One Year After Dobbs: Minnesota Abortion Providers Speak

In June 2022, the Supreme Court disregarded 50 years of legal precedent and overturned Roe v. Wade. Abortion is now banned or severely restricted in half of U.S. states, including in the four that border Minnesota. Minnesota Women’s Press spoke with three Minnesota clinic leaders, two telehealth-based medication abortion providers, as well as the team at Our Justice, a donor-funded organization that supports people seeking abortion care in Minnesota. We asked how this past year has transpired and how they are feeling now.

Tammi Kromenaker, clinic director – Red River Women’s Clinic, Moorhead

Your clinic recently relocated from Fargo, North Dakota to Moorhead, Minnesota. When and why did that decision occur?

We started looking for space in Minnesota in the fall of 2021. There was a special session happening in the North Dakota legislature, [and] we had heard legislators talking about copying Texas’ six-week abortion ban (SB8). We also knew that the Supreme Court had taken up the Dobbs case and that the North Dakota legislature would no doubt attack abortion rights [if Roe fell], so the writing was on the wall.

The building that we’re in now was the first building presented to us by our realtor. We immediately said, “It’s too big, it’s too expensive” — it is 12,000 square feet, and our Fargo building was 4,000 square feet. So we kept looking and not finding anything.

In May 2022, the Dobbs decision leaked. We went back to the first building we had seen and said, “It’s too much money, but we’ve got to do it. It’s the only one that fits our needs.” We got a loan for the down payment because we couldn’t even afford that.

We closed on the building at 3 p.m. on June 23, and they overturned Roe v. Wade on June 24.

How was the moving process?

Our security company was the first call I made after we signed the paperwork. We tried to keep the location a secret. There was a lot of covert sneaking in the side door with a hat, sunglasses, and mask on to slowly move things over from the Fargo building, which is only five minutes away.

As soon as the Supreme Court announced their decision, the North Dakota attorney general certified the trigger ban, setting off a 30-day countdown.

In June, a community member reached out to me and asked if they could start a GoFundMe for us. By August 6, it had hit a million dollars. That was beyond our wildest dreams, and it allowed us to pay back our down payment loan and to dream, for the first time in our history, about buying new tables and other supplies. We moved August 6 and saw our first patients in Moorhead on August 10.

How has this past year played out for you?

Moving day was bittersweet. We had been in that building for 24 years. In a personal vein, my dad died the day after we provided our first abortions in Minnesota.

We’ve been committed to continuity of care in this region, but it’s scary to move. We wondered, “Will people find us?” Patients had fears [such as], “Is it legal for me to come there? Am I going to be a criminal in the future?” It’s been the most challenging year of my professional life.

We are serving the same population that we did in our Fargo location — mostly patients from North Dakota and some from South Dakota and northwestern Minnesota. [Before moving, Red River was the only clinic providing abortions in North Dakota.] We’ve seen a handful of folks from Texas, [but] we’re basically seeing the same patient demographic and the same number. We have not seen a huge influx of patients, and we’re able to manage the demand. Right now, we have no delay in care. We’re working with abortionfinder.org to let people know that our wait time is short.

How did the change in state abortion restrictions affect your work?

On August 3, when we were still seeing patients in Fargo, a young person came in with her mother. They didn’t want to tell the dad, and in North Dakota you had to involve both parents. [They] went to court [to get a judicial override], and it was a very long process; the judge put her in danger by taking that much of her time.

In North Dakota, we [also] had to force materials on patients from the state intended to dissuade patients from having an abortion. It’s been so freeing in Minnesota to not have those onerous, stigmatizing restrictions on abortion care, which no other health care has.

There are still a number of restrictions in Minnesota: the cremation [or burial] of fetal tissue, and the state reporting form where we have to ask patients their reasons for an abortion [and report that to the state]. Minnesota Medicaid reimbursement is also very low. We wish those hurdles would go away.

Have you experienced increased threats to your staff and patient safety since moving?

When we were in our old location, we were right on the public sidewalk in downtown Fargo. Patients had to walk a gauntlet of protesters bullying, harassing, and intimidating them. In our new location, we have a private parking lot, and the protesters cannot come into the lot. Patients don’t come into the building crying, rattled, with their adrenaline pumping — it’s a much more welcoming atmosphere.

