From Dobbs to Skrmetti, providers in some of the country’s most hostile states know that attacks on abortion access and gender-affirming care follow the same playbook—and demand the same solidarity.
We’ve been here before.
When Dobbs v. Jackson Women’s Health came for abortion care in our states, we did two things:
- We opened clinics across state lines so our patients would still have a legal option.
- We stayed. We kept our original clinics open, expanding the care we’d always offered or always wanted to offer:
When U.S. v. Skrmetti came for gender-affirming care, we kept providing that too, because abortion care patients and transgender patients are not separate communities. The calculation patients make before they walk through the door is identical for both communities: Will I be seen? Will I be safe? Will the person across from me treat my body with humanity, or like a problem to be managed?
June marks anniversaries of both Dobbs and Skrmetti, and that conviction has never felt more urgent.
Long before Dobbs or Skrmetti, the intersection of abortion rights and trans rights was already living in our waiting rooms; in the patients who received reproductive care and gender-affirming hormone therapy under the same roof; in the person who drove hours across the state because we were the only provider they trusted; and in those who trust us with their whole-person care because their grandmothers, mothers, sisters, aunts and friends have relied on our clinics for care for 50 years.
Throughout that history, our organizations have been guided by a simple principle: When members of our community are targeted, excluded or denied the care they need, we do not look away. We listen, we adapt and we show up.
When abortion care moved across the border after Dobbs, the patients who remained still needed care they couldn’t access at home. The wall between reproductive healthcare and LGBTQIA+ healthcare that exists in policy language and funding categories has never existed in our exam rooms.
What connects every patient who walks through our doors, whether they’re coming in for an abortion or a hormone therapy appointment, is something our staff recognized long before we had language for it: the experience of arriving at a clinic while carrying the weight of a political target on your back.
A clinic’s job of creating a space where people can receive care without shame or fear has always been the same job, regardless of why they came.
They come for the most vulnerable first, in the states where the political ground is most hostile, and they build from there.
Marty had learned, growing up as a transgender person in rural Maryland, to brace himself before every medical appointment, because finding healthcare that was both competent and affirming had always required a fight. What he found at our clinic was a staff that met him without conditions, no justifications required, no explanations asked for.
His mother has supported the Women’s Health Center (WHC) since its earliest days, and used to volunteer as a clinic escort. Watching the same clinic support her son in his gender-affirming care gave her, in her own words, a peace she hadn’t known she needed.
When gaps in care left Ben, a transgender West Virginian, navigating painful dysphoric cycles and a transition that had stalled, he found his way to WHC West Virginia. Today, he says that every time he looks in the mirror, he sees more of himself looking back.
When one of our providers first interviewed to work for CHOICES—a nonprofit reproductive health clinic network that provides abortion care, birth control, prenatal care, HRT and other sexual and reproductive health services—she didn’t really know much about gender-affirming care. In the time she has been with CHOICES, she has cared for hundreds of patients seeking gender-affirming care across the South (especially Tennessee and the surrounding region) and Appalachia.
“It’s clear how important this care is for patients,” she says. “After patients start hormone replacement therapy, they come back as a much more energetic, vivacious person.”
Since the state of Tennessee has restricted gender-affirming healthcare (including banning minors from accessing care), our patients are experiencing increased anxiety and fear about their privacy, safety and continued access to care.
CHOICES’ provider (name intentionally withheld) says, “Hormone replacement therapy is routine, like every other service we offer.”
If something has such a profound impact on someone’s life, why wouldn’t we keep this care accessible?
Long before Dobbs or Skrmetti, the intersection of abortion rights and trans rights was already living in our waiting rooms; in the patients who received reproductive care and gender-affirming hormone therapy under the same roof …
The pattern behind Skrmetti is one reproductive rights advocates should recognize immediately, because it follows the same logic as the restrictions that led to Dobbs: They come for the most vulnerable first, in the states where the political ground is most hostile, and they build from there.
Idaho passed the first transgender athlete ban in 2020, West Virginia followed with the Save Women’s Sports Act in 2021, and Tennessee’s restrictions on gender-affirming care for minors moved through the courts the same way abortion restrictions moved state by state in the years before Dobbs.
Since abortion care moved across the border, thousands have received gender-affirming and LGBTQIA+ care at our clinics, even as the political, legal and financial pressure on both organizations has intensified.
Bodily autonomy is the foundational principle of reproductive rights, and it only means something if it applies to everyone. When it becomes conditional, granted to some patients and denied to others, it stops being a principle and starts being a permission slip—and permission slips get revoked.
The fights to protect abortion access and gender-affirming care are not parallel struggles that happen to share a difficult political moment. They are the same struggle, rooted in the same conviction, playing out in the same clinics with the same patients. And the forces working to end both of them have always understood that connection, even when the rest of us have sometimes lost sight of it.
Between our two organizations, we’ve earned a century’s worth of experience at the practice of staying and enduring. CHOICES has kept their doors open for 52 years, and the Women’s Health Centers of West Virginia and Maryland will celebrate 50 years of care on June 24—the same day Roe v. Wade was overturned four years ago.
Support independent clinics in hard places keeping the doors open. And when the next fight comes, show up for the communities under pressure. Remember that those targeted first won’t be the last, but they will be the ones to lead the way.
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A note from Ms. editors: We want to hear from you for The Majority, a new campaign collecting stories about how reproductive freedom has enabled readers to build the lives they want and need. Poll after poll shows a majority of Americans support reproductive healthcare access. Yet public debate overlooks the lives shaped by abortion access, contraception, IVF, miscarriage care, maternal healthcare or comprehensive sex education—countless women who chose to pursue an education, have children, not have children, protect their health and chart their own future. Add your voice and complete the sentence: “Access to reproductive choices gave me the freedom to….” Together, these stories will help show not only why reproductive freedom remains a majority value, but also what it makes possible.
Look to these trusted groups if you or a loved one needs to know more about reliable abortion care:
- A one-stop-shop for abortion seekers: I Need An A
- Safe websites to buy abortion medication: Aid Access, Plan C Pills, Abortion Finder
- If you need help affording abortion care, contact an abortion fund near you.
- To protect your digital privacy when planning your abortion, click here.
- For free legal help as a patient or doctor, call If/When/How’s Repro Helpline: 844-868-2812
- For medical advice, contact the Miscarriage & Abortion Hotline: 833-246-2632
- If you need to know the abortion law in your state, look to the Center for Reproductive Rights.
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