The Jackson Women’s Health Organization is threatened by a 2012 Mississippi law that would limit access to abortions. With the clinic’s fate in the supreme court’s hands, Diane Derzis is focused on the survival of ‘a place that cares’

In 1974, one year after the US supreme court ruled in its landmark Roe v Wade decision to legalize abortions, Diane Derzis stepped into a doctor’s office in Birmingham, Alabama, to terminate her pregnancy. The 20-year-old college student, who had been married, was three months pregnant and wasn’t ready to have a child. So she sat in a crowded waiting room, not knowing what to expect.

“You didn’t have a problem with spreading your legs before, and if you can’t do it now, I’m not going to see you,” the doctor told Derzis. He then performed a safe and routine abortion, which cost $125.

Derzis grew determined to provide other women with a more dignified abortion, to become an advocate for women’s rights, and later an owner of abortion clinics throughout the south. The 61-year-old activist has persevered in her field despite the murder of one abortion doctor, the bombing of her clinic, and the perpetual barrage of protesters seeking to shame her clients.

Now Derzis faces a new threat to the survival of what has become the state’s last standing abortion clinic, this time from Mississippi officials, who have championed a controversial law seeking to shutter the Jackson Women’s Health Organization. The fate of the law rests in the hands of the nation’s highest court.

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In the next few weeks, US supreme court justices will hold internal conferences to determine which cases should be heard in its upcoming term. One case under consideration, Currier v Jackson Women’s Health Organization, concerns a Mississippi state law passed in 2012 requiring doctors who perform abortions to received admitting privileges from a local hospital.

Upon its passage three years ago, state lawmakers justified the measure as a safeguard in case of a medical crisis. But some major medical organizations have stated that the extra protection is unnecessary, given that a woman potentially in need of such emergency care would receive treatment from a specialist working at the hospital – not the doctor terminating the pregnancy.

With the law in place, critics say, hospital board members, who are subject to political pressure, have full control over whether doctors can perform abortions.

“It’s hard to list all the ways admitting privileges laws don’t make sense,” Drexel University law professor David Cohen says. “Abortions are safer than most outpatient procedures.”

Doctors working with the Jackson Women’s Health Organization were soon unable to obtain admitting privileges. Left with little recourse, the Center for Reproductive Rights sued the state on behalf of Dervis’s clinic to block the requirement. Julie Rikelman, an attorney representing the Jackson abortion clinic, says a judge ruled in its favor and granted a restraining order that allowed the clinic to remain open.

In July 2014, the US court of appeals for the fifth circuit deemed the law requiring admitting privileges unconstitutional, given that the state would be illegally blocking its residents from access to a constitutional right, while unfairly placing a burden on adjacent states with fewer restrictions. Last February, Mississippi attorney general Jim Hood asked the US supreme court to overturn the “confusing and inconsistent” ruling.

The admitting privileges law is the latest in a long line of efforts to wipe out abortion clinics in Mississippi, which had 14 clinics in 1981, but only has one clinic today. In addition to the admitting privileges law, Mississippi legislators have also passed measures to force women to wait 24 hours between an initial consultation and the abortion itself – a policy that can deter women from having the procedure by requiring two trips – and mandates clinics to meet the same building requirements as ambulatory surgery centers.

Mincing no words on his anti-abortion stance, Mississippi governor Phil Bryant last year declared his goal to “end abortion in Mississippi”, a plan which, if successful, would make the state the first without an abortion clinic. Several other attempts to restrict abortions, such as a bill from state senator Philip Gandy to increase the waiting period from 24 hours to 72 hours, have followed since the admitting privileges law passed.

Facebook Twitter Pinterest Diane Derzis stands outside a building she owns where abortions are performed in Birmingham, Alabama, in 2013. Photograph: Jay Reeves/AP

As the US supreme court mulls the case’s merits, which are similar to another pending Texas lawsuit that could leave the state with as few as 10 abortion clinics, Derzis’s clinic has continued to operate, offering abortions to residents living in a state with one of the nation’s the lowest abortion rates.

“[Closing the Jackson Women’s Health Organization] would mean Mississippi will be back to the position where women don’t have access to basic legal abortion, forcing women to end their pregnancies without a medical professional,” Rikelman says. “When that happens, women can be hurt or die. Mississippi will have gone back to a pre-Roe time.”

In an average month, about 200 women seeking abortions make their way north on State Street to the bright pink art deco building located in Jackson’s Fondren district. Outside the clinic, simply known as the “Pink House”, anti-abortion activists hold signs and harass pregnant women, a practice which led to the creation of a group of pro-choice volunteers, called the “Pink House defenders”, to shield the women from the vitriol faced as they walk into the clinic.

Once a client is past the protesters, Derzis explains, a staff of about a dozen people strives to make her feel as comfortable as possible in the waiting room, throughout the consultation process, and during the abortion procedure.

“I think they feel like they have walked into a place that cares,” Derzis says, “and that even if they decide not to continue with their plans to have an abortion, that they know that they’ve had the best experience they could have at that particular time in their life, being where they were.”

If Derzis’s clinic is ultimately shuttered due to an unfavorable ruling, Cohen believes the constitutional rights upheld by Roe v Wade could in effect be gutted, as hospital board members would have the ability to interfere with a woman’s right to end a pregnancy along with a doctor’s ability to perform an abortion.

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Rachel Jones, a principal research scientist with the Guttmacher Institute, says the closure would exacerbate the difficulties for Mississippi residents seeking an abortion; already, nearly two-thirds of those women travel outside the state for their procedures. Though some women can afford to travel to other states for an abortion, Jones says, women living on low incomes would be further limited in their options to terminate a pregnancy – or might resort to an illegal abortion.

“When women don’t want to be pregnant, they’re resourceful and can gather resources to travel out of state,” Jones says. “But there’s only so much they can do. A lot of those women will just have babies.”

While most Mississippi women leave the state to undergo an abortion – often because it’s a shorter distance to reach those facilities – Rikelman says clinics in neighboring states like Alabama and Louisiana have faced similar legal challenges due to their respective admitting privileges laws. Faced with a conservative squeeze on many of the south’s abortion clinics, Derzis says, her work today remains as important as ever on behalf of women living in the Bible belt.

“I’ve been called a ‘baby killer’ for years,” she says. “I guess they thought ‘abortion queen’ was a really nasty thing to say. I thought it was actually kind of nice, so that’s why I embraced it. I’m not going allow someone make me feel bad about what I do.”

If the US supreme court takes up the case, Rikelman says, both sides would submit a new series of briefs before presenting oral arguments early next year, with a final ruling occurring several months later. Should the court decline Mississippi’s request, the legal fight would head back to the lower court that first ruled in favor of Jackson Women’s Health Organization.

Despite her defiant optimism, Derzis has routinely questioned whether the constant struggle to keep her clinics open over the years has been worth it, especially following the tragic moments like the 1993 murder of David Gunn, an Alabama doctor who was shot to death by a Christian fundamentalist, or the 1998 bombing of her first clinic in Birmingham, which Atlanta Olympic Games bomber Eric Rudolph staged, taking the life of her security guard.

Her moral dilemma, putting people’s lives at risk to give women a choice to have the lives they want, is accompanied by survivor’s guilt. But ultimately, she says, the importance of providing a safe abortion clinic in a state without alternatives keeps her going.

“You decide that you do the best you can,” Derzis says. “You do everything you can to make it as safe a place, not only for your staff and the doctors, but for the patients that come in there. For me, many years ago, I had to come to terms with that this was a cause worth dying for.”