Mississippi’s Last Abortion Clinic Faces the Supreme Court

Shannon Brewer’s eyes dart to a grid of grainy images on a wide, black screen above her desk at the Jackson Women’s Health Organization (JWHO). Live footage shows a large truck creeping into the clinic’s parking lot, its side emblazoned with a pair of blue, ghostly baby feet and the words Where are our children? Brewer doesn’t recognize the driver. Her spine gets stiffer.

Brewer, who is the de facto director of security for the Mississippi’s last abortion clinic, has never been scared. She has witnessed bomb threats and stalking, as well as protesters fighting with her staff over her 20-year tenure. In a seaof sticky notes, she keeps the contact number for an FBI agent. She says that this year everything is more intense. More dangerous. More serious.

This clinic is known by the nickname “The Pink House” for its brightly colored exterior walls. It’s at the heart of the battle over abortion access throughout Mississippi and across the nation. The U.S. Supreme Court is scheduled to hear arguments on a case Dec. 1. Dobbs v. Jackson Women’s Health Organization,Concerning a Mississippi law that prohibits almost all abortions within 15 weeks of pregnancy. This law is effectively null and void if it is allowed to stand. Roe v. WadeThis 1973 landmark case established a Constitutional right to have an abortion before the fetal life is reached. “This is not gonna just affect Mississippi,” Brewer says. “It’s gonna affect women everywhere.”

This moment five years ago was impossible to imagine. Even the Supreme Court’s decision to take up a case that directly challenges RoeAccording to legal experts, this might have been considered outrageous. The landscape has changed rapidly. In the last 12 months, GOP-controlled state legislatures passed an unprecedented 106 restrictions on abortion, which included a Texas statute banning abortions within six weeks. Conservative state and federal judges have allowed some of those laws to stand, while President Trump’s appointment of three Justices—Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett—has put RoeAt risk Dobbs v. Jackson Women’s Health OrganizationYou will face the most conservative bench since decades.

The anti-abortion movement is energized. In a normal year, the Pink House has its share of regular protesters, but ahead of the December hearing, “abortion tourists,” as the clinic volunteers call them, have begun showing up on the sidewalk every day. Melissa Fowler, chief program officer at the National Abortion Federation, which tracks threats to abortion clinics, says she’s heard from members “who report an escalation in anti-abortion rhetoric, criminal activities and the intensity of activities” since last year.

Brewer is a hot rod. “She thinks she’s doing a good thing,” says Barbara Beavers, who was trying to discourage patients from entering the Pink House in October. “But she’s killing babies.” Coleman Boyd, a local physician who regularly protests outside the clinic with his wife and children, also calls out Brewer by name. She and her staff, he says, “have a heart to kill.”

It’s in this context that Brewer, one eye still trained on the security footage, walks out the clinic’s front door and strides over to the unfamiliar truck, idling a few yards from the building. The driver and Brewer exchange words, but she then turns her face to give assurance to her staff. The truck is part of a national anti-abortion group’s protest that evening. There is nothing to be concerned about.

Back at her desk, in front of a sign reading Queen Warrior, Brewer considers the enormity of her role in the moment—the last director of her state’s last abortion clinic, just weeks before the most momentous high-court hearing on abortion in a generation. “I’m going to appreciate the time that we have,” she says. “Once we go to court, every day that we are open and see patients and get to talk to them—it’s like we don’t know if this is the last time.”

Abortion wasn’t alwaysThis is a highly partisan topic in America. It was almost a century ago that the Supreme Court ruled. Roe, the ruling wasn’t as polarizing as it is now, says Mary Ziegler, a law professor at Florida State University and an expert on the legal history of abortion. Republicans kept the issue at arm’s length, wary of anti-abortion activists who they saw as “wild children,” she says; Democrats rarely discussed it at all.

Ziegler explained that things began to change during the 1980s. Ziegler said that a group of GOP strategists took advantage abortion to incite the religious right and gain support from voters who may otherwise favor the Left. They began testing the limits of Roe working closely with state lawmakers to pass new abortion restrictions, such as mandated waiting periods or minimum measurements for clinics’ rooms and corridors.

This legal strategy was reaffirmed by the 1992 Supreme Court Decision. Casey v. Planned Parenthood in which the Justices ruled that states could restrict abortion so long as they did not impose an “undue burden” on patients. Over the past three decades, there have been many laws restricting abortion. Abortion opponents framed many of these new rules as protections for women’s health, but doctors often -described them as medically unnecessary.

“It’s simply that the enforcement of these regulations would make it hard to keep clinics open,” says Elizabeth Nash of the Guttmacher Institute, a research center that supports abortion rights. It worked. Guttmacher estimates that in 1992 there were 2380 US abortion providers. According to Guttmacher, 2017, there were 1,587 abortion providers in the United States.

Mississippi was the tip-of-the spear for this strategy. In the ’90s and 2000s, state lawmakers passed more than two dozen restrictions on abortion, each of which came with new costs, paperwork, or staffing rules that pushed abortion clinics out of business. JWHO, the sole remaining state clinic, was closed in 2004. Brewer says it’s still struggling to stay afloat. “There are so many hurdles,” she says.

The Jackson clinic patients find it increasingly hard to overcome all the obstacles. The patients must work extra hours, save money, and travel far to get the treatment. One 21-year old girl arrived at the clinic in October after driving six hours from Louisiana to get the best appointment. She already has two kids—a one-year-old and a three-month-old—and knew she needed to get an abortion as soon as possible because she couldn’t handle a third on her own.

