For many abortion providers, working in a clinic isn’t just a job—it’s a calling. But clinics are businesses, too, and in the 15 states that have banned almost all abortions, business has been turbulent.
Pittman had worked at Hope Medical Group, one of the last abortion clinics in Louisiana, for thirty years. She’d started there as a part-time counselor in 1992; by 2022, she was running the place. She’d gone to the Supreme Court to defend her clinic and won, successfully striking down a Louisiana abortion restriction in 2020.
Two years after that victory, she watched as the Supreme Court dismantled her life’s work by overturning Roe v. Wade on June 24, 2022. She went back to court to try and fend off Louisiana’s cascade of abortion bans, but a month after the overturning, the clinic had to close. Louisiana had outlawed nearly all abortions.
“A lot of people were like, ‘Why are you bothering? It’s inevitable that you have to close your doors.’ And I knew,” Pittman said. “But at the same time, the staff and I also knew that every day we kept the doors open was another day we could help some patients. So that was our goal. We fought for as long as we could.”
For many abortion providers, working in a clinic isn’t just a job—it’s a calling. It has to be, in order for it to be worth the emotional toll, the stigma, and the very real threats of violence. But clinics are businesses, too. They need money to stay open. And, for abortion clinics that once operated in the 15 states that have now banned almost all abortions, business has been turbulent.
When Roe was first overturned, money gushed into abortion rights supporters’ coffers. People seemed to love to rage-click the “donate” button: More than 60 percent of Americans think that overturning Roe was a “bad thing,” according to polling released last week by Gallup, which also found record-high levels of support for abortion access. The 2022 midterms also proved that, at the ballot box at least, abortion rights could be a winning issue. People voted to keep abortion rights even in some of the most crimson parts of the country.
But over the last year, the river of cash has ebbed and flowed. When abortion hits the news, it increases—although it doesn’t quite hit the records set when Roe first fell. And when the lack of abortion access starts to feel like the status quo, the donations dry up.
At least 24 abortion clinics closed altogether due to the overturning, while another 33 have stayed open but ceased providing abortions, according to data collected by Caitlin Myers, an economics professor at Middlebury College.
In total, between March 2022 and April 2023, at least 91 facilities have stopped offering abortions.
At least five of those clinics—not including Pittman’s—packed up and relocated to other, friendlier parts of the country. Jackson Women’s Health Organization, the abortion clinic at the heart of the case that overturned Roe and the last abortion clinic in Mississippi, moved to New Mexico.
So did Whole Woman’s Health, a network of abortions clinics whose victory in a 2016 Supreme Court case had, like Pittman’s case, once seemed like a sign of better things to come for abortion rights supporters. Whole Woman’s Health was once the face of abortion in Texas. Now, the network has closed down its four locations in the state. Financially, it felt impossible to stay open without providing abortions.
“That’s like having a dermatologist where you say, ‘You don’t get to do any dermatology other than exams.’ There’s no other medical provider that’s expected to stay open when they’re blocked from doing the care they’re trained to provide,” Amy Hagstrom Miller, founder of Whole Woman’s Health, told VICE News last summer, after Whole Woman’s Health announced it was relocating to New Mexico. She’s already tried to keep clinics open through abortion restrictions so onerous that clinics could no longer function. “We have tried all of these things in the past and found out that not only was it not sustainable, but we had to support those clinics from other sites. And now I don’t have that flexibility.”
Marva Sadler, who used to lead clinical services for the Whole Woman’s Health clinics in Texas, wrestled for months with the question of whether to relocate with Whole Woman’s Health to Albuquerque, New Mexico—where the network has now opened up a new location—or to one of the network’s other clinics. She’s moved across Texas four different times so that she could keep working for Whole Woman’s Health, but she was always within driving distance of her family.
“I have more roots in Texas than just the work—family, children, grandchildren, elder parents who we’re taking care of,” Sadler told VICE News in October, as she weighed the decision. “What part of those roots am I able to cut, if I did need to relocate?”
“As much as the public and the women need me, my family does as well,” she added.
For some of the clinics that are staying behind in the post-Roe South, it’s become all too clear that the financial math doesn’t exactly add up.
“We have lost so much money over the last year, but we’ve also helped probably close to 400 patients,” said Robin Marty, operations director at West Alabama Women’s Center. The former abortion clinic now offers birth control, helps people handle miscarriages, and provides gender-affirming health care, among other services. “And does that compare to the 2,500 that we used to do a year? No, but every single one of those patients is somebody who would not have been able to get care without us.”
Marty quite literally wrote the book about life in a post-Roe world: In 2019, she wrote Handbook for a Post-Roe America. But, she admits, she got some of her predictions wrong. Marty thought more abortion providers would stay—not to perform abortions, but to offer other kinds of reproductive and maternal health services.
“I thought that there would still be a network and there is no network in the South and it’s breaking my heart,” Marty said. “We know that patients are leaving some of these red states, blue states, in order to get abortions. But what happens when they come home? What happens when they come back and they don’t have a place that they can go face-to-face in order to do any sort of follow up?”
The pivot away from abortion, Marty acknowledges, has been unbelievably rough. She had imagined that it would take about three months to transform into a full-scale reproductive health clinic, but, she told VICE News, the logistical and administrative hurdles have proven incredibly hard to surmount. (“I’ve never been more wrong about anything in my life,” Marty said. “Three months is nothing.”) In one year, the clinic has made about $25,000 in patient income—which doesn’t even cover two weeks’ worth of costs at the clinic, Marty said.
