JACKSON, Miss. — The battle plays out in dueling soundtracks.

On one part of the sidewalk, longtime antiabortion demonstrator Coleman Boyd belts out a steady stream of Christian music, with lyrics about Jesus’s love for the unborn. “Your precious baby is going to be murdered in this place,” Boyd, a physician, preaches between songs.

Nearby, supporters of the Jackson Women’s Health Organization, the last abortion clinic in Mississippi, turn up their own playlist of “Jagged Little Pill,” by Alanis Morissette, and other female empowerment anthems.

The struggle on the sidewalk will soon play out at the Supreme Court, where the Jackson clinic — known as “the Pink House” for its bubble-gum color — is at the center of the most consequential women’s reproductive rights case in decades.

Later this year, the court will hear arguments about a Mississippi law that if allowed to take effect would ban nearly all abortions after 15 weeks. If the court’s conservative majority permits the law to stand, it could deal a major blow to abortion rights.

Such a ruling could give states greater latitude to limit how and when abortions are performed. And if the court goes further and accedes to Mississippi’s request to overturn Roe v. Wade, the decision giving women a constitutional right to an abortion, some legislatures are poised to ban nearly all abortions. Twelve states, including Mississippi, have passed “trigger” laws with stringent abortion restrictions that could go into effect immediately, or soon after, if Roe were overturned.

“This is just a terrible situation,” said one of the clinic’s doctors, who travels from another state because local physicians will no longer perform abortions there. (He spoke on the condition of anonymity because he fears for his safety, noting that an antiabortion activist once followed him to his neighborhood.) He said he does this work because he has seen the harm underground abortions have done to women.

The clinic’s patients are largely “Black women, they are young, single,” the doctor said. “Maybe they can’t afford a child. Maybe they were abused, or can’t go home. When you deny them the right to have an abortion and they have to have one, where will they go now?”

A billboard sponsored by Pro-Life Mississippi along a road in Jackson.
A billboard sponsored by Pro-Life Mississippi along a road in Jackson. (Bonnie Jo Mount/The Washington Post)

‘They don’t understand’

In 1973, the Supreme Court ruled that women have the right to an abortion before viability, the point at which a fetus could survive outside the womb. Although there’s no universal agreement on when that happens, most experts estimate it to be around 24 weeks.

But for much of the past 50 years, the antiabortion movement has chipped away at the ruling, and with their mostly Republican allies have passed laws that make it harder for women to access abortion providers.

Some states have enacted rules that require women to view ultrasounds, usually 24 hours before they can get abortions. In many places, women under 18 must notify guardians of their plans for abortion or seek consent. Lawmakers in a flood of Republican-led legislatures have passed “heartbeat bills,” which ban almost all abortions after a fetal heartbeat can be detected, usually around six to eight weeks into pregnancy. Alabama attempted to ban abortion, even in cases of rape and incest. Those laws are contentious even among some opponents of abortion, and have been struck down by the courts.

The legislation being considered by the court in the Mississippi case — which would ban most abortions after 15 weeks — was blocked from going into effect in 2018 by a federal judge, who ruled the law “unequivocally” violates women’s constitutional rights.

[State abortion policies have become more extreme — without Roe v. Wade, the divide could widen]

The state petitioned the Supreme Court to overturn the ruling in June 2020, before the death of Justice Ruth Bader Ginsburg, a proponent of abortion rights. That request was granted nearly a year later, months after Justice Amy Coney Barrett was named to the court by President Donald Trump. Coney has said she personally opposes abortion rights and as a law professor sharply criticized Roe.

The court has limited the question it will consider to whether “all pre-viability prohibitions on elective abortions are unconstitutional.” But in its brief to the court, Mississippi has asked the justices to overrule Roe and the court’s 1992 decision Planned Parenthood v. Casey, which said states may not impose an “undue burden” on the right to abortion before fetal viability.

Roe and Casey are unprincipled decisions that have damaged the democratic process, poisoned our national discourse, plagued the law — and, in doing so, harmed this Court,” Mississippi Attorney General Lynn Fitch (R) wrote in the state’s brief.

The clinic’s counsel, the Center for Reproductive Rights, will file its response next month. But the advocacy group’s chief executive said Mississippi seeks to outlaw abortion not just in the state, but across the country.

