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Abortion rights protesters gather at the White House to denounce the U.S. Supreme Court decision to end federal abortion rights protections on June 26.Tasos Katopodis/Getty Images

Rosemary Westwood is a journalist covering abortion and the host of the podcast Banned, about the Mississippi case to overturn Roe v. Wade.

On June 24, Diane Derzis stood outside Jackson Women’s Health Organization, the last abortion clinic in Mississippi. Behind her loomed the building’s large, bubblegum-hued façade that has earned it the nickname “The Pink House.”

Her clinic has been an icon of abortion rights in Mississippi. And it is at the centre of the U.S. Supreme Court’s decision overturning Roe v. Wade, in the most cataclysmic case for the cause in generations: Dobbs v. Jackson Women’s Health Organization. With that case’s reversal of the landmark 1973 ruling, American women no longer have a federally protected right to seek and obtain an abortion.

In an emerald-green kaftan and oversized white sunglasses, her blond curls cut short, Ms. Derzis faced the swarm of TV cameras and journalists who were wilting in the dense summer heat. She leaned into the microphone.

“It has begun,” she said.

By that evening, 12 states had banned nearly all abortions. In recent days, legal battles have erupted in some states to delay those bans from taking effect, but those are short-term reprieves. In the coming months, an estimated total of 26 states – covering more than half of the country, extending from the Canadian to the Mexican borders, from the Gulf of Mexico through the Midwest – are expected to ban nearly all abortions.

In many states, these bans will not include exceptions for rape or incest, not even for children. In a decision compared to a “nuclear bomb” – one that felt both incredibly swift and 50 years in the making – the highest court in the land eviscerated the constitutional right to an abortion. Women now have no right to control their bodies in America.

As this article goes to press, the last women to legally get an abortion at Mississippi’s last clinic will likely be undergoing their procedures. Within days of this article’s publication, Mississippi’s trigger law banning nearly all abortions is expected to take effect. And then the Pink House, since 2006 the only abortion clinic in the state, will close.

I asked Ms. Derzis if she thinks abortions will ever be legal again in Mississippi. “I don’t think we’re going to see that in our lifetime, or maybe your children’s lifetime,” she said.

How we got here is a story of one part luck, one part single-minded persistence by anti-abortion activists in Mississippi who’ve dedicated their lives to this moment. They are the reason that Mississippi’s state government passed a longshot abortion ban that defied the odds, and accomplished what more than 1,300 anti-abortion laws passed since 1973 failed to do: end Roe. And it raises a central question: Just how far are those who support abortion rights willing to go to get them back?

Clinic escorts, anti-abortion sidewalk counsellors and others stand outside the Jackson Women's Health Organization's clinic in Jackson, Miss., on March 20, 2018.Rogelio V. Solis/The Associated Press

The shift came during the 2016 presidential campaign. Donald Trump began wooing white evangelical Christians by promising to appoint conservative justices to the U.S. Supreme Court, which could give them their long-sought holy-grail victory over Roe v. Wade.

At the time, much of the national press treated Mr. Trump’s claims as gimmicky. Those who did warn that the Republican nominee’s promise was possible, even likely – especially Black abortion-rights activists in the South, where I live – were often deemed hysterical.

But anti-abortion activists and politicians believed Mr. Trump, perhaps nowhere more so than in Mississippi, one of the most anti-abortion states in the country. When Mr. Trump was elected, Mississippi already had dozens of anti-abortion laws on the books that made it harder to obtain one than in almost any other state. Those laws shuttered all of the state’s abortion clinics except one: the Pink House. If it weren’t for Ms. Derzis and her staff, legal abortions would have disappeared there years ago.

By early 2018, Mr. Trump had appointed one conservative justice to the Supreme Court, Neil Gorsuch. Some began to muse that he might get other chances, and maybe even create a conservative super-majority on the highest court.

And so the Alliance Defending Freedom, a national anti-abortion group, designed a bill aimed directly at Roe v. Wade. The landmark 1973 decision established that abortions couldn’t be banned before a fetus can survive outside the womb, which happens well into the second trimester; the organization’s proposal sought to ban abortions months earlier, at just 15 weeks of pregnancy.

Mississippi’s anti-abortion activists then lobbied state politicians at the legislature to take up the proposal and make it law, and they were met with minimal resistance. When Mississippi’s governor enacted the 15-week ban into law in March, 2018, it was the most extreme abortion ban in the country.

Terri Herring, a leading anti-abortion activist in the state for decades, said the feeling was, “Let’s try this bill, let’s see what happens, because we’re clearly looking at a new court.”

Within an hour of the governor, Phil Bryant, signing the 15-week ban into law, Ms. Derzis and the Pink House sued, and, at first, it didn’t seem like the law stood a chance. Within a day, a judge had blocked it from taking effect. Over the next two years, a total of four judges in the lower federal courts – including one stridently anti-abortion Trump appointee, Judge James Ho – sided with the Pink House. The judges agreed that Mississippi’s ban was unconstitutional under existing Supreme Court precedents, and struck down the state’s law.

