The Last Clinic An Emmy-nominated portrait of the last abortion clinic in Mississippi. By Maisie Crow and Alissa Quart The Atavist Magazine, No. 21 Maisie Crow is a photographer and multimedia producer based in Brooklyn. She has done work for The Boston Globe, Bread for the World, MediaStorm, The New York Times, the Robin Hood Foundation, Save the Children, and the Virginia Quarterly Review, among others. Maisie has taught as an adjunct professor at the Columbia University Graduate School of Journalism and as a multimedia instructor at the Salt Institute for Documentary Studies. Alissa Quart is the author of two nonfiction books, Branded and Hothouse Kids. Her next book is forthcoming in 2013. She has written longform pieces for Mother Jones, The New York Times Magazine, and many other publications. She was a 2010 Nieman Fellow at Harvard, is a contributing editor and author of the Reality Check column for the Columbia Journalism Review, and teaches in the Columbia University Graduate School of Journalism.Editor: Evan RatliffProducers: Olivia Koski, Gray BeltranCopy Editor: Sean CooperFact Checker: Thomas StackpoleResearch and Production: Nadia WilsonPublished in January 2013. Design updated in February 2021. Under Construction!If you’re here to watch the full documentary, we’re in the process of making it available. Stay tuned! It was the week before Thanksgiving, 2012, and Dr. Willie Parker was making small talk with a group of patients in one of the back rooms of an abortion clinic in Jackson, Mississippi. What are your plans for the holidays? What’s your mother cooking? They laughed as they discussed turkey and dressing. After a bit more chatter, Parker got serious. “I hope this will get done what you want to get done,” he said as an assistant went around the room, dispensing a single pill per person, along with a small plastic cup of water. Some of the half-dozen young women in the room were awkward, others assured. They were skinny, overweight; some were still in braces. Some were in high school and had mothers waiting for them in the next room. Some had children at home. They laughed, in some combination of nervousness and, perhaps, surprise at their own ease with the situation. “If you feel nauseated, eat some Jolly Ranchers,” Parker continued. “Which flavor do you like?” Parker was usually learned in his speech, but he was going “colloquial” today, as he put it. Like most of his patients, he is black and from the South. In his fifties, he reminded some of them of their fathers and uncles—or of how they wished their fathers and uncles were in their moment of crisis. All the girls were receiving mifepristone, the so-called abortion pill. Within the next few hours, they would start to cramp, and their pregnancies would terminate. The girls had all had one-on-one counseling. The group setting was for general information, required by the state. Parker is an abortion provider. But he is also the plaintiff in a case that has become a highly theatrical political maelstrom, one with potentially extreme consequences for the clinic where he works, and perhaps for abortion clinics around the nation. This clinic, Jackson Women’s Health Organization, is a bleak white concrete building surrounded by fencing. A security guard stands watch outside. Inside, it’s a warm place painted pink, yellow, and red, and alive with the volubility and vivaciousness of its workers. From within its walls, you can be lulled into forgetting that you are inside Mississippi’s Alamo of reproductive rights. This is the last abortion clinic in the state. In April 2012, the Mississippi legislature passed House Bill 1390, requiring that abortion providers obtain “admitting privileges,” an official status that grants providers the ability to admit patients at one or more local hospitals. Any clinic without admitting privileges would be shut down. It’s a maneuver intended to eliminate abortion here—Republican governor Phil Bryant has called the law “the first step in a movement, I believe, to do what we campaigned on: to say that we’re going to try to end abortion in Mississippi.” The clinic and its advocates challenged the law, and in July 2012, a federal court offered a reprieve, blocking its implementation and giving the facility until January to comply. The next, and potentially decisive, hearing arrives at the end of January. If the state wins, young women like the ones sitting in the clinic’s red leatherette chairs will be forced to travel across Mississippi state lines to terminate their pregnancies. Most of them had already traveled to get to Jackson, from places like Hattiesburg and Yazoo City and smaller towns scattered across the state, and they had been required by law to wait 24 hours for the procedure once they got there. But the effort to close down the clinic would also represent an “enormous victory” for the pro-life movement overall, said Carole Joffe, a longtime scholar of abortion rights at the University of California at Davis. “There’s a competition within the red states to see if they can be the first to close all the clinics.” As Joffe put it, channeling Tolstoy, “Each red-state attack on each abortion clinic is unhappy in its own way.” What she means is that state legislatures have many different approaches to trying to close clinics, from