When the location was not public, there were some folks, including former Minnesota State Representative Tim Miller (the current executive director of Pro-Life Action Ministries), who said, “We know we cannot legally stop them from performing abortions at the property. However, we do plan to do what we can to make a move problematic for them.”

We’ve had a target on our back for a very long time, and that hasn’t changed, but [overall] we feel welcome in Minnesota from every level of government. Senator Klobuchar called. Senator Smith and Attorney General Ellison have been here. Our state representative, Heather Keeler (DFL –District 4A), has been here multiple times. We’ve been on calls with the governor and lieutenant governor. That’s the biggest change — we don’t feel like the wart on the community.

Any future plans to expand?

We have a lot of space in the other wing of the building, and we’d like to find tenants that align with our values. North Dakota is attacking trans minors’ rights. We’ve been contacted by some [gender-affirming care] providers there who say, “If we can’t provide this care in Fargo, can we rent space in your building?

We’d like to see this whole building become a safe haven for any kind of [health care] that helps folks who are under attack.

Why do you stay in this field?

As you asked that question, I’m seeing patients’ faces in my mind; I’m seeing patients whom I saw 25 years ago bring their daughters to us. A patient said to me recently, “You’ve given me my future back.” When somebody says that to you, how do you not keep going?

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Shayla Walker, executive director & Megumi Rierson, communications director – Our Justice, statewide

This donor-supported organization distributes funding and provides logistical support to individuals seeking abortion care in Minnesota.

How were you preparing for the Dobbs decision?

Megumi Rierson: We had meetings with abortion funds in states that were likely to restrict access to talk about whether they would have to move resources to us. Many folks in the abortion access movement did organizational and personal security analysis to make sure that we weren’t going to be put at risk of any surveillance or criminalization. [We also knew] that we were going to need to start raising more money.

We were clear with our clients and supporters that abortion is still legal in Minnesota. One effect of the state bans is to materially ban abortion — but the other effect is to create fear and confusion so that people who can access abortion, which is everyone in the country who can get to the right place, think that they can’t.

Shayla Walker: People who are [able] to do the research and figure out what’s real and what’s not — and who eventually get to us — we’re able to help them. But for every person who does reach an abortion fund, there are [many] who don’t.

The laws keep changing — especially around medication abortion — and it is a confusing time. Not too long ago, we saw a patient who was told by a crisis pregnancy center that they were a certain amount of weeks pregnant, [but in reality] they were way past that, and they almost weren’t able to get care because they were lied to. There’s misinformation happening on a small level, and there’s misinformation happening on a larger level.

How did the number of people requesting funds fluctuate throughout this past year?

MR: We did not see a huge increase immediately after Dobbs because a lot of America was already living in a post-Roe reality: there were bans — and threatened bans — across the country. However, our requests did increase from 1,000 in 2021 to 1,300 in 2022. In 2020, there were around 450, and the year before that, there were 240. One of the biggest things that tripled our requests was the economic impact of the pandemic, and the ways that economic and racial injustice have been severely impacting our clients.

We were already living in an emergency state.

It is true that Minnesota is a travel hub [for abortion care], and it’s also true that we’re not seeing a huge increase in requests in the fund, which says to us that what we knew was going to happen is happening: the impact of these decisions is disproportionately falling on poor people and people of color, people who don’t have the resources, and people who don’t believe that they could find the resources to make dignified choices about their bodies. If you have the resources to travel — if you believe that you’re entitled to the resources to travel — you will. And if you have lived your whole life believing that you’re not entitled to safe, just, dignified health care and the resources to access that, then you’re not going to look for [it]. We’re really trying hard at Our Justice to advertise our resources heavily. [We want to] make clear that not only is abortion legal here, you deserve to access it, and there are people to help you.

