Before the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling overturned the federal right to an abortion, Tvedten operated the last clinic in the state of Arkansas that provided surgical abortions. But after the decision came down, a year ago Saturday, Arkansas became one of several states to ban nearly all abortions.

Many clinics in states where abortion became restricted continued providing other services. Some shuttered entirely, and others managed to successfully create a second iteration of themselves under the same management or ownership in states where abortion is allowed.

But Tvedten and his business partners split the difference, turning Little Rock Family Planning Services into a part-time medical marijuana clinic with the goal of generating enough revenue to keep the lights on and contribute to women’s health in another way.

Now, when it’s not serving as a place for Tvedten to see patients about medical marijuana use, Tvedten and his partners donate use of the building to the Arkansas Abortion Support Network, or AASN, an umbrella group that facilitates access to abortions in other states, and the YOU Center, which advertises free Plan B, pregnancy tests, and condoms among its services. In addition to space, the medical marijuana clinic — called The Healing Clinic — also plans to donate any proceeds left over after paying its maintenance bills.

“My motivation is to help the patients I can no longer see, and I’m doing that,” Tvedten said. “And to keep the building in mothball, keep it on life support basically, on the outside chance that something might happen that would allow us to reopen.”

On a recent Friday morning, Karen Musick, one of the AASN cofounders, arrived early to open up the clinic and, for the first time, accidentally set off the intruder alarm. After disabling it, she dragged a heavy sign with the words “we provide the information you need to make the right choices for you” to prop up outside.

There’s a crisis pregnancy center, a type of facility generally focused on steering women toward options that are not abortion, right next door, a common sight near abortion clinics. The emptiness of the neighborhood also came with the ban. Antiabortion protesters, once a fixture outside the clinic, no longer have a reason to show up.

Across the street a shattered Honda used for a “Smash-a-Thon” fund-raiser — in which donors who support abortion access paid to take out their frustrations on the midsize sedan — sits in a parking lot owned by the clinic, waiting to be carted away.

“I think we’re doing a really good job of reaching our supporters,” Musick said. “It’s much harder for us to reach the people who need us, and that’s where we’re really struggling.”

The quiet was soon replaced by a bustle of activity as others arrived at Little Rock Family Planning Services, including Tvedten and his stepdaughter, who worked there when it was an abortion clinic and now helps run the medical marijuana clinic. In what used to be the patient waiting room, Sarah Samuels sat on the floor filling brown paper bags with pregnancy test kits to have available at the clinic and at events. Roz Creed, who runs the abortion fund through AASN, arrived showing off knee replacements but bemoaned the lengthy recovery process.

The YOU Center came to be through a combination of increased donations to the Arkansas network in the wake of the leaked Supreme Court opinion in May 2022. The group saw another spike in donations after the Dobbs decision was issued, followed by grant money. Though the YOU Center had budgeted to pay rent, and did at one point, the space now donated by Tvedten’s clinic helps free up resources to help more people.

“The desperation that I hear when I talk to people now is palpable. It used to be, ‘I have an appointment, this is where I’m going, what can you do to help me out?’ kind of thing,” said Creed. “And now it’s like, ‘I’m desperate. … Can I get out of state? How do I get out of state?’”

The other feeling she senses over the phone: relief there are organizations and people willing and able to help people get abortions.

Before the Dobbs decision, AASN served an area that was already a reproductive care desert. According to the CDC, Arkansas has one of the worst maternal mortality rates in the United States, based on limited data from 2018 to 2021. It also has the highest teen birth rate.

In recent years, the state legislature passed a slate of antiabortion laws, even while Roe v. Wade was in place. The law that went into effect immediately after the Dobbs ruling was passed in 2019 under former governor and current Republican presidential candidate Asa Hutchinson. The current governor, Sarah Huckabee Sanders, a staunch abortion opponent, recently signed legislation approving a monument on the state Capitol grounds dedicated to the “unborn” who were aborted before the Dobbs decision.

“I’m very glad that Arkansas is named among the states where abortion is mostly illegal,” said Jerry Cox, president of the Little Rock-based Family Council, an antiabortion organization. Cox said that after the Dobbs decision, he drove and parked near Little Rock Family Planning Services.

He looked at the building, he recalled, and “thought to myself, ‘We actually did it. We mostly ended abortion in Arkansas.’”

This political environment can make the work now happening within that clinic feel especially high stakes. Though clinic volunteers are available by text or phone, they’re hoping to expand to satellite locations around the state to make their resources more easily available.

“I’ve spoken to people who believed that abortion was illegal in the entire country at this point, and thought that nobody had any options anymore,” said Ali Taylor, another cofounder of AASN. “I just cannot stress enough that Arkansans still have options.”

Maintaining those choices is part of why Tvedten decided against opening a new abortion clinic in Illinois after Dobbs, as he had once contemplated. But he realized he’d be putting himself unnecessarily in competition with another clinic in the same city. Instead, he decided to fully commit to his work in a state that he’s found himself at odds with, even suing at one point when Arkansas passed a law requiring abortion providers to be board-certified OB-GYNs.

Tvedten had opened his first medical marijuana clinic at the suggestion of his wife, Natalie, in the town of Heber Springs after voters approved medical marijuana use in the state in 2016, so he already had a hand in the work.

That first clinic was also not without complications. In 2020, the state medical board suspended his license because other health care professionals disputed his diagnosis of a minor while certifying the patient for use of medical marijuana. Medical board records confirm he was eventually approved to resume practice, with the condition that he would not certify any additional minors. He has since been awarded Best Doctor in the 2023 Arkansas Times Cannabis Awards.

After Dobbs, Tvedten wrote a book about an “amalgamation” of past patients who came into his clinic for abortions, calling them “angels.” He hasn’t published it. When he talks about the team of women who help his patients, Tvedten starts crying. He wipes his eyes with both his hands.

“There’s another group of angels in this building, and that’s my staff that have dedicated their lives, have put up with all kinds of BS from their families, other employers, and the outside world that dedicated their lives to the care of these women.”

Whatever happens in the political atmosphere around abortion, Tvedten is grappling with whether he’ll be around to lead again in times of change: He’s had colon cancer and has a metastatic lesion in his right lung that “definitely suggests that my life expectancy is shorter than it would be otherwise.”

So there’s a lot of weight to decisions, and as time passes, considerations shift. But he’s been optimistic that something in the political landscape will change— when you get on the Little Rock Family Planning Services website, it still says the clinic is closed “temporarily” — though less so over time.

“Hope springs eternal. It’s partially about that, or maybe it’s about, I don’t know, sticking my head in the sand and not recognizing the obvious,” he responds. “It’s just been a year.”

Correction: An earlier version of this story misstated the name of Arkansas Abortion Support Network. The story has been updated with the accurate name.

Lissandra Villa Huerta can be reached at lissandra.villa@globe.com. Follow her on Twitter @LissandraVilla.