic protests, denied that anyone from the group would try to intimidate an abortion provider.) They also call the clinic on Monday mornings pretending to be patients scheduling appointments, to figure out when to come stand outside. In a city with fewer than 170,000 residents, seeing a familiar face protesting outside the clinic where you’re trying to receive an abortion is not outside the realm of possibility. “We’ve had patients pull up in the parking lot,” Brewer said, “and they’ll call us and they’ll be like, ‘I can’t come in. Someone I know is standing out there.’ ”
Gov. Phil Bryant of Mississippi often says he wants to “end abortion in Mississippi.” Local Democratic politicians are not especially aggressive about abortion rights, though Jackson’s leftist mayor, Chokwe Antar Lumumba, says: “As a man, I have no place to tell a woman what to do with her body.” Abortion rights activists depend, to some extent, on one another, and the relationship between Roberts and JWHO is a fraught one. Last year, two anonymous blog posts raised concerns over the resources “the only ‘abortion fund’ in Mississippi” was spending on what the post termed “nebulous, less verifiable assistance” than paying for abortions. The posts did not name names, but Diane Derzis, the majority owner of JWHO and the majority or sole owner of two other clinics in the South, readily did when I called her: “It’s about Laurie, specifically.” She told me she takes particular issue with some of Roberts’s children sitting on the M.R.F.F. board and occasionally joining her at conferences, despite the periods when the fund cannot afford to cover clients. “I called the I.R.S. I reported it. I feel like a — what’s that called? A whistle-blower,” she said. “I want to know — where’s the accountability?”
Roberts says she is accountable to her board members (five of whom are not relatives), that her travel is mostly sponsored by other organizations and that “I am never going to apologize for how we do our work.” Hernandez, the N.N.A.F. executive director, told me her organization has no issue with Roberts’s methods of operation and considers M.R.F.F. a “visionary” member of the network: “She really situates abortion within a fuller picture of reproductive health, and she is an example of someone who is impacted by these issues taking leadership.” N.N.A.F. has offered to sponsor mediation between Derzis and Roberts.
Roberts lets donors make requests about how she uses their money, but she says most don’t. J., a donor who grew up in the South and is distrustful of “people who don’t understand the region trying to come in and do something,” told me this is one reason to donate to M.R.F.F., rather than a less grass-roots group. (Fearing professional consequences, J. asked not to use a full name.) “People look at us and think, I don’t know what that [expletive] is that they’re doing over in Mississippi, why they’re not just funding abortions,” Roberts acknowledges. “But I cannot come into the black community” — which has endured centuries of coerced sterilization and other forms of reproductive control — “and say, ‘We’re just going to pay for your abortion.’ We would not be seen as credible. I would not see it as credible.”
Roberts grew up with the white side of her family in Minnesota in the conservative Independent Baptist Church. She believed abortion was murder until, at 12, she saw a picture of a fetus that looked nothing like the miniature baby doll she’d been given in Sunday school, and began questioning her beliefs. “I was like, O.K., somebody’s lying,” she says. Beginning when she was 16, she had seven children over nine years, three with an ex-husband she says was abusive, another conceived through rape. “My doctor told me, ‘You have to stop having babies like this or you’re going to die,’ ” Roberts says. “ ‘You need to get an abortion.’ And he was a damn Catholic.” But Roberts couldn’t afford one, and by the time she scraped together the money, she was too far along. She has never had an abortion.
She has heard similar stories of failed attempts from the more than 400 clients M.R.F.F. has supported over the past five years. “A lot of our caller stories sound tragic to other people,” she said. “I don’t think of it as tragic; I think of it as life. What’s tragic is that they don’t have what they need to make their choices without having to come to me.”
Roberts lives in a four-bedroom rental house, three minutes from JWHO, that she shares with all seven of her children, ages 16 to 24. A hopscotch set of car tires sits next to the front walkway, and the only rainbow flag I saw in Jackson hangs in the window. Roberts, who has fibromyalgia and often uses a cane or a wheelchair, receives guests in the living room, which is strewn with boxes of fund supplies: diapers, condoms, pamphlets. Across the room is an Ikea bookcase packed tight with volumes of black history, fund documents and comic books.
