The people who run America’s abortion clinics agree: There’s no job like it.
There are the clients — so many of them desperate, in need, grateful. There are the abortion opponents — passionate, relentless, often furious. And hovering over it all are legal challenges, and the awareness that your clinic may be just a judicial ruling away from extinction.
That reality became more urgent last week with a leaked, draft opinion from the U.S. Supreme Court suggesting a majority of justices support overturning the 1973 Roe v. Wade decision legalizing abortion. If that happens, it could spell the end of abortion in about half the states.
The Associated Press talked with three women and one man who run abortion clinics in such states about their work. Some came to the work through personal brushes with abortion; for others, it started as a job. For all, it has become a calling.
When Kathaleen Pittman was growing up in a small, conservative community in rural Louisiana, abortion was not openly discussed. When she started working at the Hope Medical Group for Women, she sat her mother down and told her.
“To my shock … she told me then: ‘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 drawn to the work as an activist. The part-time job counseling women undergoing abortions was a good fit while she was trying to finish her master’s degree.
But she knew the fear some women feel with an unwanted pregnancy. When she was in her early 20s, a good friend asked for her help getting an abortion. At the time, in the early ’80s, the procedure was legal but they didn’t know where to find someone in northwestern Louisiana who performed it.
Pittman dialed information. It took 20 minutes to find a doctor in nearby Arkansas. Her friend despaired.
“I’m sitting there watching her cry,” Pittman says.
Pittman was counselor, director of counseling and assistant administrator before becoming director of the clinic in 2010. The clinic has survived numerous efforts to restrict abortion, such as requirements for waiting periods or admitting privileges for doctors.
When she started working there, about 11 other clinics operated in the state, and some private doctors performed abortions. Now, Hope is one of three remaining.
To alleviate stress, she does needlepoint. She also texts other clinic administrators. A few times a month they gather on Zoom to compare notes or just to vent.
“It can be very isolating, particularly running a clinic in the South,” she says.
Pittman knows the Supreme Court ruling could end abortion in her state. When the draft opinion leaked, Pittman says she had a “horrible feeling” in the pit of her stomach. But then she took stock, and reminded herself that it was not final. For now, abortion is legal.
And as always, she focused on the women who walk past her office every day, after their appointments.
“They no longer look like they have the weight of the world on their shoulders,” 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 attend college, have a career. “I didn’t want to be chained to this person for the rest of my life because of a mistake that I made in high school,” says Quinonez, now 31.
Ashamed to tell her mother, Quinonez worked at a pizzeria after school to save up for an abortion. Weeks passed; finally, Quinonez broke down and revealed her plight. Her mother was immediately supportive and helped her schedule an abortion appointment.
But by then, she was in her second trimester. The experience was traumatic. She remembers crying in pain as she walked out the door.
Shortly after she graduated 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 went with her to a different clinic, the Women’s Health Center of West Virginia in Charleston. From the nurses who held her hand to the recovery room with big comfy chairs, it was an “affirming experience.”
“There was no judgment or shame,” she says.
It was that experience that led her to apply in 2017 as the center’s development director. By that time, it was the only clinic left in the state. She became the leader in January 2020.
It was, she says, her dream job.
Every day is a challenge. Bills to ban or limit abortion care are introduced every year. The clinic is nearly surrounded by anti-abortion activists: A pregnancy crisis center moved in next door, and a pro-life organization purchased land across the street and erected a large white cross.
But she and her staff see the clinic as a safe haven from those outside forces. Even if Roe is overturned, she is determined that the clinic stays open and continues providing resources like birth control, emergency contraception and testing and treatment of sexually transmitted infections.
And a clinic fund that pays for abortions for those who can’t afford them will continue to do that — and it will also help with the cost of traveling to states where the procedure will be legal.
“I know firsthand how critical being able to get the abortion that you need is,” she says.
Dalton Johnson says his mother always thought he’d grow up to work in a dangerous job, perhaps join the FBI or the DEA. But his current line of work — owning and operating the last abortion clinic in Huntsville, Alabama — has come with its own threats and dangers.
In fact, when he and his then-partner, a Huntsville doctor, decided to open the clinic, his partner told him that it was hazardous work. The partner felt a responsibility to meet 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 to something else. But he quickly realized that this was what he was meant to do. He also realized that if he closed down, no one would take his place, and that weighed on him.
“I just really believed that … we’re really helping women,” he says.
It took roughly two years to get the approvals to open the clinic. And the challenges have not stopped.
The clinic’s doctor — who would become Johnson’s wife — was arrested for Medicaid fraud, charges that were later dismissed. There were legal obstacles involving admitting privileges for doctors at the center and the clinic’s proximity to a school. Johnson has been the target of threats; he stepped down from the board of his church to protect it from harassment.
He says he’s also been accused of preying on the Black community — an accusation that’s particularly galling because he is African American: “They’re pulling the race card on me,” he says, incredulously.
His wife has an ob/gyn practice that is 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 transfer the staff there without having to lay anyone off.
But he’s worried about the effect on Alabama women of a loss of abortion services.
“It’s really just sad how so few people can make the choice for so many women,” he says.
FARGO, NORTH DAKOTA
Tammi Kromenaker has given over her entire adult life to helping women get abortions. And with the leak of the Supreme Court’s draft opinion, she’s beginning to think the days of the Red River Women’s Clinic 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 foresaw growing up in a Catholic family in suburban Minneapolis, where she attended Christian music festivals with her boyfriend.
But during her freshman year in college in Fargo, a good friend got pregnant. Kromenaker remembers her immediate reaction: Her friend needed an abortion. She sent her money to help pay for it.
In a flash, her thinking had changed. “It was like night and day,” she says.
A professor recommended her for a part-time position at an abortion clinic. That turned into a fulltime job; then, when the Red River clinic opened in 1998, she moved there as the director. Finally, in 2016, she bought Red River — now the only surviving abortion clinic in North Dakota.
The clinic sits right on the street, and even in frigid North Dakota winters protesters are outside, calling to the women and volunteers who escort them in. There’s never been any violence, she says, but one time a protester did get into the building. Kromenaker confronted him at the top of the stairs.
“I said, ‘You need to go,’” she recalls. “And he did.”
Kromenaker, 50, talked to the clinic staff about the draft Supreme Court opinion, emphasizing that it’s not yet final. And she took solace in a story of a woman who was doing a pre-abortion consultation and took time to tell the staff she’d seen the news and was grateful for the clinic.
Kromenaker worries about her staff if abortion is outlawed in the state. Most employees work there the one day a week they perform abortions, but there are a few fulltime employees. She hopes the draft leak will galvanize Americans to support abortion rights.
But if not, she’s prepared. No state line, she says, will prevent her from continuing her life’s work.
She plans to cross the Red River to Minnesota and open another clinic there.