When the abortion doctor lost his medical license in 2004, Nancy Atkins wasn’t sure how she could keep going. Malachy DeHenre had been the only doctor at the clinic Atkins owned in Jackson, Miss. Recruiting OB/GYNs to perform abortions anywhere was difficult, but in Mississippi, Atkins had learned, it was nearly impossible. The state had the toughest regulations and the most ardent antiabortion protesters. One activist even regularly told people that killing an abortion provider might count as “justifiable homicide.”

Seventeen years later, Atkins isn’t surprised that her state is the one that some legal observers believe is poised to overturn or seriously undermine Roe v. Wade. On Wednesday, the Supreme Court will hear arguments in Dobbs v. Jackson Women’s Health Organization, a challenge to Mississippi’s law banning most abortions after 15 weeks. Roe protects a person’s constitutional right to abortion before viability, usually around 22 to 24 weeks.

For 25 years, lawmakers and antiabortion activists had worked tirelessly to put Atkins’s clinic out of business. When they succeeded in 2004, she knew she’d be leaving the state with just one abortion provider. Thousands of people would have a harder time accessing the procedure, but Atkins felt she’d fought as long as she could. She was tired, and the work had become too difficult.

As lawmakers passed increasingly stringent regulations in the decades after Roe, protesters grew more emboldened, and Mississippi was left with a patchwork of doctors, most of whom wound up in trouble with the law. Abortion rights activists elsewhere dismissed the state as especially radical or backward, local activists say, but the people on the ground knew that what happened in Mississippi could happen anywhere.

Now, the future of abortion access in the country could rest on the outcome of a lawsuit filed against the lone clinic that remains.

‘Few and far between’

Mississippi has always been one of the hardest places to obtain an abortion, but the history of access there tells the larger story of what happened in America after 1973, when the Supreme Court’s decision in Roe v. Wade guaranteed a person’s right to abortion. In the early days following the ruling, feminist-minded OB/GYNs rushed to provide the newly legal procedure. Some, like the young gynecologist who opened Mississippi’s first clinic in 1975, said they turned to the practice because they’d treated people who’d had botched abortions before the procedure was legal. Without safe access, they knew, people could fall gravely ill, or even die.

By the mid-1980s, Mississippi had more than a dozen abortion providers, and the country as a whole had close to 3,000. Then, in the mid-1980s, as antiabortion protesters began bombing clinics and threatening doctors, that number abruptly began to dip nationwide. By 1990, nearly 1,000 doctors had quit, and 84 percent of counties nationwide had no abortion clinic at all, according to surveys conducted then by the Guttmacher Institute, a nonprofit research center that supports abortion rights.

Surveys of OB/GYNs from this time reveal a number of reasons doctors declined to offer abortions. Some, particularly younger doctors, were morally opposed or said they hadn’t learned the procedure in medical school. Most said they feared the wave of brash new protesters. And, on top of it all, work at abortion clinics typically didn’t pay as much as other medical jobs did.

The doctors who remained largely had their choice of clinics, and rural states were impacted the most.

By 1992, North Dakota had one provider, and West Virginia was down to five, according to the Guttmacher Institute. The decline was equally precipitous in Mississippi. The number of providers there declined throughout the 1980s and ‘90s, from 13 in 1982 to eight in 1992, Guttmacher reported. (Guttmacher surveyed clinics, hospitals and physicians’ offices.) And in 1993, the state had three registered clinics open, according to the Mississippi State Department of Health.

The state also led the way in passing abortion restrictions. In 1992, it became the first to require a 24-hour waiting period, and the following year, after a lengthy court battle, a law began requiring parental consent for patients under the age of 18.

Between the restrictions and the protesters, Atkins said, clinic owners in Mississippi had no choice but to accept any doctor who wanted to work for them. Because of Mississippi’s particular scarcity, those doctors often came with issues, setting them apart from the vast majority of abortion providers today. Some physicians cut corners; others broke the law or found themselves in malpractice trouble. One of the first abortion doctors Atkins employed was a brilliant man, “so smart you almost couldn’t talk to him,” Atkins said, but a few years after he started working for her, police arrested him on charges of mailing videotapes of child pornography. He pleaded guilty.

Atkins looked for a replacement, but by the early 1990s, abortion doctors “were few and far between,” Atkins said. “And there were no doctors beating down the door to work here.”

A scarcity of well-trained providers

By the early 1990s, Mississippi had only a handful of abortion doctors. Just one — Tommy Tucker — performed between 60 and 70 percent of the procedures, according to news reports at the time. Tucker had started doing abortions in the mid-1980s, the Mississippi Clarion-Ledger reported, after a “rift” with administrators at the hospital where he worked in Birmingham, Ala.

“I don’t want to do abortions, God knows,” Tucker told the paper in 1993. “I do it for the money.”

Tucker was known as a “circuit rider,” hopping between several clinics across Mississippi and Alabama. At the two Mississippi clinics he owned, Mississippi Women’s Medical Clinic in Jackson and Tri-State Women’s Clinic in Southaven, Miss., he was the only regular doctor.

