In the frenetic days following the November election, longtime abortion provider Amy Hagstrom Miller spent a lot of time in meetings—some in person, some on Zoom—rallying her troops. As one of the most prominent, and tenacious, independent abortion providers in the country, with six Whole Woman’s Health clinics in four states, it was a safe bet that she and her staff of 125 would find themselves in the crosshairs of a Donald Trump presidency and the anti-abortion extremists his second term will empower.
Hagstrom Miller could feel the alarm and dread that washed over some of her employees as they contemplated an America in which the 1873 Comstock Act might be enforced to institute a national abortion ban, the abortion pill would come under myriad other relentless attacks, federal appointees would use their bureaucratic powers to target providers in states where abortion remains legal, and patients would face new risks to their physical safety and constitutional rights.
But she also felt her employees’ determination, and even excitement, to double down on the part of their work that they like to call “kicking against the pricks.” Hagstrom Miller’s consistent message was sober without being defeatist. Prepare—but don’t panic. And above all, do not comply in advance.
“One of the first signs of authoritarianism is that people start to comply with things before they are actually enforced,” Hagstrom Miller told me repeatedly during a series of interviews since before the election. “We can prepare for different scenarios but we are not going to stop doing what we do. Abortion was needed well before Trump was alive and will be needed well after he leaves office.”
As the new Trump administration takes power, Hagstrom Miller is uniquely positioned to guide abortion supporters through this terrifying crossroads for reproductive and gender rights. She spent 20 plus years in Texas battling the right-wing lawmakers and legal strategists working to pass some of the most draconian abortion laws in the country. The end of Roe v. Wade finally forced her to leave the state, but she did not go away. She has continued to be a thorn in the anti-abortion movement’s side, expanding the reach of her other clinics while counseling providers in blue states that are facing existential threats to abortion rights for the first time. Rather than succumbing to fear, Hagstrom Miller has been staying vigilant, being proactive—and reminding those in her orbit to do the same.
Her clinics in Minnesota, Maryland, and—most recently—Virginia and New Mexico have been stockpiling as much of the abortion drug mifepristone as they can in case shipping is disrupted by the administration’s policies. They’ve been over-ordering medical supplies, from gloves to exam-table paper, in light of anti-abortion groups’ well-telegraphed plans to resurrect the Comstock Act to ban the shipping of all abortion-related supplies and equipment. Far from preparing to curtail their work, her clinics have been expanding services: raising the gestational limit for medication abortion from 11 weeks to 12 weeks for telemedicine appointments; mailing pills to a larger number of states, including New York, Colorado, and California; and exploring how to accept Medicaid patients from states that allow the program to reimburse telehealth abortion care. “People tell me, well Trump is going to ban pills by mail, and I’m just like, well people have threatened to do that stuff for my entire career, actually. It’s not going to stop us from doing what we can to help our patients now,” she says.
Their preparations aren’t just logistical, but also psychological, aimed at helping her team and their allies stay resilient amid all the attacks.
“They’ve talked about Comstock, they’ve talked about a national abortion ban,” says Hagstrom Miller. “But at the same time, we can’t just bow down and normalize it all. We can’t let extremists who want to revive a law from the 1800s have that kind of power over us. We need to proceed in a way that treats these threats as remarkably radical—not just as inevitable.”
Coming from someone else, that advice might feel like Pollyannaish platitudes out of sync with this political moment. From Hagstrom Miller, who has weathered countless storms as an abortion provider in the South, it’s a bracing reminder that the future is far from hopeless—if we can draw from the lessons of the past.
“I learned a lot while practicing in Texas and I’ll leverage that experience to push back on the second Trump presidency, whether it be exploiting loopholes, filing lawsuits, or finding other creative ways of resistance,” she says. “We know how to protect ourselves while also being cautious.”
“It’s not necessarily wisdom we wanted,” Hagstrom Miller adds. “But we have it and we’re sure as hell going to use it.”
Hagstrom Miller grew up in a “fairly progressive” Christian family in what she calls “judgy progressive” Minnesota in the 70s and 80s. The attitude, she says, was, “We believe people should have [the right to] abortion.” But when it came to a woman’s decision to actually have one, “it was sort of talked about like it was still a mistake or a problem.” Majoring in religion and international studies in college, she traveled extensively and lived abroad, shaping a worldview that rejected, as she puts it, how the religious right sought to “weaponize” Christianity to attack reproductive rights and gender equality. After her first post-college job at a Minnesota Planned Parenthood, she moved to local independent abortion clinics. “I was drawn to the fact we could provide a sort of oasis where the patient could choose the course of their lives,” she says, “and we could help be their guide.”
