MOORHEAD, Minn. — The move, as the crow flies, was about two miles — just across the Red River into Minnesota. But for North Dakota’s last abortion provider, it was a world apart.
“We were very sad to leave Fargo,” said Tammi Kromenaker, director of the Red River Women’s Clinic. “The state forced our hand. … It was time to hop the river.”
Expecting North Dakota lawmakers to pass anti-abortion legislation even before the U.S. Supreme Court struck down Roe v. Wade, Red River had begun looking for a Minnesota home last fall. It signed the paperwork on the new clinic June 23, a day before the high court announced its Dobbs decision. That day, a supporter approached Kromenaker and proposed a GoFundMe campaign to help pay for the move.
“I was like, ‘Sure. Whatever. Go for it,’” she said. “Thank goodness!”
The reaction to Dobbs energized abortion rights supporters. Red River fund organizers quickly increased their initial fundraising goal of $20,000 to $250,000. Over four days, more than 10,000 donors contributed more than $750,000. On Aug. 6, as volunteers ferried equipment to the new clinic, the fund hit $1 million.
“I literally lost my breath,” Kromenaker recalled. Looking back months later, she said, it is “still surreal.”
While the Supreme Court decision has changed the abortion landscape dramatically across the nation, few states have been as affected as Minnesota, which has become an island of access in an increasingly restrictive Upper Midwest.
Neighboring Wisconsin, which had four clinics providing abortions before Dobbs, now has none. Among other bordering states, South Dakota has adopted some of the most restrictive abortion policies in the nation, and Iowa is expected to follow.
Minnesota clinics report a surge in patients from not only neighboring states but also from as far away as Texas. As out-of-state patients travel to larger metro areas, some in-state patients have had to seek appointments in more remote parts of Minnesota. And abortion has become an issue in the November elections for Minnesota Gov. Tim Walz and Attorney General Keith Ellison, both Democrats.
At Red River Women’s Clinic, Kromenaker anticipated opposition in Moorhead as she and her colleagues researched the zoning requirements for a new site. A Minnesota anti-abortion group, Pro-Life Action Ministries, had vowed to stymie the clinic’s relocation but admitted it had no legal footing to stop the move. The anti-abortion group’s executive director, Brian Gibson, did not respond to a call seeking comment.
But Red River’s new facility, about a five-minute drive from the Fargo clinic, offers other advantages, most notably an entrance from its private parking lot. Before, because the Fargo facility was on a city street, patients faced a gantlet of anti-abortion protesters.
“Patients would come in rattled and upset,” Kromenaker said. “[Now] patients’ demeanors are so different. … They’re not rattled.”
But some patients face difficulty traveling to reach the Minnesota clinics.
Ripple Effects Across Minnesota
In the first 100 days after Roe was overturned, 66 health clinics in 15 states stopped providing abortion care, according to the Guttmacher Institute, which supports abortion rights. Fourteen of those states had accounted for more than 125,000 abortions in 2020, it said. (The 15th state, Georgia, still allows limited early abortions.)
As court challenges play out and new legislation emerges, the number of states barring abortions could total as many as 26, said Ruth Richardson, CEO of Planned Parenthood North Central, which has 28 health centers across a five-state region.
Even before the Dobbs decision, about a tenth of abortion patients in Minnesota were from other states. Of the 10,136 abortions reported by the Minnesota Department of Health in 2021, 1,009 were for out-of-state residents. More than 60% of the patients from out of state were from Wisconsin, and all but 77 non-resident patients were from neighboring states.
Since the decision, the Minneapolis-St. Paul metro area, with five clinics performing abortions, is seeing the largest influx of out-of-state patients, clinic officials say. Planned Parenthood clinics, which perform about 75% of the state’s abortions, had about a 150% surge in call center traffic after the decision and about a 13% increase in patients, Richardson said.
Another metro-area clinic, run by Whole Woman’s Health, opened in February and is 10 minutes from Minneapolis-St. Paul International Airport. That clinic has seen a 50% increase in patients, said Sean Mehl, associate director of clinical services for the nonprofit, which also has clinics performing abortions in Indiana, Maryland and Virginia.
While the clinics have increased staffing, the effects of the Dobbs decision extend beyond the number of patients seeking care.
“We're seeing more need for care in the second trimester,” Mehl said, partly because some patients may have tried to get appointments at multiple clinics before finding a facility that would accept them.
