In the past, the Austin Women's Health Center bustled with patients, who sometimes waited outside on benches. Those who made it inside enjoyed carefully selected movies on the waiting room TV, avoiding violence and food scenes due to security concerns and fasting requirements. Now, nearly two years post the U.S. Supreme Court's abortion rights decision, the waiting room is noticeably quieter. On a humid day in late May, only one or two patients waited to see the clinic's nurse practitioner, with the television turned off.

The small counseling rooms where patients once met with Maria Yarborough before their abortions, and the row of massage chairs they used for recovery, now stood empty. Yarborough reflected that before the court decision, the staff arrived each day with the conviction that they positively impacted their patients' lives. However, she lamented, "The essence of our work has been stripped away from us.

Since the Supreme Court's landmark decision in Dobbs v. Jackson Women's Health Organization on June 24, 2022, Austin Women’s Health Center and numerous other former abortion clinics have faced significant challenges in staying operational. Many clinics have closed permanently or relocated to states where abortion remains legal, exacerbating the nationwide decline in access to both abortion services and other reproductive health care options. The remaining clinics are typically independent establishments grappling to sustain their operations.

The Austin clinic, established in 1976 just a few years after Roe v. Wade enshrined abortion rights, faced severe financial setbacks following the reversal of legal protections. With scaled-back services and operating hours, it operated at a loss month after month, only achieving financial stability in January. 

Dr. L.L. “Tad” Davis, the medical director deeply impacted by these challenges, personally owns the building but has forgone rent payments and hasn't received a salary in over a year. "It's been an incredibly tough period as we work to adapt," he acknowledged.

Over half of the clinic's staff have departed, many laid off in June 2023 due to financial constraints that made continued payroll unsustainable.

However, reminders of their former colleagues fill the office. Coffee cups still hang in the tiny kitchen next to Yarborough’s sunset-colored mug, handmade origami figures and Post-it note sketches adorn shelves stacked with paperwork, and decorated empty lockers remain.

Due to state regulations, the reduced staff cannot perform abortions anymore. Nevertheless, they continue to offer various forms of reproductive health care to their predominantly Black and other minority patients struggling financially—services include birth control, miscarriage management, and sexually transmitted infection testing.

In addition to handling a wide range of medical issues like "colds to hemorrhoids to Type 2 diabetes," the tightly knit team has shouldered additional responsibilities, according to nurse practitioner Ginger Ridout, who has been with the clinic for 17 years. Yarborough, who started as the medical receptionist in 2016, now oversees daily operations, assists patients, and even takes on cleaning duties since janitorial services were cut.

“We are juggling tasks like never before,” remarked Ridout, a veteran nurse practitioner of more than 40 years.

The significance of independent clinics in the aftermath of the Dobbs decision

Yarborough affectionately describes the Austin clinic, also known as the Brookside Women’s Medical Center, as a "little treehouse." Nestled away from a bustling highway under a canopy of pecan trees, it can be challenging for patients to locate. However, the dedicated team assists them by providing directions to the nearest bus line or walking route.

Yarborough notes that this intimate familiarity with the area is one of the advantages that an independent clinic like theirs holds over larger national organizations such as Planned Parenthood. While Planned Parenthood operates clinics across the state, inquiries are centralized at a center in Dallas, whereas the Austin clinic offers personalized local support directly.


Davis emphasizes that unlike Planned Parenthood, the clinic offers post-abortion medical care that is nearly inaccessible elsewhere in Texas. While he contemplated relocating the clinic out of state, Davis ultimately decided to remain, recognizing a critical need to assist Texans facing complications after medical or surgical abortions performed elsewhere, along with those dealing with nonviable pregnancies.

"There's nowhere else in Texas for them to receive comprehensive care except our office," he explained. "And Texas is a vast state."

According to a 2023 report by the Abortion Care Network, at least 65 independent clinics have either closed entirely or ceased providing abortion services since 2022. This decline is expected to continue following the enforcement of a six-week ban in Florida and the potential implementation of a total ban in Arizona, as reported by the Guttmacher Institute.

"There simply aren't enough healthcare centers," stated Erin Grant, co-executive director of the Abortion Care Network. "However, it's financially impossible to battle the state, remain open for patients, pay staff, and maintain high-quality care."

The closure of independent abortion clinics, also known as "indies," is especially detrimental because they often offer a range of healthcare services, from midwifery and fertility treatments to gender-affirming care, all of which are now at risk, Grant noted. For an indie clinic to relocate to continue providing abortion services is not only a massive logistical challenge but also poses an ethical dilemma for providers who understand that their specialized expertise in reproductive healthcare may not be replaced.

"What makes independent abortion providers so crucial in the post-Roe era is their deep commitment to their communities," Grant emphasized. "They are dedicated to staying and serving those communities.

Communities require clinics now more than at any other time.

Following the Dobbs decision, the owners of CHOICES Center for Reproductive Health in Memphis, Tennessee, launched a new abortion clinic in Carbondale, Illinois. However, this expansion didn't mean abandoning Memphis. President and CEO Jennifer Pepper emphasized the critical importance of remaining in the city CHOICES has served since 1974 and swiftly adapting to the changing landscape.

"In states like Alabama, Tennessee, and Mississippi, the absence of a healthcare provider like us is simply unsustainable," Pepper remarked. "The shortage is so acute that even losing one or two clinics can have a significant impact."


Since the Memphis clinic is no longer able to offer abortions due to state regulations, Pepper explained that her team is refocusing efforts on alternative services. This includes providing midwifery care at the city’s first and only birth center, established and operated by Black midwives. The center aims to support 200 birthing families this year, primarily focusing on uninsured or publicly insured Black women from surrounding counties.

