A Year of Change for a North Dakota Abortion Clinic

Summary

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The Political Scene | The New Yorker

Episode: A Year of Change for a North Dakota Abortion Clinic
Date: June 26, 2023
Host: David Remnick
Guests: Emily Witt (The New Yorker staff writer), Tammy Kromenaker (Director, Red River Women’s Clinic)

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Episode Overview

This episode revisits the journey of the Red River Women’s Clinic, formerly the only abortion provider in North Dakota, in the wake of the Supreme Court’s Dobbs decision, which overturned Roe v. Wade. Through reporting by Emily Witt and an in-depth conversation with clinic director Tammy Kromenaker, the episode explores the clinic’s strategic relocation across state lines, the challenges faced during this transition, ongoing legal battles, and the shifting landscape of abortion access in America. The program provides a firsthand account of how the clinic and its staff responded to legal setbacks and adapted to continue providing care, as well as insights into broader trends affecting abortion providers nationwide.

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Key Discussion Points & Insights

1. Context: Post-Dobbs Legal Landscape

(01:17 – 03:18)

• The Red River Women’s Clinic was North Dakota’s only abortion provider.
• After the Supreme Court overturned Roe v. Wade, North Dakota (and 13 other states) implemented bans on abortion.
• The clinic’s solution: relocate just a few blocks east, across the Red River and state border to Moorhead, Minnesota, where abortion remains legal.

Quote:
"The Red river isn't wide here, but it now forms a border, a distinct border between starkly different realities for women. On the one side, North Dakota, which has banned abortion, and on the other, Minnesota, where Democrats are in power and they've expanded abortion access."
— David Remnick (02:55)

2. Moving the Clinic: Planning, Secrecy, and Execution

(03:31 – 07:14)

• Clinic director Tammy Kromenaker foresaw the need for relocation as early as Fall 2021, as legal threats mounted.
• The new clinic was purchased on June 23, 2022—less than 24 hours before Roe was overturned.
• Secrecy was paramount: Kromenaker describes moving incognito to keep the location private initially.

Quote:
"I was wearing a hat and glasses and a mask and coming in the back utility door, you know, because we had to keep the location secret and secure."
— Tammy Kromenaker (04:58)

• Intensive renovation and setup ensued, described as a community effort involving staff and volunteers.
• The first patients were seen August 10, 2022, only 47 days post-purchase.

Memorable Moment:
"People were running to the hardware store and picking stuff up. But this was the Tuesday. So this is what the room looked like then. This is 10 o’ clock at night. We threw the flooring down… Oh my gosh… 12:39am."
— Tammy Kromenaker (06:29)

3. Emotional Toll and Resilience

(07:14 – 07:58)

• Staff felt a blend of exhaustion, exhilaration, and anxiety.
• Despite losing the battle for abortion access in North Dakota, Kromenaker found a “silver lining”: a better facility and a less hostile political environment.

Quote:
"I played… Sia, 'I'm unstoppable,' because I just needed like an anthem."
— Tammy Kromenaker (07:14)

4. Clinic Operations in Minnesota: New Challenges and Patient Fears

(08:10 – 13:18)

• The new location’s security and setting have made patient experiences significantly less stressful.
• The clinic only serves up to 16 weeks’ gestation due to part-time availability of their doctor and regulatory constraints.
• Staff must frequently address patient misconceptions and fears, particularly around legality, safety, and anonymity when crossing state lines.

Quote:
"Patients demeanors when they arrive in the building is so different… when they used to come in, their adrenaline was pumping, they were crying, they were upset… but it’s not every patient every time [now]."
— Tammy Kromenaker (10:13)

• Adjustments in treatment protocols have been made to reduce legal risks to patients returning to states with abortion bans.

Quote:
"We don’t want patients to go back into those hostile states… So the second medicine in the medication abortion regimen, they insert while they're still here in the clinic, into their vagina. So they're not taking a bottle… that are specifically for abortion back into those host[ile states]."
— Tammy Kromenaker (11:57)

5. Legal Battles and Broader Advocacy

(12:35 – 14:13)

• Despite the move, the clinic remains a North Dakota corporation and continues to challenge restrictive laws in court.
• Persistent rumors about potential laws prohibiting travel for abortion care are addressed; as of the episode's recording, crossing state lines for abortion remains legal.

Quote:
"There's at least three bridges over the river from Fargo to Moorhead… What are they going to have, you know, National Guard stationed on the… the bridge? And a person who appears female and of reproductive age has to, you know, submit to a pregnancy test? I mean, come on, let’s get real about this."
— Tammy Kromenaker (13:24)

6. Impact on Other Providers and Emotional Fallout

(14:13 – 16:09)

• Kromenaker reflects on the challenges faced by clinics in regions without a nearby safe state.
• Many have had to transition into support organizations or close altogether.
• Survivors’ guilt and professional isolation among remaining providers are significant.

