When the Supreme Court overturned Roe v. Wade in June of 2022, Katie Quiñonez-Alonzo knew her professional life was about to change. Then the executive director of the last remaining abortion clinic in West Virginia, she could see that the Republican majority in the state Legislature would soon pass a lasting ban on abortion.
She and the clinic’s board of directors began researching the laws in neighboring states. If their clinic had to stop providing abortions, they thought, perhaps they could open a new one in the region. It wouldn’t be as convenient to their patient population as the Charleston location, but it would be closer than many existing alternatives.
Ohio was out—a six-week abortion ban had taken effect immediately after Roe was overturned. (That law is now on hold, per a lower court’s injunction.) Abortion remains broadly legal in Virginia and Pennsylvania, but those states can be politically volatile, making it hard to predict how abortion providers would fare in the long term without the protections of Roe.
This left one neighboring state: Maryland.
There, legislators had passed a package of bills designed to expand the availability of abortion in the state. And they had also begun the process of adding the right to abortion to the state constitution.
“We felt like it was really, truly a duty, if we share a border with this state, that we should do everything in our power to try to keep abortion as accessible as possible to West Virginians,” Quiñonez-Alonzo said.
Soon after her Charleston clinic was forced to cease providing abortions, Quiñonez-Alonzo spent a day looking at potential locations for a new clinic. Standing in a parking lot of one property in rural far-western Maryland, less than two miles from the West Virginia border, the realtor pointed in the distance. “She said, ‘You see those mountains over there? That’s West Virginia, actually,’ ” Quiñonez-Alonzo recalled.
The visual proximity to the state held a symbolic resonance. “That sentence really cemented in my mind: This is the building,” Quiñonez-Alonzo said. “This has to be the building where Women’s Health Center of Maryland opens.”
In a matter of weeks, the center will begin providing abortions up to 16 weeks of pregnancy “smack-dab in the middle of an abortion desert,” as Quiñonez-Alonzo put it. It will be one of two new independent abortion clinics that have opened in Maryland so far since Roe was overturned.
While Roe stood, many Democrats in office didn’t see the need for proactive legislation to safeguard reproductive rights or expand abortion services. But over the past few years, in response to the Supreme Court’s ever-rightward lean—and, eventually, the overturning of Roe—several blue states have moved to protect abortion access, providers, and patients with new laws and funding.
Last year, recognizing that Oregon abortion providers would likely see a rush of patients from across the border in Idaho, the Oregon Legislature established a $15 million fund to help patients pay for abortions and associated expenses, such as travel and hotel stays. In California, legislators passed a robust package of abortion-access bills, including a law that eliminates out-of-pocket costs like copays for abortion services. California lawmakers are currently considering another package of 17 bills, one of which would shield health care providers from prosecution for mailing abortion medication to patients in other states.
On the East Coast, Maryland has leaned into its role as a beacon for abortion access in a region with dwindling options, and as a destination for people who need to travel across state lines to terminate a pregnancy.
Democratic Gov. Wes Moore recently signed a new law that prohibits Maryland entities from assisting in abortion-related investigations and court proceedings that originate in other states, shielding abortion providers and out-of-state patients from other states’ restrictions. Another new law helps protect patients by barring electronic medical records about their reproductive health care from being shared across state lines without consent.
A third law allows non-doctors like physician assistants and nurse midwives to provide abortions, and it sets aside funding to train them, which could relieve some of the increased burden on providers who are seeing lots of out-of-state patients. Maryland is also one of just eight states that require private insurance plans to cover abortion care with no cost-sharing.
And next year, Maryland residents will vote on an amendment that would enshrine abortion rights in the state constitution, making it much harder for any future Legislature to take them away. A poll from the Baltimore Sun and the University of Baltimore found last year that 71 percent of likely Maryland voters would support such an amendment.
In other words, in this unpredictable era of reproductive health care in the U.S., Maryland is about as safe a place an abortion provider can be.
That doesn’t mean the going is easy. At a public hearing in April, a county commissioner in the jurisdiction where Women’s Health Center of Maryland is set to open told a crowd of attendeeswho had come to protest that, though all three commissioners opposed the abortion provider coming to Allegany County, there was nothing they could do. Even if the commissioners voted to ban abortion in the county, he said, “I can’t trump the governor and I can’t trump the legislature.” In some corners of the state, there’s still plenty of hostility toward Maryland abortion providers.
But there is a lot more security. And it’s a major reason why Diane Horvath and Morgan Nuzzo, an OB-GYN and nurse midwife, respectively, opened Partners in Abortion Care in a Maryland suburb of Washington, D.C., last fall. “We have Democratic supermajorities in our General Assembly and in our Maryland Senate. We now have a Democratic governor, which is a wonderful, wonderful thing,” Horvath said. For an abortion provider in the mid-Atlantic, “Maryland is a really good place to work, and to live, and to have this clinic open.”
