What it’s like to run an abortion clinic while awaiting the Supreme Court decision

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The people who run abortion clinics in the United States agree: there’s no such thing as a job.

There are the customers – so many of them are desperate, needy, grateful. There are the opponents of abortion, passionate, relentless, often furious. And on top of it all are legal challenges and the realization that your clinic may just be a court order away from extinction.

This reality took on added urgency last week with a leaked draft opinion from the US Supreme Court suggesting that a majority of justices support overturning the 1973 Roe vs Wade decision legalizing abortion. . If that happens, it could spell the end of abortion in about half of the states.

The Associated Press spoke with three women and one man who run abortion clinics in those states about their work. Some came to work through personal contact with abortion; for others, it started as a job. For everyone, it has become a vocation.

SHREVEPORT, LOUISIANA

When Kathaleen Pittman was growing up in a small conservative community in rural Louisiana, abortion was not openly discussed. When she started working at Hope Medical Group for Women, she sat her mother down and told her.

“To my amazement…she then said to me, ‘Women have always had abortions and always will. They need a safe place,” she recalls. “That moment was kind of a watershed moment.”

She was not attracted to work as an activist. The part-time job as a counselor for women undergoing abortions suited her well as she tried to complete her master’s degree.

But she knew the fear that some women feel when faced with an unwanted pregnancy. In her early twenties, a good friend approached her for help getting an abortion. At the time, in the early 1980s, the procedure was legal but they had no idea where to find anyone in northwest Louisiana who had performed it.

Pittman dialed in information. It took 20 minutes to find a doctor in neighboring Arkansas. Her friend was desperate.

“I’m sitting there watching her cry,” Pittman says.

Pittman served as an advisor, board director and deputy administrator before becoming clinic director in 2010. The clinic has survived numerous efforts to restrict abortion, such as waiting period requirements or privileges of admission for doctors.

When she started working there, about 11 other clinics were operating in the state and some private doctors performed abortions. Now Hope is one of the remaining three.

To relieve stress, she does embroidery. She also sends text messages to other clinic administrators. A few times a month, they get together on Zoom to compare notes or just blow off steam.

“It can be very isolating, especially running a clinic in the South,” she says.

Pittman knows the Supreme Court ruling could end abortion in his state. When the draft notice leaked, Pittman says she had a “horrible feeling” in the pit of her stomach. But then she took stock and reminded herself that it wasn’t final. For now, abortion is legal.

And as always, she focused on the women who pass by her office every day, after their appointments.

“They don’t look like they have the weight of the world on their shoulders anymore,” she says.

CHARLESTON, WEST VIRGINIA

Katie Quinonez had the first of her two abortions when she was 17, months after graduating from high school. She was in an emotionally abusive relationship with a man seven years her senior.

She wanted to go to college, to have a career. “I didn’t want to be chained to this person for the rest of my life because of a mistake I made in high school,” says Quinonez, now 31.

Ashamed to tell her mother, Quinonez worked at a pizza place after school to save for an abortion. The weeks passed; finally, Quinonez broke down and revealed her fate. Her mother immediately supported her and helped her to make an appointment for an abortion.

But at that time, she was in her second trimester. The experience was traumatic. She remembers crying in pain as she walked through the door.

Shortly after graduating from college, she found out she was pregnant again and was ashamed.

But this time the experience was different. She had a supportive partner — now her husband — who accompanied her to another clinic, the Women’s Health Center of West Virginia in Charleston. From the nurses holding her hand to the recovery room with big comfy chairs, it was a “meaningful experience.”

“There was no judgment or shame,” she says.

It was this experience that led her to apply in 2017 as the center’s development director. At that time, it was the only clinic left in the state. She became its leader in January 2020.

It was, she says, her dream job.

Every day is a challenge. Bills banning or limiting abortion care are introduced every year. The clinic is almost surrounded by anti-abortion activists: a pregnancy center has set up shop next door and a pro-life organization has bought land across the street and erected a large cross white.