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SW: We haven’t seen a significant increase in [individual fund requests], but we’ve seen an increase in solidarity pledges, where a fund will reach out to all the funds across the nation [to help a patient] who is in their second trimester and the abortion costs are significantly higher, ranging from $1,000 to $20,000 [depending on the patient’s insurance status and where the procedure happens]. My assumption is that people are finding us [when they are farther along in the pregnancy] or are finding out later that they can access abortion care. Had they known when they were six weeks pregnant, they would have been able to get their abortion for a price that was within their budget.

Can you talk about increased threats of safety or surveillance since Dobbs?

MR: The highest threat of criminalization and surveillance is on clients, on poor people, and on people of color who are struggling to access abortion care and who are already at higher risk of criminalization and surveillance. Post-Dobbs and before Dobbs, [this happens the most in the emergency room] — people go to the emergency room with questions about their abortion and have the police called on them. That’s not something that we’ve seen or heard about in Minnesota, but it is happening nationwide, and it’s why we are rigorous about not sharing client information.

Do you have plans to expand?

MR: We hope to be able to increase our pledge amounts and increase the amount of case management that we can do. We’re hoping to hire someone else and thoughtfully grow our work because our requests from clients keep steadily increasing.

In the next year we’re planning to relaunch our post-abortion support group called Emerge. That would be open to anyone in Minnesota who has had an abortion and wants a space to talk about it. Many of the existing support spaces are run by anti-abortion groups, and they talk about abortion from a place of shame. Having an abortion brings up a million different emotions for people, and there should be space to talk about how abortions can provide relief and gratitude, a sense of care and safety, [as well as] grief. It should be okay to feel it all.

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Christi Hutchinson, senior health center manager – Planned Parenthood North Central States, Minneapolis

Did you see an increase in patients after the Dobbs ruling?

We’ve had a 13 percent increase in patients coming from outside of our region for abortion care [since June 2022]. We are seeing patients come from places that we’ve never seen before, like Florida and Texas. We’ve seen a 40 percent increase in second-trimester abortions, which I think speaks to the fact that there are a lot of roadblocks preventing people from accessing their care.

We’ve definitely staffed up our abortion centers [to meet this increase]. We’ve hired several advanced practice clinicians, and we’re training them on medication abortion care.

Tell us about your abortion navigator program.

Navigators connect people to financial assistance and help schedule care. Each of our navigators is frequently the first person that someone is telling they’re pregnant, because people are so afraid to talk about it.

We’ve had abortion navigators for quite a while, but they are definitely a lot busier now than they were before. They’ve helped over 1,200 patients get to their abortion appointments at Planned Parenthood North Central States since the Dobbs decision.

How can people access navigators?

Contacting [Planned Parenthood] for an appointment is a great first step. If a patient services representative knows that you need help accessing care, you’ll get connected.

Have you seen an increase in people working with abortion doulas in your clinic?

Yes, which is a beautiful thing. From my perspective — having worked in centers that provide prenatal care as well — there has been an [overall] increase in doulas for all types and all stages of reproductive health. I think it has to do with people trying to find a way to support others with connection, care, and safety — which could be a pushback against the political landscape. People want others to have the safe, secure abortions that they need and deserve.

Are there hurdles that are making your work harder?

The biggest challenge we’re facing right now is the pace at which the laws keep changing across the region. In a one-week period, we can see an abortion ban proposed and defeated.

The shifting bans make it really hard for patients to keep up with what they can and cannot access, and I think they’re instilling fear. Even in states where abortion is still legal, people are afraid that they’re going to face legal repercussions.

What are your feelings about the Reproductive Freedom Defense Act was recently signed in Minnesota?

The more protections for safe, legal abortions, the better. It’s a tremendous step in the right direction for people in Minnesota and for people who are coming here for care.

Are you changing how you provide gender- affirming care with the passage of the Trans Refuge Bill?

We are expanding care for those services, and we are moving to having gender-affirming and hormone therapy navigators as well as abortion navigators.

How have you processed this past year?

Whenever a crisis happens, you don’t know how you’re going to react. Are you going to flee, or are you going to stand and fight? Working with the people and patients that I do, I think there are more people who believe in social justice than there are trying to remove access to health care. That keeps me going.

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Paulina Briggs, executive director – WE Health Clinic, Duluth

How did the clinic prepare for the Dobbs ruling, what happened after, and how has this past year played out?

