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With just 8 abortion clinics, Minnesota may struggle to meet out-of-state demand

Whole Woman's Health of Minnesota, a clinic that opened to patients in February, is one of only eight that provide abortions in the state and is located just a few minutes from the Minneapolis-St. Paul International Airport.
Christina Saint Louis/KHN
Whole Woman's Health of Minnesota, a clinic that opened to patients in February, is one of only eight that provide abortions in the state and is located just a few minutes from the Minneapolis-St. Paul International Airport.

BLOOMINGTON, Minn. — A few minutes west of the Minneapolis-St. Paul International Airport sits a brick, one-story building with opaque windows. From the nearby freeways, most drivers wouldn't recognize it as the location of one of the few clinics in the state that provides abortions.

Should they approach its entrance, just off an Interstate 35 on-ramp, they might see anti-abortion placards propped against the pine trees that border the parking lot. Those who arrived on a recent Wednesday confronted declarations that included "Demand to see your ultrasound," "Pregnant? We will help you," and "Abortion kills a human being."

Inside, they'd find Whole Woman's Health of Minnesota, a clinic that opened in late February as uncertainties lingered surrounding the future of Roe v. Wade and abortion rights nationwide. The nonprofit Whole Woman's Health Alliance — which also operates clinics in Indiana, Virginia, and Texas — opened the Bloomington location, in part, to make abortion care available to out-of-state residents migrating from places that already significantly restricted access.

It's the kind of resource reallocation that has become commonplace in recent months: increasing available abortion capacity in states that providers and advocates believe will preserve access after the U.S. Supreme Court eliminated the constitutional right to an abortion on Friday, turning control over abortion access back to states.

In Minnesota, abortion is protected by the state's 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 also is one of 16 states where Medicaid covers the procedure beyond limited circumstances allowed by federal law, a policy designed to boost access for low-income women.

Yet the reality of obtaining an abortion in Minnesota is complicated. Minnesota has just eight clinics that provide abortions. Most are in or near the Twin Cities and offer abortions only during the first trimester. One, a Planned Parenthood clinic in St. Paul, provides abortions after 20 weeks of pregnancy.

Those who work with Minnesotans who seek abortions say barriers, both legal and practical, forced some to travel to Colorado, Nebraska, New Mexico, Washington, D.C., and Wisconsin even prior to the Supreme Court's decision.

"It's not a haven," said Shayla Walker, executive director of the Minneapolis-based abortion assistance fund Our Justice. The nonprofit helps patients cover the cost of the care, which can exceed $1,000, and related expenses like lodging. "Just because other people have worse laws doesn't mean our laws are good."

Clinicians and abortion rights advocates say Minnesota patients regularly wait at least two weeks for appointments at state clinics — a delay that could push people past the window when an abortion is an option.

"Even over this year working with abortion funds and clinics here, they're sending people from Minnesota out to other states because there are not enough appointments," particularly for those in the second trimester, said Megan Peterson, executive director of Gender Justice, a nonprofit that advocates for gender equity.

As abortion bans expand, she said, "I don't think states like Minnesota are prepared for that influx."

A capacity problem

Minnesota lawmakers, like some of their counterparts elsewhere, have spent the past five decades installing restrictions on abortions. In the 1970s, the state enacted a law that only physicians can provide abortion services. In the 1980s, lawmakers instituted a parental notification requirement for minors. And in 2003, they mandated that anyone seeking an abortion receive information about risks associated with abortions and their pregnancy, then wait at least 24 hours before the procedure.

The physician restriction is problematic for people who need medication abortions and don't live near a provider, said Walker of Our Justice, which is a plaintiff in an ongoing lawsuit filed against the state in 2019 to challenge such rules.

It forces patients living outside the Twin Cities who may have developed a relationship with a midwife in their community to travel sometimes hours-long distances to see a physician, she said, one "who could essentially do the same thing that your midwife could do."

Medication abortion is an option during the first 10 weeks of pregnancy and involves taking two pills. Its use has risen dramatically. According to the Guttmacher Institute, a research organization that supports abortion rights, pills were used in 54% of U.S. abortions in 2020, the first year medication abortion accounted for most of the abortions performed.