But she and her staff see the clinic as a refuge from these outside forces. Even if Roe is knocked down, she is determined that the clinic will stay open and continue to provide resources such as birth control, emergency contraception, and testing and treatment for sexually transmitted infections.

And a clinic fund that pays for abortions for those who can’t afford them will continue to do so — and it will also help cover travel costs to states where the procedure will be legal.

“I know firsthand how critical it is to be able to get the abortion you need,” she says.

HUNTSVILLE, ALABAMA

Dalton Johnson says his mother always thought he would grow up working in a dangerous job, maybe joining the FBI or DEA. But her current job – owning and operating the last abortion clinic in Huntsville, Alabama – carries its own threats and dangers.

In fact, when he and his partner at the time, a Huntsville doctor, decided to open the clinic, his partner told him it was dangerous work. The associate felt responsible to meet with Johnson’s parents first to address any concerns and questions they might have about their son’s new business.

Johnson initially expected to spend a few years at the Alabama Women’s Center for Reproductive Alternatives and then move on. But he soon realized that was what he was meant to do. He also realized that if he closed, no one would take his place, and that weighed on him.

“I really believed that…we were really helping women,” he says.

It took about two years to obtain the necessary authorizations to open the clinic. And the challenges have not ceased.

The clinic doctor – who would become Johnson’s wife – was arrested for Medicaid fraud, charges that were later dismissed. There were legal hurdles involving admission privileges for doctors at the center and the clinic’s proximity to a school. Johnson was the target of threats; he resigned from his church’s board to protect it from harassment.

He says he’s also been accused of preying on the black community — a particularly infuriating accusation because he’s African American: “They’re drawing the race card from me,” he says in disbelief.

His wife has an obstetrics and gynecology practice located in a separate facility. If the Supreme Court overturns Roe and his clinic is forced to close, they’ll likely turn that space into another branch of his wife’s practice and move staff there without having to fire anyone.

But he worries about the effect on Alabama women of a loss of abortion services.

“It’s really sad that so few people can make the choice for so many women,” he says.

FARGO, NORTH DAKOTA

Tammi Kromenaker has dedicated her entire adult life to helping women get abortions. And with the Supreme Court’s draft opinion leaked, she’s beginning to think the Red River Women’s Clinic’s days are numbered.

“The writing has been on the wall for a long time, but I think now it’s in ink,” she says.

It wasn’t necessarily a career she planned to grow up in a Catholic family in suburban Minneapolis, where she attended Christian music festivals with her boyfriend.

But during her freshman year at the University of Fargo, a good friend got pregnant. Kromenaker remembers her immediate reaction: her friend needed an abortion. She sent him money to help pay.

In a flash, his thinking had changed. “It was like night and day,” she says.

A professor recommended her for a part-time position at an abortion clinic. It turned into a full-time job; then, when the Rouge River clinic opened in 1998, she moved there as director. Finally, in 2016, she bought Red River — now the only surviving abortion clinic in North Dakota.

The clinic is right across the street, and even in freezing North Dakota winters, protesters are outside, calling out to the women and the volunteers escorting them. There was never any violence, she said, but once a protester entered the building. Kromenaker confronted him at the top of the stairs.

“I said, ‘You have to go,'” she recalls. “And he did.”

Kromenaker, 50, spoke to clinic staff about the Supreme Court’s draft opinion, stressing that it is not yet final. And she found comfort in the story of a woman who was doing a pre-abortion consultation and took the time to tell the staff that she had seen the news and was grateful for the clinic.

Kromenaker worries about his staff if abortion is banned in the state. Most employees work there one day a week when they perform abortions, but there are a few full-time employees. She hopes the project’s leak will galvanize Americans to support abortion rights.

But otherwise, she is ready. No state line, she says, will stop her from continuing her life’s work.

She plans to cross the Red River to Minnesota and open another clinic there.


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