Christina St. Louis / KHN
Bloomington, Minnesota – Minutes west of Minneapolis-St. Paul International Airport is housed in a brick one-story building with opaque windows. Of the nearby highways, most drivers would not recognize it as the location of one of the few abortion clinics in the state.
If they approach its entrance, right next to the Interstate 35 ramp, they can see anti-abortion posters leaning against the pine trees that border the parking lot. Those who arrived on a recent Wednesday were faced with declarations including “Request for an ultrasound examination”, “Pregnant? We will help you ”and“ Abortion kills a human being ”.
Inside, they would find Whole Woman’s Health of Minnesota, a clinic that opened in late February as uncertainties about the future of Rowe vs. Wade and abortion rights throughout the country. The nonprofit health alliance – which also runs clinics in Indiana, Virginia and Texas – opened the location in Bloomington, in part to make abortion care accessible to people outside the state who migrate from places that already severely restrict access.
This is a kind of redistribution of resources that has become common in recent months: an increase in available abortion capacity in states that providers and advocates believe will retain access after the U.S. Supreme Court eliminated the constitutional right to abortion on Friday, returning control of access to abortion back to the states.
In Minnesota, abortion is protected by the state constitution and is legal up to the point of viability, which is generally thought to begin at about 24 weeks, when the fetus can survive outside the womb. Abortions after the point of fetal viability are allowed only to preserve the life or health of the mother. Minnesota is also one of 16 states where Medicaid covers the procedure beyond the limited circumstances permitted by federal law, a policy designed to increase access for low-income women.
Yet the reality of having an abortion in Minnesota is complicated. Minnesota has only eight clinics that provide abortions. Most are in or near twin cities and offer abortions only during the first trimester. One, a planned parenting clinic in St. Paul, provides abortions after 20 weeks of pregnancy.
Those who work with Minnesotans seeking abortion say barriers, both legal and practical, have forced some to travel to Colorado, Nebraska, New Mexico, Washington, D.C., and Wisconsin even before the Supreme Court ruled.
“This is not a shelter,” said Sheila Walker, executive director of the Minneapolis-based abortion fund Our Justice. The nonprofit helps patients cover care costs that can exceed $ 1,000 and related costs such as accommodation. “Just because other people have worse laws doesn’t mean our laws are good.
Clinics and abortion advocates say Minnesota patients regularly wait at least two weeks for appointments at public clinics – a delay that can push people out the window when abortion is an option.
“Even this year, working with abortion funds and clinics here, they send people from Minnesota to other states because there aren’t enough appointments,” especially for those in the second trimester, said Megan Peterson, CEO of Gender Justice, a nonprofit organization. a goal that advocates for gender equality.
As abortion bans expand, she said, “I don’t think states like Minnesota are prepared for this influx.”
Minnesota lawmakers, like some of their counterparts elsewhere, have spent the past five decades imposing restrictions on abortion. In the 1970s, the state passed a law that only doctors could provide abortion services. In the 1980s, lawmakers introduced a requirement to notify parents of minors. And in 2003, they required anyone seeking an abortion to receive information about the risks associated with abortion and pregnancy, and then wait at least 24 hours before the procedure.
The restriction on doctors is problematic for people who need medical abortions and do not live near a provider, said Walker of Our Justice, a plaintiff in an ongoing lawsuit filed against the state in 2019 to challenge such rules.
This forces patients living outside the twin cities, who may have developed a relationship with a midwife in their community, to travel long hours sometimes to see a doctor, she said, who “could essentially do the same thing that would could your midwife do. “
Medical abortion is an option during the first 10 weeks of pregnancy and involves taking two pills. Its use has increased dramatically. According to the Guttmacher Institute, a research organization that supports abortion rights, the pill was used in 54% of abortions in the United States in 2020, with abortion in the first year accounting for most abortions.
Reflecting national trends, most abortions in Minnesota occur in the first trimester – 91% in 2020, according to the latest report from the Minnesota Department of Health to the state legislature. According to the report, 91% are for Minnesota residents, but patients also report living in Iowa, Michigan, North Dakota, South Dakota and Wisconsin, along with other states.
