The Tiny Clinic on the Frontline of Abortion Access

“They put up a hoop, we learn how to jump it, they set it on fire, they raise it, we constantly jump through that hoop.”

By Brooke Shuman, More Perfect Union

On both sides of the Tennessee and Virginia border, nestled in the Appalachian mountains, are two towns called Bristol. A sign on the main strip of downtown at the state line lights up at night with the motto: A Good Place to Live. 

But ever since Tennessee instituted a full abortion ban in 2022 following the Supreme Court’s Dobbs decision, the town on the Virginia side has been embroiled in a legal and cultural battle over whether or not the newly built Bristol Women’s Health clinic can continue providing abortions. 

Bristol Women’s Health is the only abortion provider in Bristol and, since the fall of Roe v. Wade, one of the few abortion providers for the South, where a dozen states have passed full or partial bans on abortion. The clinic’s staff is small, with only five full-time workers, but since opening, they’ve provided hundreds of patients with necessary abortion care. The next-closest abortion clinic is in Roanoke, a two-hour drive northeast.

Planned Parenthood might have the name recognition, but 55 percent of abortions in America are done in small standalone clinics, known as “indies,” like the one in Bristol. Karolina Ogorek, the administrative director of Bristol Women’s Health, started her career in abortion care in 2007 and operated an independent clinic in Knoxville, TN, that was one of just two abortion providers in the area. 

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When a draft of the Supreme Court’s Dobbs opinion—which would eventually end the 40-year precedent of abortion access guaranteed by Roe—leaked in May 2022, Ogorek knew her clinic would close. Tennessee, like many red states, had anticipated that the conservative judges would overturn Roe and had passed “trigger bans.” Once the draft was leaked, abortion providers in 13 states were counting the days until their clinics stopped operating. 

Ogorek remembers rushing to refill birth control prescriptions for patients and writing severance packages for her employees. “At the end of the day, it is a job,” she told More Perfect Union. “It's our livelihood. But most of us got into this work because we believe in choice.” 

While she was closing the Knoxville clinic, Ogorek was working with other providers to open a new clinic over the border in Virginia, where they knew abortion wouldn’t be banned. It wasn’t an easy move: after the clinic was opened, the Bristol, Virginia city council unanimously passed a “sanctuary for the unborn” ordinance banning any expansion of her clinic or the building of new ones. And now, Bristol Women’s Health is being sued by their landlord for fraud; the company Kilo Delta, LLC, claims they were not aware that abortions would be performed onsite. 

“We were not welcomed with open arms,” Ogorek says. “But we always said: they put up a hoop, we learn how to jump it, they set it on fire, they raise it, we constantly jump through that hoop.”

“Me, you, and everybody that you see at Kroger”

The Bristol clinic provides medical abortions–the drugs known as mifepristone and misoprostol–up until 11 weeks, and surgical abortions up to 16 weeks of pregnancy.

During one cold day in early December, a dozen patients came in, almost all traveling from out of state. One woman had flown in from Georgia; another made arrangements to stay in a hotel overnight. Patients take one pill in the office and the second one supervised with a nurse practitioner over a Zoom call. Most patients arrive with a driver—a friend, family member, or partner—and are met by protestors outside. 

One protestor, bundled in a bulky jacket, hat and poncho, sat in a chair near the clinic for most of the day, a bullhorn in hand, and a sign that read “You Shall Not Murder” with the image of a fetus suspended in the womb. When a patient pulled up in their car, the protester swiftly rose and began shouting: “I’m here as your neighbor, and I plea for you to have mercy on that child.” 

The clinic also has three “defenders” that stand outside and escort patients in, shielding them with brightly colored umbrellas as they enter the building. “No, Deb!” one of the defenders named Dani said to the protester, who she knows by name after months of being on opposite sides of this divide. “That’s not how Jesus behaves.” 

When asked why she does this work, Dani mentioned her own experience as a young woman, deciding whether or not to terminate a pregnancy while serving in the military. “I would hope that on what is one of the hardest moments of my life…someone would show me compassion,” she told More Perfect Union.

Thousands of people from the South have made this trip to Virginia for care. A recent report from the Guttmacher Institute showed that last year nearly one in five patients had to cross state lines to get an abortion. 

“Our patient demographic is me, you, and everybody that you see at Kroger,” Ogorek says. “Every single person that has the ability to get pregnant is affected. Every single person.” 

Potential patients also call in with questions. Because many state bans are new or contested, many women don’t know their own state’s laws. Terrie operates the front desk and is a warm voice on the other end of the phone line. “A lot of these girls are terrified when they call. They needed a little old lady.” She says, “That’s what I do. I’m a little old lady and I give free hugs.” 

Terrie has a light drawl and spent years running a local BBQ joint. She says no matter what work she did, she was always pro-choice. “It is no one else’s decision,” she says. “Biblically, morally, no one else can make that choice... I have granddaughters—the fact that they can’t have that right? Makes me a little mean.”

An abortion clinic isn’t like a typical medical facility. It’s not the care that’s different—abortions are a safe and routine procedure—but the barriers that states and cities create make clinics harder to run. 

The first hurdle is the cost of care. Most patients pay out of pocket because many private insurers are banned from covering abortion, and federal Medicaid, which 89 million people rely on for health insurance, doesn’t cover abortion at all. That’s because of the Hyde Amendment, a decades-long ban on federal funding for abortion. 

