The Last Abortion Clinic in North Dakota Gets Ready...

The Last Abortion Clinic in North Dakota Gets Ready to Leave

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On the morning of June 24th, Tammi Kromenaker sat before a desktop computer in her office at the Red River Women’s Clinic, in Fargo, North Dakota, refreshing the home page of SCOTUSblog, a Web site that provides news and commentary on the Supreme Court. Kromenaker’s clinic occupies a two-story, pale-brick building on a recently gentrified downtown street that is also home to a boutique hotel and a bar serving locally brewed beers. It is the only abortion provider in North Dakota. Patients come for abortions on Wednesdays, most of them travelling from North and South Dakota and northwestern Minnesota. The clinic also serves people travelling from the region’s many Indian reservations; the Hyde Amendment, which restricts the use of federal funds for abortions, prevents the Indian Health Service from offering them or covering their cost. Every Wednesday, anti-abortion protesters harass arriving patients and the escorts, in rainbow vests, who work to protect them. The rest of the week, the clinic is mostly empty. Only Kromenaker and a few staff members were present when a post finally went up on SCOTUSblog, shortly after nine o’clock, which is also when the clinic opens. The post was a single line: “We have Dobbs.” Then the phone rang.

Summers are precious in Fargo. The light lingers golden until almost ten at night; the clinic closes early on Fridays. After a morning of fielding phone calls from frantic patients, Kromenaker’s staff retreated to a nearby bar to process the news. Kromenaker had planned to spend the weekend readying her garden for the coming season. Instead, she stayed at the office, responding to reporters asking for comment. She sent a motivational e-mail to her staffers, reminding them that, as bad as they might feel, they had to stay calm for their patients. She texted patients who had appointments the following Wednesday to let them know they could still come in, and that their abortions would be safe and legal. She got relieved and grateful responses in return. She was already contemplating the logistics of moving across state lines. It wasn’t an ending, exactly, but it was the end of something.

The Red River Women’s Clinic’s first three patients walked through the door twenty-four years ago, on July 31, 1998. One was too far along (the clinic provides abortions only for patients in the first sixteen weeks of pregnancy); the other two received care. In the years since, the clinic has steadily served a little more than a thousand patients a year, most of them from North Dakota. A majority are already parents. They come from three to four hours away, on average, and most return home the same day. The clinic’s doctor, who prefers to stay anonymous, also drives eight hours each time she comes to the clinic. The region is sparsely populated, and Red River has never struggled to meet demand. The numbers rarely vary: twenty to twenty-five patients every Wednesday.

Kromenaker, who turned fifty in January, grew up in a Minneapolis suburb, moving north to Moorhead to attend a branch of Minnesota State University. She opposed abortion when she arrived there; she pasted a bumper sticker in her dorm room that read “God is pro life.” A friend’s unwanted pregnancy changed her mind: “It was just an immediate shift for me,” she said. A women’s-studies professor took Kromenaker under her wing, and she graduated with a degree in social work and a desire to better the lives of women. After graduation, she got a job working the night desk at a domestic-violence shelter run by the Y.W.C.A. The women’s-studies professor referred her for another job, a part-time gig as a patient advocate at North Dakota’s only abortion clinic. The week before she started, activists blocked the clinic’s driveway with junk cars. When she arrived for her first day, her new boss said, “I didn’t know if you were going to show up.”

The clinic had opened, in 1981, thanks to the advocacy of a local feminist named Jane Bovard. Bovard, who is seventy-nine, now lives in Stillwater, Minnesota. She told me that the anti-abortion movement in North Dakota had been organized since before Roe v. Wade, dating its mobilization to when a state legislator from Fargo named Aloha Eagles tried, in the late sixties, to liberalize the state’s abortion laws. After Roe legalized abortion, in 1973, two North Dakota doctors in private practice began offering the procedure. Bovard had an abortion in Minneapolis in 1975—she had four children and decided with her husband that they had reached the limit of what they could emotionally and financially handle—then took out an ad in the White Pages directing women seeking abortions to call her at home for information. In time, a local doctor asked Bovard if she might figure out a way to open a clinic. She coördinated with the Women’s Health Organization, a national network of abortion clinics, to open a branch in Fargo.

As the years passed, both the clinic and Bovard, who was hired as its administrator, became targets of the anti-abortion movement. Bovard was frequently followed home by activists, who also picketed her house. On one occasion, she recalled, an activist came to her house at three o’clock in the morning and pounded on the door. Her husband loaded a shotgun, in case the person tried to enter before the police arrived. “I believed in the cause, and I hate bullies,” she told me, when I asked if she had ever considered closing the clinic. “I was just determined that they were not going to win.”