insisting that providers have admitting privileges to creating new rules for clinics’ medical supplies, the amount of staff required, the length of patients’ waiting periods, and even a clinic’s architecture. In Virginia, for instance, the state legislature recently adopted regulations stipulating the location of bathrooms and the size of the hallways within clinics. Roe v. Wade became the law of the land 40 years ago, making abortion a constitutional right in all 50 states. Thus, the end of Mississippi’s clinics would also be historic: a single state successfully flouting the Constitution, hoping by its action to force America back in time. The bill’s supporters have argued that requiring hospital admitting privileges are an attempt to protect women from incompetent or even exploitative abortions. And outside the clinic, protesters were eager to talk about the procedure’s medical risks. I passed them as they sat on foldable lawn chairs, handing out leaflets and little squishy models of fetuses. Ester Mann, 64, was one of those protesters. She had been picketing the Jackson clinic for many years and had been arrested twice. As the choice war flares up again in Mississippi, but also in Michigan, Kansas, and Tennessee, the battle lines remain the same, but the strategies and positions of both sides, legal and otherwise, have evolved. Mann, who offered a tearful tirade against the doctors at the clinic, didn’t use the same old pro-life rhetoric. In fact, she eagerly called herself a “Jesus feminist.” What did she mean by this? Mann, a large woman dressed in a royal blue outfit, smiled at me. “Jesus loved women,” she said. “And I believe in equal pay for equal work.” Mann spoke of the women who came to the clinic as “disdaining God” and the “precious gift” of pregnancy. Mann herself was only able to have a single child. “Here I was, unable to have babies,” she recalled of her early years protesting. She was eager for January and the judge’s decision, praying for the clinic’s closure. Beyond the rhetoric outside, however, the real threat to the clinic was contained in Bill 1390. As of January, Dr. Parker and the other physicians at the clinic have been rejected by all seven of the area’s local hospitals, making compliance with the law impossible. Ironically, the chaos of the protesters is one reason the hospitals have denied those privileges. One hospital replied to the clinic’s request that granting admitting privileges to abortion doctors “would lead to both an internal and external disruption of the Hospital’s function and business within this community.” Five rejected the clinic outright because they were opposed to being associated with an abortion provider, according to the Center for Reproductive Rights. Twenty-five years ago, the factor limiting abortion care was a shortage of doctors capable of performing the procedure. But now, after the development of training programs like the one at University of Michigan, where Parker attended, the limitation on abortion care is geographical accessibility. There are plenty of providers in Seattle and New York City but not many working in rural areas. As a result, doctors like Parker—who typically flies down from his home in Washington, D.C., once a month and stays in Mississippi for a few days—may travel hundreds of miles to provide abortions. The expense of those trips multiplies the substantial cost of abortion services. Already, clinics are forced to fund mandatory security guards, legal expenses, and 24-hour video surveillance. For the patients in Mississippi, abortion could become more expensive still. If the clinic is closed, reaching an out-of-state facility will require at least a three-day trip. Beyond the travel time, there are mandatory 24-hour waiting periods in several nearby states, including Louisiana, Arkansas, Texas, and Georgia. Many of these women are among the poorest in the country, and the end of an in-state clinic could well mean the end of choice for some of them. First there are the hundreds of dollars for bus fare or gas and a hotel room. Then there are the lost wages and, perhaps, childcare for their other children. The procedure itself typically runs $450, although the cost can be higher for pregnancies that are further along. (Several of the women I spoke to said they had requested and received money from an organization called the National Abortion Federation.) Mississippi isn’t the only state which risks losing abortion care entirely. It’s one of five states with only one clinic remaining, along with Arkansas and the sparsely-populated North Dakota, South Dakota, and Wyoming. The spokesperson of the pro-life group 40 Days for Life has said that likeminded activists have targeted these states, too, hoping to bring about the “the first abortion-free state where abortion is legal but it’s simply not available.” The organization Missionaries for the Preborn has also announced that they have focused on states with one clinic, calling them “states of refuge.” According to a statement from the group, “Pro-lifers will wage an ongoing campaign in these five states” until January 22, 2013, the anniversary of Roe. Closing the Jackson clinic is a key part of the pro-life movement’s pursuit to outlaw abortion for good. It was business as usual as the January decision settling