Mirroring national trends, most Minnesota abortions occur in the first trimester — 91% in 2020, according to the Minnesota Department of Health's most recent report to the state legislature. According to the report, 91% were for Minnesota residents but patients also reported living in Iowa, Michigan, North Dakota, South Dakota, and Wisconsin, along with other states.

Dr. Julie Amaon, medical director of Just the Pill, a telehealth clinic that provides medication abortions for $350, said one factor limiting access to second-trimester services in the state is that "there's just not enough docs to go around."

Just the Pill began seeing patients in Minnesota in October 2020 and expanded last year into Montana and Wyoming. The organization saw roughly 1,300 patients in 2021; in the first five months of this year, it had already logged 1,000 patients.

Until recently, Amaon was its sole physician. She's able to mail medication abortions to 60 to 70 people a week.

The FDA's decision in late 2021 that allowed patients to receive abortion pills by mail "has opened up a lot of doors for people," she said. Yet "we still need our brick-and-mortar clinics," for patients who need abortion care later in pregnancy.

Even with Roe v. Wade intact, those clinics struggled to meet demand.

Emily Mohrbacher, director of client services for the Midwest Access Coalition, said that each week one to two of its clients travel to a Minnesota clinic for an abortion. Most are from rural parts of the state, which lack facilities. But as abortion restrictions have expanded across the nation's midsection, people are coming from Iowa, Nebraska, the Dakotas, Texas, and Wisconsin, they said. Those states collectively reported 69,295 abortions in 2020, according to health department reports.

North Dakota, South Dakota, and Texas have so-called trigger laws that ban nearly all abortions after the Supreme Court's decision to overturn Roe v. Wade. In Iowa, the state's Supreme Court on June 17 overturned abortion protections affirmed by a 2018 state court decision, and Wisconsin has an 1849 law criminalizing the procedure in nearly all cases.

The coalition, which coordinates and pays for lodging, food, transportation, and other expenses for people seeking abortion, has seen demand for its services grow across the Midwest. Last year, it helped roughly 60 individuals per month; this year that has grown to 80 to 130 people monthly.

Mohrbacher said any influx of patients to Minnesota will "put a lot of pressure on clinics."

Mounting pressure

Anticipating a surge in demand, abortion providers are hiring.

Emily Bisek, a spokesperson for Planned Parenthood North Central States, said it predicts a 10% to 25% increase in abortion in Minnesota. "But we also know that there will be some people who cannot get to Minnesota and who have very limited options for what they do with their pregnancy," she said.

The Planned Parenthood affiliate 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 the state's recorded abortions. In 1980, Minnesota documented more than 19,000 abortions. The big drop is partly due to better and widely available birth control. Nonetheless, resources are being strained as people seeking abortion migrate from states that have reduced or eliminated access.

Since opening the Bloomington clinic, Whole Woman's Health Alliance has seen Minnesota patients and travelers, including from Texas and the Dakotas.

"Just being 10 minutes from the airport and able to, in some cases, get patients in and out that same day where they can fly home in the evening and in time to go to work the next day, it has been huge," said Sean Mehl, the organization's associate director of clinical services who oversees the Minnesota location. That clinic provides abortions up to 18 weeks from a woman's last menstrual period but has plans to increase the window to 24 weeks "in the coming months."

Though the clinic does not yet accept insurance, Mehl said it works with state and national abortion funds to help patients afford the procedure. Its fees are in line with other providers — from $400 for a medication abortion to $1,450 for an in-clinic second-trimester abortion procedure.

Its team of five doctors generally has maintained a one-week wait time for appointments. One challenge is Minnesota's requirement that clinics provide state-mandated information to patients by phone or in person at least 24 hours before an abortion, Mehl said.

"If they miss that phone call and we're not able to connect, that can potentially push their appointments," he said.

Just the Pill is also working to expand access by launching mobile clinics that would provide medication abortion and first-trimester procedures.

But Amaon and other abortion rights supporters worry the increases in capacity won't meet demand.

"We've already seen a crazy increase in the need," Amaon said before the Supreme Court decision. "It's pretty devastating."

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).

Copyright 2022 Kaiser Health News. To see more, visit Kaiser Health News.

Rachana Pradhan
Christina Saint Louis