Mississippi is asking the Court to overturn Roe v. Wade and allow states to ban abortion,” said CEO Nancy Northup. “If that happens, the impact will be immediate and far-reaching, well beyond Mississippi. … To put a fine point on it: Women of childbearing age in this country have grown up under Roe and have never known a world in which they cannot control their own lives and futures in this way.”

On the ground in Mississippi, antiabortion activists say their message is clear: Life begins at conception.

“Our message should always be consistent: Why would you tie your tubes? I don’t want to tie God’s hands,” said Laura Knight, who also opposes all forms of birth control. (She does support natural forms of family planning.)

Inside the Jackson clinic, a young woman getting follow-up care after having an abortion expressed frustration with this position, which can make it tough for teenagers like her to even learn about contraception.

Sitting below a poster that explained how the different kinds of birth control prevent pregnancy, the 18-year-old, who spoke on the condition of anonymity to protect her privacy, said that because Mississippi teaches only abstinence in public schools, no one explained to her how to prevent pregnancy if she had sex.

She was back for her two-week checkup after taking the abortion pill at home. Although opting for an abortion was a hard decision, she said she feels it was the right one for her, because she’s about to enter college to study nursing.

“I feel like most of the people in politics are men. They don’t understand,” she said. “They don’t have the pregnancy and barely raise the child.”

A technician in a T-shirt supporting a women's right to abortion checks a patient's blood pressure at the Jackson Women's Health Organization.
A technician in a T-shirt supporting a women’s right to abortion checks a patient’s blood pressure at the Jackson Women’s Health Organization. (Bonnie Jo Mount/The Washington Post)

‘Woefully insufficient support’

Diane Derzis, who owns the Pink House, has been fighting for reproductive rights since she was belittled by a doctor during her own abortion in 1974. The doctor said, “ ‘You had no trouble opening your legs then, you won’t now,’ ” she said. She was married at the time and in college.

Derzis argues that her clinic is a safe place for women with few options, providing them an essential service at a critical moment. And abortion access is even more important for the poor, she said, since the state offers little support for new mothers and families.

“Who’s going to take care of these women and their babies after they are born?” she asked.

Diane Derzis, owner of the Jackson Women's Health Organization, says the clinic affords dignity to women with few options.
Diane Derzis, owner of the Jackson Women’s Health Organization, says the clinic affords dignity to women with few options. (Bonnie Jo Mount/The Washington Post)

Mississippi has the highest infant mortality rate in the country, with 8.8 deaths per 1,000 births, and remains among the top states for maternal mortality. The state legislature recently refused to expand Medicaid, and children are only entitled to health care from the state until they are 6 months old.

“It’s the paradox,” said Rob McDuff, a Jackson attorney who works for the Mississippi Center for Justice. “Mississippi provides woefully insufficient support to struggling families with children.”

Rob McDuff of the Mississippi Center for Justice worries that poor women will bear most of the burden of restricted access to abortion.
Rob McDuff of the Mississippi Center for Justice worries that poor women will bear most of the burden of restricted access to abortion. (Bonnie Jo Mount/The Washington Post)

McDuff worries that severe limits to abortion will disproportionately affect poor women of color. Nearly three-quarters of the women getting abortions in Mississippi are Black, according to federal data released in November 2020. About 38 percent of Mississippi’s population is Black.

“People with enough money who can’t get an abortion in Mississippi can travel to another state where the laws are different. But not poor people,” he said. “It’s the poor people who will be forced to go forward with pregnancy and give birth even if they don’t want to.”

[What could happen if Roe v. Wade gets struck down?]

Rebekah Tate, who protests regularly at the clinic with friends, agrees that mothers need more support. If women were provided with resources like diapers, parenting classes, child care and job placement, Tate said, far fewer would have abortions.

The 24-year-old landscaper from Magnolia, Miss., said she first became inspired to fight to end abortion six years ago, after meeting women who had unplanned pregnancies while volunteering at a pregnancy center she heard about through her church.

“I was meeting girls who had abortions who told me they had no idea there were other options,” she said. “It surprised me, which led me to come to the sidewalk to talk to other women going through this.”

Many Mississippi residents who oppose abortion see the issue through the prism of religion. The state is the most “highly religious” in the nation, meaning 82 percent of residents believe in God with absolute certainty, tying with Alabama, according to the Pew Research Center. More than 80 percent of Mississippi adults identify as Christian, and half of those residents are evangelical Protestants, the study said.