She worked briefly at a provider in Texas in the early 1990s, then moved to New York City, where her time at high-patient-volume clinics taught her the business of abortion care. She appreciated how easy it was for abortion patients and providers to go about their business there but also felt restless. “Abortion was on literally every corner and it was paid for by Medicaid,” Hagstrom Miller recalls. “That’s how it should be, right?” But she missed the advocacy part of the work she’d gotten a taste of in Texas. So when she moved back to the state in 2000, she accepted an offer to run a small clinic; three years later, she bought two clinics and merged them when the doctor-owners retired—the start of her Whole Woman’s Health network. “Be careful what you wish for, right?” she laughs.
“It seemed like almost every single time the legislature met, from the moment I touched ground in Texas in 2000, a new restriction was passed.”
Meanwhile, the conservatives who dominated Texas politics during the George W. Bush-era were taking an even harder turn to the right—and using their powers to chip away relentlessly at abortion and reproductive rights. “It seemed like almost every single time the legislature met, from the moment I touched ground in Texas in 2000, a new restriction was passed,” Hagstrom Miller says: parental notification requirements; a 24-hour waiting period; mandatory ultrasounds; restrictions on insurance coverage; bans on abortion after 24, then 20 weeks; and on and on.
Hagstrom Miller became what she calls a “loophole archaeologist.” The 2003 waiting-period law, for instance, required a doctor appointment 24 hours in advance of an abortion with the same physician who would perform the procedure—a rule designed to unnecessarily burden patients and clinics alike. Hagstrom Miller noticed that the text of the statute didn’t specify an in-person visit, so she allowed for phone consultations instead. “A lot of other providers were scared to do this,” she says. “I know what the law probably meant, but they didn’t write it that way.” Her clinic led the charge with this interpretation, and others eventually followed suit, forming a united front. The tactic bought her and other clinic’s patients another four years before lawmakers clarified the language, she says. It’s a strategy that she’s employed over and over, she adds: “comply with the law,” but “in the most liberal, progressive way possible.”
Hagstrom Miller employed a similar strategy when navigating Senate Bill 8, also known as the Heartbeat Act, which banned abortions at around six weeks. Her clinics continued to provide abortion within the confines of the radical law, even as some clinics in the state halted all care. Hagstrom Miller consulted attorneys about how to follow the law while avoiding legal liability, boosting her staff’s confidence in treating patients, and changed the scheduling process to fit in more patients, which helped keep the clinics afloat even as they operated at 40 percent capacity. She shared these tactics with providers in Georgia and Florida who eventually faced similar bans and also urged them to pay attention to whether a law permits abortion through six weeks versus up to six weeks, a distinction that lawmakers might not notice but that would be critical to delivering care. “Sometimes the pockets of resistance are mundane legal jargon. But social change often relies on the mundane,” she adds. “The words ‘may’ and ‘shall’ or ‘through’ and ‘up to’ in a law can make all the difference in the world in whether we can see patients or not.”
Meanwhile, even as she was finding loopholes, Hagstrom Miller often used the legal system to fight the underlying restrictions, filing about a dozen lawsuits over the years, with varying degrees of success. The most high-profile case, Whole Woman’s Health v. Hellerstedt, was a challenge to so-called TRAP (targeted regulation of abortion provider) laws that required abortion doctors to obtain admitting privileges at a hospital within 30 miles of a clinic and forced clinics to conform to the same building codes as ambulatory surgical centers. With a Republican-appointed majority on the US Supreme Court, “many people, even on our side, told us we were crazy to bring the Hellerstedt case, that we were taking too much risk and were never going to win,” Hagstrom Miller recalls. But in a surprising, and historic, 2016 decision, the high court deemed the TRAP laws an “undue burden” on abortion patients.
By contrast, Hagstrom Miller’s legal challenge to Senate Bill 8, the so-called Heartbeat Act, in 2021 was an unmitigated defeat, with the Supreme Court allowing the law to stand. “What’s the alternative?” she asks, referring to litigation even when victory is far from guaranteed. “Our backs are up against the wall. You can’t only do things if the odds are in your favor. You have to do what’s right no matter what.”
