The last eight weeks have been an emotional rollercoaster for Nicole Smith, the executive director of one of Montana’s only independent abortion clinics. 

When news broke in early May indicating the U.S. Supreme Court was prepared to roll back federal protections for abortion, Smith felt as if a longstanding prediction was coming true.

“Many of us have been trying to scream at the top of our lungs for years that things are not OK,” the leader of Blue Mountain Clinic in Missoula said during a recent phone interview. Reading the leaked draft opinion written by Justice Samuel Alito, she said, was “just a huge reawakening for everyone.”

As written, the opinion would overturn the landmark Roe v. Wade ruling, the 1973 decision that has kept abortion legal in the United States despite decades of legal challenges from abortion opponents. As it began to circulate, some supporters of abortion access bluntly predicted widespread negative consequences for people who they say would essentially be forced to carry unwanted pregnancies to term. But as she watched the news unfold, Smith said, gloom didn’t have time to settle in. 

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The publication of the leaked draft happened to coincide with Missoula Gives, an annual fundraising drive for nonprofits in Missoula and Ravalli counties. Smith said Blue Mountain Clinic received the most individual donations of any participating organization, raising more than $60,000 from 350 people in just two days.

The windfall was more than three times what the clinic had hoped to raise, a sum Smith said “far exceeded our expectations.” The money will be used to upgrade security systems, retain and hire staff, and prepare for a possible influx of clients from across the country. Those expansions will buttress what Smith and other Montana abortion providers point to as their primary mission: keeping clinic doors open.

“The number one priority for us now is protecting abortion access in our state,” Smith said. “We are standing united. We are standing strong.”

Montana is one of a handful of non-coastal states that would maintain a constitutional right to abortion if Alito’s draft opinion becomes binding this month, putting pressure on abortion providers and clinics to prepare to care for patients from across the country.

The Montana Supreme Court decided in 1999 that abortion access is protected by the state’s Constitution. The unanimous opinion in Armstrong v. State means that access to abortion, like other medical choices, is considered an exercise of Montanans’ constitutional right to privacy. 

The court’s decision has endured through multiple gubernatorial administrations, changes in political leadership in the Legislature, and a number of legal challenges. The most recent package of proposed abortion restrictions passed during the 2021 Legislature is still working its way through the state court system, with Planned Parenthood of Montana and the Montana attorney general’s office expected to remain locked in litigation for several months.

Even with Armstrong in place and restrictive legislation on hold, accessing an abortion in Montana is not always easy. There are just three organizations in the state dedicated to providing abortions at in-person locations — All Families Clinic in Whitefish, Blue Mountain Clinic in Missoula, and Planned Parenthood of Montana, which operates clinics in Great Falls, Helena and Billings. Other private practice doctors and certain clinicians may provide abortions, but often don’t advertise those services to avoid public blowback in a highly politicized environment. 

Providers say the state’s patchwork system is still a more robust network than those in some nearby states. Montana’s operational clinics and legal landscape mean providers are expecting to see increased demand for services from out-of-state patients. The anticipated influx of patients, they say, may begin with residents of the states bordering Montana, all of which have
“trigger laws” in place that would make abortion illegal if federal protections fall. 

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“We need to prepare to expect who knows how many people from other states,” said Helen Weems, founder and director of All Families Clinic in Whitefish. While Weems anticipates her clinic might see a boost in patients from across the nearby Idaho border, she said a surge could also come from states in the southeast and southwest, including Oklahoma, Texas, Arkansas and Mississippi.  

“We just can’t predict what that overflow will look like,” she said.

Weems’ clinic, like Blue Mountain Clinic and Planned Parenthood of Montana, has spent much of the past two months preparing to ramp up a variety of abortion services. Depending on the clinic, that might include surgical abortions up until roughly 21 weeks of pregancy, earlier-term medication abortions, telemedicine consultations, and the delivery of abortion medication by mail. Smith said Blue Mountain Clinic just launched its own abortion-by-mail program last month to better serve patients around the Missoula region. Other national groups like Plan C and Just A Pill have also begun using telemedicine and mail programs to help patients in Montana and other states get earlier-term consultations and abortions.  

In a large, rural state like Montana, providers stress that telemedicine appointments and medication abortions need to be protected as diligently as in-person clinical services. Making those options more available for Montanans could help ease the demand for later-term surgical abortions, a procedure that will likely become more important for patients traveling from other states where abortion becomes illegal.

But providers also point out that ensuring a full range of medical services is only part of the access puzzle. Many patients face acute financial hurdles, including prohibitively expensive medical care, travel, lodging and childcare. Montana’s abortion providers are trying to plan for that as well by setting aside their own pools of money to help patients cover costs as needed. 

One Montana resource to help patients overcome financial barriers is the volunteer-run Susan Wicklund Fund. In the weeks following the leaked draft opinion, that group also saw a boost in financial support, raising nearly $30,000 in a Gallatin Valley nonprofit fundraiser similar to Missoula Gives. In a May 31 post on Instagram, the fund said it had put nearly $4,000 toward helping 21 patients fund abortions and related expenses in that month alone. 

Along with financial support and medical access, Montana providers are expecting another challenge in a post-Roe world: educating the public about abortion access in the state. When the draft opinion blanketed news platforms in May, patients who had scheduled abortions at Planned Parenthood of Montana began calling to double-check that those procedures were still legal, said the group’s president and CEO Martha Fuller. 

If the formal opinion comes down, Fuller said misinformation and uncertainty about Montana’s laws and medical services will likely start to spread.

“I hammer this point over and over and over again,” Fuller said. “Reminding folks of the protections that we have here in Montana, and the fact that abortion providers have their doors open and are ready to see patients, no matter where those patients are from.”

Without adequate information, Fuller said patients from around Montana and the U.S. might never be aware of the resources that are available.

“I don’t think we can say it enough,” Fuller said. “Just giving people the knowledge, across our region, that Montana is an option.” 

Editor’s note: This story was updated June 27 to correct the spelling of Susan Wicklund Fund.

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Mara writes about health and human services stories happening in local communities, the Montana statehouse and the court system. She also produces the Shared State podcast in collaboration with MTPR and YPR. Before joining Montana Free Press, Mara worked in podcast and radio production at Slate and WNYC. She was born and raised in Helena, MT and graduated from Seattle University in 2016.