Before Dobbs, there were some reports indicating that Minnesota clinics could anticipate a 25 percent increase in patients traveling from outside of Minnesota for abortion care, so that’s the number that we were preparing for. That proved to be true at our clinic; we saw about a 25 percent increase in the number of abortions that we provided from 2021 to 2022. We didn’t see a huge increase in patients coming from out of state to our clinic. Instead we saw a ripple effect, especially last summer, of patients not being able to go to their local abortion clinics in the Twin Cities [because of long wait times] and coming to our clinic. That has continued.

Our staffing has been steady, and we have been able to meet the need pretty seamlessly. We were prepared for the possibility of having to increase the number of days that we provide abortions [from one day a week], but so far we haven’t had to do that.

We started offering telehealth medication abortion in late 2021. Our policy is that people have to be in Minnesota at the time of their telehealth visit, and we mail the medication to a Minnesota address. We heard from a few people hoping to get telehealth medication abortion in other parts of the country, but we aren’t able to do that.

The only time we have to turn patients away for in-clinic procedures is if they are too far along in the pregnancy [WE Health performs abortions up to 17 weeks]. [At that point] we refer them to clinics in the Cities, where the limit is around 24 weeks.

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Are there any legal hurdles causing strain on your work?

Nationwide, we’re keeping our eye on Texas [where a 5th Circuit Court of Appeals judge ruled against the FDA approval of mifepristone], because that could affect the way that we provide medication abortion. Misoprostol alone is safe and effective, but it is more uncomfortable for a patient, and it’s a longer process [than the mifepristone and misoprostol pill regimen]. The [Texas] case is based on the safety of mifepristone, [but] that has been proven for over 20 years with over 100 peer-reviewed studies. We don’t think it’s a medically or legally sound decision. [On April 21, the Supreme Court granted a request from the Biden Administration to preserve access to mifepristone while legal proceedings continue. Depending on the outcome, the Supreme Court could hear the case and make the final determination on whether the drug is taken off the market or restricted.]

The Doe v. Minnesota ruling last summer [that lifted a number of state restrictions] did not remove the restriction that fetal tissue has to be cremated [or buried], which we do with the local funeral home. If a patient wants to have a service or dispose of it in a way that they prefer, it would be nice to provide that option.

Is there a crisis pregnancy center near your clinic?

There is one right across the street from us called the Women’s Care Center. Our name used to be Women’s Health Center, so they intentionally confuse patients. I think it depends on who’s working at the CPC that day — it seems like sometimes they tell patients they are in the wrong place and send them our way, and other times they don’t. We see patients who have received inaccurate ultrasounds that indicate they are not as far along as they actually are in the pregnancy; the patient believes they have more time to make their decision [than they do]. We have also seen CPCs miss something important in an ultrasound that could affect a patient’s health. So we’re not fans of them.

Have you seen an increase in the presence of protestors outside of your clinic?

We have a local group that [protests] in front of our clinic on a weekly basis. They have been coming for years. I think they feel emboldened by what’s going on across the country, and it just seems like they are louder. They are part of a larger network of anti-abortion protesters — Pro-Life Action Ministries — that [disseminates protest] strategies. In some ways, they’ve ramped up their efforts. Recently, one of their tactics has been calling the police in an effort to disrupt our services. For instance, they called the police and claimed that one of our escorts was intimidating them. One of the protesters fell down while they were following a patient, and [they called the police] claiming that one of our escorts tripped them.

What are your thoughts on abortion access in the Northland generally — do you see it improving in the future?

We’ve always been the only abortion clinic in northeastern Minnesota; people have always had to travel hundreds of miles to get care, which [has long been] true across the country. I am optimistic about telehealth and medication abortion because [those things help with the travel barrier].

I feel really lucky to be in Minnesota. But it is scary for patients who are traveling from Wisconsin, where abortion is technically illegal based on an 1849 law. The attorney general and governor of Wisconsin have said that they won’t pursue a case for someone traveling for abortion care to Minnesota, but it just takes one prosecutor to challenge that. [This interview was conducted prior to the passage of Minnesota’s Reproductive Freedom Defense Act.]