There have been exceptions–for rape, incest, and the life of the pregnant person–that have changed depending on the administration. But regardless of political shifts, Congress has continued the ban for nearly a half-century. “American rights are often we call ‘negative constitutional rights,’” Mary Ziegler, a legal scholar and historian on the pro-life movement, told More Perfect Union. “You have a right for the government to leave you alone, but you don't actually affirmatively have a right to do anything.”

There were a number of legal challenges to the Hyde Amendment that failed in the late 1970s. Ziegler explains that the amendment, while limiting access to hundreds of thousands of patients each year, was not seen as a violation of the protections granted by Roe v. Wade. “By 1977, the Supreme Court had said, essentially, if a state wants to ban insurance reimbursement for Medicaid for abortion, or they want to say you can't use funding for public hospitals, that's okay,” she says.

Today, only 17 states allow Medicaid coverage for abortion and 11 states don’t even allow private insurance coverage. A medical abortion at Bristol costs $700 and surgical abortions, which they provide once a month when a traveling doctor visits, cost between $750 and $1,300.  Patients arrived at the clinic with envelopes of cash or searched their purses for the remaining dollars to cover the procedure. 

So clinics like the one in Bristol rely on a network of privately-donated abortion funds to cover patient’s costs, and often have to subsidize the cost themselves. “We wouldn't be here without funding organizations because sometimes the price of a medical abortion or a surgical abortion is not attainable,” says Ogorek.

Many states don’t recognize abortion as healthcare

When Roe v. Wade made abortion a constitutional right in 1973, abortion could have been folded into regular healthcare—at the time, 50 percent of abortions were taking place in hospitals, according to Ziegler. But that changed quickly.

Many hospitals and the physicians working there didn’t want to provide the procedure. It was both risky and divisive—hospitals could jeopardize their funding if they performed abortions, and they didn’t want to deal with protestors.

To ensure access, the pro-choice movement took it upon themselves to provide abortions and spent the early years after Roe establishing new clinics. Activists saw stand-alone clinics as an alternative way to give comprehensive, affirming care to patients in need. It was also a new business opportunity; Ziegler points out that Roe coincided with the rise in stand-alone physician’s offices in strip malls and off of highways. Small medical offices with specialized care became just another consumer choice. 

By 1989, the number of hospitals providing abortion care shrank and 86 percent of abortions were happening in clinics, according to Eyal Press, author of Absolute Conviction. But the boom of standalone clinics had an unintended consequence: they were easier for anti-abortion protesters to target. Anti-abortion extremist groups like Operation Rescue staged blockades and harassed patients entering and exiting clinics throughout the 1980s and 90s. In 2009, Dr. George Tiller, one of the few doctors in the U.S. providing abortion care after 22 weeks, was murdered at his Wichita church by anti-abortion terrorist Scott Roeder.

As the anti-abortion movement’s influence grew, so did the stigma around the procedure. This stigma produces unexpected costs even today. 

“Unless you own your real estate, it's hard to get somebody to rent to you,” Ogorek says. “More than likely there will be protesters in that building. And [landlords] just don't wanna be a part of that. They may say even, ‘Look, we support what you do, just not here, just not in our building.’” 

Getting basic repairs and contractors who will do the work can even be a challenge. “They have absolutely no problem going into a dentist's office, but they may not want to come to an abortion clinic,” Ogorek told More Perfect Union. (In Knoxville and now in Bristol, Ogorek has built a network of people who are willing to support the clinic.)

The state of Virginia imposed additional restrictions: until the law was repealed in 2020, only board-certified physicians were allowed to perform abortions, which studies have shown isn’t medically necessary, since nurses and physician assistants are just as capable. These are sometimes known as TRAP laws: Targeted Regulation of Abortion Providers. They spread in the 2000s, driven by anti-abortion activists who designed laws that could be replicated state by state. 

These new regulations were pitched as common sense and for the “safety of women,” but instead just made abortions much harder to access. TRAP laws were largely enacted in states that now have bans, but some of these laws, like the certification requirements, still exist in states where abortion is legal. 

In states that are hostile to abortion providers, it’s also much harder to get other forms of reproductive healthcare. Hospitals are having trouble recruiting new doctors, and 5.6 million women now live in what are known as “maternal health deserts.” 

Bristol Women’s Health isn’t the only new clinic that opened to serve patients in banned states. Indies and new Planned Parenthood offices have opened in Illinois, New Mexico, and Maryland to help meet demand from bordering cities and states. 

Ogorek’s career provides a window into how small the world of abortion providers really is. Bristol Women’s Health was started in Virginia with the help of workers from an indie clinic in Knoxville, TN, and the owners of a clinic in Bristol, TN that were both in operation for decades. Ogorek opened Bristol Women’s Health with the help of Diane Derzis, a 47-year veteran of the abortion rights movement who was the owner of Jackson Women’s Health, the Mississippi clinic at the center of the Dobbs decision. Over the course of her career, Derzis survived the bombing of her Alabama clinic and opened clinics in Georgia, Virginia, and New Mexico. 

In Ogorek’s office is a picture of herself standing with two other abortion providers she has known since she started this work. On the opposite side of her desk is a small tarot card: Strength. 

Because this work is so contentious, and because it is now criminalized in many places, the workers providing abortion care can seem heroic. Ogorek appreciates the public support she’s gotten from the pro-choice community but envisions a day when this routine procedure won’t seem like a radical act. 

“Since Roe fell, people realize more how important this work is,” Ogorek says. “But I hope in my lifetime, we are not seen as special. I hope in our lifetime, we just become a normal part of healthcare.”