PHOTO ILLUSTRATION BY FIVETHIRTYEIGHT / GETTY IMAGES
This is the first entry in a series tracking what it’s like to open an all trimester abortion clinic in the US as abortion rights are curtailed.
At the end of last year, Dr. Diane Horvath and Morgan Nuzzo that they wanted to take the plunge and start their own business. They sought funding from both traditional and non-traditional sources, found creative ways to cut costs, and hired attorneys to help them navigate the world of business leases, bank loans, and incorporation documents.
It’s a journey familiar to entrepreneurs across the country — but unlike Horvath and Nuzzo, these entrepreneurs aren’t opening Abortion clinic for all trimesters.
It’s a troubling time to be an abortion provider in America. Sometime in the next few weeks the Supreme Court Roe v. Wade could fallthe 1973 Opinion, which established a constitutional right to abortion and sent the matter back to the states. Thirteen states would immediately ban the procedure, and another dozen could severely limit it. When that happens, abortion providers in states where abortion remains legal would suddenly be faced with one Increase in patients from abroad.
One state likely to see an influx is Maryland, where Horvath and Nuzzo are opening their Partners in Abortion Care clinic. In a country where abortion providers are increasingly on the defensive, both Horvath and Nuzzo are oddly optimistic. “The only thing that drives us forward and doesn’t make us despair is that we are working to open this clinic,” said Horvath. “We all want to burn shit down and light it, but we’re going to build something instead.”
But, given the upcoming Supreme Court decision, can they build it fast enough? When I met Horvath and Nuzzo in April, they had been trying to get their clinic up and running for five months. They had qualified for a business loan, which they estimated would cover about a fifth of their costs, but they were still awaiting feedback from foundations saying they were working to expand access to abortion. In desperation they founded a GoFundMe page, which eventually became a major source of funding: in just over two months, they raised more than $260,000. “I never thought I would have to crowdfund an abortion clinic,” Horvath said.
David F. Choy / PARTNERS IN ABORTION TREATMENT
When we spoke a few weeks later, Nuzzo told me she had a lead on a dental chair she found on Facebook Marketplace. “I’ll keep it in our storage next to the ultrasound machine we bought on Craigslist,” she said. That sounds a little odd, Nuzzo was quick to add, but she said the equipment is working well and they need to make progress. “Why don’t we just wait for our money to come in and buy everything new? Well we can’t if we want to open in the fall.”
Starting a small business is never easy, but starting an abortion clinic presents unique hurdles — especially one that offers later-term abortions. Even if timing and funding aren’t a factor, something as simple as find location can be incredibly difficult. Many landlords don’t want to rent to abortion providers, and local zoning laws sometimes restrict where abortion clinics are allowed to operate. Other businesses might also object to being in the same mall as a facility that’s a magnet for protesters.
Because of these challenges, it’s relatively rare for a new provider not affiliated with Planned Parenthood or another existing clinic to gain a foothold. According to Caitlin Myers, an economist at Middlebury College who maintains a database of abortion providers who publicly advertise their services, between January 1, 2013 and June 1, 2022, 356 providers opened or reopened, while 405 clinics closed, re-closed or have stopped offering abortions. About 58 percent of newly opened or reopened clinics are affiliated with Planned Parenthood, and many more belong to established clinic chains. Roe’s impending fall hasn’t changed that trend. As of June 1, Per Myers had only 10 clinics open since January, and only three others (including Partners in Abortion Care) planned to open in the fall. In the meantime, 20 clinics had closed or closed again in the first five months of the year.
Horvath and Nuzzo are used to doing difficult things. A certified nurse and midwife, Nuzzo is something of an anomaly in her field. Maryland recently became one of them a handful of states Certain healthcare workers who are not physicians, such as e.g. nurses and midwives, to perform both medical and procedural abortions, but it is still uncommon for midwives to specialize in abortion. “The only reason I was trained [to do abortions] It’s because I was just hanging around and I was like, ‘Can I try? can i try Do you think I could do that?’” Nuzzo said. For her part, Horvath comes from a more traditional background and was an outspoken advocate for abortion rights. In 2016, after the hospital she worked for tried to prevent her from speaking publicly about the abortions she performed, she filed a lawsuit Federal civil rights complaint.
There are no such barriers at Partners in Abortion Care. Despite considerable pressure from potential donors, Horvath and Nuzzo decided not to set up as a non-profit organization, leaving them free to engage in political advocacy, which they intend to continue doing. “I remember when Trump said, ‘Oh, they’re ripping babies out of their wombs for abortions at 39 weeks,’ blah, blah, blah, I’ve been asked about that in a number of interviews,” Horvath said. “I was working for a non-profit advocacy group at the time, and the phrase we encountered was something like ‘Such statements do not reflect medical reality.’ And I thought, ‘What we should say is that this is a damn lie.'” (What Trump described does not happen.)
To find a place for their clinic, Horvath and Nuzzo worked with an investor who agreed to purchase a rental facility in College Park, Maryland. This gave them peace of mind that they didn’t have to raise money to buy their own space since their landlord supported the clinic. But the clock was ticking. They’d signed a lease, but by early June, when Roe was likely to be knocked over any day, they still didn’t have keys to the facility — meaning they couldn’t buy equipment or hire staff.
Entering the room to start the renovations was another hurdle. After months of unsuccessful meetings with potential donors, they received a $300,000 grant from a small foundation. Combined with money from GoFundMe, Horvath and Nuzzo were finally able to afford to pay themselves a salary three months ahead of the clinic’s scheduled opening.
Even that timeline — which is short by the standards of starting any other company — wasn’t as quick as Horvath and Nuzzo had hoped. Ideally, it would have been better off opening in June before the Supreme Court ruling. Now, by the time Partners in Abortion Care opens, the landscape of abortion access could be vastly different. And the number of people who need the services of an all-trimester abortion clinic is likely to be higher.
Horvath told me about a third trimester abortion she had performed with Nuzzo’s help. “I remember taking care of a very young girl who was stunned the whole time,” Horvath said. The patient was confused because abortion at this stage of pregnancy involves induction of labour, which can be very painful. “She kept saying, ‘Why am I in all this pain?'” Later, when the girl was recovering, Horvath reached out to her and asked what she was most looking forward to when she got home. “And she’s like, ‘I just want to be a kid again,'” Horvath said. “I had to go to my office and I just started sobbing. And I thought, ‘I’ll never be able to do anything else. Because this is where I need to be.’”
In a way, this is why Horvath and Nuzzo are so optimistic: in a moment of crisis, they have a job to do. I spoke to Nuzzo on a Friday afternoon in early June when the Supreme Court decision could come out any day. “I’m feeling very lucky right now,” she said. “Roe may fall on Monday, but OK: we finally have money. Enough to open I think. This is the moment and we are here. So I feel good about it.”