All of these restrictions further increase existing barriers. It’s great if you’re able to travel and take time off from work and get help with child care. But there are always going to be people [who] fall through the cracks and aren’t able to get the care that they need. It’s scarier [now] for patients and for providers — there are targets on our backs, but we’re committed to meeting people’s needs.

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Julie Amaon, medical director – Just the Pill of CO, MN, MT, and WY

What is Just the Pill able to provide at this time?

Currently we’re still providing medication abortion via telehealth with mifepristone and misoprostol, as well as contraception, in all four states that we operate in: Minnesota, Montana, Wyoming, and Colorado. We’re also offering abortion medication pickup from our mobile clinic van in Colorado. Patients [who do not live in those states] need to come over the border to have their telehealth visit, and they need to receive the medication either at our mobile clinic or at a mailing address or UPS Access Point in those states.

We work with about 20 different funds that help with practical support, including child care, food, and lodging. We also work with funds to get the abortion covered.

We aren’t able to take insurance yet, but we just hired a new consultant [to help us] provide Medicaid in Minnesota first, then Montana; and we’re hoping to be able to accept general insurance by the end of 2023.

What were you doing to prepare for the Dobbs ruling, and what happened directly after?

After [Texas’] SB8 passed in fall 2021, we saw a huge uptick in the number of requests we were getting from patients from all over the country. Leading up to the Dobbs decision, we were trying to staff up. We started with 10 staff at the beginning of January 2022, and we now have 30 total. [After Minnesota restrictions lifted], we were able to provide jobs for advanced practice clinicians. We have two physicians, one nurse practitioner, and two nurse midwives on staff.

I was the only clinician until May 2022 — that was an intense January through April for us, but we were able to hire more staff and patient educators, and we were ready for when Roe fell. The day of Dobbs, we received quadruple the number of patient requests for our services. Thankfully, we were ready to go and didn’t have more than a day’s wait for appointments.

In 2021, we saw 1,335 patients. In 2022, we saw 3,301. As of April 2023, we have seen 914.

Currently we are in a slow-down phase; no longer in the sprint, we’re in the marathon. We just hired our first director of people and culture, and an operations and finance person, so we’re building our infrastructure.

How are you preparing for what could happen with the ruling on mifepristone?

I feel like I need a law degree as well as my medical degree, because it has been so confusing. We work with a great group of pro bono lawyers, and we’ve been attending webinars from Abortion Care Network, the National Abortion Federation, and the Society of Family Planning, and everybody has different ideas about what could or could not happen. We’re looking at what the state laws are, because we think federal laws, based on what the FDA has approved, will be less of an issue. It’s really about which states are going to be prosecuting and which will be lenient. We’re looking at our pharmacies to determine who [would be] able to continue providing those medications, and we’re talking to the manufacturers to see what their stances are. Worst-case ruling, we are prepared to switch over to misoprostol only, and we know that’s a very safe and effective method as well.

Are you going to expand your mobile clinic program?

Yes, it’s going really well, and we’re hoping to expand that to Minnesota. We have another couple of mobile clinics that are being produced and should be operating soon. The mobile clinics are for patients [who] are traveling long distances and can’t stay [to pick up mailed medication]. Patients can have their telehealth visit and pick up their medication in the mobile clinic on the same day.

The one currently in Colorado is a van with medication lockers. We have another one that is larger with an exam table, a toilet, a sink, a fridge, and a place to sit for blood draws. We’re about to go pick up our largest [mobile] clinic, which will have two exam rooms and a waiting room. We’re hoping to be able to utilize those for [abortion] procedures in the future, as well as other general health care, including fertility care, gender-affirming care, Pap smears, long-acting contraception, and other things that people in rural areas typically have to travel long distances for.

How are you feeling right now?

I’m pretty tired. I will be honest, the whiplash from the court [regarding mifepristone] — it’s traumatic, right? There are a lot of things happening recently that feel like reliving when Roe fell. But I wouldn’t be doing anything else; this is where I belong. I love being able to continue to provide access in the face of these restrictions. Just the Pill is strict about following the laws, but we are also trying to push the envelope [in terms of] how we provide care. I love that we’re nimble enough to quickly adapt to the courts.