Quote:
“I, too, at a point, I was having some survivor’s guilt… really it was a victory of what happened for us, and… other people had to shutter their clinics… especially in the South. The whole South is a hot mess.”
— Tammy Kromenaker (14:28)

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Notable Quotes & Timestamps

• "The Red river isn't wide here, but it now forms a border, a distinct border between starkly different realities for women."
  — David Remnick (02:55)

• "I was wearing a hat and glasses and a mask and coming in the back utility door… because we had to keep the location secret and secure."
  — Tammy Kromenaker (04:58)

• "Oh, my gosh, yes. But also like exhilarated and nervous and scared and all of those things. I played… Sia, 'I'm unstoppable,' because I just needed like an anthem."
  — Tammy Kromenaker (07:14)

• "Patients demeanors when they arrive in the building is so different… now."
  — Tammy Kromenaker (10:13)

• "We’ve changed some of our medication abortion administration, because we don’t want patients to go back into those hostile states… So the second medicine… they insert while they’re still here in the clinic."
  — Tammy Kromenaker (11:57)

• "We still are a North Dakota corporation, and just because we… moved five minutes across the river doesn’t mean we’re abandoning North Dakota…"
  — Tammy Kromenaker (12:59)

• "There’s at least three bridges over the river from Fargo to Moorhead… What are they going to have, you know, National Guard stationed on the… the bridge?"
  — Tammy Kromenaker (13:24)

• “Especially in the South. The whole South is a hot mess. You know, there was no easy place for them to go to.”
  — Tammy Kromenaker (14:28)

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Important Segments & Timestamps

• Dobbs aftermath, context for move: 01:17 – 03:31
• Clinic relocation planning and secrecy: 03:31 – 05:20
• Clinic renovation and emotional journey: 05:20 – 07:14
• Opening and adjusting to the new facility: 07:14 – 08:10
• Patient care and new protocols: 08:10 – 12:35
• Legal challenges, cross-border fears: 12:35 – 14:13
• Reflection on loss, survivor’s guilt, and the wider impact: 14:13 – 16:09

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Summary & Takeaways

Amid an increasingly restrictive landscape for abortion access in North Dakota and surrounding states, the Red River Women’s Clinic serves as a poignant example of perseverance, rapid adaptation, and the new realities facing reproductive health providers. With patient anecdotes, operational details, and heartfelt observations, the episode offers a clear-eyed view of both the personal and political stakes. The conversation underscores broader questions about access, the consequences of legal shifts, and the resourcefulness and vulnerability of providers at this historic crossroads.

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Transcript

[A]

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[B]

This is the political scene and I'm David Remnant. One year ago, staff writer Emily Witt visited Fargo, North Dakota. She was there to report on the Red River Women's Clinic, the only abortion provider in the state. The Supreme Court's Dobbs decision had just come down and the Red River Clinic was in deep peril. Since then, 14 states in the country, 14, including North Dakota, have now largely banned abortion.

[C]

Let's just pull over for a second.

[B]

So about a year later, Emily Witt went back to Fargo and the site of the Red River Clinic.

[C]

Yeah, there used to be security. Well, the security clearances are still there and the kind of glass bricks to keep things private. But there's really no sign except for the sign that's still up against the wall there that this used to be a clinic for, I think almost 25 years. All right. Turning on the car.

[B]

She headed east past an anti abortion billboard, past some parking lots and auto shop, driving toward the river.

[C]

The Red river, which is the border between Minnesota and North Dakota, is really just a couple of blocks from the old clinic. And we're driving over it right now on the First Avenue Bridge. We're passing by a recreated Viking Ship museum.

[B]

The Red river isn't wide here, but it now forms a border, a distinct border between starkly different realities for women. On the one side, North Dakota, which has banned abortion, and on the other, Minnesota, where Democrats are in power and they've expanded abortion access. So the women's clinic relocated from Fargo right across the river to Moorhead, Minnesota.

[C]

So we're pulling in. It could not be more nondescript of a building. It's kind of pale brown bricks, two stories.

[B]

Emily Witt met with the director there, Tammy Cromonaker.

[D]

So you can just, you know, come out in the building and then we've got, you know, first layer of security.

[C]

Tammy is just a person that really has her act together. She's very detail oriented. She's very organized. She's not easily ruffled.

[D]

Did you have to do a lot of work, honestly, in this part of the space? Not really. We had to paint some walls.

[C]

She's often asked to lobby or testify, not only locally in North Dakota, but also sometimes in Washington. I think she's really seen as a leader in the field nationally.