At his clinics, Tucker had a reputation for cutting corners to make extra cash, multiple people said. By 1994, he was facing a 34-count complaint from the Mississippi State Board of Medical Licensure, which included allegations that he mishandled prescription drugs and allowed unlicensed staff to perform medical procedures. In the hearing before the medical board, a former employee accused him of fudging gestational ages so he could jack up his prices. The family of a woman who died after Tucker performed her abortion also accused him in a civil suit of medical malpractice.

When presented with a detailed list of the allegations in this piece, Tucker said, “75 percent of what you reported is a lie.” He did not elaborate.

Tucker was not the only abortion doctor in Mississippi to face malpractice claims in the 1990s and early 2000s. Because Mississippi was such a difficult place to be an abortion provider, clinics were often left with doctors “on the bottom rungs of the medical ladder,” said John Jones, who represented several clinics in the state in the early 1990s.

In the 1990s, abortion was considered a “rogue procedure” by much of the medical community, said Eve Espey, a spokeswoman for the American College of Obstetricians and Gynecologists and chair of the OB/GYN department at the University of New Mexico. Leading professional organizations like ACOG were “completely silent” on the issue, she said, and top-notch abortion training was hard to come by, leading to a scarcity of well-trained providers.

That changed in the late ’90s and early 2000s, Espey said, as ACOG and other organizations began to speak publicly on the importance of quality abortion care. Now, many OB/GYN residencies include abortion training as a standard part of the curriculum, especially in the northeast and on the West Coast, which has yielded a large group of highly qualified and committed abortion doctors, Espey said. While antiabortion activists still talk about the relative dangers of abortion, studies show it’s an extremely safe procedure. Major complications occur in less than a quarter of 1 percent of abortions, a frequency comparable to colonoscopies.

While abortion rights activists were troubled by the allegations about Tucker’s behavior, they felt they had to stick by him, said Gail Chadwick, the spokeswoman for the abortion rights group Pro-Choice Mississippi in the early 1990s.

“It was either the doctor or a coat hanger, is what it boils down to,” she said.

Jones said doctors in Mississippi were also “under a microscope,” with antiabortion protesters stationed outside of their clinics. When protester Doug Lane noticed a distressed-looking couple leaving Tucker’s clinic in the early 1990s, he said he followed them to the hospital, where he introduced himself and, hearing that the woman was experiencing complications, offered to help them contact a lawyer. The couple filed a lawsuit in April 1994, according to news reports. Lane said they won significant damages.

“These doctors were such sleazebags,” Lane said, referring to Tucker and others who practiced around the same time.

The medical board ultimately found Tucker guilty of 32 of the 34 complaints and suspended Tucker’s license for a year, which shuttered his two clinics. Eleven months later, the board permanently barred Tucker from practicing medicine in Mississippi. A judge ordered Tucker to pay $10 million in damages for the death of the patient whose family sued him for medical malpractice.

Lane was thrilled to see Tucker lose his license. Without Tucker’s two clinics, he added, far fewer people could access the procedure. Antiabortion advocates celebrated the “precipitous decline” in the number of Mississippi abortions, he said.

In 1993, 6,002 abortions were performed in Mississippi, according to the state health department. In 1995, the first full year without Tucker, that number fell to 3,563.

Violent attacks

The protesters who scrutinized Tucker had always hindered clinic owner Atkins’s ability to attract abortion providers. In the 1980s, before her clinic’s first doctor went to prison, antiabortion activists stalked his neighborhood. Once, they even knocked on the doctor’s front door and presented a small casket and a jar of fetal remains they said they’d taken from outside Atkins’s clinic, according to news accounts and court records. By the time Tucker lost his license, they’d grown especially emboldened.

Jackson’s lead protester was a man named Roy McMillan. McMillan’s wife, Beverly, opened the first abortion clinic in Mississippi in 1975, but she left the business after converting to Christianity, and the couple began speaking out against abortion together. Roy McMillan, who died in 2016, carried graphic signs, and he used a childlike voice to scream at women, “Mommy, mommy, please don’t kill me.” Police arrested him dozens of times for trespassing and blocking the clinic.

McMillan made a national name for himself in 1993, after another abortion protester killed a doctor in Pensacola, Fla. McMillan and an activist and minister named Paul Hill began circulating what they called a “Defensive Action Statement.” In it, they declared that murdering an abortion doctor was “justifiable.” The next year, Hill shot and killed another doctor and an escort, and wounded a third person, in Pensacola. The Clarion-Ledger later reported that hours after the crime — for which Hill was executed in 2003 — McMillan went to Atkins’s clinic and confronted Joseph Booker, the lone doctor who worked there.

“Booker,” McMillan said. “You ought to stop this because someone’s going to terminate a terminator.”

Violent attacks occurred in other states, too. Between 1977 and 1994, there were ​​129 bombings and arson attacks at clinics. But few antiabortion activists were as blatant as McMillan was. The New York Times profiled him. He told Time Magazine in 1995, “It wouldn’t bother me if every abortionist in the country today fell dead from a bullet.”

Michelle Colon, an abortion rights activist who has worked in Mississippi and other southern states since the 1990s, said McMillan alone made doctors reluctant to work there.