Rather than travel to Minnesota, some patients from North Dakota have gone as far as Colorado, Montana or Nebraska for abortions.
“Sometimes the nearest clinic isn’t the soonest clinic,” said Destini Spaeth of the North Dakota Women in Need Abortion Access Fund, which helps patients in the Dakotas with travel and other expenses.
And not all patients have the resources, time or ability to travel.
“We haven't even gotten into the reality that abortion bans don't restrict access for everyone in the same way,” said Richardson, a Democratic state representative for a suburban district south of St. Paul. Lack of access, she said, is linked to higher maternal mortality, which disproportionately affects Black and Indigenous communities.
Donors motivated by the Dobbs decision are helping close that gap. In Duluth, for example, there’s the H.O.T.D.I.S.H. Militia. The acronym stands for “Hand Over The Decision It's Healthcare.”
Some clinics in Minnesota’s northern areas, which are more remote with limited flights in and out, have not seen a large influx of out-of-state patients.
“What we really did see in the beginning of the year was an increase in patients from southern Minnesota,” said Paulina Briggs, laboratory supervisor and patient educator at the WE Health Clinic in Duluth.
“We think there’s a big ripple effect there where [out-of-state] patients are going to the [Twin] Cities, and their local patients are getting pushed up to us because their waiting times were a long time … And abortion is a time-sensitive procedure.”
Midwest Policies in Flux
All Upper Midwest states have had to adapt to changing abortion laws.
In Wisconsin, where an 1849 law banning abortion took effect after the Dobbs decision, all three Planned Parenthood clinics that performed abortions halted procedures. The weekend after the high court issued its ruling, its clinics had to cancel appointments scheduled with 70 patients.
“The providers had to go into waiting rooms and tell the patients … they could not access that care,” said Tanya Atkinson, president and CEO of Planned Parenthood of Wisconsin.
Planned Parenthood’s 22 Wisconsin health centers still offer pre-procedure help and connect patients with “navigators” to help them find the care they need.
In the first month after the Dobbs decision, Planned Parenthood clinics in Illinois saw 350 patients from Wisconsin, 10 times the usual number, Dr. Kathy King, Planned Parenthood of Wisconsin's medical director, told NPR. That figure did not include Wisconsin patients at non-Planned Parenthood clinics.
Planned Parenthood personnel from Wisconsin are now working in Illinois to expand the capacity of a Waukegan clinic, an hour’s drive south of Milwaukee.
At least one day a week, the Planned Parenthood of Wisconsin team runs the Waukegan center, Atkinson said. Also, a physician from Madison, Wisconsin, has bought two buildings just south of the state border in Rockford, Illinois. Neither site is open yet.
Illinois clinics also see patients from Missouri and Kentucky, which have some of the nation’s most restrictive abortion laws. Illinois providers also anticipate more limits on abortion in neighboring Iowa and Indiana.
In Iowa, Republican Gov. Kim Reynolds has asked state courts to lift an injunction against enforcement of a law that would ban abortions after six weeks. Republicans also control both chambers of the Iowa legislature.
Minnesota leaders moved quickly to cement the state’s abortion rights when the Dobbs decision was announced. While noting that the Minnesota Constitution protects abortion rights, Attorney General Ellison said in a statement that the decision will make life harder for people seeking abortions, including in the states that border Minnesota.
“No one from any state will be prosecuted in Minnesota for seeking an abortion that is legal in Minnesota,” Ellison said.
On June 25, Walz followed with an executive order to protect those who travel to the state seeking abortions. And in July, a district court in Minnesota ruling removed a 24-hour waiting period and a requirement that minors notify two parents.
But GOP gubernatorial candidate Dr. Scott Jensen, a former state senator who said as late as May that he would try to ban abortion in the state, is within striking distance of Walz in some polls. Since Dobbs and the August primary, Jensen has taken a softer stance, saying that abortion is protected in Minnesota and criticizing Democrats for using abortion rights as a campaign issue.
Kromenaker of the Red River clinic is continuing to fight abortion restrictions in North Dakota as well. The clinic won an injunction to put the state’s trigger law on hold. But she’s wary of new anti-abortion legislation coming forward when the Republican-dominated North Dakota legislature convenes in January. She fears women traveling out of state for care might be targeted or intimidated.
“There are three bridges across the river,” she said. “What are they going to do … station the National Guard and check for positive pregnancy tests?”