This is what it’s like to move an abortion clinic from Texas to New Mexico

When the Supreme Court overturned Roe v. Wade in June, Amy Hagstrom Miller knew what she would have to do. Like so many other abortion advocates, she had spent years fighting off escalating restrictions and bracing for this moment.

Back in 2013, after Texas passed legislation that imposed exacting standards on abortion providers and required hospital admitting privileges, the clinics that Hagstrom Miller operated had struggled to stay open amid a yearslong legal battle, forcing her to temporarily close five of them. Despite a Supreme Court ruling that eventually struck down the Texas law in 2016, one of those clinics never reopened.

“During that time period, we tried all the things that many people are now trying in other parts of the country for the first time,” says Hagstrom Miller, the founder and CEO of Whole Woman’s Health, which got its start in Texas but now provides abortion care across seven states. “We tried to stay open and provide ultrasounds or pregnancy tests only, or started adding [services]—and it just was not sustainable. We didn’t have the resources to be able to keep staff and pay the rent and the mortgage.”

Soon after the Supreme Court officially released its decision this June, Whole Woman’s Health announced that all four of its Texas clinics would be closing.

“I did not make the decision to close my doors; I was forced to stop doing the work that I love in Texas,” Hagstrom Miller says. “We don’t want to close our clinics. We don’t want to have to deny people access to safe abortion. We know better than anybody who passes these laws what is needed in the communities that we live in and serve.”

Making the move to a safe haven

Whole Woman’s Health is now raising money—largely through a crowdfunding campaign on GoFundMe—to open a clinic in New Mexico, a state that is quickly becoming a safe haven for people seeking abortion care. As the sole state bordering Texas that still protects abortion access, New Mexico has already attracted a number of providers, including the now-shuttered clinic at the center of the Supreme Court case, whose director has opened a new location in Las Cruces.

Hagstrom Miller has plenty of experience acquiring facilities and transforming them into Whole Woman’s Health clinics. (“I fantasize about having an HGTV show: Flip This Abortion Clinic,” she quips.) Still, even in a state that has enshrined abortion rights, it’s no small feat to open a new clinic, between the slim margins and stigma associated with abortion care.

The process of closing up shop in Texas has itself proven complicated, as Whole Woman’s Health navigates layoffs and off-loading real estate. (Since I spoke with Hagstrom Miller, Indiana has passed a near-total ban on abortion, which means Whole Woman’s Health will also close its clinic there when the law takes effect next month.)

“This is a tremendous amount . . . to handle at the same time: a startup and acquisition, a wind-down, and the population you serve migrating thousands of miles,” Hagstrom Miller says. Losing revenue from four clinics in one fell swoop is also a major financial strain, one that can’t be recouped without opening a new location.

Of Whole Woman Health’s four clinics in Texas, two were leased properties, so Hagstrom Miller has been negotiating lease buyouts while trying to sell the other two properties (which she owned). With a staff of 45 people—including 15 physicians—she had no choice but to lay off about half her employees, though she managed to secure remote work arrangements for many others.

“It’s really heartbreaking because these folks are being laid off for no reason other than politics,” she says. “We have obviously been very open and honest the whole time, which would be my advice if you’re ever in a situation like this.”

Dealing with the “abortion tax”

Meanwhile, Hagstrom Miller has been searching for a space in New Mexico that could be repurposed more easily, like a doctor’s office, to save time and money and mitigate some of the roadblocks that are unique to abortion care. Even finding a pro-choice landlord or a contractor willing to build an abortion clinic can be a challenge.

“I call it the abortion tax,” she says. “From getting funding from a bank to getting a contractor, electrician, or a plumber, or even a building inspection or a title company—all those things can be political. And [they] have been for us in other communities.”

Another priority is securing a location where staff and patients feel safe and are less likely to be targeted by anti-abortion activists, a looming threat as protestors from across the U.S. descend on New Mexico.

At the time of this writing, Whole Woman’s Health has raised just over a third of its $750,000 target on GoFundMe. Unlike other businesses, abortion providers often have little recourse when they endure financial hardship, in many instances facing resistance from traditional lenders or insurers. Many providers rely on donations in the absence of, say, a line of credit, and the vast majority of abortion clinics are independent entities that don’t have the name recognition—or grant funding—of Planned Parenthood.

It’s an issue Hagstrom Miller has raised directly with the White House, proposing the equivalent of Paycheck Protection Program loans or support from the Federal Emergency Management Agency for providers who are moving their clinics. Over the years, she has sought to diversify funding for Whole Woman’s Health by opening nonprofit clinics and creating a nonprofit entity, Whole Woman’s Health Alliance.

“I think about that entrepreneurial maxim ‘constraint begets innovation,’” she says. “Like, are you kidding me? I’m an abortion provider in the American South. We’re off the chain when it comes to adapting to new environments and figuring out how to make something work with fewer resources.”

As a new crop of abortion providers settles into New Mexico—a state that has long failed to provide adequate reproductive care to its residents—another potential hurdle is staffing. Once Hagstrom Miller finds a clinic space, she intends to first extend relocation offers to former employees in Texas. But it’s not clear how many of them will be willing to make the move.

“We’re already trying to see if any of those Texans will go to Minnesota, our two clinics in Virginia, or our clinic in Baltimore,” she says. “But folks are very rooted in the community; they’re from Texas [and] have extended families.” Abortion providers that move to the state may end up competing for local workers, especially if their clinics are clustered around border towns.

Wayfinding for patients

For now, Hagstrom Miller is doing what she can to blunt the impact of losing four clinics virtually overnight. Last fall, when Texas passed a six-week abortion ban, Whole Woman’s Health started the Wayfinder program to help residents access abortions outside the state, which is now expanding to serve people nationwide. Since Hagstrom Miller already operates clinics outside of Texas, she can direct patients to those locations; she also hopes to eventually open additional clinics in North Carolina and Virginia, as well as in Illinois, where Whole Woman’s Health currently provides virtual abortion care.

But the work is daunting. In Texas alone, more than 50,000 people obtain legal abortions each year. Though it’s difficult to accept, Hagstrom Miller recognizes that her efforts will never be enough—that abortion providers can’t rectify such a monumental loss through sheer force of will.

“We can set up all these clinics and try to help people travel, but the damage [from] this abortion ban and the reversal of Roe is huge,” she says. “I’m trying real hard to support my team [and] not to feel frozen, because it’s an overwhelming prospect. Part of our work is to accept that and not dwell in the grief too long.”