A Montana abortion provider surveys a landscape of political threats

On a Thursday in early August, Helen Weems and the two nursing assistants at All Families Healthcare in Whitefish had, by their standards, a typical day.

They arrived at the clinic early that morning, using a back entrance that routes them away from the anti-abortion protesters who post shifts in front of the building twice a week. Inside, they opened a key-coded door and entered a small waiting area with soft lighting, white walls, and a collage of bright thank-you cards. As they prepared for patients, one of the nursing assistants turned on an oldies radio station. The day’s first abortion was scheduled for 9 a.m.

In an interview later that day, Weems, the clinic’s founder and sole abortion provider, said the first patient was also fairly typical. The woman had decided to end her pregnancy, Weems said, because she and her partner were “super clear” they weren’t interested in having kids at the time. Like many of Weems’ patients, she was also feeling the emotional fallout of the June U.S. Supreme Court ruling that overturned Roe v. Wade, upending the precedent that had made abortion legal for nearly 50 years.

“She felt like this was so important that she be able to have this option,” Weems recounted as the refrain of Billy Joel’s “My Life” played quietly in the waiting room. “And she became really angry and tearful when we talked about how we could lose this right in Montana.”

All Families Healthcare is one of three organizations that provide abortions in Montana. An advanced practice registered nurse, Weems provides abortions either by prescribing a two-dose medication regime or performing in-clinic procedures for patients who are up to 12 weeks pregnant. She estimates her clinic scheduled 75 abortion appointments between June and August, in addition to other health services including birth control appointments, STI testing and pregnancy counseling.

Weems has been providing those services since she first opened the clinic in 2018. During that time, she said, she’s considered politics a “verboten” topic with her patients, but that’s changed in the post-Roe era. For the first time, Weems is now warily watching the coalescence of a political movement in Montana that could make her close her doors. With passionate anti-abortion politicians holding the state’s highest elected positions and Republicans poised to win a supermajority in the Legislature this November, Montana’s abortion opponents are more empowered than they have been in decades.

For abortion-rights advocates like Weems — and for those who want abortion banned — the stakes in Montana are especially high: All of the state’s immediate neighbors have advanced strict abortion limits, bans and penalties since the overturn of Roe v. Wade, making abortions difficult to obtain in Idaho, Wyoming, South Dakota and North Dakota. In that context, Montana stands out as both a legal haven and a political target.

Weems has had to adjust to the intensified political climate. She designed All Families Healthcare to be a comforting and uplifting space for patients to navigate an intensely private and personal decision, decorating her exam room with colorful posters and twinkling string lights. Increasingly, though, Weems feels like public politics have cast an unavoidable shadow over her conversations with patients.

“Typically people will say, ‘What can I do to help?’” Weems said. “And I’ll say, ‘Are you registered to vote? Voting to support access to abortion is probably the most important thing you can do.’”

WEEMS' FIRST job out of college was at an abortion clinic in Seattle, where she grew up. Seeing the work there inspired her to become a nurse practitioner, and she eventually took a job in Seattle public schools as an adolescent health provider. Years later, her husband wanted to move back to Whitefish, where he had lived for a time in the 1990s.

When Weems, now 54, began researching health care in Montana, she realized abortion access was strongly protected and that, at the time, there were no abortion clinics in the Flathead Valley. She started envisioning how she could fill that gap and provide the region with what she sees as an essential service.

“People choose abortion oftentimes because they don’t have the resources, they don’t have the energy, they don’t have the capacity to raise their children in the way that they would want to,” Weems said. “It’s so positive, it’s so rewarding. It’s like you’re helping people be the people they want to be.”

But Weems also knew that being an abortion provider in the Flathead wouldn’t be easy. In 1994, an anti-abortion activist firebombed a Kalispell abortion clinic, among others in the region, operated by the physician James Armstrong and physician assistant Susan Cahill. Two decades later, in 2014, Cahill’s new clinic in Kalispell, also named All Families Healthcare, was vandalized beyond use by a man whose mother sat on the board of a local anti-abortion ministry. After that incident, Cahill decided not to reopen.