"The demand for these services hasn't diminished since the Dobbs decision," Pepper emphasized. "In fact, our community needs these services from us now more than ever."

Meanwhile, other clinics have responded by enhancing care for individuals who now must travel out of state to access abortion services. According to a Guttmacher report, the proportion of people crossing state lines for abortion has doubled since 2020, with nearly one in five doing so in the first half of 2023.

Houston Women’s Reproductive Services, located 150 miles east of Austin Women’s Health Center, has adapted by offering ultrasounds for women obtaining abortions out of state, as detailed by administrator Kathy Kleinfeld. To sustain operations, staffing was reduced from 12 to four employees, and the clinic downsized from a 5,000 square-foot facility to a space now less than 800 square feet.

"Due to a significant drop in income, we had to adjust our expenses dramatically," Kleinfeld explained.

The clinic considered expanding into new gynecological services, Kleinfeld noted, but given its history primarily with medication abortion, such a move didn’t appear viable. Relocating was never seriously considered, especially with the proliferation of crisis pregnancy centers that, according to Kleinfeld, "often use scare tactics and misinformation" to dissuade individuals from seeking abortions.

"We recognized that if we ceased providing services in Houston, the only alternatives might involve such facilities," Kleinfeld stated. "That was something we were determined to prevent."

Dobbs shattered trust in medicine.

Robin Marty, author of the "Handbook for a Post-Roe America" and executive director of the West Alabama Women’s Center, anticipated a challenging landscape following Dobbs, but reality has surpassed her fears. Marty had hoped that even if clinics couldn't perform abortions, they would remain open to offer other crucial reproductive health services.

However, as clinics throughout the South closed their doors, obstetricians and gynecologists altered their career trajectories to avoid practicing in states with stringent abortion laws. Marty herself contemplated relocating the clinic to states like Virginia or Illinois but ultimately found the move unfeasible.

"We can't relocate. There's nowhere for us to go," she stated. "Everything around us has disappeared."

Following the Dobbs decision, Marty's clinic in Tuscaloosa, Alabama, briefly closed to mark the end of its abortion services. It reopened soon after as a nonprofit reproductive health care center offering prenatal care, contraception, and STI testing and treatment on a free and sliding scale basis. Marty emphasized that for many, these services are just as challenging to access as abortion.



Marty explained that due to legal restrictions and fears of criminal prosecution, the clinic cannot refer women to out-of-state facilities for abortions, a limitation currently under legal challenge by healthcare providers.

"What people fail to grasp about Dobbs is that it hasn't only restricted abortion access; it has eroded trust between doctors and patients going forward," she lamented. "It has effectively undermined confidence in the medical profession."

Over the past two years, Marty noted, the clinic has served approximately 2,000 patients, predominantly Black and often uninsured or Medicaid recipients. The greatest obstacle, she stressed, has been navigating bureaucratic hurdles to deliver essential care to those most in need.

Despite successfully obtaining Medicaid provider status, Marty disclosed that the clinic faces challenges in receiving reimbursement for patients' prenatal care, as local hospital doctors refuse to deliver babies due to the clinic's history as an abortion provider, perpetuating stigma.

To sustain its operations, the clinic primarily depends on small-dollar donations, foundation grants, and an increasing number of patients with private insurance, Marty explained. However, she candidly admitted, "Let's be honest, we are losing a significant amount of money every month."

"I worry constantly about everything. I worry about keeping our clinics open and what will happen if we can't," she shared. "Currently, we have about three months of cash reserves, and we're depleting that at a rapid pace."

Clinics experience a 'significant rise' in violence and threats.

The Abortion Care Network has allocated nearly $9 million to support independent clinics like Marty's, Pepper's, Kleinfeld's, and Yarborough's in staying open. However, co-executive director Grant cautioned that this funding is inadequate compared to the substantial financial requirements. They estimated that the average annual operating cost for such clinics is around $1 million.

In addition to covering legal expenses and operational needs, a portion of the funds goes towards enhancing security measures in response to heightened threats from "white supremacist violence and anti-abortion extremism," Grant explained. A report by the National Abortion Federation documented a "sharp increase" in violence and disruptions at clinics nationwide, including incidents such as arsons, burglaries, death threats, and invasions since the overturning of Roe v. Wade.

Yarborough mentioned that the Austin clinic continues to receive hate mail, and occasionally groups of up to 30 or 40 protesters gather in the parking lot, which is separated from the building by a natural spring creek.

While intimidating for patients, Yarborough noted that once inside, the sounds of highway traffic usually drown out the protesters' jeers and shouts. She has grown accustomed to the noise, but she expresses concern that one day the protesters might locate her on social media or, worse, discover her home address.


Securing funding to sustain operations at The Austin Women's Health Center remains an ongoing challenge. Although the clinic raised nearly $40,000 through GoFundMe, which helped cover payroll temporarily, it fell short of its fundraising goal by tens of thousands of dollars, according to Yarborough. Nurse practitioner Ridout even considered reaching out to a celebrity like Texas native Matthew McConaughey for assistance.

"I once found his contact information online and thought about sending him a letter," Ridout recalled. "But I never ended up doing it."

The clinic continues to accept public donations through its website and has received support from one of the state’s abortion funds, which assists Texans in affording abortion care. Yarborough is also actively pursuing nonprofit status for the facility and seeking federal funding through the Title X program.

"It's an additional workload for us," Yarborough explained. "We dedicate our efforts to it whenever possible, but those opportunities are not frequent."

Currently, the clinic remains unable to budget for a cleaning service. At the end of each week, Yarborough and another staff member stay several additional hours to thoroughly clean each room, sanitize instruments, empty trash, handle laundry, and set the alarm.

Yarborough intends to continue this routine each Monday. Looking ahead, she admits uncertainty about the future of Austin Women's Health Center.