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On the 49th anniversary of Roe v. Wade, could it be the last?


For many of the anti-abortion rights protesters demonstrating on the National Mall, this year's annual March for Life felt different.


JEANNE MANCINI: We are hoping and praying that this year, 2022, will bring a historic change for life.


MCCAMMON: That's Jeanne Mancini, president of the March for Life, speaking Friday afternoon.


MANCINI: Roe is not settled law.


MCCAMMON: She told the crowd that a decision expected from the U.S. Supreme Court this summer on a case challenging a Mississippi abortion ban could lead to overturning the 1973 Roe v. Wade decision and dramatically reshaping the legal landscape around abortion rights.


MANCINI: Your presence makes a difference.

MCCAMMON: At clinics around the country, doctors and staff are also watching the Supreme Court, preparing for what feels like an increasingly uncertain future.


MICHELLE INGRAM: Good afternoon. Thank you for calling Whole Women's Health. My name is Michelle (ph). How can I assist you?

MCCAMMON: Michelle Ingram (ph) is the manager at Whole Women's Health, a clinic in Alexandria, Va. She says she was a patient herself at another clinic in the area about a decade ago.

INGRAM: It meant everything. And the fact that I had the ability to choose to get an abortion - like, I had the ability to choose. I didn't have to have it. I needed to have it, and I wanted to have it, and it was no restrictions. So it meant everything.

MCCAMMON: But now a Supreme Court with a conservative majority is weighing a case that could do away with decades of abortion rights precedent.

INGRAM: I have no idea what that would mean. Our doors might close. I'm not sure. I don't know.

MCCAMMON: Sofia Levy, a nurse practitioner at the clinic, says she's already getting some sense of what it could mean if Roe falls. As it is, clinics, she notes, are few and far between, especially across much of the Midwest and South.

SOFIA LEVY: We're already starting to see people come from West Virginia, North Carolina, Ohio and Texas, of course. We're starting to see patients come from all other areas because accessibility is lower, and it's really becoming an issue.

MCCAMMON: Amy Hagstrom Miller is CEO of Whole Woman's Health, which operates eight clinics nationwide, including the office in Northern Virginia and four in Texas, where a law took effect in September banning most abortions after about six weeks of pregnancy. She says access to abortion has never been more in question at any time since Roe.

AMY HAGSTROM MILLER: We have been unfortunately kind of leading up to this for some time. And SB8 is really, in many ways, the straw that broke the camel's back. This is the longest we've seen an abortion ban that's this extreme.

MCCAMMON: And it's likely just the beginning. The Guttmacher Institute, which supports abortion rights, estimates that if Roe v. Wade is overturned, more than two dozen states will quickly move to ban abortion, either with laws that are already on the books or by passing new legislation in short order. Elizabeth Nash is a policy analyst at Guttmacher. She says many patients seeking abortions are going wherever they can get an appointment or have a support network.

ELIZABETH NASH: Texas is a bit of a microcosm right now where there's a six-week ban in effect. And people are not only going to places like Oklahoma and Louisiana, like, states that are right next door, but they're going as far as Washington state and Maryland. So they're going much, much further.

MCCAMMON: Some abortion providers already are preparing to handle more patients traveling long distances. Dr. Colleen McNicholas is chief medical officer for Planned Parenthood of the St. Louis Region and Southwest Missouri, which operates a large clinic in southwestern Illinois. Like many around the country, McNicholas says her clinic is seeing an influx of patients from Texas.

COLLEEN MCNICHOLAS: We've seen a number of folks get in their cars in Houston at 3 in the morning, drive 12 hours to southern Illinois to meet with me for 20 minutes, get their medication abortion pill and get right back in their car, driving back to Houston in the same day.

MCCAMMON: Making a journey like that may be financially out of reach and difficult or impossible for people with unreliable transportation and flexible work schedules or family responsibilities. In Boulder, Colo., Dr. Warren Hern's clinic has been providing abortions since 1975. He's one of only a handful of doctors nationwide who perform abortions later in pregnancy - sometimes into the third trimester - often for patients whose pregnancies have been diagnosed with severe fetal abnormalities. Hern says his staff has been working with patients traveling from around the country for years.

WARREN HERN: And so we have women who will wind up with a dozen different approaches to help. And then we help them make travel arrangements and arrange for them to stay in a local hotel when they get here and those kinds of things. And we actually have a pantry in my office for women who don't have any food.

MCCAMMON: Data from the Guttmacher Institute suggests that nationwide, about 6 in 10 patients who have abortions are already mothers. Hagstrom Miller says about 70% of patients coming to her clinics have children, and many feel they cannot handle another. So the clinics are adapting to those needs.

HAGSTROM MILLER: The patient might be with us for, you know, three or four hours for the whole abortion - the procedure, recovery, everything. And her husband or her best friend might be with her along with her children, right? So we give them some options of places to go. Like, you could go for a walk in the local mall. You could go shopping at IKEA and have lunch and play in the little kids' playground that's in IKEA.

