In a nondescript, windowless office facing a narrow hallway, abortion clinic administrator Catherine Pittman watches patients come and go, coordinates her staff, and tamps down the occasional wave of paranoia. 'If you get too caught up in the what-ifs, you can become paralyzed,' she says. 'We have to focus on caring for these women. Many patients ask, "What will happen?" and we can't guarantee them anything." This small independent clinic in Shreveport, Louisiana, is the new epicenter of America's abortion wars, because even worse times are ahead.

On March 4, Hope will appear before the U.S. Supreme Court in a case that could upend abortion access in Louisiana and across the country and signal the beginning of the end of Roe v. Wade. The case stems from a 2014 Louisiana law that forces doctors who perform abortions to have admitting privileges at nearby hospitals. The law is the same law that was struck down in the landmark 2016 Texas Supreme Court decision, Whole Woman's Health v. Hellerstedt, but the Louisiana version was nevertheless upheld by one of the nation's most conservative appellate courts, the Fifth Circuit Court of Appeals, in 2018 by the It was upheld. The ruling infuriated abortion rights advocates, who described it as "brazen" and "unjust. "In October, the Supreme Court agreed to hear Hope's appeal. A ruling is expected in June.

Louisiana law 620 is a classic example of what pro-choice groups refer to as TRAP, or regulations aimed at abortion providers. Admission privileges, which give abortion providers the ability to admit and treat patients at nearby hospitals, were an important part of such a law. The main reasons for this are that abortion procedures have a very low complication rate, hospitalization is extremely rare, and by law hospitals must treat emergency patients regardless of whether or not they have an agreement with a physician.

These laws have forced clinics to close. This is because it is difficult, and often impossible, for physicians to obtain admitting privileges at hospitals in states where opposition to abortion is strong. In Texas, before the Supreme Court struck down the law, half of the state's approximately 40 clinics were closed by the law, many of which never reopened because they lost their leases and their staff and doctors found other employment or sold their equipment. Once the Louisiana version of the law takes effect, the last three abortion clinics in the state, including Hope, will likely close.

Bipartisan groups across the country are supporting Hope's lawsuit. In a brief filed with the Supreme Court, the American Medical Association argued that the law is unnecessary, in part because abortion is extremely safe. The American Bar Association (ABA), in its first amicus brief to the Court in an abortion case, warned that allowing the law would jeopardize the integrity of the Court.

Since the 2016 Texas decision, however, two things have changed. Louisiana's law will be the first abortion case to be argued before the newly conservative Supreme Court, remade by President Donald Trump. At the very least, some expect the Court to use cases like Louisiana's to gradually dismantle Roe and weaken its power until it is virtually powerless. Upholding Louisiana's law, many fear, would show that the Court is hostile to Roe.

The Hope Company is located at a discreet intersection in Shreveport, a small city in a quiet corner of Louisiana. Entering a simple one-story brick building, a heavy green door opens to a second security door. On one visit, a woman in her twenties from Texas came for an abortion procedure as part of her plan to leave her abusive partner. A couple from Lake Charles, Louisiana, who already had three children with special needs, told me they could not care for a fourth child for fear of a similarly serious condition.

Even the majority of Democrats in the area are pro-life; in 2016 alone, Congress passed seven anti-abortion bills. Last year, Democratic Gov. John Bel Edwards signed the "Heartbeat" abortion ban into law. When Pittman entered the clinic in 1992, it was one of 17 in the state. Since then, she has watched Louisiana steadily chip away at abortion rights.

Pittman grew up in the small town of Davarie, a half-hour away in northwestern Louisiana. The 14th of 16 siblings born into a devout Baptist family, his first encounter with abortion was when he tried to help a friend get an abortion shortly after the Roe decision. Today, Pittman is a presence in every sense of the word. His imposing height, broad shoulders, slightly wild hair, and big smile.

Growing up in a large family, she has learned how to keep her cool in the midst of drama, which she notes makes her a good fit for her job. She manages a staff of 23 people, many of them part-time, and handles the daily stresses with calm, but also with a uniquely Southern firmness in the face of what she calls the "pro-birth" movement.

After nearly 30 years in the clinic, Pittman says it is "unrealistic" to face a Supreme Court case. 'It's amazing how many more battles we're fighting than we were back then. The clinic staff practices a kind of extreme compartmentalization. She says, "If we didn't, we'd go absolutely nuts."

Katie Caldwell, a counselor and advocate at the clinic, has worked at the clinic for most of the last decade. 'It's gotten harder to do this job, but it's always been that way,' Caldwell says. 'You can't get back on track if you despair of this job.' Pittman is always calm. Pittman is always calm. I think she feels the weight, but she takes it gracefully," Caldwell says. She may be sweating, but she doesn't let it show. Because she knows that's what you have to do as a leader."

Another counselor, A.J. Haynes, describes this as "survival mode." She says the clinic has seen an increase in greeting cards with kind messages and offers of help, a sign that the public understands the threat. Says Haynes, "We already have this level of awareness of what's at stake, and now we're just waiting for everyone to wake up."

The clinic handles about a third of the 8,000 to 10,000 abortions performed in the state each year while complying with the state's nearly 1,000 abortion regulations, managing clinic protesters and patient escorts, and responding to countless media requests. Hope has also received legal support from the Center for Reproductive Rights (CRR), one of the nation's leading pro-choice legal nonprofits. The center has filed 27 lawsuits in Louisiana since 1992, when CRR was founded, and Hope has worked with Pittman's attorneys throughout his career. Says Pittman, "Thank God." Without the lawyers, "there wouldn't be a single clinic still open in Louisiana."

Julie Reichelman, CRR's senior litigation director, who will argue the case before the Supreme Court, says the case is "extremely important. Not only is Louisiana arguing that its law should be put into effect, it is asking the Court to reconsider whether clinics should even be allowed to sue because of the constitutional rights of patients who undergo abortions. It is difficult to overstate the impact of this court case. For decades, it has been clinics that have sued the government to protect their reproductive rights, and the Supreme Court has always ruled in favor of the clinics. They acknowledged that a pregnant person seeking an abortion is in an unfavorable position to file and fight a lawsuit that could drag on for years. By the time a final ruling is rendered, it will be too late to have an abortion. Says Rickelman. 'They are trying to make it harder for people to challenge restrictions on abortion. It's just another strategy to try to put abortion out of reach."

But this argument underscores another important element of the ultimate defense for abortion rights. The main players in this battle are small clinics like Hope. According to the Abortion Care Network's 2019 report, all remaining clinics in Louisiana are privately owned, as are the last three in Alabama, the remaining two in Wyoming, and the only remaining clinics in Kentucky, Mississippi, North Dakota, and West Virginia The same is true for the only remaining clinics in Kentucky, Mississippi, North Dakota and West Virginia. Says Pittman. "It's 'little old us.' 'We are up against this wall and we have no choice. We cannot back down and we must move forward.

CORRECTION: An earlier version of this article misspelled Julie Rickelman's name. Our apologies.

This article appeared in the March 2020 issue of Marie Claire

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