In Texas, just two independent abortion clinics pivoted to provide reproductive health care, according to Kathy Kleinfeld, administrator of the Houston Women’s Reproductive Services clinic. Every other independent clinic closed. (Independent clinics are clinics that don’t belong to Planned Parenthood. Although the words “Planned Parenthood” might be synonymous with abortion within political circles, indie clinics in fact provide the majority of abortions in the United States.)
The cost of keeping Houston Women’s Reproductive Services open was extraordinarily high. The clinic moved from a 5,000-square foot space down to a space with just 800 feet. They used to have 12 staff members and three physicians; now, they have three staffers and one medical director. Those who remained on staff took pay cuts.
Texas has banned almost all abortions, but people still call, every day, asking for them. And people come in all the time after getting out-of-state abortions. Kleinfeld recently treated a woman who returned to Texas only to find out, in Kleinfeld’s clinic, that her medication abortion did not work and that she was still 13 weeks pregnant. Now, that woman will have to travel out of state again.
“It was very traumatic for those patients to have traveled, only to find out that they have to go back,” Kleinfeld said. “The stigma, the fear, the anxiety—all of that has escalated to a sometimes-paralyzing level for people faced with a pregnancy that they cannot, do not want, to continue. Somebody has to be their lifeline.”
In the nine months following the end of Roe, there were nearly 66,000 fewer abortions in states with abortion bans, according to research from the Society for Family Planning. Although the number of abortions in states without bans rose, researchers estimated that they didn’t increase enough; people may have been self-managing their abortions, or simply going without.
Kleinfeld feels confident that her clinic will continue to soldier on. Right now, Marty has enough money to keep the clinic open for about four to five more months.
“When the state doesn’t want to help you and when the federal government seems to think that they can’t do anything… that’s when I have to turn to foundations. That’s when I have to turn to individuals and beg for money,” she said. “And that’s all I do now. I beg for money in my sleep.”
Because many independent clinics are not non-profits, they have to pay taxes on donations; for that reason, some clinics don’t necessarily want direct donations. The website for Red River Women’s Clinic, an abortion clinic that once operated in North Dakota before moving to Minnesota last year, lists out other ways that people can support the clinic, from paying for staff’s meals to helping escort patients in and out of the building.
At the top of that list is a link to the clinic’s GoFundMe.
On June 23, 2022—the day before Roe fell—Tammi Kromenaker, clinic director for Red River Women’s Clinic, closed on the building that would become her clinic’s new home in Minnesota. That same day, someone called Kromenaker to ask if they could set up a GoFundMe to help pay for the clinic’s upcoming move.
“I was really actually kind of dismissive. I was like, ‘Yep, sure. Great,’” Kromenaker recalled. “So we bought the building, June 23. They overturned Roe v. Wade, June 24. By August 6, we had reached $1 million in the GoFundMe.”
In the 10 months since, the GoFundMe has only raised another $13,000. But that fundraising has still made it possible for Kromenaker to pay off the loan she took out to buy her new building, as well as hire more administrative staff.
“I have no way, at this point, of separating out the GoFundMe from our operational dollars to be able to tell you how we're doing, because the GoFundMe is such a cushion right now,” Kromenaker said.
There’s just one ongoing national fundraising campaign dedicated to independent clinics: Keep Our Clinics, a campaign by Abortion Care Network, a membership organization for indie clinics. In 2021, Keep Our Clinics distributed $350,000 to independent clinics. That number, unsurprisingly, exploded in 2022, when the campaign gave $4.6 million. So far in 2023, indie clinics have asked Abortion Care Network for $2.5 million in aid, and the organization has so far been able to dole out $1.3 million.
“We’re nowhere near the fundraising capacity or the major recognition of a Planned Parenthood or a NARAL or anything like that,” said Erin Grant, Abortion Care Network’s co-executive director. (Despite receiving a $275 million gift from MacKenzie Scott, Jeff Bezos’ ex-wife, last year, Planned Parenthood is currently in the midst of layoffs.)
After the Court overturned Roe, Pittman raised $16,695 in a GoFundMe that had just one goal: opening a new clinic, as close to Louisiana and the South as possible, where she could still provide abortions to the same people she used to help at Hope.
Once Pittman found a new clinic, she and her clinic’s assistant administrator moved, leaving their families behind in Louisiana to take care of their houses. (Pittman asked that VICE News not publicize the location of her new clinic in order to minimize protests ahead of opening. Last year, a woman set an abortion clinic on fire in Casper, Wyoming, before it could open.) She gets homesick sometimes. But then she thinks about how she felt at the end of a day working at Hope, when she would watch patients walk out after their procedure. They were always so relieved.
“That’s what made me get up in the morning, is being able to see the patients leaving us and being ready to go out and move forward,” Pittman said. “Just seeing the relief on the patients, when you tell them, ‘You’re here now, we’re going to take care of you, it’s going to be okay.’ That makes it all worthwhile.”
Now, Pittman is only waiting on a license to fling open the doors of her new clinic.
“We were just so angry. And you make all these threats when you’re angry. Mine was, ‘Well, whatever it takes, I’m going to do it.’ But we held up our end of the bargain,” said “So we’re here.”