Brewer is familiar with this struggle. In 2001, she was hired by the Pink House as a sterilization technician. According to her, back then she was not aware of national abortion politics. Growing up in Jackson and not receiving sex education, her outlook was informed by her personal experience. No one in Jackson ever discussed the topic of abortion. In her mid-20s, she tried to get an abortion, but was too far along, and had a baby when she didn’t feel prepared to do so. Brewer is now a mother to six children she loves. When she talks about “reproductive justice,” she describes it as letting people decide if, when and how they choose to have a family.

Brewer became the clinic director in 2010. In 2010, national politics was born. Brewer gives Diane Derzis credit for her success. “She taught me how to speak up and how to fight,” Brewer says. “In the South, we’re limited on who’s speaking out. This is not the time to be quiet.”

After getting an abortion in 1975 in which she was a vocal advocate, Derzis bought four clinics across the South. She also owns two other clinics in Virginia and Georgia. For decades, she has been at the forefront of this battle. A Florida anti-abortion activist killed Derzis, a Derzis friend for many years. In Birmingham, Alabama, five years later, a bombing destroyed her Birmingham clinic, killing one guard and inflicting permanent injuries on a nurse. The Pink House almost closed in 2012 when a Mississippi law was passed. However, a federal court blocked the new Mississippi law from taking effect on its first day. It set off a legal dispute that would last until 2017.

So for Derzis, this strange moment—in which her clinic is the plaintiff in a Supreme Court case that could result in overturning Roe—doesn’t feel strange at all. It’s almost inevitable. From her vantage, the anti-abortion movement’s long-term objective was always to capture politics at every level, from local city councils to state legislatures to Congress and the presidency, in order to reshape the court and relitigate Roe. Trump campaigned with the promise of appointing judges to overturn Trump’s presidency RoeRepublican legislators in the state of Mississippi turned their attention to the passage of a series laws that would allow the justices the opportunity to complete the task. Marjorie Dannenfelser of Susan B. Anthony List recognized the efforts made by state legislators to pass anti-abortion legislation in Mississippi. This was done in order for the case to be heard before the Supreme Court. “This is a landmark opportunity” for the anti-abortion movement, she said last spring.

“This has been a campaign they have waged over 45 years,” Derzis says. With Trump, “they got their Supreme Court Justices.” It was game time.

More than 50Over the past two decades, more than twenty cases have been heard by the Supreme Court pertaining to abortion. It also considered an enforcement mechanism that was embedded in Texas’ abortion law earlier this month. The Mississippi case, however, that will be brought before the court Dec. 1, is a different story by an order. This one is not “biting around the edges” of abortion access, says Ziegler It’s “going for the jugular.” Mississippi has explicitly asked the court to overturn Roe.

Unfortunately, it is impossible to know how the court will rule. Six conservatives are on the court, so a majority might choose to change the precedent that has been in place for nearly 50 years. Although it would seem bold, such a decision is not uncommon. The court has reversed precedent dozens of times in the nation’s history. It could happen again. The consequences for those seeking abortions will be severe. Twelve states, including Mississippi, have what are known as “trigger laws” that ban nearly all abortions immediately or shortly following such a court decision. A further nine states already have specific restrictions they are able to quickly put into effect.

But legal scholars say it’s much more likely that the court would rule in a way that stops short of technically overturning Roe—while weakening the constitutional right to abortion so substantially that it’s largely hollow. For example, the Justices could hold that the “viability standard”—the idea, embedded in Roe, that states cannot restrict abortion before a fetus can survive outside the womb—is no longer central to the precedent. While this decision is formal, it leaves behind RoeIt could be almost unrecognizable if the court allowed it to remain in force. The court could allow states to prohibit abortions before viability. There are many other restrictions that can be applied which have been blocked by lower courts and may need to be considered.

The Supreme Court could also decide that Mississippi’s law is constitutional because it allows people to access abortion prior to 15 weeks, and therefore does not present an “undue burden,” as defined by Casey.Such a decision would jeopardize the viability of the standard. And redefine the court’s previous definition of “undue burden” Whatever the court decides, legal experts say the justices may be likely to remand the case back to lower courts, asking federal judges to reconsider the law under a newly modified interpretation of Roe.

Pro-abortion rights advocates claim any Mississippi court ruling which doesn’t explicitly declare the Mississippi law invalid is an indistinguishable distinction. “The law has been absolutely clear for 50 years that bans on abortion before viability are unconstitutional,” says Julie Rikelman, the litigation director at the Center for Reproductive Rights, who will represent JWHO before the Supreme Court. And any decision that creates more legal uncertainty is bad for abortion access, as it leaves clinics—most of which are already operating on a shoestring—to fight costly legal battles or temporarily shut down while judges deliberate.

Brewer and Derzis met in secret to plan contingency strategies as they approached the Supreme Court hearing. Brewer said that even though only 10 to 15% of JWHO’s 300 monthly patients request abortions after 15 weeks, she is concerned about what Mississippi laws will be passed next.

Brewer remains focused on her fight in the interim. The day after we spoke was a Saturday, but she planned to be at the clinic bright and early—as she always is. She’s doing it for the next generation, she says, in hopes they take up the mantle for the ones who come next. “That’s kind of how it goes,” she says, turning her eyes briefly away from the security screen. “You have to have people to continue to fight.”

—With reporting by Mariah Espada/Washington and Leslie Dickstein/New York

To Abigail Abrams at abigail.abrams@time.com.