Antiabortion protester David Lane has been a regular on this sidewalk for 35 years. The former U.S. Army medic and pastor says it’s not a crime to grow up poor, without government support. “Nothing wrong with being poor,” says Lane, 77. “I think self-reliance is good.”

Lane says his wife and a friend of hers persuaded several women not to have abortions. He tries to direct women coming to the Pink House to go instead to a Christian pregnancy center around the block, which can offer them support and free ultrasounds.

David Lane, 77, a former U.S. Army medic and pastor, tries to persuade a woman entering the clinic to consider alternatives to abortion.
David Lane, 77, a former U.S. Army medic and pastor, tries to persuade a woman entering the clinic to consider alternatives to abortion. (Bonnie Jo Mount/The Washington Post)

Once, he says, he persuaded a pregnant woman to skip her appointment by offering her six months rent and computer training. They no longer keep in touch, but he often shares her story as proof “that we can help them pull their lives together.”

Standing near Lane, a woman hands out small pink and purple bags filled with Goldfish crackers and Hershey’s Kisses, wrapped with bows and attached to fliers telling women they have “choices other than killing their baby.”

The pamphlets show serene women cradling newborns, with quotes about how they can’t imagine life without their children, and how relieved they are that they didn’t go through with an abortion.

Derzis, the owner of the Pink House, also sees herself as serving God and the most vulnerable, and has Bibles and crosses throughout the clinic.

“When I see the faces and hear the stories of the women, it still gives me goose bumps,” she says, pausing and touching her arm. “Because no woman should feel shameful when they walk in here. It’s a gift to make one of their toughest days a day where they are treated with dignity — no one knows their lives.”

Antiabortion protester Coleman Boyd prays aloud outside the Jackson Women's Health Organization.
Antiabortion protester Coleman Boyd prays aloud outside the Jackson Women’s Health Organization. (Bonnie Jo Mount/The Washington Post)

‘Some time to decide’

As Lane lobbies outside, Takeita, 31, waits for her appointment, her legs nervously bouncing up and down. (She spoke on the condition that she would be identified by her first name because of concerns about her privacy.)

Takeita is considering an abortion. She already has a 14-year-old daughter, she said, and wants to focus on giving her a good life. She recently got a raise from $7 to $15 an hour working the line at the local Nissan plant, which gave her the freedom to take her “baby girl to Memphis and Dave & Busters [restaurant and video arcade] for her birthday.”

“When she says, ‘I love you, mama,’ I just feel like I’m doing okay,” she says. “I’m able to give her a decent life. Not like them soccer moms. But a decent life.”

Takeita has terminated four pregnancies at the Pink House. She says that she has asked for birth-control pills, but her church and family urged her to practice abstinence until marriage. They also told her that birth control rarely works, she says.

Once, she asked for a tubal ligation, a minor surgical procedure that provides permanent birth control, but her doctor said he wouldn’t consider performing the operation unless she had two children.

On this day, Takeita waits for a sonogram.

“I don’t know if I want another. I’m just not sure,” she says after being called in.

Shannon Brewer, the longtime clinic director, rubs some special lubricating jelly on her belly, then studies the image on the screen. “You’re 11 weeks and two days,” Brewer tells her.

“For real?” Takeita says, rubbing her eyes.

“You still have some time to decide,” says Brewer, as she prints out the sonogram. “You can have the photo.”

Shannon Brewer performs a sonogram test on a client of the Jackson Women's Health Organization.
Shannon Brewer performs a sonogram test on a client of the Jackson Women’s Health Organization. (Bonnie Jo Mount/The Washington Post)

In the waiting room, Takeita stares at the photo. She keeps some of the other sonograms stored on her cellphone, to remind her of the children she might have had.

Under Mississippi law, she must wait 24 hours before she can come back to schedule an abortion. She’s still not sure what she will do.

But for now, she takes comfort in knowing she can return if she chooses.

Cha reported from Washington. Robert Barnes contributed to this report.

Story editing by Amanda Erickson. Photo editing by Bronwen Latimer. Design and development by Tara McCarty and Junne Alcantara. Graphics by Daniela Santamariña. Graphics editing and additional development by Danielle Rindler. Copy editing by Karen Funfgeld.