In June, the Supreme Court issued its decision on Dobbs v. Jackson Women’s Health Organization, a landmark ruling that overturned Roe v. Wade and eliminated constitutional protections for abortion care. North Dakota was among more than a dozen states with trigger laws in place, which in this case meant abortion providers had just 30 days to continue providing care before abortion became illegal except in cases of rape, incest, or when the mother’s life is in danger.

Tammi Kromenaker is the owner and operator of the Red River Women’s Clinic, the sole abortion provider in North Dakota for the last 20 years. For Teen Vogue, she explains how she and her staff reacted to the devastating news — and quickly pivoted to ensure their patients could continue accessing crucial reproductive care. Now, with a pending lawsuit and midterm elections on the horizon, she says the fate of abortion care could very well be decided by first-time voters.

This conversation has been condensed and lightly edited for clarity.

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When the Dobbs decision came down, I was sitting at my desk in our Fargo, North Dakota, clinic refreshing the news on my computer. When I saw the announcement, I screamed. My staff rushed into my office and I told them, “Oh, my God, you guys, they just overturned Roe v. Wade.” They were in disbelief. A few people started crying. I felt my stomach drop. Then the phone rang. It was a young mother. I could hear a children’s television show playing in the background as she told me she needed an abortion.

It was seconds after the announcement, so there was no way she knew what had happened. Though I was on the verge of bawling, I didn’t bring up the news or let my emotions come through. I didn’t want her to think that I was in any way upset about her having an abortion. When she came in the following week, I didn’t bring up Dobbs then either. But I did introduce myself and make small talk. I knew because she was the first person I scheduled after that pivotal moment in history, that I would remember her for a very long time.

Our patients travel to our clinic from North Dakota, South Dakota, and northwest Minnesota — a tremendous burden, especially for those facing financial stress. These are rural areas, so people often drive up to five hours one way just to get to our clinic. Many struggle to access this care because they can’t afford to take time off work or pay for transportation, gas, or child care. I had a patient who borrowed a friend’s vehicle to get to her appointment. Though she could pay for the abortion, she didn’t know how she would afford the gas money to get home. Meanwhile, patients who are low-income or lack insurance often struggle to come up with the money to pay for the procedure. A lot of people lost their jobs during the pandemic. Others are cobbling together two part-time jobs in the service industry just to get by.

We’ve done our best to help bridge these financial gaps by partnering with North Dakota WIN Abortion Access Fund. In the case of the patient who borrowed her friend’s truck, we were able to work with the WIN fund to give her some gas cards so she could drive home to western North Dakota. But when the Texas Heartbeat Act went into effect last summer, banning abortion at around six weeks, and some legislators in our area started expressing interest in copying that law in our state shortly after that, we knew there were going to be new legal barriers, in addition to the financial.

North Dakota has had a trigger law in place since 2007, which meant if Roe v. Wade was overturned, abortion would become illegal in our state. So in 2021,  nearly a year before the Dobbs decision was announced, we started planning to move the clinic to Minnesota, where abortion is protected by the state constitution. We wanted to stay close to our original location, so we settled on Moorhead, a town five minutes across the river [by car]. We had to buy because anti-abortion folks pressured landlords not to rent to us. And the only building in Moorhead that worked was 12,000 square feet, more space than we needed and more money than we could afford. Luckily, a GoFundMe organized by some local pro-choice folks, which has since raised more than $1 million, made it possible. We signed the paperwork the day before the Dobbs decision came down.

With only a month before the trigger law was scheduled to go into effect on July 28, we knew we’d have to rush to get the new clinic up and running. We filed a lawsuit to try to stop the ban from going into effect and buy us some time. Our court case is still pending, but it delayed the start of the ban while a judge considers what to do. Those extra weeks were crucial. We were able to continue seeing patients in Fargo until the Moorhead location opened on August 10 without having any gap in care.

The six weeks leading up to the move were hectic. Our staff fielded daily calls from patients who were afraid and confused about what Dobbs meant for them. They were asking, “Oh, my God, is abortion illegal? Can I still have my appointment? What do I do? Where do I go?” There was so much panic. Almost immediately, I sent out a text message on the service we use to communicate with patients basically saying, Your appointment is still valid. Abortion is still legal in North Dakota. And we just kept reiterating that on social media, in media interviews, and on our website. Still, patients are terrified. On our intake forms, we ask patients if they have any concerns about the care they are there to receive. Usually, they write, Will it hurt? Are there any complications? But I remember one patient we saw in July asked, Will I be prosecuted in the future for having this abortion today? People were scared for their safety.

My staff and I did our best to reassure patients, but we were also uneasy. In May, what was to become the sole abortion clinic in Wyoming was firebombed. (Luckily, no one was hurt.) Wyoming governor Mark Gordon also signed a bill [that went into effect in July] banning abortion in the state except in cases of rape, incest, or if the mother’s life is in danger. (It has been temporarily blocked from going into effect.) It was all just more confirmation that we had to continue to be careful, so we kept the exact location in Moorhead a secret.

Since abortion would no longer be legal in South Dakota or North Dakota, and moving the clinic to Moorhead meant that some patients would have to travel farther to our clinic, we were still worried about the cost of transportation, gas, possibly overnight accommodations, not to mention wages lost for our patients taking time away from work. These financial constraints are significant. And limiting access only extends their financial stress, often for years. The Turnaway Study conducted by researchers at the University of California, San Francisco, found pregnant people who were denied an abortion and went on the carry the pregnancy to term experienced an increase in household poverty, and were less likely to be able to afford basic necessities like food and housing. It increases the debt and the number of negative public records, like bankruptcies, lowering their overall credit scores. The ramifications don’t just impact pregnant people. They impact the whole family.