Partners in Abortion Care began as a dream nurtured by Horvath and Nuzzo, who had previously worked together at an abortion clinic in the area. When they spent time together outside of work, the two women would often talk about what they would have done differently if they’d been in charge at the other clinics where they’d been employed.
“As you do with your badass friends, you talk about your five- and 10- and 20-year plans for what your life is going to look like,” Nuzzo said. “And it always included the idea of having a clinic together at some point.”
In her medical training, Horvath had learned to do abortions later in pregnancy, including in the third trimester, which are a bit more complicated than earlier abortions. But it had never been the focus of her work. Even in states where such abortions are legal, not many clinics offer them. But patients who need abortions later in pregnancy are often younger—a disproportionate number are children. Others are adults with deeply wanted pregnancies who get a catastrophic fetal health diagnosis, or people who know they want an abortion from the start but need time to save up the money and make the trip to a clinic.
“I kept saying to myself for years: ‘Third-trimester care, later care, is so important, but I can’t do it.’ Or ‘It’s not right for me in this point in my life.’ Or ‘Someone else is taking care of it,’ ” she said. But Horvath realized that many of the practitioners who offer later abortions were getting older. They couldn’t meet the need forever. “It became more and more clear, as time passed, that I couldn’t keep saying that, and I couldn’t keep counting on other people to provide the care.”
Horvath and Nuzzo decided that when they opened a clinic together, they would offer abortion care in all trimesters of pregnancy. Neither of them knew much about what it would take to open a clinic or run a business. But in December 2021, they both happened to be out of a job, and they were paying close attention to the growing conservative bloc on the Supreme Court.
“We were like, listen, we think Roe is going to fall,” Nuzzo said. “We know how to do later abortion. There are very few clinics that do it. Why not us? Why not now?”
The two friends gave themselves a crash course in operating a business. They courted donors, talked to banks, got what they call a “predatory loan,” and raised nearly $425,000 on GoFundMe. Then, in May 2022, while they were having dinner together, the Dobbs decision leaked.
“And so we’re sitting there being like, ‘All right, it has to happen. There is no other option for this clinic to not be open,’ ” Nuzzo said. “ ‘There’s going to be this huge influx of people, this huge influx of need for care, especially for later procedures. We have to get this clinic open.’ ”
In October of last year, Partners in Abortion Care opened in College Park, Maryland. So far, the clinic has served patients from more than 30 states, many of whom had never been on a plane or even left their home state before traveling to Maryland for an abortion.
The opening of new clinics in Maryland is not just a benefit for out-of-staters. It will directly benefit Marylanders who might have otherwise faced longer wait times at clinics overburdened with patients from across the Midwest and Southeast. “We know that whenever abortion is banned in one state, the harms of that abortion ban don’t stay within that state’s borders,” Quiñonez-Alonzo said. “It spreads out, and it disrupts the ecosystem of abortion access in neighboring states.”
That ripple effect could worsen in months to come, as some states where abortion is now legal may pass stricter bans. In Ohio and South Carolina, for instance, bans passed by the state legislatures were blocked by judges. The political will to ban abortions still exists in those states, though, and they are liable to be controlled by Republicans for the foreseeable future.
All it will take is a new judicial ruling or a creative legislative workaround to push a ban through.
Even Virginia may not stand as a buffer for long. It is closer than Maryland to the states in the Southeast where abortion is banned, and abortion is still legal in Virginia until the point of fetal viability. But it is not a reliable sanctuary. Though Democrats held the governor’s seat and both chambers of the state Legislature just a few years ago, they now retain only a meager majority in the state Senate. Earlier this year, that majority was the only obstacle standing in the way of the Republicans in the state House and Gov. Glenn Youngkin, who tried to ban abortions after 15 weeks of pregnancy. If Democrats lose that majority in the next state Senate election, a ban will almost certainly succeed.
When Horvath and Nuzzo first found the 3,100-square-foot property in College Park where they would open Partners in Abortion Care, they expected that the space would be big enough to meet their needs for about five years, at which point they’d consider expanding. But already, less than a year in, they have had to bring on more staff and expand their schedule to accommodate patient demand.
“Even knowing all of the information, we still underestimated the need,” Nuzzo said.
With conservatives eager to restrict abortion access to the greatest extent possible wherever it is politically feasible, a federal ban—such as the 15-week ban Sen. Lindsey Graham has proposed—could someday render Maryland’s protections moot. It would only take a couple of bad elections for Democrats to give the Republican Party the votes needed to ban abortion nationwide. The Supreme Court would not stand in the way.
But for now, Maryland abortion providers are doing what they can, where they are, to be a regional backstop for abortion access.
“We’re talking about the five-year plan involving some bigger space and more staff, and we want to continue to hire,” Horvath said. “I tell my dad, who’s conservative, that I’m a job creator now, so I’d like to create more jobs.”
