This is part two of a five-part series from MPR News examining the state of abortion in Minnesota one year after Roe v. Wade was overturned.

The Supreme Court last year forced Tammi Kromenaker to make a choice she hoped she’d never have to make: Stay or leave North Dakota.

The high court in late June struck down Roe v. Wade, ending a federal constitutional right to abortion. Kromenaker knew her Red River Women’s Clinic in Fargo — the only clinic across North Dakota performing abortions — would now face a state wave of prohibitive abortion laws.

She couldn’t stay. By September, with $1 million in GoFundMe donations, she’d moved the clinic across the Red River to Moorhead, Minn., where it sees more patients than ever. While most are still from North Dakota, she said patients are coming from across the U.S. 

“We had a patient from Texas who just sort of inadvertently, partway through her visit, let it slip that she was from Texas. And we said, ‘that’s OK and, in fact, here’s some additional travel money from the local abortion fund,” Kromenaker recalled. “She just was so relieved. She said, ‘Oh, my gosh, I thought you guys were gonna have to report me or something.’” 

Minnesota abortion clinics say demand for abortion services has climbed significantly in the year since the high court overturned Roe, leaving Minnesota an island in a patchwork of abortion availability around the country. It’s brought huge challenges for clinics here working to meet the needs of a growing list of patients from around the country.

Planned Parenthood North Central States reports that its Minnesota clinics performed 25 percent more abortions in the 10 months after the Dobbs ruling striking down Roe, compared to the 10 months prior. 

Staff at the clinics saw out-of-state patients traveling for abortions in Minnesota nearly double during that period, creating new challenges.

“We’ve seen this bottleneck of patients who are trying to fit into appointments in states where abortion is accessible,” said Dr. Sarah Traxler, chief medical director for Planned Parenthood North Central States. 

“Patients from South Dakota and North Dakota are moving into Minnesota,” she said. “Patients from Missouri are moving into Iowa, patients from Wisconsin are coming to Minnesota, because the providers who are there in those states who know how to provide this essential health care are not legally able to do it anymore.”

Ripple effect

Outside the WE Health Clinic on a recent day in Duluth, a small group stood in prayer, competing with the noise of a massive road construction project. A car facing the clinic was wrapped with a decal showing anti-abortion messages and the image of a fetus. 

It’s a sensory overload, one that clinic staff say more patients are walking through regularly. 

Before Red River Women’s clinic moved to Moorhead, WE was the only abortion provider across northern Minnesota and northern Wisconsin. It’s now feeling a new kind of ripple effect.

“We had been told to expect a 25 percent increase in the number of patients traveling to Minnesota for abortion care, which was true at our clinic,” said Paulina Briggs, executive director at WE Health. “However, most of those patients weren’t traveling from out of state for us. They were from clinics in the Twin Cities.” 

As more people from outside the state flew into the cities for care, they made appointments at clinics nearby like Whole Woman’s Health in Bloomington or Planned Parenthood in St. Paul. That meant that Twin Cities residents were seeing longer and longer wait times locally, forcing them to travel elsewhere, including to Duluth.

Stunning political wins for abortion rights supporters last November in the state put the DFL in charge of the Legislature and governor’s office leading to a vast expansion of abortion rights as they contracted in much of the rest of the country.

It’s created a hard-to-fill demand in Minnesota.

“We’ve probably doubled our volume as far as the numbers in the first part of last year, versus the first part of this year,” said Dr. Julie Amaon, medical director for Just the Pill, a nonprofit telemedicine abortion pill provider.

Amaon said the organization, which operates in Minnesota, Wyoming, Montana and Colorado, had four times the amount of requests for appointments after Dobbs than before. But the most striking thing she’s noticed this year is the volume of patients who are traveling for care. 

“In Minnesota we obviously [see] everybody surrounding the Dakotas, Wisconsin, Iowa, people from Nebraska. We have people coming from Idaho to see us in Wyoming or Montana, whatever’s closest,” she said. “We do have a fair amount from Texas, Louisiana, Arkansas… so people are coming from really all over the place.”

While providers say they’ve seen their individual numbers climb, it’s still unclear what the broad impact of the last year has been across Minnesota. The state Health Department compiles an annual report on the subject, but numbers for 2022 haven’t yet been released. 