“Our backs are up against the wall. You can’t only do things if the odds are in your favor. You have to do what’s right no matter what.”
Backing down under Trump II isn’t an option either. “If they enforce Comstock,” she says, “we are going to sue them.”
The clever maneuvering and legal battles, even when successful, have been costly and draining. During the Hellerstedt lawsuit, for example, Hagstrom Miller was forced to temporarily close her five Texas clinics and then permanently shutter two of them. Even with pro-bono representation from the Center for Reproductive Rights, she still spent about $1 million on the case, she says. “Depositions and trial prep, all of that stuff takes a ton of time, and we need to make sure providers have resources to support them,” Hagstrom Miller points out. But without the major name ID and fundraising power of an organization like Planned Parenthood, independent abortion clinics—which historically have provided the majority of abortion care in the U.S.—have always been at a disadvantage when it comes to financial support, with big funders directing their money elsewhere.
Hagstrom Miller recalls how, during a cocktail party in 2014, a Planned Parenthood executive mentioned receiving a million-dollar donation from the late billionaire (and onetime third-party presidential candidate) Ross Perot in response to the Hellerstedt lawsuit. She was “gutted.” While major reproductive health groups benefited from her Supreme Court case, her Whole Woman’s Health clinics were struggling. “I was just tired of Planned Parenthood raising money off of our lawsuit,” Hagstrom Miller says. “I love people at that organization, but here we were, with no way to fundraise ourselves. I decided I’m not going to stay mad, I’m going to do something about it.”
So in 2015, she created Whole Woman’s Health Alliance, a nonprofit that allowed the group to accept donations and foundation grants to finance “non-revenue generating” work, such as communications, advocacy, and sometimes, legal fees. The Alliance helped Hagstrom Miller keep her Texas clinics afloat and expand her network into a handful of friendlier states. “A lot of people reach out to me when they want to retire and sell their practices,” she says.
And then, in 2022, the Supreme Court issued its Dobbs decision overturning Roe v. Wade. Texas swiftly enforced a criminal trigger ban that threatened providers with at least $100,000 in fines and up to life in prison for performing an abortion. Hagstrom Miller was forced to immediately shutter her four remaining clinics in McAllen, Ft. Worth, McKinney, and Austin simultaneously and lay off half of her 45-person Texas staff, including 15 physicians.
“Everything collapsed all at once. Dobbs devastated us—financially and emotionally. It was a traumatic and heartbreaking time.”
“Everything collapsed all at once,” she says. “Dobbs devastated us—financially and emotionally. It was a traumatic and heartbreaking time.”
It wasn’t just the Supreme Court decision that was demoralizing, Hagstrom Miller says. She also felt “betrayed” by the wider national reproductive rights movement. When her practice collapsed in Texas, leaving her with huge financial burdens, major abortion-rights funders were missing in action. Hagstrom Miller says she asked multiple donors and foundations—including some of the movement’s biggest backers—for “clinic wind-down” resources, to pay for everything from administrative overhead to severance for staff, only to be repeatedly turned down. As she recalls it, one funder told her: “Why would I invest in something that’s dying anyway? There’s no future there.”
“It felt like such disrespect to the clinic workforce,” Hagstrom Miller says. “We felt abandoned. When the movement needed us to fight these big Supreme Court battles, we were there. But when we needed them, they just cast us aside.”
“We felt abandoned. When the movement needed us to fight these big Supreme Court battles, we were there. But when we needed them, they just cast us aside.”
Hagstrom Miller says she tried to appeal to the Biden White House directly about this issue, proposing something akin to FEMA support or Paycheck Protection Program loans for providers forced to move out of state. She hoped to continue to lobby the Harris administration; now, under Trump, she worries about how independent clinics will fare if they must self-fund their efforts to relocate.
The lack of help for shuttered clinics is symptomatic of the reproductive rights movement’s broader failures, she says, including its unwillingness to channel resources to red states where abortion is banned and to local abortion funds that are suffering major money problems. A growing chorus of state-level activists have stressed the deep and “alarming” disconnect between the priorities of powerful national abortion organizations and the actual needs of abortion providers and patients. Hagstrom Miller hopes movement leaders and funders will learn from their mistakes, fundamentally rethinking what they do and increasing their investment in grassroots groups on the ground. “When [the people] that say they are supporting the movement don’t do anything to actually help those of us working every day to help abortion patients, then something needs to seriously change.”