Roberts has lived in Jackson since 2005, when she came to pursue a political-science degree at Jackson State University. “I had the classic black-girl press and bump under,” she says. “And the pearls. I was very much the respectability politics chick.” She was not focused on reproductive issues until she developed a crush on one of the women who staffed her dormitory’s reception desk, and she took up the preferred cause of the object of her affection — the National Organization for Women, which has agitated for feminist causes since the 1960s. Within a year, she had dropped out of school and become a full-time activist, later joining NOW’s national board and becoming president of the Mississippi chapter. M.R.F.F. began as a line item in NOW’s 2013 budget. Two years later, at the urging of black feminists she met on Twitter, Roberts left to run the fund independently. “Laurie’s not from here, but she’s been here long enough that she’s ours now,” Felicia Brown-Williams, who directs Planned Parenthood Southeast in Mississippi, told me.
At first, M.R.F.F. supported three or four clients a month. Now, Roberts says, it’s an average of 35. Roberts said she devotes at least 60 hours of every week to that work, for which she pays herself a $5,000 annual stipend. She also supports herself by cobbling together money from writing articles for Jackson’s alt-weekly, attending births as a doula and making jewelry and other crafts. “But my main job is that I’m the parent of two disabled people,” she said: Most of her family’s income comes from Medicaid, SNAP, disability and child support from her ex-husband. “I’m very lucky to be on a fixed income so that I can do this work.”
The years of parking-lot intakes like Brandy’s are long past. Now each case begins with a call to an automated phone line, then a conversation via text or email. “The process of calling funds can be arduous,” Roberts says. “People have this overwhelming pile of obstacles in front of them, and then they’re calling these strangers for help and getting busy signals, or lectures about how they should be running their lives.”
That’s what happened to A., a 25-year-old whose abortion the M.R.F.F. paid for in October 2017. If there is such a thing as a typical M.R.F.F. client, or a typical abortion-fund client, A. was it: a young mother whose job couldn’t support a bigger family. “I’m engaged, but when it’s morning time, I’m a single parent,” she told me of raising her two children. “At the grocery store, I’m a single parent. When it’s bedtime, I’m a single parent. I just wasn’t ready for any more children.”
Before going to JWHO, four hours away from her home in Southern Mississippi, A. went to Google. “I tried to have a natural miscarriage,” she said. “I read a lot of stuff about organic methods, and I fell for it and wasted two weeks.” (Sites recommended everything from swallowing vitamin C tablets to eating multiple pineapples a day.) She found abortion pills online, but they cost hundreds of dollars, including shipping from China. She gave up and headed to Jackson.
When she arrived, the JWHO receptionist told her there were no appointments that day; she would have to come back later for an initial consultation, then a third time for the procedure. This amounted to a gas bill A. couldn’t afford. She walked out to the parking lot, numb, and dialed the number the clinic had given her for the National Abortion Federation, whose hotline offers income-based assistance for the procedure, but nothing else. When A. said she needed gas money, N.A.F. directed her to M.R.F.F., which covered everything. Other than the friend who drove A. to the clinic, Roberts was the only person who knew it happened. “Miss Laurie is real and didn’t sugarcoat things,” A. remembered. “Nothing could really make it easy, but she made it easier.”
In 1994, worried that Clinton-era Democrats were considering sacrificing reproductive care from health care reform in an appeal to Republicans, 12 black women met at a Chicago abortion rights conference to have what Loretta Ross described to me as “our W.T.F. moment.” Ross, now an author and lecturer on race and reproductive issues, was at the time doing anti-Ku Klux Klan organizing in Atlanta. As the conversation in Chicago went on, her fellow activists started talking less about reproductive rights and more about how the movement surrounding it was failing black women.
“One of the things we talked about,” Ross says, “was that, since the Civil War, the African-American community has been subject to strategies of population control, trying to make sure that we don’t have children. So we have to fight equally hard for the right to have the children that we want to have. As we thought about it further, we said, Well, once we had kids, no one seemed to care. So we have to fight for our right to parent our children in safe and healthy environments.” They eventually named their new framework “reproductive justice” and their group SisterSong. The idea took decades to gain traction. Khiara M. Bridges, a law professor at Boston University who studies how poor women of color navigate health care systems, told me that the concept “just wasn’t a thing” when she studied law at Columbia University in the late 1990s. But at the same time, “reproductive rights alone didn’t make sense to me or the work I was doing. It’s just not a useful tool to describe how people’s lives are on the ground.”
