JACKSON, Miss. - From Texas to Alabama, laws are being enacted that would greatly restrict access to abortion, forcing many women to travel hundreds of miles to find a clinic. The laws, requiring abortion doctors to have privileges to admit patients to local hospitals, could have a profound impact on women in poor and rural sections of the Bible Belt.
In many places in the South, clinic doctors come from out of state to perform abortions and don't have ties to a local hospital. Critics say the laws mean hospitals, leery of attracting anti-abortion protesters, could get veto power over whether the already-scarce clinics remain in business. They say the real aim is to outlaw abortions while supporters say they are protecting women's health.
The laws are the latest among dozens of restrictions on abortions that states have enacted in the past two decades, including 24-hour waiting periods, parental consent and ultrasound requirements.
"You're looking at huge swaths of the country where women's options are becoming severely limited," said Amanda Allen, state legislative counsel for the New York-based Center for Reproductive Rights.
The requirements are already in effect in Texas and Tennessee. Laws in Mississippi and Alabama are on hold during court challenges. Louisiana and Oklahoma are about to enact their laws, which would bring the total to 10 states. If the law there is upheld, Mississippi's lone abortion clinic would have to close, meaning women in some parts of the state would have to travel at least three hours to an out-of-state clinic.
Republican Gov. Phil Bryant bluntly gave one reason for signing that law in 2012: "...we're going to try to end abortion in Mississippi."
The Center for Reproductive Rights says besides the South, other states with the laws are in the Midwest or the West - Kansas, North Dakota, Utah and in Wisconsin, where it is being challenged in court this week.
After judges allowed Texas' privileges law to take effect earlier this year, 19 of 33 abortion clinics closed.
If Mississippi's lone clinic would shut its doors, one option would be to drive about three hours from Jackson to Tuscaloosa, Alabama, or about three and a half hours from Jackson to Bossier City, Louisiana. A less likely option for a small number of women would be to find a Mississippi doctor who performs 10 or fewer abortions a month. If the doctor performs more, the practice is considered an abortion clinic under the law.
Supporters say admitting privileges protect women in case they hemorrhage, have cervical injuries or infection or other problems during an abortion.
Denise Burke is vice president of legal affairs for Americans United for Life, one of the main anti-abortion groups lobbying state legislatures to enact such laws.
"An admitting privileges requirement is an obvious and medically appropriate regulation of the abortion providers," Burke said.
Allen counters that the privileges are "absolutely not medically necessary" and that they are aimed at shutting down clinics and to severely restrict access to a legal medical procedure.
The Guttmacher Institute, which supports legal access to abortion, in a February report said first-trimester abortions carry "minimal risk," with less than 0.05 percent - 1 in every 2,000 cases - involving "major complications that might need hospital care." The report also said 89 percent of abortions in the U.S. are done within those first 12 weeks of pregnancy. A full-term pregnancy is 40 weeks.
And if there were complications, hospitals would still accept and treat a patient even if her doctor can't sign her in, opponents of the law say.
In 1992, the U.S. Supreme Court upheld the landmark 1973 Roe v. Wade decision that legalizes abortions nationwide. It gave states the option to regulate abortions before fetuses are viable. But it came with the caveat that states may not place undue burdens on or create substantial obstacles to women seeking abortions.
Court challenges are arguing that admitting privileges laws create just such burdens.
Religious-affiliated hospitals might ignore or reject applications from abortion providers, and some won't grant privileges to out-of-state physicians. Both obstacles were encountered by the traveling doctors who work at Mississippi's clinic.
In Alabama, operators of three of five abortion clinics testified last week during a trial challenging the law that they use out-of-town doctors who wouldn't be able to admit patients to local hospitals. They said they'd have to close. That would leave clinics in two cities, Tuscaloosa and Huntsville, which use local doctors, according to the state attorney general's office.
In Louisiana, opponents said the Louisiana law would close three of the state's five abortion clinics, leaving two in the northwest corner of the state - one in Shreveport and one in Bossier City. That creates a five-hour, one-way drive for women who live in the southeastern end of the state.
At Mississippi's clinic, Jackson Women's Health Organization, protesters on several days a month stand outside to pray, sing hymns and hold posters with photos of aborted fetuses. Escorts in fluorescent yellow vests walk patients from the parking lot to the clinic, often as music blares from a boom box to drown out the protesters' voices.
Laurie Bertram Roberts has volunteered as an escort and said if facilities close, women would likely try to end their own pregnancies in potentially dangerous ways.
"Desperate people do desperate things," said Roberts, president of the Mississippi chapter of National Organization for Women.
Ashley Sigrest is at the clinic every few weeks to persuade women not to end their pregnancies because she regrets the abortion she had in August 1998. Sigrest said she supports admitting privileges laws because she believes they protect women's health.
"The abortion doctors are flying from out of state and so they're not being held responsible for harming these women," Sigrest said.