When Choice is 221 Miles Away: The Nightmare of Getting an Abortion in the South

Update, October 12, 2021: The Jackson Women’s Health Organization, a clinic that was open three days a week at the time of writing, has expanded its hours since our publication and now operates Monday through Saturday.

“I would drink bleach right now.”

Kate shakes her head, and her long, sun-streaked brown hair, piled high in a messy bun, shivers. “That’s so bad, and I don’t mean it,” she quickly adds.

She’s exhausted; shadowy crescents frame her bright eyes. Just a few weeks ago, she graduated from the University of Mississippi. “My one goal, as pathetic as it sounds, was do not walk across that stage pregnant,” she says. “Everything I worked for…I’m going to remember graduating and being pregnant.” Kate has been trying to get an abortion since March. It’s a Friday evening at the end of May, and she was just turned away from an Arkansas clinic, about 200 miles from home.

 
In the morning, she’ll have to go back home to Oxford, Mississippi, where she’ll wait yet another week, and return to the clinic in Little Rock for the third and hopefully final time.

Her day began at 3 a.m., with a text from Laurie Bertram Roberts. Roberts helms the Mississippi Reproductive Freedom Fund, the nonprofit that was helping Kate get her abortion. Around 7:45 a.m., a white medical transport van arrived at her apartment, and Kate climbed in to join two of Roberts’ daughters, Sarah and Aolani, as well as Roberts’ partner, who was driving but did not want to be named. The crew journeyed northwest, through Mississippi, then Tennessee, then Arkansas. Traffic on the interstate slowed them down; by the time they made it for her 10:45 a.m. appointment, it was nearly noon.

 

Tired and dusty—the van’s air conditioning was broken, so the windows stayed down—the foursome stepped out into the humid Arkansas air. About 15 protesters hemmed in the clinic, and Kate kept her head down as a man bellowed that God would not judge her, if only she would turn around. Another protester, a woman with an infant, shrieked that Kate should carry to term and give the baby to her. It was that image—the baby nestled in the stroller, in the edge-of-June heat—that Kate says was seared into her mind the rest of the day.

After rushing into the clinic cocooned by her companions, Kate faced the metal detector, putting her wallet in a dish. The strict security was jarring the first time she visited, even though it’s pretty typical in clinics. Still, she couldn’t bring herself to unclasp the vintage necklace she almost never takes off; she breathed a sigh of relief when it didn’t trigger the alarm. Her cellphone was left in the van—another security measure, meant to protect patient privacy and stymie anti-abortion activists who pose as patients and film inside clinics—making her feel even more alone. She hadn’t told her mother, who was battling a serious illness, about her pregnancy, or her new boyfriend. Just about everyone she had told was in the clinic with her.

Kate’s memory of the rest of the appointment is blurry. She remembers some complication with payment and a sharp admonishment from an administrator about her tardiness, which brought forth the tears she had successfully held in until then. Called back to the exam room, she was relieved to see her favorite clinic staffer there. At a prior appointment, the staffer had made Kate feel comfortable and reassured. But now, performing the ultrasound, the energetic, warm woman grew quiet. “What’s wrong?” Kate demanded, her body tightening with fear.

“Oh, things are just going to go a little differently today,” the staffer replied, trying to keep her tone light. Kate clenched her jaw against the rising bile in her throat.

The ultrasound was showing the fetus at 20 weeks, but Kate’s appointment was for someone who was 18 weeks along. That meant Kate couldn’t get her abortion. The extra two weeks triggered a 48-hour waiting period and state-mandated counseling about fetal pain—a concept that’s been widely debunked for more than a decade. She would have to make the journey all over again for an appointment next week. That would be her final chance to get the procedure in Little Rock; abortions after 22 weeks are illegal in the state. It was already too late to get one in Mississippi, where abortion is not available after 16 weeks.

As a nurse explained the situation and began the required monologue about fetal pain, Kate’s eyes filled with bright white light, and she gagged.

