Photography by Lauren Miller

Earlier this year, clinic administrator and nurse Brittany Brown sat at her desk, refreshing a state webpage over and over. She was checking to see if the Wyoming state legislature had passed new laws restricting abortion access. At any moment, her work might turn on a dime to make sure that Wellspring Health Access—the only full-service abortion clinic left in Wyoming—did not run afoul of them. “The situation changes hour by hour,” says one of Brown’s colleagues, medical assistant Valarie Wakefield. “And we all know that on any given day, we might lose our jobs.”

In the two and a half years of Wellspring’s existence, it has faced not only an ever-changing landscape of state laws, but also arson, protestors, the reversal of Roe v. Wade—and now, the reelection of President Trump. By staying open despite these challenges, Wellspring has become an oasis in a sea of red. Most of the states that surround Wyoming heavily restrict abortion care, and some of them have no abortion providers at all.

“We see patients from Idaho, North Dakota, South Dakota, Utah” and “from Montana, from Nebraska,” says Katie Knutter, the executive director of Wellspring. “We regularly have patients who are traveling up to eight hours,” she adds. Some patients have even come from Georgia and Louisiana. Wellspring is also the closest clinic to multiple Native American reservations—one of which, the Oglala Sioux Reservation, is in South Dakota, which virtually bans abortion altogether. 

“There is no one-size-fits-all” patient, says Brown. “I have seen 15 year olds, I have seen 50 year olds. I see married women, I see single women. I see women who have a whole bunch of kids already. I see women who’ve never been pregnant before.”

Abortion is currently legal in Wyoming, but that could change at any time. The Wyoming legislature passed several laws restricting abortion in 2022 and 2023. A court has temporarily prevented these laws from going into effect, but a more permanent decision or a ruling from an appellate court could change that outcome—and the legislature could pass new restrictions on abortion whenever it is in session. If new restrictions go into effect, then Wellspring might need to close. Even photographing this piece proved tricky because the clinic could not be sure it would be open throughout the summer.

Wellspring currently provides abortion care as late as state law allows: up to 23 weeks and 6 days into gestation. Although a few other entities in Wyoming provide medication abortion by telehealth, those medications may be used only in the early weeks of pregnancy—long before doctors can detect most types of fetal anomalies and before many maternal health complications emerge. For anyone seeking abortion care after about 11 weeks, Wellspring is the sole option in the entire state of Wyoming. According to Wellspring staff, hospitals in the state cannot always guarantee that a patient will be able to access abortion care there, even if the patient is facing an emergency. 

This scarcity isn’t isolated to red states, either. Even here in Washington, which is largely considered to be a safe haven for abortion access, large swaths of the state have no clinics at all, and many of the clinics that do exist only provide medication abortion. If a person living in Newport learned at their 20-week ultrasound that their fetus had a fatal anomaly, they would need to travel roughly 250 miles to Yakima to reach the nearest clinic that could provide abortion care.

Many of these restrictions emerged at a time when Democrats controlled the White House—which will no longer be true in January. Although Trump himself waffled on abortion during his campaign, many of his appointments have been stridently anti-choice: Dr. Mehmet Oz (who has been nominated to head the Centers for Medicare and Medicaid) supports the reversal of Roe v. Wade, and Martin Makary (who has been nominated to head the Food and Drug Administration) is “a known anti-abortion extremist who will push the Project 2025 agenda,” according to Mimi Timmaraju, CEO of Reproductive Freedom for All. And Project 2025—one playbook for Trump’s second term—says that Trump should reverse the FDA’s approval for medication abortion. Medication is the most common form of abortion in the United States, accounting for roughly two-thirds of all abortions nationally, and a large share of Wellspring’s work.

“Across the industry and in all the clinics, everybody is just bracing for things to get worse,” says Brown. “With higher need for abortion services and a shrinking number of clinics and providers, we’re going to see higher death rates” for women and children, she adds. “And more than the mortality rates, you’re just going to see more people who have long-term injuries from being denied necessary health care.”

Photographer Lauren Miller visited Wellspring this summer for The Stranger to document the clinic as it survived in purgatory. She witnessed protestors standing in the alley across the street from the clinic. When one of the protestors—who is at the clinic every day—saw Miller, he called other protestors to join him. Once inside, though, the environment is overwhelmingly “normal,” Miller explains, and the staff works hard to create a sense of community for the patients by (for example) ordering in food and having indoor picnics with them.

Nationwide, the number of brick-and-mortar abortion clinics has declined from 807 in 2020 to 765 in March 2024. There’s little stopping that trend from continuing next year. But their doctors, their nurses, and their patients will keep showing up until there’s nowhere to show up to. 

This is a day in the last abortion clinic in Wyoming.

“We huddle every morning and talk about what’s coming that day,” says Wakefield. “We go about the day, see how we’re going to tackle it, see where everybody’s going to be, look at the patient list.” Wellspring tailors its plan for the day to make sure that it is appropriately addressing each patient’s individual needs.

The morning we visited the clinic, a woman who planned to have children was coming into the clinic for an abortion, shortly after learning that her pregnancy was not viable. The staff made a plan to give extra space and love to her.

In addition to abortion care, Wellspring provides a variety of birth control options, screens patients for sexually transmitted infections and urinary tract infections, and conducts pelvic exams, Pap smears, cancer screenings, and other services related to reproductive health.

That day, nurse Ashley Stephens wraps a patient’s arm after she received a hormonal birth control implant called Nexplanon. 

