Across from a derelict dairy farm in far Western Maryland is a simple brick building marked with a white sign: Women’s Health Center.

The center is many things: a place to obtain gynecological care, a place for trans people to receive gender-affirming hormones and a place where people end pregnancies. It’s also a lifeline, cast over the border to West Virginia.

Before the Supreme Court overturned Roe v. Wade in 2022, the border between Maryland and West Virginia felt like a formality. Out here, amid the Appalachians, folks cross state lines to get to work, pick up groceries or visit family.

But in our increasingly polarized country, the invisible border between Maryland — where voters recently chose to enshrine abortion rights in the state constitution — and West Virginia, where abortion is illegal in nearly every circumstance — feels monumental. Maryland, like other blue states, is now a refuge, a safe haven, for people who need to end a pregnancy.

For years, the Women’s Health Center in West Virginia’s capital, Charleston, was the state’s only provider of abortion. When the state’s abortion ban went into effect, the clinic’s staff decided their best hope was 3 1/2 hours north, just over the border in Maryland.

Staff members scouted locations in Western Maryland and interviewed local educators, religious leaders and community activists about the needs of their community.

“What we heard was that people wanted not only more health care, because there’s really a lack of access to health care in general, but they wanted more sexual reproductive health care, and they wanted an abortion clinic in their community,” said Katie Quinonez, the center’s executive director.

In September 2023, exactly one year after West Virginia’s ban took effect, the new clinic opened its doors in tiny Cresaptown in Allegany County. Since then, nearly 300 people have terminated pregnancies at the clinic and about 200 have received other kinds of health care. (The center’s Charleston location remains open, providing other health care, but not abortions.)

The work is daunting, both logistically and emotionally. There are the protestors, of course, who arrive periodically by buses from other states. There is the looming fear of what will happen when Donald Trump returns to the White House later this month and Republicans control both the House and Senate.

Slightly more than half of the patients live in West Virginia, or another state with strict limits on abortion. Most already have children, and they must arrange child care, take off work and make the journey to the center. West Virginia’s Medicaid program does not pay for the procedure, and most patients don’t have much money to begin with. Finances are a constant source of stress for the clinic’s staff; about half of the center’s $1 million operating budget comes from donations. Most clients need financial aid to cover the cost of a procedural abortion, which is $450 in the first trimester of pregnancy. (A medication abortion costs $495.)

That’s where donors come in. Through a fund managed by the West Virginia clinic, donors help cover the cost of abortions for those who otherwise could not pay.

Such funds are vitally important in making abortions accessible to those of limited means, said Dr. Diane Horvath, cofounder and chief medical officer at Partners in Abortion Care clinic in College Park and a fellow with Physicians for Reproductive health, a national advocacy group.

“People sometimes think their $20 donation doesn’t matter, but all those donations together make a big impact,” said Horvath.

While people flooded abortion access organizations with donations in the wake of the Dobbs decision in 2022, many have ceased giving and many abortion funds are now struggling.

“All of those rage donations that happened after Dobbs are gone,” said Horvath, adding that for a while she worried that her clinic would close due to lack of funding. “Abortions are an important form of health care and communities are going to have to step up and support it.”

One key donor for the West Virginia clinic is Emily Schoenbaum, a Baltimore resident and philanthropist whose father, Alex Schoenbaum, founded the Shoney’s restaurant chain.

In other words, some of the money people spent on Big Boy burgers, onion rings and ice box pie is now being used to fund reproductive health care for their granddaughters, great-granddaughters and great-great-granddaughters.

“I’ve always been interested in women’s lives, women’s rights, women’s comfort,” says Schoenbaum, 58, a Mount Washington resident. “I think it’s a scary world for women right now.”

“I don’t have any offspring, so I have to give it all away,” said Schoenbaum, a tall woman with thick, wavy black hair and dark-rimmed glasses.

Schoenbaum describes herself as a “hillbilly Jew,” one of the only Jewish students at the public elementary school she attended in Charleston, West Virginia, where her father’s restaurant chain was headquartered. “I understand what it means to be ‘other,’” she said.

Schoenbaum spent several years in New Orleans, where she helped fund The Green Project, a salvage store and paint recycling program, the Second Harvest Food Bank, and endowed a scholarship at St. Augustine, a private Catholic boys high school. She also helped support the Planned Parenthood in New Orleans.

She also began donating to the Women’s Health Center of Charleston about two decades ago, back when it seemed unthinkable that abortion would one day be outlawed again in her home state. At first, she gave money from the Schoenbaum Family Foundation, but after the foundation changed its rules a few years back, she began giving from her own personal funds.

After contracting long COVID in 2021, Schoenbaum moved from New Orleans to Baltimore to be closer to medical specialists. In 2023, as she was lying in bed, so sick she could hardly move, a message arrived from Ramsie Monk, the development director at the Women’s Health Center. The costs associated with running both centers were staggering; could Schoenbaum help?

Schoenbaum proposed a matching funds grant. She would give up to $25,000 to match donations from others. And the theme would not be a generic holiday campaign, but the winter holiday her family celebrates: Hanukkah.