The clinic was firebombed, and, in the early nineties, it was targeted by the Lambs of Christ, an organization founded by a Roman Catholic priest who had served in the U.S. Army as a Green Beret, and whose tactics one prosecutor described as “paramilitary.” Its members believed that they were engaged in a holy war against sin, and their favored strategy was invading abortion clinics and U-locking their bodies to immovable objects. A Harvard-educated anti-abortion zealot named Martin Wishnatsky took up residence in Fargo full time and was repeatedly convicted of violating a judge’s order to keep his distance from the clinic. He told the Washington Post, in 1993, that America was in the midst of a moral decline caused by “ ‘unbridled lust’ and pervasive sexual immorality spawned by rock and roll music.”

Kromenaker would work the night shift at the Y.W.C.A., shower there, then go to her shift at the clinic. Sometimes she would cover for an assistant administrator. The clinic operated out of an old house that wasn’t well maintained; patients had to use a back entrance off the driveway. “Like going into the back alley, you know?” Kromenaker said. “It was really bad in Fargo,” she remembered; anti-abortion activists “thought it could be the first abortion-free state.” In 1996, while pregnant with her daughter, she was hired full time.

Two years later, Bovard and George Miks, a doctor who worked at the clinic, bought a building on First Avenue belonging to a female real-estate agent, who herself had bought it from the family of its first owner, a woman who’d started a wig shop and barbershop there after the structure was built, in 1907. “A woman has always owned this building,” Kromenaker told me, proudly. Bovard chose the name Red River deliberately; a forced move to Minnesota was a possibility even then, and she wanted the clinic’s identity to work in both states. After Bovard and Miks retired, they asked Kromenaker, in 2016, if she wanted to take over ownership. Abortion clinics have difficulty securing bank loans; Miks and Bovard loaned her the money to buy the clinic, and she is still paying Bovard back. She bought the building from them in 2019, but was able to get a commercial mortgage for that. A building is stable collateral; an abortion practice in North Dakota is not.

The Monday after the Supreme Court ruling, Kromenaker was at her desk again, this time looking at the Web page of North Dakota’s attorney general, who still had not certified the state’s trigger law. Kromenaker keeps her curly blond hair at chin length; she wore business casual and Birkenstocks. Her life is patterned around the weekly ebb and flow of the clinic, with its Wednesday crest of activity. Nothing about her manner would indicate an idealist practicing one of the most threatened and beleaguered professions in the country during a crucial moment in American history. The profession seems to attract people who are not easily riled, who can conduct routine business at the white-hot center of a culture war.

When the clinic opened as usual, at nine o’clock, there was no sign of its imminent dismantlement. In the carpeted second-floor waiting room, with its large windows that overlook the street, chairs were still spaced apart, a precaution for COVID. Two mannequins displayed clinic T-shirts on sale. (“Abortion—you betcha” was the slogan on one.) Hanging on the walls were a plaque commemorating the clinic’s George R. Tiller Award for Excellence, bestowed by the National Abortion Federation in 2015, and the framed text from a “Service of Blessing” (“May these doors be held in safety against the evil desires of any forces that wish to do harm”), given in 2011.

The clinic has a purple theme: its windowsills and file folders are purple, and the walls of its intake rooms are shades of lavender. Photographs of flowers in the same color family hang from the walls; floral adhesives cover the fluorescent lights in the rooms where procedures take place, to spare the patients some of the glare. A sign hangs in the bathroom: “Everyday, good women choose abortion. Everyday, we care for their bodies & hearts. When you come here, bring only love.” The décor is not meant to provide empty uplift but to undo some of the shame inflicted on patients by the outside world. Sarah Haeder, the clinic’s head nurse, remembers crying after a patient told her that a man had hissed in her ear on the way in, “You opened your legs—can you open your heart to this pregnancy?”