While preparing to move to the Flathead, Weems asked Cahill to mentor her. Cahill eventually agreed and the two ultimately reopened All Families in 2018, this time in Whitefish. They worked together for a year before Cahill retired.

Today, Weems’ clinic is the only abortion provider in the Flathead area. The next closest provider offering the same services is Blue Mountain Clinic in Missoula, 133 miles to the south. Planned Parenthood of Montana operates four health clinics around the state. As of September only one, in Helena, is providing in-clinic abortions for pregnancies after 11 weeks in addition to earlier-term medication abortions. Another provider at an independent clinic in Bozeman, who did not publicly advertise her abortion services, shut her doors this summer, citing high costs and the strain of the current political environment.

Weems said she’s had patients drive to her clinic all the way from Havre, more than four hours to the east, and Glasgow, a seven-hour, 400-mile one-way trip.

“We’re pretty alone in this state,” Weems said. “It’s Blue Mountain. It’s All Families. And it’s Planned Parenthood. It’s not very much for a huge state.”

SINCE THE U.S. Supreme Court struck federal protections for abortion in June, Montana’s clinics have continued to operate legally on the basis of the precedent laid out in Armstrong v. State, a 1999 case named after Cahill’s former partner. In its Armstrong ruling, the Montana Supreme Court unanimously defined abortion as a protected, private medical procedure that may only be restricted if lawmakers identify a “compelling state interest” distinct from political ideology.

Despite the national tumult created by the end of Roe, Montana’s abortion providers have been mostly resolute about continuing to provide services. Planned Parenthood of Montana temporarily stopped providing medication abortion to patients from abortion-ban states out of fear of litigation, but reversed that decision in August. Montana’s primary abortion access fund, the Susan Wicklund Fund, raised more than $15,000 in July and August of this year, compared to less than $4,500 during the same months in 2021, to help people afford abortions and related costs like travel and childcare. A board member for the fund, Aileen Gleizer, told Montana Free Press the number of funding requests it has received from in-state and out-of-state residents also jumped this summer compared to last year, from 36 to 77.

And some Montana abortion providers, including All Families and Blue Mountain Clinic in Missoula, have expanded their telemedicine and medication-abortion-by-mail programs to serve more people in the state’s rural areas. Nicole Smith, Blue Mountain’s executive director, credits the clinic’s current operations to Montana’s strong legal protections and lack of restrictive laws intended to discourage abortions.

“We have access in Montana, and we come to work every day and we don’t have barriers,” Smith said. “Our patients don’t have waiting periods or forced ultrasounds or any of that.”

Yet Montana abortion access advocates are acutely aware of how the state’s current political dynamics threaten their cause. For 16 years, while many other states steadily whittled away at reproductive choice, Democratic governors in Montana blocked abortion restrictions passed by the GOP-controlled Legislature. Now, Republican Gov. Greg Gianforte and the conservative majority in the state Legislature have made opposing abortion a top priority.

Last year, Gianforte signed a handful of abortion restrictions into law, including a bill that would restrict medication abortions and ban the distribution of that medication by mail. After being challenged by Planned Parenthood of Montana, that law and two others were temporarily blocked from taking effect last October with a preliminary injunction issued by a Billings judge who cited the Armstrong precedent.

Throughout the legal fight, Gianforte and Republican Attorney General Austin Knudsen have urged the state Supreme Court to reconsider the Armstrong case, a decision Knudsen’s office has called “wrong from the day it was decided.” In August, the court upheld the district court’s injunction but declined to deliberate on Armstrong. The case is now scheduled to continue in Billings.

While the new laws are on ice, Weems is tracking other political developments she said could undermine abortion rights, including a potential Republican supermajority in the Legislature that could ask voters to consider a constitutional amendment to ban abortion outright or change the Constitution’s privacy provision on which Armstrong is based.