“Other states, they didn’t have the name-brand antis,” Colon said. “We had someone who was friends with Paul Hill, who was outside our clinics all of the time, and that was huge. Our people celebrated him.”

The years Booker worked for Atkins were among the most violent in abortion rights history. Antiabortion activists followed Booker to the grocery store, and they huddled in the driveway outside his house. After Hill killed the abortion doctor and his escort, Booker began wearing a bulletproof vest and an Army helmet. Eventually, federal marshals began providing him around-the-clock security.

Atkins hadn’t wanted to hire Booker. The doctor had spent a few years performing abortions on the Gulf Coast. He’d filed bankruptcy, and in the early 1990s, a patient won a lawsuit against him after she claimed that he’d botched her abortion. Still, Atkins hadn’t been able to find anyone else after her previous doctor went to prison for child pornography, she said, so she hired Booker. Eventually, though, his troubles caught up with him. In 2000, he went to prison for tax evasion for five months. (Booker died at home in 2013.)

Eventually, Atkins found another doctor, DeHenre, a physician who’d studied in New York then moved to Mississippi as part of a loan forgiveness program. Atkins said he was the most talented doctor she ever worked with, but in 2004, he lost his license in Alabama after a patient died. Mississippi officials revoked his license soon after. In 2008, he was convicted of manslaughter in the 1997 shooting death of his ex-wife.

Atkins considered looking for yet another doctor, but by that point, she’d run her clinic for 25 years, and she was tired of dodging McMillan every day on her way to work, she said. She had three kids, including a 4-year-old daughter with special needs, and the work had taken an emotional toll on her. For years, Atkins said, she was in the room for every procedure.

“I felt like I had had so many abortions myself from standing with patients and looking into their eyes and holding their hands,” Atkins said. “I had done my battle, I felt. I was ready to pass the torch.”

‘Double careful’

Jackson Women’s Health Organization opened in 1995, less than a year after Tucker’s license was suspended. Now known as “the Pink House,” JWHO has been the sole abortion clinic in Mississippi since Atkins closed her doors in 2004.

At the time, JWHO founder Susan Hill owned eight other clinics across the country, many in cities with no other abortion provider. Like Atkins and Brown, Hill struggled to find local physicians “brave enough and willing to provide care,” she said in 1996, according to a Supreme Court filing for the upcoming case. As antiabortion protesters — including McMillan — continued to harass employees at her clinic, she paid to fly in doctors from other states, rotating between seven doctors who worked at her other clinics.

More than two decades later, JWHO still employs no doctors who live in Mississippi. Antiabortion activists have continued to vandalize the clinic and stalk its staff. JWHO representatives meet regularly with members of the FBI to discuss security concerns.

While Hill encountered fewer of the medical licensing issues that plagued many of the other Mississippi clinics, she had to contend with a steady barrage of government restrictions. In 2004, Mississippi passed more antiabortion legislation than any other state in the country.

In a state where abortion was a “political hot potato,” Hill realized she had to be “double careful,” said Ann Rose, who started JWHO with Hill. Their staff couldn’t “cut corners,” as some of the other Mississippi doctors had done, said Betty Thompson, a counselor who worked at the Jackson clinic when it opened and later became its director. From the beginning, Hill required her staff to undergo extensive training on every aspect of clinic operations, Thompson said, including equipment sterilization and waste management.

“You followed your protocol,” she said. “You didn’t deviate.”

That attention to detail has protected the clinic, Thompson said. They’ve come close to closing several times, most recently in 2012, when they were faced with new legislation requiring doctors to have admitting privileges at local hospitals. A judge blocked the law the day it was slated to take effect.

The law before the Supreme Court wouldn’t necessarily shutter JWHO. The clinic only offers abortions up to 16 weeks, and the proposed law would ban the procedure after 15. But Mississippi Attorney General Lynn Fitch has asked the court to use the case to overturn Roe v. Wade, and a subsequent 1992 endorsement of abortion rights in Planned Parenthood v. Casey. States should be free even to ban elective abortions so long as they show the prohibition promotes a legitimate government interest, Fitch wrote in her brief.

Lane, the Mississippi antiabortion activist, is hopeful that the Supreme Court will overturn Roe. While he’s glad that just one clinic remains open, he said, “they are still killing babies in Mississippi.” He won’t be satisfied until abortion is illegal in his home state, he said.

In their own amicus brief for the Dobbs case, advocates from the Southern Poverty Law Center and the National Organization for Women argued that a ruling in favor of Mississippi might reward the tactics that McMillan and others used, ultimately emboldening others to try similar acts of violence and intimidation.

Atkins shares those fears. She assumed, when she closed her clinic in 2004, that Jackson Women’s Health would persist and that Roe would protect it.

“I fought for so many years, and I believed,” Atkins said. “It will be a sad day to me if there are no clinics here. You start unraveling one thing, and you can unravel anything.”

About this story

Editing by Annys Shin and Lena Felton. Design and development by Kat Rudell-Brooks. Design editing by Rachel Orr. Photo editing by Annaliese Nurnberg. Research by Eddy Palanzo. Copy editing by Annabeth Carlson. Photos by Emily Kask.