That Monday morning, Haeder’s fingernails were painted a sparkly violet. She sat at the front desk with patient charts spread in front of her. On Mondays and Tuesdays, staffers call patients with abortions scheduled for that week to talk over the details: how long it will take, how they will pay for it, how many protestors will be outside. When Haeder made the morning’s first call, she barely had time to introduce herself before a breathless nineteen-year-old on the other end of the line began lobbing a barrage of questions: Do I get to keep my appointment? Where do I have to go? Are you going to tell me where I have to go? Is it going to cost more money? For the first of many times that day, Haeder reassured the patient that her scheduled abortion was still legal; thanks to a grant from the National Abortion Federation, a procedure that normally costs seven hundred dollars would cost half that amount. In a cubicle toward the back of the office, another staffer was answering a question about whether the law would be retroactively applied in order to prosecute people who got abortions during North Dakota’s thirty-day window of reprieve. Staffers at the clinic have noticed, in recent months, that patients calling for abortions have started to speak in more coded language: instead of asking outright, a patient might ask “What do you do there?” or “Can I have that medication?”

As Kromenaker showed me around, she carefully aligned pamphlets about Paragard and Mirena IUDs—the clinic also offers birth-control services. In an administrative area with popcorn ceilings and skylights, impeccably maintained houseplants were placed evenly along the cubicle dividers. The medical offices and recovery room are on the first floor, down a stairway with the words “Chase your dreams” written on the wall above it. Kromenaker told me that she played office when she was a little girl. Lately, she has started posting the hate mail she receives on her social-media accounts with the senders’ contact information visible.

As the only clinic in the state, Red River, with help from its lawyers at the Center for Reproductive Rights, has been the primary legal opposition to the state’s attempts to pass new restrictions on women’s health care. They sued to stop a ban on abortions after six weeks that North Dakota attempted to pass in 2013, and an attempt to add language to pre-abortion consent statements about so-called medication-abortion reversal. Litigation on a state and federal level is a near constant for Kromenaker, as it is for most abortion providers, and even her staff has been deposed. She has travelled to Washington during oral arguments for abortion cases that have come before the Supreme Court—a visit there for the oral arguments in Dobbs v. Jackson Women’s Health Organization was the first time that she saw many of her peers from around the country since the pandemic began.

Kromenaker first met with a realtor about buying a building in Moorhead in September, 2021. The Supreme Court had announced that it would take up Dobbs, and Texas had just passed Senate Bill 8, which bans abortion at six weeks and authorizes citizens to enforce the law. It was time to figure out a backup plan, and Kromenaker knew that she didn’t want to rent. “My colleagues who own clinics say that’s a bad idea—the landlord will be relentlessly harassed, you’ll be kicked out,” she said. “You gotta own.” Moorhead doesn’t have a hospital, and there were no ready-made medical offices. Kromenaker and her husband, a strategic planner and business consultant, looked at industrial spaces, which would have required extensive builds to turn into clinics, and at an old house. Nothing was promising.

At the end of January, when she turned fifty, the couple took their first vacation in ten years. Before they left, they went to see a building up for sale. The space was bigger than they needed, and it had tenants, but, as the spring progressed, it started to seem like the best option. After a draft of the Dobbs opinion was leaked to the press, Kromenaker made an offer, taking out a loan for the down payment. Her husband coördinated the inspections and paperwork; they bought the building under the name of an L.L.C., signing the paperwork the day before the Dobbs decision was officially issued. As far as Kromenaker knows, her new tenants have no idea that their new landlord is an abortion provider. She is now responsible for things like snow removal, which she did not have to pay for at the smaller clinic, and she is worried about how she’ll be able to afford everything should the tenants break their leases. But an online fund-raiser for the move has raised more than nine hundred thousand dollars. She is hoping the money will help her add telehealth services to the clinic’s offerings; in Minnesota, unlike in North Dakota, telemedicine is legal.

The patients finished their appointments in the afternoon, and the escorts formed tight clusters around them as they walked to their cars, chased by activists wielding pamphlets. A bald volunteer named Gary coördinates the escort effort for the clinic—one of two community-service gigs for him, the other being photographing cats and dogs that are up for adoption at a local animal shelter. He told me that many patients will accept the pamphlets, but quickly hand them off when escorts offer to take them. I noticed that the patients were less passive leaving the clinic than they had been on their way in. When a protester said, “Jesus loves you,” a patient snapped back, “I don’t believe in Jesus.” Another, urged by a protester to look up Project Rachel, a post-abortion Catholic ministry that collects and publishes stories of regret on its Web site, said, “Hail Satan. I killed the fucking baby. I hope you’re happy.” (“Project Rachel, free counselling,” the protester responded.) Two women arrived with a banner that read “Covid-19 vaccines are made from aborted babies”—a false conspiracy theory that has taken hold among anti-abortion activists—and began intoning the Lord’s Prayer.

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