In her office, Weems ticked through a mental list of levers Republicans in the Capitol could pull to advance their longtime anti-abortion crusade: Win their legal fight against the Armstrong precedent, enact more abortion restrictions that bypass the Armstrong ruling, or revise the Constitution.

“Suddenly we’re like, oh, my God, it’s not so protected. We’re incremental steps away from losing this right,” Weems said.

In an August radio segment produced by the Montana Family Foundation, a conservative policy group, president and lobbyist Jeff Laszloffy endorsed the rollback of the Armstrong decision. Abortion policy, he said, should be decided by state lawmakers.

“The executive and legislative branches, along with the U.S. Supreme Court, have put the Montana Supreme Court on notice,” Laszsloffy said. “Roe was flawed. Armstrong is flawed and the Legislature wants that power returned to its rightful venue, the People’s House.”

But advocates on both sides of the issue, including Laszloffy, have acknowledged that bringing Montana’s abortion policy in line with the restrictions in neighboring states would require a long fight. Smith, from Blue Mountain Clinic, sees the same possibilities on the horizon but is hesitant to call any of them an imminent threat. Access in Montana “could change, but also it could stay exactly the same,” she said.

“I’m not spending a whole lot of my time speculating on what could happen, because I think that there’s also a lot of reason to be optimistic that we are going to hold the line and that our status here is going to stay the same,” Smith said. “We have to wait and see. We just don’t know.”

Smith and Weems agree that one hypothetical future risk for abortion access could be a conservative tilt on the Montana Supreme Court leading to rulings that weaken the protections laid out in Armstrong. They’re closely watching this year’s Supreme Court races, particularly for the seat held by Ingrid Gustafson, a longtime district court judge in Billings who was appointed to her seat by Democratic Gov. Steve Bullock in 2018. Gustafson is facing a challenge from Republican attorney James Brown, the state GOP’s former counsel and current president of the Montana Public Service Commission, where he was elected as a Republican in 2020.

The candidates, constrained by judicial ethics requirements, have been careful to avoid commenting directly on how they’d rule on abortion cases. Nonetheless, defenders of abortion access are rallying behind Gustafson, who has pledged to uphold and protect the rights laid out in the Montana Constitution. Brown has been explicitly endorsed by anti-abortion conservatives, including Gianforte and Knudsen. While Brown, Like Gustafson, has promised to protect Montanans’ constitutional rights, he’s also openly criticized the Montana judiciary as having a liberal bent and for blocking “democratically passed legislative enactments” the Republican-held Legislature passed last year.

The outcome of November’s Supreme Court races could also affect the decision in one particular case that looms large for the Whitefish provider: Weems v. State.

As she and Cahill were working to reopen All Families in Whitefish, Weems realized that Montana law codifying the 1999 Armstrong decision did not explicitly allow advanced practice registered nurses like her to provide abortions, instead authorizing only physicians and physician assistants. Represented pro-bono by the Center for Reproductive Rights, a national advocacy group, and the ACLU of Montana, Weems sued the state to clarify that nurses with her license and appropriate training are qualified to provide abortions in line with the Armstrong decision.

In 2018, a temporary ruling by a Helena district court judge allowed Weems to open her clinic. After years of litigation, the same judge in February struck down the law entirely, saying the state had not established a “compelling interest” in restricting the performance of abortions to physicians and physician-assistants. Attorney General Knudsen appealed that decision to the Montana Supreme Court later that month, writing that the district court’s ruling made abortion “less safe for Montana women” and “re-exposes” abortion patients “to back-alley medical standards.”

The future of All Families hinges on the case’s ultimate resolution.

“I’m definitely sitting on pins and needles,” Weems said. “It’s my livelihood, it’s my business, it’s my passion,” she said.

JOHN O'NEIL, 82, and Bette Schultz, 77, are among the rotating cast of protesters who can often be found waving anti-abortion signs and soliciting honks from drivers outside Weems’ clinic.

