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.

Published July 2, 2007 3:45PM (EDT)

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.

There are probably as many situations giving rise to these later abortions as there are women who have them. I once spoke with a woman whose husband of a few weeks, a seemingly reasonable and gentle man she had known for less than a year, had thrown her into a wall when she was three months pregnant. One month later, as she was weighing her options, she found legal documents that included photos of a bruised and battered woman and discovered he had spent time in jail for attacking an ex-girlfriend. A few weeks after that, her husband threatened to kill her and her 11-year-old daughter -- and the woman decided to have an abortion in her 22nd week of pregnancy.

(Except to protect the life or health of the mother, abortion is generally illegal in the third trimester, which starts at the 26th week of pregnancy and is where the Roe v. Wade decision put the beginning of viability in 1973. But because of medical advances since then, there is now general agreement that a baby can often survive outside the womb at an even earlier point, which doctors have the legal authority to determine on a case-by-case basis.)

In Mississippi and elsewhere, poverty plays a huge role. Federal legislation known as the Hyde Amendment forbids the use of federal funding for most abortions. So many women scrounge for the $380 price of a first-trimester abortion. The Jackson Women's Health Organization decreases the fees by up to $75 for the poorest women, but, according to clinic staff, even that is sometimes not enough.

The time women spend trying to scrape together that money can easily push them past the now-crucial 12th week, and into the second trimester, when abortions are both riskier and more expensive. "Sometimes, they're so close on the edge, by the time they come in and they let the light bill go or whatever, it's too late," says Betty 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. Thompson, a stately grandmother who had her first child at 16, always encourages resourcefulness in the women she counsels who are struggling to pay for abortions. "I ask them, 'Have you sold your jewelry yet? Have you asked to borrow from everyone you know?'"

As Thompson knows -- and as many women seeking abortions in Jackson do not -- the stakes in the money scramble are now higher, since too much dallying can push women who want abortions past the 12th week of pregnancy. "They might let one period go. And then the next period doesn't come again -- so we're talking eight weeks," says Thompson, ticking off the weeks on her fingers. "Let's say you get paid once a month -- nine, 10, 11, 12 -- then there you are."

Research backs Thompson's anecdotal evidence. Sixty-seven percent of poor women having an abortion say they would have preferred to have had it earlier, according to a 2004 study published in the journal Contraception. Specifically, researchers have determined that poor women take both additional time in confirming a pregnancy and several more days between making the decision to have an abortion and actually obtaining one. In Mississippi, where 98 percent of counties don't have an abortion provider, the logistics of getting the procedure can be particularly daunting: First there is the long drive to Jackson, then the phalanx of protesters surrounding the clinic, followed by the two-day ordeal that begins with the informational session and ends, finally, with the abortion.

No one knows for sure what now happens to the women with unwanted pregnancies in Mississippi who have progressed beyond 12 weeks. In the year since the law went into effect, the clinic has performed 458 fewer abortions than the previous year. Many would-have-been patients, like Angie, were referred to a Montgomery clinic, New Woman All Women Health Care, which allows women who have attended informational sessions in Jackson to get abortions without having to repeat the session in Alabama. The Montgomery clinic (which was firebombed in 1998) hasn't tracked how many of its patients have come from Mississippi, but according to a staff member, several women who have passed Jackson's 12-week limit call seeking abortions each week, though many of them don't show up for their appointments.

Those missed appointments are, no doubt, exactly what the authors of the Mississippi legislation wanted. The abortion rate here is low, despite the fact that the state has the third-highest teen pregnancy rate in the U.S. The state's many restrictions clearly help depress the numbers. There were only six abortions for every thousand women of reproductive age in 2000 in Mississippi, compared to 21.3 in the U.S. In the six years following the enactment of the law requiring a 24-hour waiting period after counseling in 1992, the rate dropped from 11.3 per thousand to 9.9, according to a study published in Family Planning Perspectives in 2000.

It's unclear how long the standoff between the Mississippi health department and the Jackson clinic will last. Hill says she has not filed suit against the state yet because she is "so tired of being in court." Indeed, battle fatigue has meant that several antiabortion laws that haven't survived in other states have gone unchallenged in Mississippi. By law, clinic doctors there must give the scientifically unfounded warning that having an abortion might increase the risk of breast cancer, for instance. And the state issues "Choose Life" license plates, despite the fact that the practice has been found unconstitutional elsewhere.

Still, Hill and other abortion rights advocates have taken on some legal battles in Mississippi. Most recently, the Center for Reproductive Rights successfully challenged a state law that, like the 2006 one, created a special category for facilities that perform abortions after 12 weeks, but, unlike the more recent law, gave the Jackson clinic no way to apply to become such a facility. Hill says she's working up to fighting the current situation, but fears it will be difficult because the state hasn't officially refused to certify the clinic to do second-trimester abortions -- just repeatedly delayed doing so.

So young women like Angie continue to risk jobs and borrow money in order to make it out of state to get abortions. Others, like a young Mississippi woman named Tammy, forgo the procedure entirely. Tammy first came into the clinic last October, when she was in her 14th week of pregnancy. She hadn't known the law had changed and had assumed she would be able to get an abortion. Instead she was told she'd have to make a trip to Alabama. A single mother, she would have had to arrange for childcare to go out of state, and she was struggling to raise the money for travel, according to Cheryl McGee, a staff member at Jackson Women's Health Organization. "She had just started her job and she couldn't get no time off and she couldn't get nobody to take her," explains McGee. "She doesn't have a car to get there and she didn't have the money to get a bus."

It's hard to imagine someone who can't afford a bus trip taking responsibility for a new life -- especially when she doesn't want to. Yet Tammy, who reportedly had her baby a few weeks ago, will no doubt find a way. Anti-choice activists can now chalk one more victory up to the passage and enforcement of Mississippi's latest abortion restriction -- even if, for Tammy, it means defeat.

By Sharon Lerner

Sharon Lerner is a journalist and a senior fellow at the Center for New York City Affairs at Milano Graduate School, New School University.

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