Thirty years ago, Blue Mountain Clinic Director Willa Craig stood in front of the sagging roof and broken windows of an abortion clinic that an arsonist had burned down early that morning in Missoula, Montana.

"This morning, Missoula, Montana, learned that there is no place in America that is safe from hateful, misguided groups," she told the crowd of reporters and onlookers.

The 1993 fire at Blue Mountain Clinic was part of a particularly violent period of anti-abortion attacks in the U.S. that continued through the 1990s and 2000s, when clinics were bombed and abortion providers killed. Now, less than a year after the U.S. Supreme Court overturned Roe v. Wade, rhetorical and physical attacks have increased against clinics that still provide abortions in conservative-led states.

The U.S. Justice Department formed a Reproductive Rights Task Force after last year's Supreme Court decision, in part to bring more attention to anti-abortion violence and threats. Since 2011, the DOJ has prosecuted dozens of criminal and civil cases over obstructing access to, threatening, or damaging abortion clinics. It charged 26 people in 2022 — more than in the previous three years combined.

The FBI is also investigating a series of abortion clinic arsons, primarily in states that have maintained or bolstered abortion access since the June 24 Dobbs v. Jackson Women's Health Organization decision overturning Roe.

The increase in violence has led abortion-rights advocates to worry that more violence could be coming if the fringes of a fragmented anti-abortion movement become impatient with judicial and political efforts to ban and restrict abortion. Meanwhile, anti-abortion activists worry that vandalism committed at pregnancy resource centers over the past year is an indication that abortion-rights advocates could escalate into violence if states further tighten abortion access.

Violence has been rising since 2020

Violence against abortion providers was already on the rise before the Supreme Court's decision to end federal protections for abortions, according to the National Abortion Federation. Nationally, from 2020 to 2021, reports of stalking rose 600%, clinic invasions 129%, and assaults 128%, according to the federation. The organization is still aggregating its 2022 figures, which include data from after Roe was overturned, but it expects the upward trends to continue, according to chief program officer Melissa Fowler.

"When a clinic closes, the protesters don't just pack up and go home," Fowler said. "A lot of times, they will travel or even move to other communities and states and target the clinics that remain open there."

There have also been attacks on anti-abortion pregnancy resource centers, which have been vandalized in several states since last year. Police in Minnesota were looking for the vandals responsible for smashing windows and spray-painting in red, "if abortion isn't safe, neither are you," at Abria Pregnancy Resources in St. Paul last summer, KSTP reported.

The clinic's director, Angela Franey, had previously voiced support for the Supreme Court's Dobbs decision.

Last May in Wyoming, after a draft opinion of the decision was leaked to the press, a new abortion clinic in Casper was set on fire before it could open. Owner Julie Burkhart blamed the incendiary rhetoric of anti-abortion groups.

"They are highly skilled in getting these lone wolves to come in and do their dirty work so that their hands can remain clean," Burkhart said.

Federal officials recently charged a woman with arson in that case. According to an affidavit, 22-year-old Lorna Green allegedly admitted to lighting the fire at the Wellspring Health Access clinic in her hometown of Casper because "she did not like abortion."

The clinic plans to open this spring, but its future is uncertain. A state law bans nearly all abortions in Wyoming, though on March 22 a judge temporarily blocked the law while a legal challenge against it is pending.

Vandalism and fear of violence in Montana

In Montana, the most recent attack against an abortion clinic happened in 2014 in Kalispell, about 120 miles north of Missoula by car, where the son of an anti-abortion activist broke into and vandalized All Families Healthcare. He was sentenced to 20 years in prison with 15 years suspended.

All Families Healthcare owner Susan Cahill said she wanted to continue working after the break-in. But her family, fearing for her safety, persuaded her to retire.

"I was quite depressed for a couple of years after the office was destroyed," Cahill said.

The clinic's closure created an abortion care desert for four years before another provider took over the practice.

Montana continues to allow access to abortion services because of protections in its state constitution, but clinics that perform abortions are few. Blue Mountain reopened after its 1993 fire, and Planned Parenthood of Montana also provides abortion services in multiple Montana cities. All Families reopened under new owner Helen Weems, in Whitefish, just north of Kalispell in northwestern Montana's Flathead Valley.

Montana's Republican governor and Republican-led legislature are now seeking to restrict abortion access. Gov. Greg Gianforte and state Attorney General Austin Knudsen are asking the state Supreme Court to overturn its 1999 decision in the case Armstrong v. State, in which it held that abortion access is protected under the Montana Constitution's right to privacy.

"It's time for the Montana Supreme Court to take up the Armstrong case, take another look at it, and reverse it," Montana Attorney General Austin Knudsen said at a January anti-abortion rally in the Montana Capitol. "It is garbage law and it needs to go."

Conflicting desires within the anti-abortion movement

Montana state lawmakers are moving legislation that seeks to decouple abortion access from the constitutional right to privacy, along with other measures that would restrict abortion. Gianforte's administration and conservative lawmakers are also trying to make it more difficult for Medicaid patients to obtain medically necessary abortions.

However, polling suggests most Montanans support abortion access, and voters rejected a 2022 ballot initiative that would have created criminal penalties for health officials who do not work to save the life of an infant born after an attempted abortion or birth, even if the infant has no chance of long-term survival.

A recent survey from the Public Religion Research Institute found a greater percentage of Montanans than of people in any bordering state think abortion should be legal in most or all cases.

The message sent by voters in Montana — and those who passed 2022 ballot measures in support of reproductive rights in California, Kansas, Kentucky, Michigan, and Vermont — has left Republican lawmakers with unexpected challenges, said Mary Ziegler, a law professor at the University of California-Davis who studies the anti-abortion movement.

Those politicians want to avoid upsetting voters, but they also want to pacify the more extreme anti-abortion groups by promising progress through legal means, said Ziegler. With the movement fragmented after Roe was overturned, those in the mainstream anti-abortion movement worry about what the more radical elements might do if their cause isn't advanced in the courts and statehouses, she said.

"Quite literally the last thing you want is PR where your movement is being associated with violence," Ziegler said.

Health care providers in Montana said the post-Roe era has been an uneasy time as they defend themselves against legal and political attacks while trying to keep their doors open for patients from Montana and neighboring states where abortion is banned.

"Our patients show up every day because they are desperate to get this care," said Nicole Smith, the current executive director of Blue Mountain Clinic. "We have to be there and hold the line for them."

Weems, of All Families Healthcare, said having to constantly fend off legal attacks on abortion care has changed how she thinks of herself.

"It's felt like there's been a change in my role from strictly a medical provider to more of a political activist," she said.

Abortion-rights advocates are working to support medical providers in managing the mental toll these legal attacks take. The newly created Montana Sexual & Reproductive Health Collective is partnering with licensed therapists to provide free emotional and psychological support for providers.

"We don't want to have to be doing triage on our abortion providers or our abortion-rights community," said Hillary-Anne Crosby, the group's leader. "We want to be there every step of the way so it does not get to that crisis point."

This story comes from NPR's health reporting partnership with Kaiser Health News (KHN) and Montana Public Radio.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Edited by Matt Volz of KHN and Carmel Wroth of NPR.