MCCAMMON: Last week, Planned Parenthood announced the creation of a regional logistics center at its Illinois clinic that will help connect out-of-state patients with networks that offer funding and other resources. Michelle Colon of SHERo Mississippi, a reproductive rights group focused on Black women and other people of color, says if Roe falls, marginalized people will be the most affected.

MICHELLE COLON: Criminalizing abortion is never going to stop abortion. It makes abortions less safe. And so the people who are going to feel this the most are going to be low-income, you know, poor people who are already working trying to make ends meet altogether who are, you know, robbing Peter to pay Paul.

MCCAMMON: A recent study in the journal Contraception found that women of color and women living in lower-income counties in Mississippi were more likely to wait longer for abortions.


UNIDENTIFIED PERSON: Are you guys ready?


MCCAMMON: At the March for Life on Friday, several speakers employed the language of racial and social justice...


MANCINI: We're hearing a lot about equality.

MCCAMMON: ...Including President Jeanne Mancini.


MANCINI: And these are topics that need to be discussed. And the truth is that we're all equal in dignity regardless of skin color, disability status...

MCCAMMON: However, the crowd that gathered on the mall appeared to be overwhelmingly white.

JACOB VOELP: And we're just here for the babies.

MCCAMMON: Jacob and his wife, Hannah Voelp (ph), live in Maryland. He's 21, and she is 19. And they say they've been married for two years. They say the solution to unwanted pregnancies is not abortion but adoption or abstinence from sex before marriage.

J VOELP: What's the greater good? Is the greater good you being more convenienced? I don't want to have another kid. We don't have it in the budget to have another kid and go to the Bahamas next year. I know that's not everybody, but I think a lot of the times, it's about convenience.

MCCAMMON: I mean, I have to push back on that a little bit because the doctors we've spoken to - many of the patients they're dealing with literally can't even afford food. I mean, they have set up food banks at their offices because the women that are coming there are so low income, they can't afford to travel and eat.

J VOELP: Sure.

MCCAMMON: I mean, it's not - with all due respect, it's not about going to the Bahamas.

J VOELP: Yeah, no. And that's what I was saying is - it's - I don't know all the statistics on it, but I know there's a lot of nuanced cases. And I think at the end of the day, we should trust in God and trust that taking someone else's life isn't worth - we should rather live in poverty.

MCCAMMON: Some marchers said they'd like to see their movement do more to help low-income parents, whatever their circumstances.

MIKE SAWICKI: One thing I will say - and I really believe this - our country puts out a lot of money for a lot of people in situations. We really need to find a way to support women better.

MCCAMMON: Mike Sawicki (ph) said he and his wife came to the March for Life from Connecticut for the first time now that they are retirees.

SAWICKI: I think that's - it's critical is this movement is to find a way that women that are in trouble or choose to have their baby have access to support and not just say, OK, we've solved the abortion problem, and you figure it out.

MCCAMMON: He said they also want to see laws like the Texas abortion ban spread across the country. Elizabeth Braman (ph) came to the March for Life from Maryland with her husband and their infant daughter.

MCCAMMON: And who's this?

ELIZABETH BRAMAN: This is Joy. She is five months old.

MCCAMMON: Congratulations.

BRAMAN: Thank you.

MCCAMMON: Staying warm in her little...

BRAMAN: Yes, we're trying.

MCCAMMON: ...Bear onesie? Why are you here today?

BRAMAN: Because we believe in life. We just want to support everybody. I got pregnant before we got married, and it was really scary. Having her was the best thing I ever did, and I want to be here to support other women going through something similar. So...

MCCAMMON: Did you consider ending the pregnancy?

BRAMAN: No, but it was just very scary. And in that moment, I understood why people would want to. I get that fear.

MCCAMMON: Braman says she understands it, but she believes abortion is murder and hopes the Supreme Court will overturn Roe. And then she says it will be time to talk about what's next for the movement.

BRAMAN: We need to start funding more women's shelters - women's care, all of that. So ending Roe v. Wade is step number one, and then there are so many after that.

MCCAMMON: Braman said she wants states to pass laws prohibiting abortion and punishing doctors who perform them with jail time. For leaders of the anti-abortion rights movement, like Jeanne Mancini, the next fight will be in state legislatures, which could soon have much more power to restrict abortion.


MANCINI: If Roe falls, the battle lines will change. But make no mistake - the fight for life will need to continue in the states and here in D.C.


MCCAMMON: Already, many state lawmakers are proposing a host of new restrictions on abortion, some modeled closely after the Texas law, which the Supreme Court has now allowed to stand for nearly five months - a possible sign of what's to come this summer. Transcript provided by NPR, Copyright NPR.

Sarah McCammon
Sarah McCammon is a National Correspondent covering the Mid-Atlantic and Southeast for NPR. Her work focuses on political, social and cultural divides in America, including abortion and reproductive rights, and the intersections of politics and religion. She's also a frequent guest host for NPR news magazines, podcasts and special coverage.