Amid the lack of institutional support in post-Dobbs Texas, Hagstrom Miller was thrust into one of the most chaotic periods of her career. What happened at her Whole Woman’s Health clinic in the town of McAllen, in the Rio Grande Valley, was a particularly painful lesson—one about which some reproductive health advocates around the country remain upset.
Community advocates wanted to buy the facility and turn it into a reproductive justice center, but fell far short of the money they needed, partly, they say, because a Whole Woman’s Health employee asked them to remove the clinic’s name from their fundraising campaign. Meanwhile, Hagstrom Miller was frantically negotiating lease buyouts for facilities in Austin and McKinney and trying to sell off her clinic in Ft. Worth (she had to pay the mortgage for a year before it finally sold).
In the fall of 2022, a father-daughter pair of doctors, calling themselves the Peruvian Alliance, made a $275,000 cash offer to buy the clinic, claiming it was for their own family medicine practice. Hagstrom Miller, her employees, and lawyers say they researched the prospective buyers and that their backgrounds checked out. But just two weeks after purchasing the clinic, the new owners turned the deed over to the McAllen Pregnancy Center, an anti-abortion crisis pregnancy center that had long targeted Whole Women’s Health. Reproductive advocates were understandably furious at Hagstrom Miller. “They were so easily able to Trojan Horse their way in there,” Noemi Pratt, then the board secretary for South Texans for Reproductive Justice, said at the time. “How did you so easily allow this to happen?”
Hagstrom Miller, on the other hand, says she felt “duped.” “We were completely stunned. This was such a huge and painful betrayal, I still have difficulty talking about it today,” she says. “It was hard not to internalize it and blame ourselves. We just felt such grief.”
After being pushed out of Texas, Hagstrom Miller decided to move to abortion-protective New Mexico. She initially hoped to establish her clinic somewhere near the Texas border. But those rural communities were prime targets for anti-abortion activists pushing for the passage of “sanctuary for the unborn” ordinances. “It just didn’t feel safe for our patients,” she says. So Hagstrom Miller turned her sights to Albuquerque, raising $450,000 on GoFundMe to help fund the new facility.
Since opening its doors in March 2023, the vast majority of the clinic’s patients originate from Texas. Just minutes from the airport, the facility includes a special waiting room for families and others accompanying patients from out of state. There are couches for the driver to sleep on and toys to keep children entertained.
In the coming years, Hagstrom Miller hopes to see more collaboration among providers nationwide to strategize and help each other out. “There is a legacy of wisdom and expertise with some of us abortion providers here in the South who have been doing this for decades,” she says. “It could be useful to not only people on the federal level but people in states who haven’t yet needed to flex those muscles and may be afraid of what’s to come. There’s a lot to be learned.”
And a lot to fight for. Since taking office, President Trump has already reinstated the global gag rule, a policy that restricts US funding for foreign organizations that advocate or even refer for abortions; scrapped the federal government’s reproductive rights website, and limited protections for abortion clinics against violent protestors (a development Hagstrom Miller predicted). He’s stacked federal agencies with anti-abortion appointees and faced a pressure campaign from activists to ban medication abortion. Hagstrom Miller’s mind races with some of the other, less obvious ways the new administration could target patients and providers, from shredding privacy protections like HIPAA, to launching arbitrary Medicaid audits—and other possibilities she’d rather not discuss publicly even as she prepares for the worst.
“Some of these things are very behind the scenes,” she says. “A lot of people don’t understand how regulatory interference works because it feels largely invisible. But anti-abortion activists sometimes understand them better than pro-choice advocates do. And these maneuvers could shut us down as easily as an abortion ban.”
Hagstrom Miller doesn’t sugarcoat how difficult the next four years are likely to be. She gets triggered when people reflexively refer to her and other providers as “resilient” or “tireless,” words that fail to acknowledge how deeply exhausting her work has become. (“Fuck you all, I’m very tired!” she laughs.) “Sometimes we are just numb and have to stare off into space,” she admits. “You can’t immediately spring into action—it feels fake and forced. It’s okay to take time to mourn these huge losses and then act when we are ready.”
What continues to motivate her is the gratitude she receives from her patients, day in and day out. “This is still super meaningful work,” Hagstrom Miller says. “I can directly see the value it brings to people’s lives and that fills my cup and keeps me going. As long as I have that, I will keep fighting.”
