On the calendar at Jackson Women’s Health Organization on Tuesday, every appointment slot was filled. Patients drove in from across Mississippi, as well as from Louisiana, Tennessee and as far away as Texas, taking the long trip to obtain an abortion from a clinic that now seemed doomed.
A draft opinion leaked from the Supreme Court has indicated that a majority of the justices were in favor of overturning the constitutional right to abortion, a decision that could spell the end of clinics like this one, the lone provider in Mississippi and the named plaintiff in the case that will lead to the most consequential abortion rights decision in decades.
But on Tuesday, as it will until an official ruling arrives, the clinic remained open. Volunteer escorts showed up to usher patients past the activists who arrive each day to discourage women from going inside. The doctor and staff pledged to keep working for as long as they possibly can.
“We’re going to continue to see patients,” Shannon Brewer, the director of the clinic, said. “I don’t know anything different we would do other than see patients.”
Demand at many clinics across the country has surged in recent months as conservative states have passed new restrictions in anticipation of the Supreme Court ruling. On Tuesday, that frenetic pace continued, with clinics pushing to see as many patients as they could — even as they anticipated with new certainty a ruling that could ultimately put many of them out of business.
But news of the draft opinion also intensified concerns about the void that will be left when clinics in states with restrictive laws will likely be forced to close.
“For our patients, they have the same concern they had yesterday and that they have most days that they’re coming in to see us,” said Dr. Bhavik Kumar, a family physician who provides abortions at a Planned Parenthood in Houston. “And that’s, ‘I’m pregnant and I can’t be and I need an abortion. Can you help me?’”
Abortion clinics in conservative states have become accustomed to navigating hurdle after hurdle while lawmakers work to make abortions as difficult as possible to access. Providers have also faced threats to public safety and difficulty simply finding staff.
“We aren’t exaggerating when we say that the legality of abortion is a moment-by-moment thing out here,” said Robin Marty, director of operations at West Alabama Women’s Center in Tuscaloosa, Ala.
“Once we have to close these doors to elective abortion, I don’t know where people are going to go because they’re not going to have babies,” Ms. Marty said. “There’s no way they’re going to say, ‘Now I’ll just give birth.’”
Even though survival for these clinics has hung in the balance as a Supreme Court ruling loomed, abortion providers have seen demand grow.
West Alabama Women’s Center, one of three providers in Alabama, has seen a 50 percent increase in its patient load since the beginning of the year. Jackson Women’s Health went from operating three days a week to five, seeing 300 patients or more in a given month. Much of that influx has come from Texas, which instituted some of the most severe restrictions in the country.
“I don’t recall ever having to turn someone away because we didn’t have a slot for them until the past couple of months,” said Dr. Cheryl Hamlin, an obstetrician-gynecologist from Massachusetts who travels to Jackson, Miss., once a month. She is part of an out-of-state rotation of doctors who keep the clinic operating because it has been unable to find local physicians willing to provide abortions.
Hope Medical Group for Women in Shreveport, La., one of three abortion clinics in the state, according to the National Abortion Federation, has a wait list of more than 300 patients. Kathaleen Pittman, its administrator, said the draft opinion was an indication that the clinic’s days were numbered.
But she said the clinic would take advantage of whatever time it had left.
“I will not stop providing care,” Ms. Pittman said, “and I don’t think any of us will.”
Just as clinics kept operating, anti-abortion activists, too, kept at their work on Tuesday, setting up outside abortion facilities and trying to persuade women to consider other options.
Outside the main Planned Parenthood clinic in Houston, a bus from the Houston Coalition for Life, an anti-abortion group, sat in its usual spot, offering free ultrasounds and consultations. A black-and-white billboard towered overhead nearby, reading, “Adoption is an option.”
“I come here every Tuesday,” said Nancy Shaw, 71, holding a rosary and seated on her car tailgate by an “Abortion ends a heartbeat” bumper sticker. She had parked steps from the driveway into the clinic’s parking lot, as she has done, she said, almost every week since 2008. “I pray, and if somebody comes, I try to counsel,” she said.
Roughly a dozen states, mostly in the South and Midwest, have trigger laws in place that will make abortion unlawful almost immediately if Roe v. Wade is overturned. Other states are expected to follow. Clinics have long been preparing for what that would mean, but the draft opinion created a new urgency.
In South Dakota, one of the states with a trigger law, employees at a Planned Parenthood clinic in Sioux Falls arrived to work early to discuss the ruling.
The manager of the clinic, Misty, asked that her last name not be used because she fears threats, and said she had gathered with her employees in a conference room where the mood quickly shifted from quiet and somber to tearful and angry. Several employees cried as they stood or sat on the floor discussing the leaked Supreme Court draft. Every patient who called or visited the clinic on Tuesday had mentioned the report, she said.
Some asked for clarity on what the opinion would mean. One woman who arrived at the clinic for an appointment said she was “scared to get pregnant” because of the possibility that abortion would be outlawed, the manager said.
The clinic in Jackson has been thrust to the center of the national debate over abortion as its challenge to Mississippi’s law — banning abortion after 15 weeks of pregnancy — reached the Supreme Court and paved the way to a major ruling.
Yet there has always been a gulf between the legal fight and the practical realities on the ground. Ms. Brewer, the director, has talked about moving the clinic — known as the Pink House for its flamingo exterior — to New Mexico, if necessary.
But most of her efforts have been focused on the community in front of her, serving a population of patients that reflects Jackson, which is largely African American, and Mississippi, one of the poorest states.
It has taken a lot to keep the Jackson clinic operating. The clinic has not had a staff doctor for more than a decade. Over the years, other providers in Mississippi shuttered, buckling under the onerous restrictions imposed by the state. The Jackson clinic abides by them, though, providing ultrasounds and mandated counseling.
As the law dictates, Dr. Hamlin tells patients that abortion creates a heightened risk of breast cancer, though experts say the claim is unsupported by science.
But at the end of her counseling sessions, in a quick dash of defiance, Dr. Hamlin urges her patients to vote if they believe that access to abortion is important.
“I’m going to be more forceful,” she said of her plea. “What have you got to lose?”
Nicholas Bogel-Burroughs and Richard Fausset contributed reporting.