[B]

In fact, Cromnaker had the foresight to start planning this move quite a while ago when the Supreme Court first announced it would take up the Dobbs case. And that was back in, in the fall of 2021. And she figured that the clinic needed a backup plan, and she was right.

[D]

Wow.

[C]

What day did you officially open here?

[D]

We saw our very first patients on August 10th of 2022. And we bought the building at 3pm on June 23rd, the day less than 24 hours before they overturned Roe. Wow. So 47 days from purchase to seeing our first patients.

[C]

At first, Tammy tried to keep the new location secret. When I visited last year, she wouldn't tell me where it was and didn't want me to know or the press to know.

[D]

It was less than a week before we opened that anti abortion protesters said, we know where the building is, and made the announcement. And it was sort of actually a relief because I'd been coming over here incognito. I was wearing a hat and glasses and a mask and coming in the back utility door, you know, because we had to keep the location secret and secure.

[C]

The building that she bought in Minnesota was kind of a very ordinary office complex set up for small businesses. So she had to totally renovate it to turn it into a functioning clinic.

[D]

And I can show you pictures too, from the Remodeling. But like these cupboards all came with. We just had to put new countertop on. We were able to get all new exam tables delivered. I think five days before we saw our first patient. There's kind of a lot of motion happening.

[C]

And this is just to clarify, we're in an exam room, there's an examination table, ultrasound machine.

[D]

The machine on the floor over there is the suction machine for the in clinic suction procedure, you know, and just your regular, you know, kind of what you would see in any other doctor's office on the counter. If you want to see some pictures really quick. Sure.

[C]

Yeah. I always say it's better to have. We were sitting in Tammy's office and she brought up some pictures on her. On her desktop screen and there were pictures of the renovation, of the floor torn up, of her staff setting up the WI fi on their phones for the first time.

[D]

I know. So, yes. So the volunteer, I mean, I had been moving things slowly and then once we, you know, was out, then I expanded the field to, you know, all of our escorts. And there actually was one gal who showed up in downtown Fargo at tenney. And at 6pm Here, I said, vanessa, go home. Like you've been here all day. I mean, people were running to the hardware store and picking stuff up. But this was the Tuesday. So this is what the room looked like then. This is 10 o' clock at night. We threw the flooring down. Oh, my gosh. And 12:39am.

[C]

And.

[D]

I think that's the worst picture right there.

[C]

Were you exhausted?

[D]

Oh, my gosh, yes. But also like exhilarated and nervous and scared and all of those things I played. That was that Sia. I'm unstoppable because I just needed like an anthem.

[C]

She seemed pleased and maybe a little bit surprised that they had managed to pull it off in such a short time and, you know, really, that they were able to continue on almost seamlessly, even though everything she had worked for for more than 20 years in Fargo had been taken away.

[D]

And then this is our staff debrief after our first day. But. Yeah, so that's what that room looked like the day before. That is wild. And then. Hi.

[C]

Hi. Sorry to interrupt. There's a patient on line one who is probably like 22ish weeks along. Her period was in December. Could you talk to her about where to go?

[D]

Yes.

[C]

Besides here.

[D]

Thank you. Hi there. Thanks for holding. What's your name? All right. And where do you live? Okay. All right. And did you have an ultrasound then? No, but what was the first date of your last period? So if we guess, like, January 1st, does that feel like a fair guess? Okay. All right. So, yeah, you are too far for us right now. And if you want to continue and have an abortion, you're going to have to travel out of state. There's a number of places that you can go to, but it's going to take some effort on your part, and I can help you find some of those places.

[C]

Red river only sees patients up to 16 weeks. That's mostly because their doctor only comes once a week, and procedures later in pregnancy need the patient to stay for another day, usually.

[D]

Okay, so what I'm going to do is I'm going to start texting you some of the names of the clinics, and you're going to have to call and make those appointments, and then we'll just keep in touch via text and get you all those other resources that you need. Okay. Is there anything else I can answer for you right now? Okay. You bet. Take care. Bye. Bye.

[C]

Tammy admits that the other side has won. They achieved what they hadn't achieved in decades, which was to ban abortion in North Dakota. But the silver lining to all this is that the new clinic is actually a better place to see patients than the old one was. And she's also now in an environment where she's not in political opposition to every legislative body in the state.

[D]

It's been a game changer having the parking lot. The protesters have to stand at the sidewalk over there. They cannot come into the parking lot. So patients demeanors when they arrive in the building is so different. When they used to come in, they'd be, you know, their adrenaline was pumping, they were crying, they were upset. And I mean, sometimes some do, but it's not every patient every time. So March and April were two of our busiest months in our history. We've seen a handful of patients from Texas. We saw a patient from Nebraska recently. I think we're seeing people from elsewhere. They're not necessarily telling us. Yeah.