A recent study from the national group WeCount said that the number of abortions during the past year decreased overall, but states like Minnesota, with abortion protections, saw an increase.

Officials with Planned Parenthood North Central States said they’ve been working to expand capacity to meet the rising need for in-clinic appointments and telehealth appointments where drugs are sent through the mail and patients walk through the process with a provider on-screen. 

“Those patients who are from Minnesota who are eligible for that service don’t have to come to a health center,” said Traxler, the Planned Parenthood chief medical officer. “That actually leaves a lot of space open for people who are traveling from out of state, where they’re not eligible for medication abortion by mail, so they can be seen in our brick-and-mortar health center and not necessarily take the appointment spot of someone who’s living in Minnesota.”

‘Figure out what they need to do’

In-state or not, the increase in demand for abortions has strained Minnesota’s providers, Traxler said, forcing many to reevaluate their options for serving patients. 

“Every time you put a barrier in front of someone who is seeking an abortion, it prolongs their gestational age,” Traxler said. “And sometimes it’s too many barriers, and they can’t actually access the abortion. So most of what I’ve seen in discussing with patients is all of the just logistics, additional logistics that have gone into them being able to get to an appointment, and that is new.”

More out-of-state patients are choosing procedural, rather than medication, abortions, according to Planned Parenthood. That figure is up to 53 percent, compared to 35 percent prior to the Dobbs decision.

That may be because, in some cases, patients feel more comfortable going through the process in-clinic. 

“It’s just a very volatile world out there. And I think there’s something incredibly reassuring about connecting with a provider in person, seeing medication in person, having a conversation in person,” said Emily Mohrbacher with the Midwest Access Coalition. 

“Certainly if you’re doing an in clinic procedure, you know, just being able to leave that facility knowing like this part of your process is done versus the kind of volatility of the U.S. Postal Service or where something’s getting mailed to. Or are you in a safe place to do a telehealth appointment? Or is someone going to walk in?”

But it also comes with its own drawbacks. Traveling takes time, and every day counts when it comes to accessing a timely abortion. 

According to the most recent data from the Minnesota Department of Health, in 2021, 8,934 abortions happened before 12 weeks, roughly 90 percent of all abortions in the state. One abortion was reported after 25 weeks. Half of the clinics in Minnesota only provide abortions through the first trimester. And only one will provide abortions through 23 weeks. There are no clinics that provide abortions after 23 weeks and 5 days.

Traxler said that Planned Parenthood has seen a 22 percent increase in second-trimester abortions overall, compared to last year. Much of that change has come from patients traveling for abortion, she said.

Patients arriving at Minnesota clinics will still likely be met by people who want nothing more than to change the  minds of people seeking abortions.

Outside the Planned Parenthood clinic in St. Paul on a recent day, Pete Coyan of Shoreview stood on the sidewalk with a group of protestors, holding rosary beads and wearing a poster board with the image of a baby on it. Demonstrating is an act of faith, he said, adding that he prays that someday even if abortion is available that no one will want it.

“I’m compelled by the Holy Spirit to be here, as a ministry of God, to do the best that we can to convince mothers that are coming in to have an elective abortion, to choose to keep the life the human life that is within them,” Coyan said.

Just down the driveway, Planned Parenthood volunteers in bright pink vests greeted cars as they approached. Volunteers there said they try to present a warm and welcoming presence after drivers approach protesters on the way in.

“Our patients that come in here … it could be an emotional day for them. And having someone yelling at you is, it’s hard,” volunteer Pam Grossman said. “I just stand here so they can see me in my pink vest and they know that there’s someone here to welcome them and make them feel comfortable.”

At the Red River clinic now In Moorhead, Kromenaker believes the influx of patients to Minnesota from around the country is a clear sign of just how determined people are to take control of their own situation.

“I really think that when a person doesn’t want to be pregnant, they will figure out what they need to do,” she said, recalling her conversation with the Texas woman who feared trouble for traveling to Minnesota. “And if they need to come up with a different address to make themselves feel safe until they get to the clinic and feel safe enough to disclose it to us, they’ll go to any lengths to end that pregnancy.”