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For eight years, Derenda Hancock has ushered women from their cars to the doors of Mississippi’s only abortion clinic, donning a rainbow vest as she shields them from protesters waving religious pamphlets and shouting “turn back!” through bullhorns.

Hancock, a 62-year-old part-time waitress, grew accustomed to repeated attempts by lawmakers and anti-abortion activists to block access to abortions at the Jackson Women’s Health Organization where she leads the clinic’s volunteer escorts.

But the future of that access feels threatened like never before after the U.S. Supreme Court thrust the clinic’s noisy city block into the center of the country’s contentious debate over abortion rights.

The court on Monday agreed to review Mississippi’s bid to ban most abortions after 15 weeks of pregnancy, a Republican-backed measure enacted in direct challenge to the landmark 1973 Roe v. Wade ruling that legalized abortion nationwide.

The court’s new 6-3 conservative majority, which is not expected to rule on the case until next year, could decide to weaken or overturn that ruling, which established a woman’s right to terminate a pregnancy before the fetus is viable, usually between 24 and 28 weeks.

The Jackson Women’s Health Organization, known locally as the “Pink House” because of its bubble gum-colored paint, is named in the case.

“Our little case here, everything hangs on it,” said Hancock, tears forming under her lavender eye shadow as she talked about patients, some who drive hundreds of miles and scrape together the $150 needed for an initial appointment.

“If they do overturn Roe, we’re done,” she said. “I know in my heart this is the big enchilada.”

Mississippi is one of six states with a single abortion clinic. It is also one of about 10 states with “trigger laws” that would effectively ban abortion outright without Roe v. Wade, according to the Guttmacher Institute, which supports abortion rights.

Three others border Mississippi – Arkansas, Louisiana and Tennessee – meaning an overturn of Roe could eliminate legal abortion access for millions of women in the U.S. South.

Mississippi has enacted other laws that impede the ability to get abortions. Women must wait at least 24 hours between their first consultation and the procedure, there are mandatory sonograms, minors need parental consent, and public funding through Medicaid does not cover most cases.

The Jackson clinic has been on the brink of a shutdown before as a result of various restrictive laws. After the Supreme Court news broke last week, the clinic received a flurry of calls from panicked patients asking if it would stay open, said its director, Shannon Brewer.

Sitting at her office desk a few days later, Brewer’s eyes darted constantly to a television showing feeds from the clinic’s security cameras. She said she could not break the nervous habit: People have vandalized the property in the past, and Brewer fears for the safety of the staff and doctors.

“The impact it would have affects so many clinics, so many women,” Brewer said. “This one has a huge impact across the country.”

CAUTIOUS OPTIMISM FOR ABORTION OPPONENTS

The Supreme Court’s review is a victory for anti-abortion lawmakers who have pushed hundreds of abortion restrictions through Republican-led state legislatures in recent years.

Outside the Pink House, most of the anti-abortion protesters said a favorable decision would not be enough.

“Ideally I’d like a constitutional amendment that recognizes the humanity of the unborn,” said Dr. Beverly McMillan, a former Mississippi abortion provider who now opposes the procedure.

She paced along the clinic sidewalk praying her rosary beads, part of a group of protesters that included street preachers blasting gospel music and soft-spoken elderly women handing out prayer cards.

Allan Klein, an engineer also praying rosary beads, said he felt removing the constitutional right to abortion was just an initial step and that religious reasoning was needed to prevent women from ending pregnancies.

“I’m more interested in getting people to change their minds,” he said. “Ultimately, law enforcement isn’t going to completely keep people from doing what they want to do.”

For L.W., a 33-year-old mother of two who asked to go by her initials for privacy, difficult circumstances led her to shift her stance on abortion.

A Jehovah’s Witness, she previously leaned against abortion. But financial hardship and her struggle with alcoholism played a role in her decision to get a medication abortion at eight weeks pregnant, she said.

“I struggled between ‘I don’t want to do it’ and ‘I have to do it,’” L.W. said, sitting in the clinic’s gated courtyard last week after a check-up.

In Mississippi, where some 20% of residents live in poverty, the majority of abortion patients get financial assistance through national abortion funds to cover the procedure, which can exceed $600. The women often still have to save up for the cost of at least two trips – one for state-mandated counseling and another for the procedure.

About half of women who get abortions in the United States are in poverty, according to Guttmacher’s most recent data from 2014.

L.W. said her experience made her more passionate about protecting abortion rights.

“No one here knows what I’m going through,” she said, her hands folded in her lap as shouting and music echoed from the street.

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