Pregnant and poor in Mississippi

Mississippi law limits abortion to the first 12 weeks of pregnancy. But for poor women short on time and money, that can be an impossible deadline.

By Sharon Lerner

Read more: Abortion, Poverty, Mississippi, Pregnancy, Life

July 2, 2007 | The other day, a quiet 17-year-old, let's call her Angie, walked into the only abortion clinic in Mississippi. A wiry teen with coffee-colored skin and delicate features, Angie had recently screwed up the courage to tell her mother she was pregnant. The pregnancy had blindsided her. (Sure, she had been nauseated and had thrown up a few times, but she figured it was just the stomach bug going around.)

But the real shock hit her inside the unassuming stucco clinic in Jackson. An ultrasound revealed that Angie was not eight or 10 weeks along, as she and her mother had assumed, but 14 weeks into her pregnancy. Then, as they were absorbing the news, a staff member informed them that at that stage of pregnancy, Angie wouldn't be able to get an abortion anywhere in the state.

One year ago, Mississippi became the only state in the country where abortion is limited to the first 12 weeks of pregnancy. If the lone doctor, Joseph Booker, at the lone Mississippi clinic, the Jackson Women's Health Organization, were to perform any abortions after the first day of that week, he could face jail time. Angie and her mother aren't the only ones in the dark about the change, though; most patients who come to the clinic have no idea of the 12-week cutoff -- fully four weeks earlier than the 16-week limit the clinic had observed for the previous decade and at least 10 weeks earlier than federal law allows. Several other states have also shortened the window in which abortions are available, though not as drastically. In South Carolina, Indiana, Alaska and South Dakota, for instance, abortions are only available up to the 6th day of the 13th week of pregnancy.

Along with the ban on so-called partial birth abortions, which was upheld by the Supreme Court in April, the new limit in Mississippi has been a way for abortion opponents to target relatively advanced pregnancies. While the vast majority of abortions take place in the first 12 weeks (also known as the first trimester) of pregnancy, some 11 percent take place after that point.

Problems with the fetus are sometimes the reasons for later abortions -- and are often the examples pro-choice advocates bring up to illustrate the need for them -- but the majority of relatively late abortions have more to do with the nitty-gritty realities of everyday life. And here, in the poorest state of the country, all too often the reasons for delaying the procedure have to do with the struggle to come up with the money to pay for it.

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The state law passed in January 2006 requires that any Mississippi facility where abortions are performed after the 12th week of pregnancy be approved to do so by the Mississippi Department of Health after complying with a new set of regulations. So while the only Mississippi clinic already had met rigorous rules determining the width of its hallways and the size of its parking lot, for example, it now had to spend almost $100,000 to meet the new standards, which require costly changes like hiring another full-time nurse and expanding the hours of the ultrasonographer.

The exacting letter of the law is in keeping with the kinds of restrictions the state has already placed on abortion -- which include a mandatory 24-hour waiting period after counseling and a requirement that minors inform both parents before having an abortion -- but the way this law is being enforced in itself amounts to "a form of harassment," according to Susan Hill, president of the National Women's Health Organization, which oversees abortion clinics in five states, including Mississippi.

Hill says the Jackson clinic complied with most of the regulations almost a year ago. By late July 2006, the only outstanding requirement, she says, was that the clinic's doctor have admitting privileges at a nearby hospital. Though Dr. Booker applied to several hospitals, including Women's Hospital in Jackson, none would grant him the status. "Some wouldn't even send an application," says Hill. "They said they didn't allow abortions in their hospital, even though the arrangement isn't so he can do abortions there, it's for treating complications."

On Dec. 14, 2006, the Mississippi State Board of Health, which is responsible for enforcing the law, recommended that the clinic's existing transfer agreement with a nearby hospital should suffice. But, in the six-and-a-half months since then, the clinic has still not received a definitive response from the health department about its status.

Liz Sharlot, director of communications for the Mississippi Department of Health, says that the clinic must apply yet again before it can be granted the go-ahead to perform abortions after the 12th week. According to Sharlot, the delay thus far is due in part to the fact that the Board of Health, which can make the final decision about the clinic's fate, was disbanded in late March. Sharlot says a new board is expected to meet July 2 and may reconsider the issue.

In the meantime, the holdup -- be it due to bureaucratic snafus or intentional defiance -- translates into serious hassles, and perhaps worse, for young women like Angie. After having already driven more than an hour west to get to Jackson, Angie and her mother must now go back east into Alabama to a Montgomery abortion clinic. The nearly four-hour trip will cost them gas money they don't have to spare, and the extra day of travel could cost both of them their jobs in the cafeteria of a military base.

A 2005 study found that 21 percent of women getting abortions after the 13th week cited fetal health problems as the reason. (In fact, most genetic problems are detected by testing that happens after the first trimester, such as amniocentesis.) Another 10 percent referred to their own health issues. But perhaps even more common are scenarios like Angie's, in which delay is caused by some combination of obliviousness and denial. Even two or three missed periods can be chalked up to irregularity. And who doesn't get tired and gain weight sometimes? Plenty of women, particularly younger ones, don't let themselves think about what might be going on in their bodies. Others take the deer-in-the-headlights approach: be still, do nothing, and hope the oncoming truck of pregnancy will miraculously go away.

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