On that Thursday in early August, O’Neil was wearing a cowboy hat and blue jeans. He’s been protesting long enough to have laminated business cards he distributes without invitation. “Are you Pro-Life?” one side reads. “There is an Abortion Clinic in the Flathead … Prayer Vigils conducted every Tues and Thurs 9:00 AM to 5:00 PM.”

The clinic’s entrance for patients and staff is on the back side of the building, shielded from the busy street that funnels traffic into downtown Whitefish. O’Neil said the protesters choose to stand near the street, in full view of passing cars, so they can spread their message to as many people as possible.

“We never know if we’ve turned someone’s mind,” O’Neil said. Even if protesters dissuade 10% of patients from going through with their appointments, “that’s great for us,” he said.

In the span of five minutes that Thursday, the reactions of passing drivers to the protesters were mixed. Some honked and flashed thumbs-up. Others rolled down their windows to shout profanities. O’Neil and Schultz appeared unfazed by the latter, saying the “vast majority” of responses are positive.

Montana’s continuing legal access to abortion while nearby states enact restrictions is only “more cause for prayer,” O’Neil said. Beyond that, he said, Montana’s abortion laws will change, or not, through the ballot box. He said he’s paying particular attention to the state’s legislative races, the contests that could deliver a GOP supermajority capable of taking abortion policy directly to voters.

“It’s going to wake up a lot of folks, we hope, to pay attention to who’s going to get elected this November,” he said.

Inside All Families, Weems knows some of the regular protesters by name. She and O’Neil have spoken several times.

“We are equally passionate in our positions,” Weems said with a wry smile. “I think he really believes that he is fighting for what is right. And I, too, with equal passion, believe that I am doing what is right. I just think that he’s misguided and I’m sure he thinks I’m misguided. And the twain shall never meet.”

What they have in common is an appreciation for what the November election could mean for the future of All Families Healthcare and other Montana abortion providers.

Weems said her daily work routine — helping patients and soliciting donations for her clinic — supports her belief that abortion access matters to Montanans from all walks of life. That’s a big part of the reason, she said, that All Families Healthcare was voted Best Family Practice in the “Best of Whitefish” competition this year.

“We’re totally supported in this community,” she said, gesturing to a copy of the annual Whitefish Pilot award magazine on a nearby table. “That was not about me, that was not about All Families. That was about the community — I’m going to start crying — that was about the community being like, ‘We believe in abortion. We believe this is a human right.’ That was a huge deal.”

Google reviews for All Families Healthcare also indicate that Weems and her staff have a great deal to do with winning that support in Whitefish. Former patients praise the clinician for creating a welcoming and supportive space. “Their customer service feels like family,” one patient wrote two years ago.

Another client, writing about her abortion at All Families last year, said she had been feeling unsure about the procedure. In the end, she said, going to the clinic was the “best choice ever,” in part because Weems was caring and patient.

“I felt okay to cry and talk to her,” the patient wrote. “She makes you feel comfortable to talk honestly and gives you space when it’s needed.”

Weems responds to almost every review, thanking patients for the kind words and saying how happy she is to hear about their positive experiences.

Weems used to see politics as incompatible with the calming atmosphere she’s tried to create at the clinic. But as anti-abortion advocates keep working to eliminate the procedure in Montana, she said she’s reconsidered. Some of her patients have only a general awareness about the laws and court cases and state elections that keep Weems preoccupied.

When it comes to abortion access and reproductive health care, Weems said, she wants her patients to feel empowered to advocate for their rights. If and when they cast their ballots, she wants them to feel like they have a choice.

“There are so many people who’ve moved here recently. And then there’s other people who just aren’t voters,” Weems said. “I’ll be like, ‘Hey, maybe you haven’t been active in voting. But if this right is really important to you, we need to protect it. Because we’re at risk of losing it.’”

The Montana Free Press is a Helena-based nonprofit newsroom. To read the article as originally published, click here.