the clinic’s fate approached. In late November, the clinic’s waiting room was full, an old Jamie Foxx show filling it with canned laughter. A depressed-looking girl in Ugg-style boots sat staring at her phone, next to someone else’s boyfriend, young and plump, with a beard, who stared at his. A sign on the door read “No Purses, No Bags, No Children.” The clinic’s director, 40-year-old Shannon Brewer-Anderson, mother of six, walked around the facility, making sure that what she referred to as the state’s “severe regulations” were being followed. “If we have a lightbulb busted or a stain in the carpet, we get written up,” she said. The Department of Health would visit often, sometimes as much as eight times a year, spurred by “complaints from people outside,” said Brewer. “Everything having to do with an abortion,” she says, “is political.” On each day I observed him in Mississippi, Parker—one of two doctors who alternate at the clinic—shifted between counseling future patients and performing abortion procedures. In counseling, patients receive general information about both medical and surgical abortion, including certain statements required by law. Counselors must underline the dangers of the procedures, although in truth abortions are less dangerous than giving birth—something Parker pointed out after running through the state-mandated boilerplate. They must inform patients that having an abortion raises a woman’s chance of breast cancer, although there is “not a shred of scientific evidence to support that,” as Parker told his patients. As I roamed through the rooms, the contrast was stark with the quieter, more anonymous clinics I had visited in New York City. There, staffers were unlikely to know any of the patients personally, let alone assure them that their secret was safe, as Mississippi staffers told me they had done. There were many clinics where patients might never learn their doctors’ names. But not here. I spoke to some of the patients as they waited for counseling or abortions. I met Hillary from Yazoo City, who worked in an auto shop. She was 22 and had two children: One had been born at two pounds and the other at four pounds. Why had both her babies been born so small? “Bad prenatal care,” she said. “I was wishing it away.” Hillary was tall and thin, with a cloth flower in her hair. “I want to provide. I don’t have enough money to provide for my kids now,” she said. She was unmarried and barely earned minimum wage. She said she hoped to get her “tubes tied,” permanently preventing her from having children, even though she was young. I sat with her and other young women as they were instructed in where a woman’s vagina is, where the cervix is, and breathing techniques for the procedure—breathe in through the nose, out through the mouth. When a clinic counselor explained to Hillary that she would have to stay off her feet for several days following her abortion, she shook her head. “I lift in my job,” she said. “Well, try and stay off your feet, hide in the closet, take a long lunch,” the counselor said. Hillary was afraid to lose her job, she said. So was 21-year-old police trainee Sara, who said she’d have to leave the police academy if she remained pregnant. “It’s against the law to be out on the road pregnant as a police officer,” she explained. She wasn’t telling her “very religious Baptist family” about it and had to come up with excuses for the two and a half hours she drove each way to get here. “I had to cover it up, as I live with my family,” Sara said. “I had the pill because I want to be on my own, in a room with the door closed, and able to hide it from my family.” I spoke to Aarimis, who worked at the clinic as an assistant but had first visited as a patient. She had had a total of four pregnancies and terminations, starting when she was 14. One pregnancy had come along when she was with a boyfriend who physically abused her. She said she still struggled to afford the monthly $80 out of pocket for birth control. There was also a teenager, sitting next to her mom, who everyone in the waiting room thought was a basketball player because of her height and athletic clothes. That a teen was there to terminate her pregnancy wasn’t surprising: Mississippi has the highest birthrate among teens in the nation, according to the Centers for Disease Control and Prevention. In 2010, there were 55 births per 1,000 teens aged 15 to 19 in the state, compared with a national average of 34.2. Even more troubling is the data showing the likelihood that the infants born to teenagers may not survive. In Mississippi, babies are at far greater risk of dying before their first birthday than in any other state in the nation. In 2011, 9.4 babies out of every 1,000 died. That’s similar to infant mortality in Botswana last year—10 out of 1,000. Mississippi is also one of only two states to demand that a minor receive consent from both parents to have an abortion. In addition to poverty, religion was a powerful presence in the clinic’s bright back rooms, where batches of young women sat clad in their day clothes or pale hospital gowns. A few girls who were about to get the procedure told me that they thought it was wrong, that they worried about standing before God. One white woman told me she was having an abortion because the