As Mississippi persisted – pushing its 15-week ban through the courts – it got lucky, and not just once. As the case was moving through these courts, the Supreme Court was becoming more conservative. With the July, 2018, retirement of Anthony Kennedy, a crucial swing vote on the Supreme Court and a conservative who had upheld abortion rights, Mr. Trump appointed Brett Kavanaugh, giving the court a solid 5-to-4 conservative majority.

Mississippi saw an opening. It asked the Supreme Court to take its case in the spring of 2020. But the state’s attorney-general, Lynn Fitch, argued that the court didn’t even have to overturn Roe v. Wade: All it had to do was allow abortion bans earlier in pregnancy. It was only in one footnote that Ms. Fitch said that if the justices felt they had to overturn Roe, she wouldn’t object.

Then, just a few months later, Ruth Bader Ginsburg – a feminist icon and the court’s most famous defender of abortion rights – died. Mr. Trump got a third appointment, creating a 6-to-3 conservative supermajority with the selection of Amy Coney Barrett.

Laurie Bertram Roberts, a Mississippi abortion-rights activist, told me that that could have been avoided. “RBG should have resigned or left when the left had all of the stuff locked up,” she said, referring to the Democrats’ hold on the Senate and White House between 2009 and 2015. “And she could have been replaced.”

After Ms. Barrett joined the bench, the Supreme Court took Mississippi’s case. And then Ms. Fitch pivoted: Instead of asking the court to simply uphold its 15-week ban, she argued that this was the case, after nearly 50 years, that the court should use to overturn Roe v. Wade.

“They turned what was a footnote into an entire argument … in the Supreme Court,” said Rob McDuff, a lawyer for Jackson Women’s Health.

Mississippi’s last clinic became the last line of defense for the constitutional right to an abortion – a right that fell on June 24, when the Supreme Court majority explicitly overturned Roe v. Wade and Planned Parenthood v. Casey. Decades of work by a generation of women’s-rights activists collapsed in just a day.

Jackson Women's Health Organization is the last abortion clinic in Mississippi.KATHLEEN FLYNN/Reuters

There is no simple way to summarize the overwhelming consequences of the court’s decision. Based on the concurring opinion of Justice Clarence Thomas, other rights that have not been written into the Constitution – from birth control to gay marriage – could be next.

And during arguments in December, liberal Justice Sonya Sotomayor warned that overturning Roe based on political appointments could decimate respect for the court. “Will this institution survive the stench that this creates in the public perception, that the Constitution and its reading are just political acts?” she asked. Now, in the wake of the court’s overturning of Roe, polling shows confidence in the court has dipped to its lowest on record. A significant majority of Americans – 58 per cent – oppose the decision, compared to 40 per cent who support it.

But what is clear is that each year, potentially hundreds of thousands of women and pregnant people who want abortions will be living in states where they are banned.

Those women will have three options.

They could travel out of state. But many will need to go far to find a legal abortion. They will need to find the money, child care and time off work. And that’s going to be much harder for minors, people with fewer resources, and undocumented immigrants.

They could use the abortion pill. That pill is available online, including from one international site that mails the pills to states regardless of local laws. But ordering pills online and taking them yourself is already illegal in 32 states. Still, women are doing it; I met one, in Louisiana, who found out through TikTok about getting her pills online. Demand for these pills is rising, and expected to surge.

The final option, of course, is to stay pregnant. This will be the fate of many women. In Mississippi, Jackson Women’s Health performed between 2,000 and 3,000 abortions a year, with Black women making up about three-quarters of its patients. They often already have kids. Many had a hard time paying for their abortion – an unsurprising fact, given that Mississippi is among the poorest states in the United States. When I visited Jackson Women’s Health, I heard a story about a woman who’d driven hours to get to the clinic, part of the way on a doughnut tire after she caught a flat, with two car seats for kids strapped in the back. She’d had to search for spare change in her glove box to cover the abortion fee; she was one dollar short.

Staying pregnant could have serious health risks. Nationally, abortions are 14 times safer than giving birth. Mississippi has among the highest maternal mortality and infant mortality rates in the country – rates that are higher if you’re Black, as the majority of the Pink House’s abortion patients are.

With Roe gone, the anti-abortion movement is already shifting its focus to the national stage.

On the day the decision came down, former vice-president Mike Pence – the man whose evangelical bona fides helped affirm the religious right’s support of Mr. Trump – tweeted that Republicans “must not rest and must not relent until the sanctity of life is restored to the center of American law in every state in the land.”

It took half a century for the anti-abortion movement to take down Roe, and its work may not be finished. The question now is whether the abortion-rights movement can mount an expansive, well-funded, enduring movement of even greater force to restore women’s rights – and how fast.

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