When You Run an Abortion Clinic, Every Budget Line Is a Battle

On the front lines of the most challenging small business in America

- Cynthia Koons and Rebecca Greenfield

“We’ll take out your trash, but you have to pay more”

Amy Hagstrom Miller, owner of Whole Woman’s Health in Austin, has faced many existential threats to her business. When Texas passed a law in 2013 requiring abortion providers to have admitting privileges at a nearby hospital, she was forced to close the clinic. She fought the measure all the way to the Supreme Court, and in 2016, she prevailed. By a 5–3 decision, the court ruled in Whole Woman’s Health v. Hellerstedt that the law wasn’t medically justified. There’s an iconic photo of Hagstrom Miller descending the Supreme Court steps afterward, fist raised, smile radiant. Nine months later, she reopened her clinic.

It looked like a happy ending. But a year later the Austin clinic was on the brink again. An anti-abortion funder offered Hagstrom Miller’s landlord five years of rent for the clinic and the offices she’d been renting next door to prevent anyone from setting up a crisis pregnancy center there. These places, which counsel women against having abortions, have proliferated in recent years, with more than 2,500 nationwide, and some try to operate as close to providers as possible. Hagstrom Miller estimates it would have cost her $250,000 to match the group’s offer, a sum she simply couldn’t spend. The clinic is now a crisis pregnancy center called the Source.