At the 100-day mark after the Supreme Court decision that overturned Roe v. Wade, at least 66 clinics across 15 states stopped offering abortion care, and 26 clinics shuttered entirely.
Those who need abortions in states with bans without the means to travel out of state and those most marginalized will feel the impact of clinic closures in their community most potently. But it is the doctors, office managers, counselors, nurses, administrative coordinators, medical assistants, and directors, among other inner workers at abortion clinics, who are left without jobs.
There is no one trajectory for abortion clinic workers in states with bans. Limited resources compounded by a sputtering economy greet those looking for work. Given a landscape fraught with change and uncertainty, what do career moves look like for former abortion clinic employees?
Two months after the Supreme Court decision, Kioshana LaCount Burrell began offering services to employees affected by the dismantling of Roe v. Wade. Burrell is a career coach who believed helping providers and advocates to continue doing their work was a no-brainer. Burrell offers career coaching, resume building, networking, and interviewing strategies through ReproJobs, an online resource for job seekers within the “repro” space, an all-encompassing term for work within reproductive health, rights, and justice.
Since late August, Burrell has coached 180 clients through navigating job seeking in repro. The overwhelming majority of workers are continuing in the field.
About 80% of Burrell’s clients are what she calls “repro warriors,” those in the space who are providers, people doing policy work, or community workers who have made repro their life’s work. Burrell explained that they might not know the way forward but are in it for the long haul. “They are trying to figure out what the next steps are because the industry is dead in their area or drastically changing, and they need to respond to that,” Burrell said.
Another portion of Burrell’s clients want to stay in repro, but they are not sure what that might look like, given the changing landscape and, now, shortage of jobs directly within their community. Burrell said that a large portion is looking for remote work.
Some workers that are moving to general health care face stigma for formerly working in abortion care. Burrell works with these clients on applying their transferable skills to resumes. “This is healthcare we are talking about,” Burrell said “If you’re a nurse, you’re a nurse.”
For Burrell, a surprising outcome of offering coaching services in the repro community has been the response from people who have never worked in the industry before. “They have been galvanized by what's going on in our country and want to lend their hands to the movement in a more concrete way.”
Open but closed for abortion
In the fight to keep doors open, many clinics in states with abortion restrictions that have been forced to stop offering abortion care either still provide general reproductive health services or have had to pivot their offerings. Women’s Health Center of West Virginia paused abortion care on June 24, 2022, due to a pre-Roe abortion ban from the 1800s, Katie Quinonez, MPA, the clinic’s Executive Director, explained. “We filed a lawsuit and secured an injunction in July that allowed us to provide abortion care to over 100 patients until West Virginia legislators rushed to pass a total abortion ban on September 13, 2022. West Virginia’s governor signed the ban without reading it,” Quinonez said. Since then, the clinic’s budget has been slashed by 40%.
Quinonez explained that the clinic continues to offer essential services such as annual exams, birth control, breast and cervical cancer screening, gender-affirming hormone therapy, PrEP, pregnancy and parenting support, and STI testing and treatment. But the difficulty of having to turn people away from abortion care is harrowing. “The patients we have had to turn away are carrying the trauma of being denied an abortion, and our staff are carrying the secondary trauma of being forced to deny care. Our patients and staff alike deserve better than this,” Quinonez said.
Austin Women’s Health Center, a clinic in Texas (who I have worked with), is open for various services but halted abortion care. A staff member from the center who has requested to remain anonymous told me that they still receive calls for abortion and provide ultrasounds, resources such as the site I need An A, or general information on which states offer abortion care.
Open clinics in states without abortion bans are pivoting to meet the needs of patients coming from across state lines. Hanz Dismer, the Director of Psychosocial Services at Hope Clinic in Illinois, said that the clinic has had to hire more staff to accommodate the influx of people traveling for care. “We've seen folks from Missouri, Texas, Oklahoma, Tennessee, Florida, nearly half of the country,” Dismer explained.