Like Hanukkah, the fundraising campaign lasted for eight days and eight nights. The clinic quickly hit the $25,000 goal, but donations kept rolling in. By the eighth evening, donors had given more than $131,000.

Schoenbaum’s donations help cover the operating costs of the West Virginia clinic as well as salaries for the executive staff who work at both locations, Quinonez said. The West Virginia clinic brought in $2.36 million in revenue last year and had $2.09 million in expenses, according to tax filings.

Schoenbaum made the trek to Cresaptown this fall to visit the Maryland clinic. The outside of the building is nondescript and visitors must be buzzed through two sets of doors monitored by video cameras.

Inside the clinic, the vibes are very different. A bold mural in the waiting room features native animals and plants, including the Baltimore oriole, the black-eyed Susan and Queen Anne’s lace, a natural abortifacient that midwives traditionally gave to women looking to end a pregnancy. There are free boxes of emergency contraceptives, condoms, lube and pins proclaiming pronouns: she/ her, they/them or he/him.

Past another locked door are hallways that lead to offices, a nurses’ station and clinical rooms. The walls are covered in paintings by a local artist that highlight the beauty of the bodies of women and trans people. “Make abortion great again” declares one flag. “Abortion is ok. You know what’s right for you,” says a framed artwork.

There are exam rooms where practitioners determine the gestational age of a pregnancy, procedure rooms where abortions are performed, and a recovery room, with comfy chairs and heating pads, where patients rest and are monitored by nurses after an abortion.

Family nurse practitioner Rachel Kashy examines nearly every patient who comes to the clinic. A high-energy woman with a nose ring and a tangle of strawberry blonde curls, Kashy has seen firsthand how a raft of abortion restrictions in red states have limited health care access. She spent seven years working for an abortion provider in Louisiana, but left in 2022 after the state imposed a near total ban on the procedure.

Kashy then moved to North Carolina and worked at a Planned Parenthood clinic there until the state banned abortions after 12 weeks. After she was hired to be the Maryland clinic’s chief nurse executive, she purchased a home in Cumberland. “I’m putting down roots here, which is a huge thing for me,” she said.

Kashy provides routine gynecological care for patients: performing pap smears, administering tests for sexually transmitted infections and prescribing birth control. She prescribes medications that induce abortions in the first 11 weeks pregnancy. She also prescribes gender-affirming hormones to trans and nonbinary patients, and says she is the only provider in a 100-mile radius to provide such care.

“I see those patients for not only their hormone therapy, but also other health routine maintenance, like blood pressure and annual exams, building trust with them over the course of a year,” Kashy said.

A physician who lives in Washington, D.C., makes the trek to the clinic once a week to perform procedural abortions. The center’s staff declined to provide the physician’s name, saying they feared that would make the physician a target for harassment. The center provides abortions up to 16 weeks of pregnancy; those further along in pregnancy are referred to other clinics. (Maryland allows abortions up until the point a fetus could survive outside the womb, which is usually around 24 weeks.)

Clinic staff also declined to make patients available to interview. The center was closed to patients the day that Baltimore Banner staff visited to protect patients’ privacy.

Quinonez understands what it feels like to terminate a pregnancy. She was inspired to work in the field after having two abortions, including one at the clinic’s original location.

“I was met with such grace, compassion and humor,” she said. “It’s an honor to know firsthand how important this work is.”

It’s also exhausting work, said Quinonez, who has been with the clinic in various capacities since 2017. In September, she announced that she would be stepping down early next year.

This fall brought mixed blessings to the clinic. On one hand, Marylanders voted to add abortion rights to the state constitution. On the other, the country chose to send a man back to the White House who has bragged that the three Supreme Court justices he selected were instrumental in overturning Roe v. Wade.

The contrast between blue and red states feels particularly poignant inside the clinic. The office walls are decorated with art celebrating bodily autonomy, but the windows frame views of the mountains of West Virginia, where women and trans people have fewer freedoms than just a few years ago.

The demographics of Maryland and West Virginia are strikingly different. Maryland is the eighth healthiest state in the nation, according to U.S. New & World Report’s health rankings; West Virginia comes in last. About 11% of Maryland children live in poverty, while about 20% of West Virginian children do, according to data from the Annie E. Casey Foundation. And while 63% of Marylanders cast their ballots for Kamala Harris last month, 70% of West Virginia voters backed Trump.

“Starting the day Trump takes office, we anticipate a wave of renewed attacks on bodily autonomy, including abortion access and trans rights,” Quinonez said. “These policies will, as always, disproportionately impact rural communities like Mountain Maryland, where access to reproductive health care is already limited.”

Quinonez said the clinic was committed to continue to providing abortions, gender-affirming hormones and other health care — while also fighting stereotypes about rural communities and the needs of people in these areas. But the need for support for the center, both donations and awareness, was more urgent than ever.

“We need to be in solidarity right now,” said Quinonez. “People living in bigger cities need to support those held hostage by far-right conservative ideals.”