Dr. Julie Amaon, medical director of Just the Pill, a $ 350 medical health abortion clinic, said one of the factors limiting access to second-quarter services in the state was that “there are not enough documents that to go around. “
Just the Pill began accepting patients in Minnesota in October 2020 and expanded last year to Montana and Wyoming. The organization has seen approximately 1,300 patients in 2021; in the first five months of this year, he has already registered 1,000 patients.
Until recently, Amaon was his only doctor. She is able to send abortions with drugs to 60 to 70 people a week.
The FDA’s decision in late 2021, which allows patients to receive abortion pills by mail, “opened many doors for people,” she said. Still, we “still need our standard clinics” for patients who need abortion care later in pregnancy.
Even with Rowe vs. Wade intact, these clinics struggled to meet demand.
Emily Morbacher, director of customer service for the Midwestern Access Coalition, said one to two of her clients travel to a Minnesota abortion clinic each week. Most are from rural areas of the state that lack facilities. But as abortion restrictions have spread to the middle of the nation, people come from Iowa, Nebraska, Dakota, Texas and Wisconsin, they said. According to health department reports, these states reported a total of 69,295 abortions in 2020.
North Dakota, South Dakota and Texas have so-called trigger laws that ban almost all abortions following a Supreme Court decision to overturn Rowe vs. Wade. In Iowa, the state’s Supreme Court on June 17 overturned protection against abortion, upheld by a 2018 state court ruling, and Wisconsin has a law from 1849 criminalizing the procedure in almost all cases.
The coalition, which coordinates and pays for housing, food, transportation and other expenses for people seeking abortion, is seeing an increase in demand for its services in the Midwest. Last year, she helped about 60 people a month; this year it has grown to 80 to 130 people a month.
Morbacher said any influx of patients in Minnesota “will put a lot of pressure on clinics.”
Anticipating a jump in demand, abortion providers are hiring.
Emily Bisek, a spokeswoman for Planned Parenthood North Central States, said she predicted a 10 percent to 25 percent increase in abortions in Minnesota. “But we also know that there will be some people who can’t get to Minnesota and who have very limited opportunities to do what they do with their pregnancies,” she said.
The Planned Parenthood partner operates clinics in Iowa, Minnesota, Nebraska, North Dakota and South Dakota. It provided 7,491 abortions in Minnesota in 2020 – or more than three-quarters of registered abortions in the state. In 1980, Minnesota documented more than 19,000 abortions. The large decline is partly due to better and more widely available birth control. However, resources are strained as people seeking abortion migrate from countries that have reduced or eliminated access.
Since opening the clinic in Bloomington, the Whole Woman’s Health Alliance has seen patients and travelers from Minnesota, including Texas and Dakota.
“Just 10 minutes from the airport and the opportunity in some cases to bring in and out patients on the same day, where they can fly home in the evening and on time to go to work the next day, was huge,” said Sean Mel, associate director of the clinical services of the organization that monitors the Minnesota location. This clinic provides abortions up to 18 weeks after the woman’s last period, but has plans to increase the window to 24 weeks “in the coming months.”
Although the clinic still does not accept insurance, Mel said she works with state and national abortion funds to help patients afford the procedure. Its fees are in line with other providers – from $ 400 for abortion with drugs to $ 1450 for abortion procedure in the second trimester at the clinic.
His team of five doctors generally maintains a one-week waiting time for appointments. One challenge is requiring Minnesota clinics to provide information to patients over the phone or in person at least 24 hours before an abortion, Mel said.
“If they miss this phone call and we can’t connect, it could potentially ruin their meetings,” he said.
Just the Pill is also working to expand access by launching mobile clinics that will provide medical abortion and procedures during the first trimester.
But Amaon and other abortion rights advocates worry that increasing capacity will not meet demand.
“We have already seen a crazy increase in need,” Amaon said before the Supreme Court ruling. “It’s pretty devastating.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. This is an editorially independent operational program of KFF (Kaiser Family Foundation).