I first meet Kate, a pseudonym to protect her identity, by the pool at a Little Rock hotel a few hours after she was turned away by the clinic. Her fingertips are stained bright orange-red, courtesy of a bag of Flamin’ Hot Cheetos, and she is wearing the summertime uniform of college girls in the South—oversize T-shirt, athletic shorts, sandals. She greets me with a warm familiarity and says she hopes I can explain what just happened to her, because she has been too afraid to Google much of anything.

Kate tells me repeatedly that she’s passionate about helping people. She wants kids someday, with the right person. The man who impregnated her is not that. They were only sexual the one time; she had been drinking and she doesn’t remember how they ended up at her apartment that night. When she told him she was pregnant and that she wanted an abortion, he said it was her choice.

Kate worried she would be judged if she went to the clinic in Jackson—the only one in the state. “Ole Miss is apparently the most liberal area in Mississippi, and it is not open-minded,” she says. It took her some time to find an alternative, sifting through search results for crisis pregnancy centers—anti-abortion establishments that aim to convince women to carry to term based on religious conviction. She called a legitimate abortion clinic in Memphis, but the receptionist sounded overwhelmed, and it made Kate’s anxiety swell. Finally, she made an appointment in Little Rock for early March.

The man who impregnated her drove her to the clinic that day, and he promised to pay for her procedure, Kate says. They were in the car by 4 a.m.; Kate wanted an early appointment so she could make it back in time for a night class. She was later surprised when the clinic asked for payment upon her next visit. Apparently, the man declined to pay for the appointment while she was in the exam room.

He later asked Kate to keep the baby and give it to him. She refused. The morning of her third appointment, she found her tires slashed. That’s when she decided she needed help. That’s when she found Laurie.

Laurie Bertram Roberts’ life is chaotic. A 41-year-old woman with seven children, she lives below the poverty line. Her family cobbles together a modest life with the help of food stamps, government assistance, and the odd jobs they do to survive. Roberts spends much of her time bedbound due to painful fibromyalgia, but her phone and laptop are never far, basically operating as digital appendages. As a co-founder and the executive director of the Mississippi Reproductive Freedom Fund, the only abortion fund in the state, Roberts has run an organization for the past six years that’s neither seamless nor neatly organized, but it is powerful. Its budget grew to $110,000 this year and it helps at least 10 or so individuals each month get abortions, sometimes smuggling those in abusive relationships out of their homes for the procedure.

The fund doesn’t just pay for abortions and coordinate logistics. Roberts, a woman of color, is a true believer in the reproductive justice framework—a term coined by a group of black women in the ’90s, detailing, as their organization now puts it, the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” The Mississippi Reproductive Freedom Fund helps women pay for health care, diapers, food, contraception—wherever there’s a need, the fund will fill it. Roberts delightedly shows me several boxes of Barbies, in every shape, size, and color, that she purchased for a playroom for her clients’ children. “No one comes to us just needing one thing. Needing abortion funding is usually one part of their greater struggle of being a low-income person,” she says.

When I visit the house in West Jackson where Roberts lives and eventually plans to host clients overnight, it is teeming with activity. The one-story “fundshack,” as she and her family call it, is modest, with a front porch framed by lacy white iron posts, shot through with rust, and bars clamped protectively over the windows. Roberts’ daughters Kayla, Sarah, and Aolani—who grew up with social justice at the center of their lives the way most kids here grow up with religion—drift in and out, as do local activists from youth empowerment and LGBTQ organizations. An unexpected donation of several mattresses is delivered, while fund volunteers intermittently pop into the room where Roberts sits in bed, chatting with me, her lower half wrapped in a blue sheet. Roofers work in the hot sun to replace the worn-down shingles. Roberts tells me it took her a few tries to find a reliable crew who didn’t mind working for a group that funds abortion care and were willing to work in a poor “black” part of town. She seems to have hit it off with these guys. A day or two prior, the subject of condoms came up when she was talking with them, as it tends to around Roberts, and soon enough she was using a wooden penis to demonstrate how to properly put one on. She says the men left that day with a generous bag of free condoms.

“I’m very plainspoken about sex,” she says, shrugging.

