Planned Parenthood, which has been under siege by state leaders in Texas for years, is using millions of donated dollars to expand to West Texas in the coming months. Planned Parenthood of Greater Texas will announce this week that it will open a facility in El Paso, which has been the largest city in the country without a Planned Parenthood presence. The organization also plans to open in one other West Texas city in 2019, but it isn’t yet identifying the specific city.

The West Texas expansion is being funded by more than $10 million in contributions from two donors who have asked not to be identified, said Ken Lambrecht, CEO of Planned Parenthood of Greater Texas, which operates 22 health facilities across the state. It still needs to raise more than $4 million for its West Texas expansion. The organization has relied increasingly on philanthropy since 2011, when the Legislature barred the use of state funds for Planned Parenthood. “Obviously at the highest levels of the state government, Planned Parenthood has been eliminated from most grants for birth control and preventive health care because our governor, our lieutenant governor, and the majority of the Texas Legislature and state politicians unfortunately put their own religious beliefs ahead of access to health care for our communities,” Lambrecht said. Governor Greg Abbott’s office did not respond to a request for comment about Planned Parenthood’s expansion plans.

Despite its recent absence, Planned Parenthood has a long history in El Paso. A forerunner of Planned Parenthood set up a women’s birth control clinic in 1937 with the help of Margaret Sanger, the pioneer of the women’s reproductive rights movement. Planned Parenthood of El Paso never provided abortion services but was still a political lightning rod in a predominately Hispanic and Catholic community. In the nineties, some El Paso City Council members tried repeatedly to block Planned Parenthood from receiving Community Development Block Grant funding for cancer screenings. After years of financial struggles, Planned Parenthood of El Paso closed in 2009, two years before the state cut off health care spending for Planned Parenthood facilities.

The new El Paso facility will be different in a number of ways. Rather than being run as a stand-alone nonprofit agency, it will be run by Planned Parenthood of Greater Texas, which operates across the stateF. And unlike the prior incarnation, the new Planned Parenthood facility in El Paso will perform abortions as soon as it secures a state license. It will be replacing another nonprofit agency, Reproductive Services, Lambrecht said. That organization struggled to stay open as Texas passed increasingly stringent abortion regulations. Planned Parenthood initially will operate from the current Reproductive Services facility in central El Paso, but will eventually move to another expanded location. El Paso also has one for-profit abortion provider, Hilltop Women’s Reproductive Clinic.

In 2011, then-Governor Rick Perry signed legislation that barred money from the Medicaid Women’s Health Program, which funds family planning services, from going to clinics affiliated with abortion providers. Planned Parenthood had been the largest recipient of those funds before being cut off. The legislation cost the state millions of federal Medicaid dollars, money the state has been unsuccessfully trying to recoup for years. The state then tried in 2016 to bar Planned Parenthood from receiving any Medicaid funding for health care services, but that effort so far has been blocked by the courts.

The Legislature in recent years has passed a number of laws that more deeply regulate abortion providers. Most notably, a 2013 law required that doctors performing abortions must have hospital admitting privileges and also required that clinics performing abortion meet requirements for ambulatory surgical centers. That law, parts of which were later struck down by the courts, led to the temporary or permanent closing of many Texas abortion providers, including Reproductive Services in El Paso. In the 2017 legislative session, lawmakers passed a bill that required the cremation or burial of fetal remains. That law has been blocked for now by the courts.

El Paso’s Catholic Diocese has been involved in prayer protests at Reproductive Services over the years, and celebrated its closing last month. El Paso’s Catholic bishop, Mark J. Seitz, said he was “very disappointed” to hear of Planned Parenthood’s plans to open an El Paso clinic. “With their presence in our border region, our children in the womb will be facing a new and menacing threat to their existence and expectant mothers and fathers will be more likely to make a choice that they will regret for the remainder of their lives,” he said in a statement to Texas Monthly. Seitz accused Planned Parenthood of exaggerating the importance of the health services it provides. “In El Paso, women’s comprehensive health needs are better served by our existing community health centers,” Seitz said.

Despite the bishop’s sentiments, Lambrecht said El Paso’s current political climate is more amenable to Planned Parenthood. Current political leaders recognize that El Paso continues to be medically underserved, particularly when it comes to women’s health. “El Paso County is the only county in the 100 most populous counties for women aged 18 to 24 in the United States without a Planned Parenthood health center,” he said.

State Senator José Rodríguez, D-El Paso, said Planned Parenthood’s closing nine years ago left huge gaps in El Paso’s health care system. “The void that was created when they left—and I was very supportive of them when they were here—has caused a lot of women to go without the basic women’s health services that they provide,” he said. State Representative Mary Gonzalez, D-Clint, said Planned Parenthood has deep experience in medically underserved communities like El Paso County. “I think unfortunately what state leaders don’t understand is the history and role that Planned Parenthood has played in so many women’s lives. Planned Parenthood has a successful track record of reaching out specifically to the most vulnerable women—women of color, LGBT women, low-income women—and providing services,” she said.

Dr. Jacquelyn Brito, an El Paso family practitioner originally from Los Angeles, said she has been surprised by the lack of health care services available to low-income families in El Paso. “I think this is a city that needs Planned Parenthood,” she said. Brito said she understands the religious objections to abortion, but she believes that the priority for any health care provider is to give patients the information they need to control their own health. “One thing I think is very important across the board is just giving a patient all their options. Whether it coincides with my moral or my Catholic perspective is beside the point. When I see my patients, I lay it all out to them. I lay out the risk, I lay all their options out. I want my patients to be an active participant in their health. And that means in order to do that they have to be very knowledgeable, and abortion is sometimes what the patient is going to choose, whether I believe in it or whether I don’t believe in it,” she said.

Lambrecht said Planned Parenthood of Greater Texas will continue its efforts to expand services in the state. But he said philanthropy can’t fully replace the money lost by the state’s refusal to provide funding for health-care services to Planned Parenthood. “We’re obviously not thriving in Texas if we have the highest uninsured population in the country and among the highest pregnancy-related death rates in the developed world and we’re the highest repeat teen pregnancy rate in in the United States,” he said. “All we have to do is look at California and their health outcomes and compare it to Texas and we know we live in the equivalent of a Third World country.”