Dismer lives across state lines in Missouri, where abortion is completely banned, and traveled out of state for work before the Dobbs decision. Only one clinic in Missouri offered abortion before Roe’s fall. Dismer said that in Illinois, Hope Clinic has received calls from clinic workers out of state seeking employment.
An impossible decision
Since the decision, physicians have expressed varying moves, each met with specific ramifications. Leaving your community creates a shortage of physicians who offer reproductive health care services; some of the worst maternal mortality rates across the country plague states with the most severe abortion bans. For doctors who stay, their hands are tied in states with bans where they cannot perform life saving procedures or offer any care at all.
National Abortion Federation’s job board caters to doctors and other front-line clinic staff interested in moving or traveling to provide abortion care. Melissa Fowler, the Chief Program Officer at National Abortion Federation, detailed that this time last year, it was hard to fill schedules with physicians. But now, states without restrictions are overwhelmed by requests from physicians in states with bans looking to travel and get a license in that state.
For doctors who do move, it can be devastating. “It's been particularly heartbreaking to have to close their doors for no good reason. They know that they're denying care to people,” Fowler said.
“Many people have families, they’re deeply rooted in the communities, and they live there because they want to be there. So it's not a solution for everyone to pick up and move to another state,” Fowler said.
Fowler explained that for many doctors, abortion care has been an entire career’s focus. Pivoting to another branch of health care is not easy. “There can be a lot of stigma for people if your resume has just 20 years of abortion work on it.”
A network of resilience
Austin Women’s Health Center reports that since Roe fell and the clinic was forced to stop providing abortion care, they have only had one employee leave, who went on to work in another OB-GYN office.
“We have a very dedicated staff, and they want to continue the fight even if it looks different. This is despite hours being cut and just the general sad nature of our work now. I think that we get a lot of support from our community locally and nationally, and that helps staff feel like the work we are still doing is important,” a staff member from Austin Women’s Health Center told me.
When Houston Women’s Reproductive Services was fully operational, it had a staff of 10 part-time and some full-time employees. It now has just 3 employees total. Kathy Kleinfeld, the director of the clinic, estimated that around half of former staff have continued to work in repro, and half left it altogether due to the inability to relocate. “Not everybody has that luxury of being able to uproot, sell homes, and uproot family to move to a safe state,” Kleinfeld said.
Why people fight to stay in the repro space is clear. “People who work in abortion clinics—it's not a job, it's a mission, and it's often a life mission … It's changing lives every day in the work that we do,” said Kleinfeld. “I want people to understand that abortion care is beloved, sacred work,” Quinonez said.
Women’s Health Center of West Virginia has begun to partner with the harm reduction movement and support those in the community who are unhoused and use drugs. “We will continue to listen to what our community needs and work to fill those gaps. We’re not going anywhere,” Quinonez said.
The repro community is used to reorienting, facing unique challenges, and even violence. Dismer reported that clinic staff now face increased stress and harassment.
“I have such a profound admiration for repro workers, both as providers and on the advocacy side of it … they’re kind of used to facing losses. Anyone who works in the industry is accustomed to not winning most of the time,” Burrell said.
Still, in the four months that Burrell has offered career coaching in the repro space, she has yet to see a single person ready to abandon it. Instead, the sentiment among workers has been one of pulling up their sleeves and learning how to continue the work.
Burrell reports positive outcomes in workers placed within the network of repro, which has a lot of momentum through community support. “The network is keeping each other safe and holding each other up—it’s the definition of mutual aid,” Burrell said.
ReproJobs established a Repro Worker Aid fund to help mitigate the impact of job loss for those affected by Roe v Wade’s overturning, such as clinic or organization workers. Since the Supreme Court decision to overturn Roe leaked, National Abortion Federation saw a 250% increase in job seekers registering to find openings and matches. As the landscape shifts, more employees will continue to face its repercussions. But if one thing’s for certain, they are doing everything they can to continue their work.