When applied to an individual abortion, reproductive justice involves taking into account everything else in a patient’s life. After Roberts helped A. receive her abortion, M.R.F.F. began paying for her birth control. When Brandy got a new job after her trip to Tuscaloosa, Roberts’s children helped look after her kids. Reproductive justice is why Roberts named her organization the Mississippi Reproductive Freedom Fund and not the Mississippi Abortion Fund.
Four years in, Roberts concluded that M.R.F.F. couldn’t carry out this mission without its own physical address. Funding abortions, birth control, groceries — this could be done from her home. But in a state that mandates abstinence-based sex education and has the nation’s highest infant-mortality rate, her ambitions were bigger: comprehensive sex education, breast-feeding classes, a food pantry.
She tried to rent, but when landlords learned what she planned to do with the property, they stopped returning her calls. So in 2017, she says, she spent $12,000 — almost half the fund’s money at the time — on a two-bedroom with a cottage in West Jackson, one of the city’s poorest neighborhoods, which is 98 percent black. She wanted, she says, to invest in the community, and the location also offered a slight buffer from anti-abortion activists. “They are less inclined to come to the ’hood,” Roberts says. “I don’t think the city of Jackson would take kindly to a bunch of white folks showing up to protest a group giving away diapers to black moms.”
Last winter, Roberts stopped by the house, which she had taken to calling the “fundshack,” to make sure the grass was trimmed and the squatter that she’d had to evict hadn’t returned. “These are all going to be new and energy efficient,” she said, pointing to front windows missing half their shutters. In the backyard, a bare-branched oak towered over dense weeds. “We’re going to have cookouts and movie nights here.” She opened the cottage door and waded into standing water. “We’ll clear all this out” — mildewed couches, broken glass — “and tidy up the little kitchen in here, maybe set up some beds for folks who need a place to stay.” The front house, she said, would host classes, the M.R.F.F. office, a playroom and whatever else clients end up needing. And, if possible, a Plan B vending machine on the porch. “If someone drops $300 in my lap tomorrow, I’m buying the damn vending machine,” she said, cackling at the thought. “If Plan B is illegal to put in there, I’ll do condoms.” She sighed. “I know it don’t look like much, but it’s going to be amazing.”
By May of this year, she had checked off about half her list of improvements, including kitchen appliances, a new bathroom and a tiny food pantry and library on the front lawn. She now operates the fund from the house. Paying for construction on top of a steady stream of clients brought resources down to emergency reserves of a few hundred dollars in April. “I have to do triage on each program,” she told me. “If I have a single mom who’s been a longtime client who’s about to be homeless, and another person who needs money for an abortion, and I only have money for one, which one do I choose?”
A rise in donations began after March of this year, when Mississippi’s Legislature passed a ban on abortion past six weeks. (The previous March, it passed a ban beyond 15 weeks.) In May, Georgia passed a similar bill that grants full legal personhood after six weeks. Alabama passed its latest legislation, and Louisiana also passed a cardiac-activity law. (None of these are yet in effect.) M.R.F.F. relies heavily on clinics in all three of those states.
When Mississippi’s 15-week ban passed last year, Roberts remained philosophical about it. “It’s one of those things where it’s awful, but it has little to no impact on our clients’ lives,” she told me then. This year’s tidal wave of legislation, though, has been more unsettling. “I’ve publicly stated a few places now that I feel like this might be the year that the South breaks me,” she told me last month. When she thinks of quitting, she told me, she considers what would happen to her clients if M.R.F.F. closed: nothing. As in, no diapers, no groceries, no abortion funds, in one place that’s run by people who have found themselves needing all those things and understand what it’s like to need them. “We are the people we serve,” she said. “We are poor black women in the South.” She added: “So we have to keep going.”
Zoë Beery is a freelance journalist and a former editor at the Village Voice who covers reproductive health and sex work. This is her first article for the magazine.
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