Roberts is actually plainspoken about almost everything—she doesn’t much care for bullshit, and she’s not afraid to let you know it. She knows firsthand there are worse things than appearing abrasive: like being denied an abortion when your back is against a wall. Like nearly dying in a Catholic hospital because the doctor is more interested in saving the fetus than the woman with children at home. Like being a low-income woman of color in a state with a long record of denying the humanity of those who look like you. All of these factors, all this personal history, contribute to why she’s doing this work and why it is messy and frenzied—such is the life of someone who lives with the odds stacked against them, and such are the lives of those who come to her for help.

“We’re all poor women and femmes and people of color, for the most part. We have a couple of low-income queer white folks working for us,” she says. “To be part of our leadership, you have to be a low-income or working-class person, period. We’re not apologetic about that at all, and we’re unapologetically black as fuck. You can either rock with it or kick rocks, we don’t care.”

That’s a revolutionary attitude for Mississippi, the state with the second-highest poverty rate in the nation, where, in many ways, post-Roe America is already a reality. In a study of 47 states there were 11.8 abortions per 1,000 women of reproductive age in 2015, but in Mississippi there were just 7.8. Even so, a year earlier an estimated 47 percent of all pregnancies in the state were unintended, while nationally it was 41 percent. Also, in 2017, Mississippi’s birthrate among 15- to 19-year-olds was 65 percent higher than the national average.

In recent years, the state has twice attempted to place a severe gestational limit on abortion—first, a 2018 law that would have banned abortions after 15 weeks, and this past May, another law that would have banned abortions after six weeks. The measures were signed by Gov. Phil Bryant, who famously said his “goal is to end abortion” in Mississippi, but a federal judge struck down or blocked the laws.

The Jackson clinic’s capacity has been slowly whittled down by an onslaught of legislative attacks. It is required to meet the onerous standards of an ambulatory surgical center. The state mandates every patient undergo medically inaccurate counseling and be subjected to an ultrasound and a 24-hour waiting period, which means two separate trips to the clinic. Nearly half of Mississippians seeking abortion care travel out of state to get it, but even then, its neighbors in the Bible Belt aren’t much better off. While Tennessee has seven clinics operating as of recently, Alabama and Louisiana have just three each, and Arkansas was down to two this summer. These states feature a patchwork of Targeted Regulation of Abortion Providers (TRAP) laws, policies aimed at limiting access to abortion care through seemingly harmless provisions about hallway widths or expensive medical equipment unnecessary to abortion.

Low-income women suffer the most in the state’s abortion desert, making Roberts’ job all the more crucial. According to 2017 data from the Kaiser Family Foundation, more than 1 in 10 women in Mississippi receive health care coverage through Medicaid and likely can’t afford to pay for an abortion or nonemergency contraception on their own. In 2016, the state health department closed nine clinics; the following year, two-thirds of the department’s regional offices were shuttered due to a series of budget cuts. According to Roberts, some women she knows who rely on Medicaid have had to wait up to six months to get birth control. The state has a single Planned Parenthood, in Hattiesburg, that distributes birth control but does not provide abortion care—which, according to Barbara Ann Luttrell, director of communications for Planned Parenthood Southeast, “is because the state of Mississippi intentionally has made it next to impossible to be an abortion provider.” Planned Parenthood Southeast is also one of the most under-resourced affiliates in the country.

“I don’t think [outsiders] understand that the structural barriers are at every turn of care, that it starts before people even have sex,” Roberts says.

Roberts wishes her fund could overcome some of these obstacles by helping women like Kate manage their own abortions at home, in peace—largely with medication abortion. She sees misoprostol and mifepristone as equalizers for anyone seeking an abortion, particularly rural women who live hundreds of miles from a clinic. But in Mississippi and 33 other states, it is a crime to use medication to induce an abortion if that medication is not administered by a licensed clinician. Mississippi also bans the use of telemedicine, in which doctors see a patient remotely, despite a 2017 study finding that telemedicine is as safe as an in-person doctor visit for medication abortion.

