If you lived in the Flathead Valley and wanted or needed to abort a pregnancy in the past four years, the closest clinic was more than 100 miles away in Missoula, Great Falls, Helena or Billings.
"In the Valley it's like, if you want to have an abortion or you want to not carry whatever to term, you're placed in a category of an irresponsible, ill-fitted individual," said a woman, who we’re not naming to protect her privacy, a few days after she got an abortion at All Families Healthcare clinic in Whitefish, which reopened this February after a four-year closure.
The woman says the father isn’t in the picture and her family supports her decision.
"I'm still trying to focus on getting my life together," she says. "So how can I sacrifice all my goals, my dreams, my aspirations, everything I'm still working on, due to an irresponsible act of adulthood?"
The Montana and U.S. Supreme Courts have upheld the right to abortion since the 1970s. But some advocates fear that could change if President Donald Trump’s Supreme Court nominee, Brett Kavanaugh, is confirmed. Trump has promised to name someone to the court who would overturn Roe v. Wade.
Currently, most regulation about abortion comes at the state level. Montana has relatively few laws concerning the termination of pregnancy. This year, two nurses are challenging one that limits who can provide both medical and surgical abortions.
Advanced practice nurse Helen Weems re-opened All Families Healthcare in Whitefish with the goal to make the full spectrum of reproductive healthcare more accessible. All Families is a family practice that specializes in adolescent and LGBTQ healthcare. It also provides abortion and same-day access to long-lasting birth control, a pair of procedures this patient is finishing up today.
"That's being responsible so that I don't to put myself through an abortion again. Essentially in the end, I'm the one who is in this room by myself, making this choice, making this decision," says the patient.
Helen Weems says this type of same-day service, which All Families can often provide free of charge thanks to community donations, is unusual.
"It usually takes a couple of visits and weeks and months for the office to wrangle with insurance companies to get the IUD or the implant paid for," says Weems. "And in the meantime, the woman's really at risk for becoming pregnant. And unfortunately we’ve seen those patients here—'I was waiting to get my IUD. I got pregnant.'"
All Families Healthcare has a tumultuous history. Physician’s Assistant Susan Cahill opened the clinic in Kalispell after her mentor’s office there was firebombed. All Families was destroyed 20 years later, in March of 2014, when Zachary Klundt broke into it in what he called a drunken search for prescription drugs. At the time, Klundt's mother was on the board of Hope Pregnancy Ministries in Kalispell, which advocates for alternatives to abortion. She resigned after the attack. Both she and her son have said the incident had nothing to do with their politics or religion.
Klundt destroyed pretty much everything inside All Families. He served three years in prison before he was released on parole this February. He’s been praised by radical abortion activist groups for his actions.
Weems says abortion will always be a polarizing issue.
"No one can enter into this work blindly or naively," she says.
Weems says most days a small but dedicated group of protesters wave signs outside the clinic. But she says their presence is eclipsed by community support. More than 100 people are on the All Families volunteer list. They’ve driven patients from as far as Browning to their appointments, shoveled walkways, escorted patients to and from their cars and offer free options counseling. Letters of thanks and encouragement cover every inch of doors and spill onto the walls.
"Thank you for the services you are doing for women and families in our community. Know that there are a lot of people who have your backs, and we are so appreciative," reads one letter.
Weems says All Families fills a gap in the greater Flathead, but there’s a hitch: A Montana law only allows physicians and physicians assistants to perform abortions. Weems is an advanced practice registered nurse. In February, she and another unnamed nurse represented by the Montana American Civil Liberties Union filed suit, challenging the law.
Elizabeth Nash is a policy analyst with the Guttmacher Institute, a research and policy organization that advocates for sexual and reproductive health and rights in the United States and abroad.
Nash says, "We're really looking at about 14 states not including Montana that allow advanced practice clinicians, such as physician assistants or certified nurse midwives or advanced practice nurses, to provide abortion services."
Montana has one of the most severe physician shortages in the country. Nash says the laws that limit providers mostly date back to shortly after the Roe v. Wade decision in 1973, when states considered these limitations a way to protect women from unqualified providers.
"The laws around physician-only are just incredibly outdated. And moreover, what is important is that advance practice clinicians have the ability and the training to provide abortion services. So really there is a practice and law mismatch here," says Nash.
Some states allow boards of nursing to regulate whether to include abortion services in nurses’ scope of care. Elsewhere, state legislatures have enacted laws to regulate who can provide abortions. Nash says some state legislatures have limited access in some states, especially in rural areas, where nurse practitioners had been providing the service.
"In my mind the Board of Nursing is the appropriate place to be making these decisions, not the legislature and not the court, because the Board of Nursing handles the scope of practice," says Nash.
Nash adds state legislatures have limited access to abortion in other ways, including so-called targeted regulation of abortion providers, or TRAP, laws that regulate clinics like requiring corridors be a certain size, requiring patients to receive options counseling or instituting a waiting period.
Montana doesn’t have these regulations, but the question of who can provide abortions has been an incremental tug of war over the past few decades. Susan Cahill, Weem’s partner at All Families and a physician’s assistant, successfully challenged a Montana law in 1997 that said only physicians could provide abortions. State lawmakers expanded it to include physicians assistants.
Weems and the unnamed nurse have filed a lawsuit to allow advanced practice nurses to perform abortions as well.
In April, they won an injunction that allows Weems to provide supervised abortions as an advanced practice nurse while she trains in the procedures. Weems calls the injunction vitally important.
"Providing these tools, providing unfettered access to birth control, providing unfettered access to abortion helps women parent if and when they want to," says Weems, "And that's a powerful tool for social change."
Montana’s Attorney General Tim Fox has appealed the injunction that allows Weems to continue providing abortions while training to the state Supreme Court, arguing that abortion services are not within a nurse’s scope of practice. A response brief from the nurses’ attorneys is due November 16.