father was black (“a football player”) and her parents wouldn’t accept the child were she to carry it to term. “There’s no way I can go through this pregnancy, my family being as racist as they are,” she said. Of the young women I encountered, the most charismatic was Adriana (her middle name), from Hattiesburg. “This is my second time,” she told me. She was 23 and worked at a bingo hall, and her boyfriend wanted her to have the baby, “but I’m the only one working: He doesn’t work.” “I’ve been love-drunk all my life, you know,” she said. “I want to join the Air Force. That would help me get myself together.” Adriana’s belief that terminating her pregnancy might help her gain greater solvency and ultimately achieve more professionally is supported by some compelling new data. A research study called the Turnaway Project, begun in 2008 at the University of California at San Francisco, examined three sample groups of poor women, recruited at abortion clinics around the country. One group had been turned away from a clinic, another group had carried their pregnancies to term, and a third had had abortions. One year later, 76 percent of the women in the study who were denied abortions were on welfare, compared with 44 percent overall. The women who had sought abortions but hadn’t received them were also less likely to be working and far more likely to be living below the poverty line. With its inaccessibility looming, abortion in Mississippi could become something of a new social-class marker if opponents have their way. A middle-class woman with an unintended pregnancy will be able to drive to Texas; many others won’t be able to leave work long enough to make the trip. And the women I met at the clinic were among the poorest in the country—according to the census bureau. In 2011, Mississippi had a poverty rate of 22.6 percent—nearly one in four. Its median household income was $36,919. Given the financial straits of these women, no one is quite sure what will happen to those who rely on the place if Jackson’s clinic closes. As a woman in the waiting room put it, “Thank God this is still an option for my daughter. She is only 17.” Dr. Parker riffed with his patients about their eating habits, dating, even their constipation. To one of the counselors at the clinic, “Miss Betty,” he offered an adage about dating in middle age: “Old enough to know what to do but young enough to still want to.” His jabs at earthy humor were meant to put both his colleagues and his daily allotment of patients—around a dozen or two—at greater ease. He called this palaver “verbocaine.” He used it all day long, especially as he could offer only a local anesthetic before surgeries. General anesthesia was not available; administering it would require hiring a nurse anesthetist, and the clinic already struggled to find nursing support. Nor does the clinic provide prescription painkillers, as tracking them on-site would be too labor intensive. When Parker was not talking or performing procedures, he sat serenely in his office. On one break, he ate what he called a “cardiac” breakfast of bacon and eggs, loading up for the dozens of operations in front of him. He spoke of Martin Luther King, and likened the battle for reproductive rights to King’s civil rights campaign. He spoke about Dr. King’s understanding of the Good Samaritan and explained how his notion of medical care was more about the person needing help than the person giving it. He had been forced to stop worrying about his own safety, he said, and the Christian component of Parker’s drive was underlined by the “Pro-faith, Pro-family, Pro-Christian” sign affixed to a clinic wall. Parker, who is unmarried and has no children, grew up poor in Birmingham. He never knew his father and was “raised by committee,” as he put it. He had a “fundamentalist” upbringing, he said, and even proselytized to others. He was educated at a small Southern Christian school, Berea College in Kentucky, and then attended the University of Iowa Medical School. He came to abortion care in midlife, after many years as a gynecologist. Making the shift went against the values of his upbringing. “I grew up in the black church, and I was conflicted about what it would mean to help women with their unplanned pregnancies,” he said. But then he had an epiphany. He realized that “a safe and early abortion was the Christian thing. After that, I became less worried about myself.” His revelation came, he explained, when he re-envisioned Christianity as “a love ethic, especially around the doctrine of compassion.” Part of that compassion, he concluded, involved helping these young women with nowhere else to turn. His own grandmother, he told me, had died in childbirth. Parker began performing abortions about 10 years ago, after he graduated from the University of Michigan program, working at clinics in Philadelphia and D.C. It was a struggle even up north, due to what Parker described as “the stigma” around having and providing abortions. This ostensible disgrace prompted many providers to be less candid about what they did, to couch their work in euphemism and hide their identities for their own safety. The stigma manifested itself in small ways for Dr. Parker, as well—few patients came back and thanked him, for instance. An abortion is usually