Above all, Roberts fears what seems like the next big battle in the war on abortion: criminalizing women by giving fetuses the same rights as people. This is already happening, most frequently when pregnant women use drugs. While Mississippi doesn’t have a law that criminalizes drug use while pregnant, prosecutors in at least one county, Jones County, have fashioned a loophole through which approximately 20 women have been charged under a “felonious child abuse statute”—reasoning that if a woman uses drugs, she is poisoning the fetus, and therefore is criminally liable. Roberts has put up bail for one woman who was jailed under the statute. “I knew Jones County was bad when we called the bail bondswoman to get her out, and the bail bondsperson told me, ‘I’m so glad y’all are helping her, because I have so many women that I bail out every year in her same situation and it’s horrible, it’s ridiculous, and someone needs to stop it,’” Roberts says, laughing darkly. “Bail bondspeople aren’t usually on the side of the people they’re bailing out.” Roberts also got involved in a widely publicized case in Alabama, in which a black woman named Marshae Jones was charged with manslaughter when she was shot in the stomach while pregnant. Though the charges were ultimately dropped, Roberts helped a local abortion fund raise money to pay Jones’ bail and hire a lawyer.

Despite this excruciating landscape, Roberts is proud that Mississippi is where she came into her own—it’s where she fled her abusive partner when she was 27; it’s where she went to college; it’s where she raised her kids. It’s where she grew into a hellraising activist, surrounded by other activists, many of whom had a history in the civil rights movement. It was the first place in her life where she found herself in a majority-black space. “I generally talk about Mississippi being the Broadway of activism,” she tells me. “If you can make it here, you can make it anywhere.”

Kate spends most of the journey home from Little Rock curled up on the floor of the van. She hadn’t been sleeping much since she found out she was pregnant a few months ago, and last night was no better. After lunch, Sarah and Aolani stop at a Walmart for a thin foam mattress pad and a cheap tie-dye blanket to make a bed for Kate. As the van hurtles down the interstate, Roberts’ partner behind the wheel chugs energy drinks, slinging expletives out the window every so often at other motorists. Air roars through the open windows, and a vent in the top of the van clatters, making it impossible to talk much. Kate quietly lies there, occasionally picking up her phone only to set it back down. Sweat has pasted her two-sizes-too-big T-shirt to her back, and the folds of the blanket have left creases on her legs. Sarah passes her phone around every so often to share an amusing Tumblr meme. Kate humors Sarah, but her smile hardens into more of a grimace.

“I can’t believe I have to do this all over again in a week,” Kate mumbles as we wait to use the restroom in a grimy gas station near the Tennessee state line. She is eager to see her dog, who has been her devoted companion throughout this ordeal, sleeping in the bathtub on nights when Kate was too sick to move from the toilet. When we pull into her apartment’s parking lot, she tries to quickly exit the van but has to wait for a nosy neighbor to go inside. “Let us know if you need to talk,” Sarah calls after Kate.

As I watch Kate hurry away, I wonder if she’ll be able to steel herself to repeat the trip. I would have understood if she couldn’t; she had pushed through a series of grueling obstacles only to be met with still more. But less than a week later, on a rainy Thursday morning, the group began the process all over again. This time, Kate got her abortion. If she had waited even a few days longer, she would have been rendered ineligible for the procedure, which would have meant a journey to Florida or Colorado. What’s more, if she had started this arduous process just a few weeks later, she might not have been eligible for an abortion in Arkansas at 20 weeks. This year, legislators passed a law banning abortions past 18 weeks there, shaving four more weeks off the window for the procedure, but its opponents sued the state and a federal judge has temporarily blocked it from going into effect.

When we speak a few days after the abortion, Kate sounds lighter. She says she finally feels calm and ready to move forward. She’s considering a couple of internship options, one of which would take her out of Mississippi altogether. “When I got into my apartment, I literally just laid down with [my dog], and finally, I felt like I had a sense of control again.”

This story is part of our post-Roe issue, in which we examine an America without the right to an abortion by looking at areas where that is already a reality. Be sure to read our essay on how the fight for Roe is already affecting abortion access, and our investigation into the consequences of state laws that ban abortion without exceptions for rape.