[C]

What kind of fears and misinformation are your patients exposed to now?

[D]

Literally thinking that because abortion is illegal in North Dakota or South Dakota that they cannot receive one. And I've had a patient within the first few weeks while we were still in Fargo and the preliminary injunction was in place. Say, am I too late? Did I lose my chance? Am I screwed? Is what they literally said to me. Just last week, I had a patient from South Dakota say, is it even okay, you know, for me to leave South Dakota to Come there, they are fearful that somebody's going to find out. And it's why we've changed some of our medication abortion administration, because we don't want patients to go back into those hostile states. It only takes one rogue prosecutor, you know, to bring something forward. And I think people know that and have it in the back of their minds.

[C]

And so what have you changed just so they don't have to come back?

[D]

Or so patients from banned states, whether it's South Dakota, North Dakota, on and off, or maybe a place like Texas, those patients don't take right now misoprostol back into those hostile states with them. So the second medicine in the medication abortion regimen, they insert while they're still here in the clinic, into their vagina. So they're not taking a bottle with their name and the clinic's name and the physician's name, a bottle of pills that are specifically for abortion back into those host.

[C]

For decades, every time the North Dakota state legislature has tried to pass a law banning or restricting abortion, Red River Women's Clinic has been the entity that sues to try to protect it. And a few days after I left on this most recent visit, they had to sue again for a law that passed in April that almost totally bans abortion in the state.

[D]

We still are a North Dakota corporation, and just because we, you know, moved five minutes across the river doesn't mean we're abandoning North Dakota or abandoning the fight or giving up on continuing to lead the fight for bodily autonomy in North Dakota.

[C]

And do they have any ability to control who comes here?

[D]

No, there is no law. We'd actually heard rumors that they had anticipated passing a law that said you cannot cross the border. And, you know, I had some people say, oh, my gosh, this is, you know, this is going to happen. I said, come on, you guys. There's at least three bridges over the river from Fargo to Moorhead that I myself might cross four or five times in a day, depending on where I'm going to go grocery shopping or which target I'm going to go to. What are they going to have, you know, National Guard stationed on the. On the bridge? And a person who appears female and of reproductive age has to, you know, submit to a pregnancy test. I mean, come on, let's. Let's get real about this. But it's something we routinely have to educate patients about. It's okay to cross state lines for this care. It's okay to come here. Nobody's going to prosecute you.

[C]

And you were in a Group chat with a bunch of abortion providers from around the country. I'm just wondering what you're hearing from your colleagues. I'm sure a lot of those clinics have had to close. How have people regrouped and readjusted?

[D]

The folks that I've interacted with have not had as close a proximity that we do from Fargo to Moorhead and. Or had the space. I mean, literally, we signed on the building the day before. I think a lot of people said, oh, I'm going to, or I dream to. And so some people have moved to Florida or New Mexico. A lot of those clinics also transition to being sort of practical support networks. Like, we can't see you, but we can help you go to this place or we work with this fund and we'll help you get elsewhere. So I think, and I, too, at a point, I was having some survivor's guilt, and it was hard for me to talk to some of those friends and colleagues because I felt like, I mean, really it was a victory of what happened for us, and we're able to see those same patients. And again, I'm not going to say it was easy, but from the outside, maybe it looked easy. And other people had to shutter their clinics and sell the buildings. And there was no close, you know, especially in the South. The whole south is a hot mess. You know, there was no easy place for them to go to. And so I was having some, you know, extreme guilt, you know, didn't want to talk about it, and so felt like I sort of had to keep it under wraps for a while. So it's just been. It's been a really hard year in a lot of ways for providers.

[B]

That's Tammy Kromanaker, director of the Red River Women's Clinic. Emily Witt is a staff writer, and you can read her reporting from north [e-mail].

[E]

I'm Katie Drummond. I'm Wired's global editorial director. I'm Michael Kalore, Wired's Director of consumer tech and Culture.

[D]

And I'm Lauren Good.

[C]

I'm a senior correspondent at Wired. And our show, Uncanny Valley, is about the people, power and influence of Silicon Valley.

[E]

And right now, Silicon Valley and Washington have never been more intertwined. So each week we get together to talk about a big story, often at the intersection of tech and politics.

[D]

Right.

[E]

So whether we're talking about Trump, Coin, Doge, or Elon Musk, we will always explain how these Silicon Valley forces are affecting Washington and how they affect you. Make sure you're following Uncanny Valley in your podcast app of choice so you don't miss an episode.

[C]

From prx.