something women would rather forget, and the poorer patients at the clinics Parker worked at were usually “putting out lots of other fires” in their lives, as he put it. The one patient who had kept up a friendship with him was a woman who learned of rare genetic abnormalities late in her first and second pregnancies. Parker did the procedures after she and her husband chose to abort. Just this summer, the woman had a healthy baby and invited him to the newborn’s bris. It was the taint of the procedure, he thought, that led his patients to ask him, as they sat on the examining table, whether they would be punished. “They fear divine will and divine intervention. They’ll ask, ‘Do you think God will kill me for killing my baby?’” Stigma or no, abortion was Parker’s avocation as well as his vocation—that was why he started working in Jackson in May. He was contacted about the job half a year before he began traveling down, and he felt an immediate pull. He had read about the impending law and had a strong sense that he was needed. Nevertheless, the decision to go down a few days each month was not an easy one. He recalled the film Mississippi Burning when he thought of Jackson and initially told himself, “I am not going there, where men say ‘Hey, boy!’ White guys with skinny ties, glasses, and shotguns.” When he arrived, he found Jackson both better and worse than he imagined. The area around the clinic was “avant-garde,” he told me, replete with vintage stores and a coffee house. But Jackson as represented by the protesters was also more challenging than Parker had anticipated. A small group of anti-abortion activists were camped out around the clinic at all times during the day. One of them took a picture of him at Lenny’s, a local sub shop, and a passer-by had recently shouted out his full name, including his middle name—an unsubtle reminder that Parker was being watched. Parker said that his girlfriend, while she supports his work, also “fears harm will befall me” from “the threats,” which he refers to only obliquely, as if discussing them more fully would make them more real. “I don’t want to falsely reassure myself,” Parker said. “Slepian died in the kitchen, Tiller at church,” he continued, referring to two abortion providers, Bernard Slepian and George Tiller, who had been killed by pro-life extremists. Yet Parker remained more fixated on the future of the clinic’s patients than on his own. “Which women deserve or don’t deserve care?” Parker asked. “I want for other people what I want for myself. These women should have what I have. And that’s dignity and making peace with an uncertain God.” A woman waits for a procedure at Jackson Women’s Health Organization, the last abortion-services clinic in Mississippi, in November 2012. Ron Nederhoed, a Pro-Life Mississippi board member, and Ester Mann, the organization’s secretary, outside the clinic’s parking lot in November 2012. Angela Orey, an administrative assistant, behind the clinic’s front desk in January. Orey has been on staff there for 12 years.Security cameras monitor the parking lot. According to Shannon Brewer-Anderson, the clinic’s director, “We have eight cameras to cover the entire perimeter against the ‘antis,’ because you never know what they are going to do when [the staff] are there and when they are not there.”Miriam, 21, at a pre-operation appointment in November 2012. Patients are required to wait 24 hours before having an abortion. Prior to that, they must fill out paperwork, receive an ultrasound, undergo counseling, and speak with a doctor about the procedure.In January, Nikki Gooch-Jordan (far left) and Stephanie Battle (far right), both operating-room technicians, wait for surgery to begin while Brewer-Anderson schedules an appointment and the clinic’s security guard monitors the cameras.Matt Friedeman, a professor at Wesley Biblical Seminary, sings outside the clinic gates as women arrive for a counseling session in November 2012.Dr. Willie Parker performs an abortion in November 2012 while Battle assists. Parker is one of two physicians who fly in to Mississippi to work at the clinic. It has had difficulty finding local providers.Aarimis Armstrong, 21, a scrub technician, prepares to weigh a specimen after a procedure in November 2012. Armstrong began working at the clinic a week after she had her own abortion there. She said she wanted to use her experience of what it felt like to make the decision. Having an abortion, she said, had been the only option for her.Pro-Life Mississippi president Dana Chisholm (center) and other protesters seen from the window of the security guard’s car as he drives one of the clinic’s doctors to the airport in November 2012.Ron Benjamin IV, the clinic’s security guard, is in charge of ensuring the safety of its staff and patients.A billboard on Interstate 55, just outside Jackson, advertises a website aimed at ending abortion. “We are not asking for donations,” the site maintains. “We just ask that you stop paying taxes and tell your friends to do the same.”The surgery room sits empty on a day when surgeries are not performed. Because doctors must travel to the clinic from out of state, the facility provides abortions only three days a week. The staff spends the rest of the week answering phones and preparing for surgery days.