In recent years, Houston Women’s Reproductive Services has downsized significantly, moving from a nearly 5,000-square-foot facility to an 800-square-foot space. The Texas clinic, which once employed more than a dozen full-time staff members, now operates with only a medical director and three part-time employees. Despite no longer being able to provide abortions, the clinic remains open, focusing on broader reproductive health care.
“I was willing to make whatever sacrifices needed to be made to keep our head above water, just keep the doors open and the lights on, and be able to provide care to these people who desperately need our help,” said clinic administrator Kathy Kleinfeld.
The clinic’s shift in focus reflects the broader changes in the abortion landscape following the Supreme Court’s Dobbs decision, which ended the federal right to abortion two years ago. Since the decision, 14 states have implemented near-total abortion bans, forcing many clinics to adapt or close.
Prior to the Dobbs decision, there were approximately 3,000 abortions performed monthly in Houston. Anticipating continued demand, Kleinfeld’s clinic pivoted to offering pre- and post-abortion care for those traveling out of state or self-managing their abortions.
“There were a lot of different ways it could have gone; most of all would have involved closing,” Kleinfeld said of her clinic. “That was just not something I was willing to do.”
In 2021, the United States had about 750 abortion clinics, with less than a tenth located in the states that have since banned abortion. These states often had restrictive regulations, creating significant barriers for providers and patients alike.
“The reason that banned states did not have many facilities to begin with is that they were hostile to abortion and put up barriers to providing abortion services even before Dobbs,” said Caitlin Myers, an economics professor at Middlebury College.
The Dobbs decision was not the first challenge for Texas abortion clinics. In 2013, a state law requiring clinics to meet hospital-like standards led to the closure of about half of Texas’ abortion facilities. Although the US Supreme Court later overturned those restrictions, many clinics never reopened.
By 2023, the number of abortion-providing facilities in the US had dropped to about 725. Each closure has significant impacts, especially in areas where services were already limited.
“We need every single abortion clinic in this country. There really aren’t enough for the number of people who need care,” said Nikki Madsen, executive director at Abortion Care Network.
Approximately two-thirds of the clinics in states with abortion bans have stayed open in some capacity, often providing other reproductive health services.
“Independent clinics have always been based in their communities. They really understand the communities where they’re located and the people that they serve,” Madsen added.
Some clinics have relocated to states with fewer restrictions, such as New Mexico and Illinois. The number of abortion clinics in New Mexico doubled from five in 2021 to 11 in 2023, while Illinois saw an increase from 27 to 36 clinics.
CHOICES Center for Reproductive Health moved from Memphis, Tennessee, where abortion is banned, to Carbondale, Illinois. Red River Women’s Clinic relocated from Fargo, North Dakota, to Minnesota.
“We knew that if we didn’t do something, those patients who already drive three, four, five hours one way just to get to our clinic would face even bigger hurdles,” said Tammi Kromenaker, director of Red River Women’s Clinic.
Finances remain a significant challenge for clinics navigating the post-Dobbs landscape.
“It costs money to close the clinic. It costs money to reopen the clinic,” Madsen noted. “All of these shifts really require community support and financial support.”
The rise of telehealth abortions has helped bridge some gaps in access. In late 2023, about 1 in 5 abortions in the US were telehealth abortions, where medication was mailed to patients after a remote consultation.
“Some people have resources to travel, but the pressure on brick-and-mortar clinics continues to build,” said Kirsten Moore, director of the Expanding Medication Abortion Access Project.
A recent Supreme Court ruling maintained broad access to medication abortion, yet ongoing legal challenges continue to create uncertainty. Despite relocating services to Minnesota, Red River Women’s Clinic retains its address in Fargo to remain involved in legal battles with North Dakota.
“It would have been easy to just walk away,” Kromenaker said. “We have fought so long and so hard, we just didn’t want to give up. We’re just one little clinic, but downtown Fargo is still, technically, our corporate address so that we can maintain that standing in North Dakota and continue to fight for those patients we’ve served for … 26 years in July.”
