I Was North Dakota’s Last Abortion Provider

This story was supported by the journalism nonprofit the Economic Hardship Reporting Project.

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.


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.

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