Luckily, the Red River Women’s Clinic in Moorhead can partner with the WIN Fund to ensure our patients can continue to access abortion care from us. If they can’t afford the procedure, we can invoice the WIN fund and they’ll cover it and any travel costs, if needed. The clinic staff handles all of that directly so there are no additional hurdles for patients. In July, there was a pregnant person who couldn’t be seen at our clinic because she would be past North Dakota’s gestational limit of 20 weeks by the time of her appointment. But I texted some colleagues and friends, and they were able to get her an appointment in Nebraska. The WIN Fund bought her a $1,200 plane ticket, and a hotel room, gave her money for food and travel expenses, and paid for the procedure.

Beyond financial assistance, the WIN fund also offers practical support. Maybe someone has never been on a plane and has no clue what to expect going through TSA. Maybe they don’t know how to get to the airport. There are a lot of Indigenous folks in these states that we serve, so sometimes it’s helping them figure out how to leave the reservation and navigate some of those barriers. We also work closely with the nonprofit Indigenous Women Rising, which has abortion funds specifically for Indigenous folks. It’s not about throwing money at people. It’s about supporting them with everything they need to be successful.

If there’s any good news to come from this, it’s that young people seeking an abortion can now do so without parental consent in Minnesota. In July, as we were preparing for the move, that was one of the many restrictions on abortion that Judge Thomas Gilligan, Jr. in Minnesota struck down to make it easier to access care. That’s huge. North Dakota has very restrictive parental involvement laws. Both biological parents have to be notified unless the parent is deceased or their parental rights have been terminated. It prescribes these very traditional family roles that involve people who you might not have had much contact with over the course of your life.

One of the last patients we saw at our Fargo clinic was under 18 and had one parent’s consent, but did not want to involve the second parent. She had to embark on a judicial bypass that requires a hearing before a judge, which took nearly two hours. It’s just overly cumbersome for a young person. What if they’d had to account for their time, whether it be to school, a job, or their family? What if this was an abusive situation where news of the pregnancy could endanger their life? These cases are supposed to be confidential, but in a small town you might know someone who works at the courthouse and the gossip mill gets churning. I always say, was that parent with them when they got pregnant? Nope. So why should they be with them when they end that pregnancy?

On August 6, with the help of my husband, 30 volunteers, and a friend’s truck, we officially moved the Red River Women’s Clinic from Fargo to Moorhead. It was in the middle of that that one of our volunteers informed me that GoFundMe had raised $1 million. My jaw hit the floor. I literally bent over to catch my breath. I gathered everyone together and told them, “You guys made this happen. This is for the patients and everything we’ve worked for.” We couldn’t have opened this new clinic without that support. That financial support enabled us to update and purchase new equipment and supplies so we could provide the best care possible. We’re a tiny, little clinic in flyover country. But we’ve worked really hard for a long time to build our reputation and I’m grateful people feel invested in us.

Over the next several days, we worked 17-hour days assembling exam rooms. We were there until 12:30 a.m. on August 10, opening day in Moorhead. I went home, fell into bed, got up a few hours later, and came back to start seeing patients. I was exhausted. But it’s the patients that keep me going. I know from two decades of running the only abortion clinic in a hostile red state, where people faced enormous obstacles to receive abortion care, the stories that patients tell, the compelling information they share — it matters. Nobody walks into an abortion clinic lightly. And to be with a person at that moment, have them trust you with one of the most intimate things somebody can go through, hear their processes, and be able to provide them with excellent medical care in an emotionally supportive environment where they’re treated with dignity and respect, is an honor.

Of course, we don’t know what the future holds. Right now, Minnesota’s abortion laws are far more permissive than North Dakota’s, but the fight for reproductive rights is far from over. The other day, I was speaking to a patient as she waited for her ride. She turned to me and said, “They’re just trying to keep women down, right?” We talked a little about the news and then she continued, “Tammi, thank you for opening this clinic and making it possible for me to be here today.” I get teary talking about it because it just really reaffirms my belief that we must do whatever it takes to keep our doors open and provide [patients with] this service.

A lot of young people are going to be turning 18 and having the opportunity to vote for the first time in the midterms and the next presidential election. Every election, at every level, is going to have a component of abortion in it, whether it’s overtly on the ballot or not. The people you are voting for will have a say in what abortion looks like in your area. Here in Minnesota, if Democratic governor Tim Walz and attorney general Keith Ellison don’t get reelected, the people who are running against them could spell real trouble for abortion access in this state. So it’s important to get tapped in and see who’s talking about it, what they’re saying, and what their stance is. We just have to keep pushing. We have to vote!

Not long after we opened our doors in Moorhead, I made an abortion appointment for a 16-year-old gal and I was delighted when she told me she’d be bringing her mom with her. It felt like a small victory to know that her mom wasn’t coming with her because she had to have her mom’s permission. There is no parental consent barrier here in Minnesota. She didn’t have to go before a judge to prove she was competent enough to make a decision about her own body. Instead, she had been given the freedom to select the support system she wanted with her for that moment in time. That patient got to be in the driver’s seat.

And that’s how it should be. Abortion is about a patient’s hopes and dreams, and how they want to be in the world. It’s really profound stuff. And it’ll take each and every one of us fighting — especially now — to ensure those futures stay in our hands.

Ashley Edwards Walker is a freelance writer specializing in issues-based storytelling whose work has appeared in outlets like Glamour, Marie Claire, Cosmopolitan, Self, Prevention, Hacking Finance, Refinery29, New York Post, the New York Times and more.

Co-published with Teen Vogue.