Wellspring also provides gender-affirming care to roughly 15 to 20 patients. These patients range from teenagers to people in their fifties and sixties. Brown recalls one call from an older individual who wanted to ask about hormone-replacement therapy. The patient was still using their dead name, and Brown asked what she would like to be called instead. The patient whispered her chosen name, and Brown used it for the rest of the call.

Realistically, all of the services that Wellspring provides are at risk. The Wyoming legislature has already acted to restrict gender-affirming care for minors, and the U.S. Supreme Court will soon decide whether similar restrictions are constitutional. Some Justices on that Court have also hinted at restricting access to birth control.

This patient, who drove roughly 9 hours from her home in South Dakota, found out that even despite her trek across state lines, she wouldn’t be able to receive an abortion that day. She was experiencing a medical issue that needed to be treated before she could receive an abortion.

Wellspring staff made arrangements for this patient to see the appropriate type of physician in her home state of South Dakota. After that visit, she would need to take another day off work, find childcare again, and drive back to Wellspring for an abortion. Abortion is entirely banned in South Dakota, except when it is necessary to save the pregnant person’s life.

The doctor chose not to be named in this piece to protect herself from the harassment and violence that abortion providers face. When asked how she keeps a level head in difficult situations, such as informing this patient that she cannot receive an abortion today, the doctor says: “It’s something I’ve gotten used to compartmentalizing, because I need to help other patients...It breaks my heart. I feel like a terrible person because I want to help everyone,” but “if we mess up, we’re done.”

Brown says she wraps the blankets “in a heating pad, and then when [the patients] come out, I give them a warm blanket.” Sometimes patients take these blankets into procedures with them to help them feel secure. And after a procedural abortion, every patient must sit “for thirty minutes,” Brown adds, explaining: “We take their blood pressure three different times, every fifteen minutes, check their bleeding, check their pain level, and just let them sit and chill and relax and then we go over discharge instructions and feed them if they want food.” Typically, by that time, they are experiencing minimal to no pain or bleeding.

During recovery is when patients are “often ready to tell their stories about what brought them here,” says Wakefield. “I want each and every one of them to feel supported.”

Almost everyone who works at the clinic is a part-time or volunteer employee. 

Like many other clinics in red states, Wellspring relies entirely on doctors who live out of state to provide abortion care to its patients. These doctors fly in for one or two days each month, and the clinic covers the cost of their travel. This arrangement is expensive, but it helps keep the doctors safe from harassment and violence. It also allows Wellspring to avoid hiring a new doctor when Wyoming law on abortion could change at any moment, leaving any newly hired doctor without a job. 

The rest of the staff are local, and work other jobs to make ends meet. This patio where Brown, Stephens, Wakefield, and medical assistant Kerra Young take a break is enclosed by a high fence to protect the staff from protestors. 

“We all originally met when we were working in a local nursing home,” Brown says. “Kerra and Val are truly my very best friends in the entire world. [When] I left the nursing home, and eventually ended up here in the clinic as a floor nurse, we needed help, so I started hitting up all my friends.”

Wakefield wears this necklace to Wellspring every day. It was a gift from Brown, who bought it at a conference for abortion providers. “I want people to know that I’m out here and I support abortion.”

Later in the day, Wakefield removes her scrubs to leave the clinic momentarily to get a coffee from her girlfriend. The clinic’s policy is to have staff remove their scrubs whenever they leave the building to try to minimize harassment from protestors and anyone else in the area who may be strongly opposed to abortion. “Somebody sitting in a car, seeing you with scrubs, that makes you an instant target. They don’t care who you are,” says Wakefield.

When asked about the challenges of working at Wellspring, Brown mentions the protestors. She says: “I don’t appreciate the assumption that I’m going to rot in hell for what I do or that I need their prayers or that I need any opinion of theirs in any way, shape or form. I don’t like them yelling at my patients. I don’t want my poor patients to have to feel any iota more of discomfort than they already may feel about the decision or the situation that they’re in.” The protestors, she adds, “don’t know all the details. They don’t know if that person has terminated because they don’t want to be a parent or because that baby’s not going to survive outside the womb. They don’t know what those people are going through.”

A former clinic escort, who asked not to be named in this piece, waits outside Wellspring with an umbrella, which she carries to protect patients from protestors. The protestors “position a wagon across from the clinic parking lot with several GoPros mounted on it,” she explains. “They video every car and person who enter[s] the lot and the facility.” She uses her umbrella to shield the patients from the cameras. When asked what prompted her to volunteer as an escort, she explains: “It’s just about helping people who are coming because this could be the worst day of their entire life.” Since this piece was photographed, Wellspring ended its clinic escort program, in part due to security concerns.

Austin Haynes, who is 19 years old, works for a local security firm and handles security for the clinic. He specifically asked his boss to be assigned to the clinic after he heard about the arsonist who firebombed it because he wants to help keep people safe. 

Leslie Kee, a former minister at both the Casper and Laramie Unitarian Universalist churches, works the front desk at Wellspring. She says her job is “such a good fit. I actually retired from both of the churches, so now I’m doing social justice ministry as the patient care coordinator here at the clinic, with my pastoral care training, my social justice advocacy, and being a lifelong feminist. I was a sophmore in high school when Roe went in, so the cause has been in my blood from the get-go. I just feel like the universe was nudging me where I needed to be, and I ended up here.”

When patients leave Wellspring, they complete a survey about their experiences. They report arriving nervous, and leaving feeling cared for. Young says this is one of her favorite parts of her job: seeing patients go from high anxiety to calm at the clinic. “It’s like a high,” she explains.

Wakefield says that she wants everyone to know that “the best decision any person can make is one they are able to make on their own, without the fear [of] rejection or judgment.”