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Advance-practice registered nurse – Just the Pill – CO, MN, MT, and WY

Anonymous due to safety concerns

You got involved with the Doe v. Minnesota lawsuit back in 2018. That lawsuit was decided in July 2022, and ruled a number of state abortion restrictions unconstitutional, including the ban on qualified advance-practice clinicians providing abortion care. How did you become involved, and why are you passionate about this?

My first job out of nursing school in 2008 was [as] a recovery room nurse at the Planned Parenthood affiliate in Northern California. While I was there, the University of California was collecting data on the safety and efficacy of advance-practice clinicians (APCs), also called advanced practice providers, providing first trimester abortions; that data was [eventually] used to change many states’ physician-only laws. My direct mentors were part of that study. When I was becoming a nurse practitioner, it was with the intent of becoming an abortion provider, knowing that state laws were changing.

I came back to Minnesota in 2011. In 2018, I reunited with one of the physicians who was part of the California study, a dear friend and mentor. She was telling me about her work successfully changing the physician-only law in Montana through a lawsuit. I thought, “If Montana can pass this law, then Minnesota can do it too.” I blind-called Megan Peterson, [executive director] at Gender Justice, and she was totally on board; she got me connected with the Doe v. Minnesota lawsuit that was already in the works.

Why should APCs be allowed to provide this care?

Giving us access to abortion care helps to normalize it and provides a continuum of care. In Minnesota, physiological reproductive health care in clinical settings is already done predominantly by APCs — more so than OB-GYNs, who manage more complex care.

Abortion has historically been siloed from all other reproductive health care, [but] people should be able to get this care at their primary clinic. Allowing APCs to provide abortion care has advanced the conversation about bringing it into primary care settings.

My colleagues in Minnesota are approaching their [clinic leadership] and saying, “This lawsuit happened, it’s legal now for us to be doing this, it is within our scope of practice, and it will increase access, especially since that has been diminished in our neighboring states.”

Because laws changed and APCs have been pushing the envelope, abortion access has come into several clinic settings. For example, Fairview has expanded to include midwives doing medication abortion, and Hennepin Healthcare has brought abortion into some of its primary care clinics.

Do you have any advice for APCs outside of the metro who want to provide abortion care at their clinic?

If you’re providing reproductive health care in a rural area, one of the best things you can do is expand your knowledge of how telehealth medication abortion is available so that you can [inform] your patients and help remove the travel barrier. As far as primary care clinics providing abortions, it will probably grow in the metro and then build out. It is still very new [in Minnesota], and we will have to continue to expand in number in order to normalize it — that could lead to rural providers feeling [safer] from being ostracized or forced out of their communities for doing it.

In rural settings, birth centers are closing and getting absorbed into bigger networks, and people are having to travel further for their obstetrics care in general. In rural communities, it is harder to recruit physicians anyway, and with the privacy, safety, and security concerns that go with abortion, it is especially challenging to find people who are willing to do this care outstate. There is a legacy of violence and aggression toward clinics and providers. It’s intimidating.

At Just the Pill, we’re not brick and mortar, but for the doctors who are showing up every day at clinics, it’s a vulnerable thing — I want to honor that and thank them. If [abortions happened] in primary care settings, nobody could know which providers are doing it, what a patient is [visiting the clinic] for; it would not attract as much attention.

What could help more APCs in Minnesota provide this type of care?

More public training opportunities — on-the-ground educational opportunities for APCs to learn medication and surgical first-trimester abortion. That hasn’t happened in Minnesota in a significant way yet. When the laws changed in Maryland, there was funding set aside to create a training site for APCs to learn abortion care, [but] if an APC in Minnesota wants to learn first-trimester surgical abortion, they have to leave the state to train. The California Nurse Midwives Association offers training as part of their annual meeting. It would be great if there were a training site like that in Minnesota.

Some APCs have the skills [after training outside of Minnesota], but most APCs I’ve spoken with have not considered pursuing out-of-state training — everyone is hoping that it will be made available to us here.