‘It’s not a haven’: With limited capacity for abortion care, Minnesota clinics brace for influx

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Just a few minutes from the Minneapolis-St. Paul International Airport is a brick building of one story with opaque windows. Most drivers would not recognize the building from the freeways nearby. It is one of few state-run abortion clinics.

They might find anti-abortion placards against the pine trees bordering the entrance. On Wednesday, those who arrived encountered declarations such as “Demand to have your ultrasound”, “Pregnant?” We will help and abortion kills a person.”

They’d find Whole Woman’s Health of Minnesota inside. This clinic opened in February, as uncertainty lingered over the future of Roe V. Wade, and abortion rights across the country. The Bloomington location was opened by the nonprofit Whole Woman’s Health Alliance, which has clinics in Indiana and Virginia. It also serves residents from other states who are unable to access abortion care.

This is the type of resource reallocation that has become more common in recent months. It involves increasing abortion capacity in states that advocates and providers believe will maintain access after the U.S. Supreme Court revoked the constitutional right to abortion on June 24, handing control back to the states.

Minnesota’s constitution protects abortion until the time that a fetus is viable (23 weeks). Only abortions after the point where the fetus is viable are permitted to protect the mother’s life and health. Minnesota is also where Medicaid covers abortions beyond the limited circumstances permitted by federal law. This policy was created to increase access for low-income women.

Minnesota has a complicated system for obtaining abortions. Minnesota only has eight abortion clinics. The majority of these clinics are located in the Twin Cities or nearby and provide abortions only during the first trimester. One Planned Parenthood Clinic in St. Paul offers abortions after 20 weeks.

People who work with Minnesotans seeking abortions claim that there were legal and practical barriers that forced them to travel to Colorado, Nebraska, New Mexico, Washington, D.C., and Wisconsin before the Supreme Court’s decision.

Shayla Walker is the executive director of Our Justice, a Minneapolis-based abortion assistance program. The nonprofit assists patients with lodging and medical expenses. “Just because others have worse laws does not mean that our laws are better.”

Advocates for abortion rights and clinicians in Minnesota claim that Minnesotans often wait two weeks to see a state clinic. This delay could cause people to miss the window of opportunity for an abortion.

“Even though they have been working with the abortion funds and clinics in Minnesota, they are sending people out of Minnesota to other states because there is not enough appointments,” said Megan Peterson executive director of Gender Justice, which advocates for gender equality.

She said that as abortion bans increase, she didn’t believe states like Minnesota can handle the influx.


A problem with capacity

Like their counterparts in other countries, Minnesota legislators have spent the last five decades imposing restrictions on abortions. The 1970s saw the state pass a law limiting the ability of doctors to perform abortions. In 1980, legislators established a parental notification requirement to minors. In 2003, the law required that all minors seeking abortions be informed about the risks and to wait at least 24 hours prior to the procedure.

Walker of Our Justice is a plaintiff in a lawsuit against the state filed in 2019 to challenge this restriction.

Patients who live outside of the Twin Cities may have a relationship to a midwife in their area, but are now forced to travel hours to see a doctor, she stated. One “who could essentially perform the same thing as your midwife.”

Medication abortion can be an option within the first 10 weeks. Its popularity has increased dramatically. The Guttmacher Institute, an organization that supports abortion rights, claims that pills were used in the first year of medication abortion.

According to the Minnesota Department of Health’s most current to state legislature, the majority of Minnesota abortions take place in the first trimester. This mirrors national trends. The report states that patients in Minnesota, Iowa, North Dakota, South Dakota, Wisconsin and other states are also eligible for abortions.

Dr. Julie Amaon is the medical director at Just the Pill. The telehealth clinic offers medication abortions and provides a wide range of services.


The Availability of Medication Abortion

Just the Pill started seeing patients in Minnesota in 2020. It expanded to Montana and Wyoming last year. It saw approximately 1,300 patients by 2021. In the first five months, it had seen 1,000 patients.

Amaon served as the sole physician of Amaon until recently. She can mail medication abortions to 60-70 people per week.

She said that the FDA allowed patients to send their doctor for abortion pills via mail. This “has opened up many doors for people.” However, “we still have to have our brick-and mortar clinics” for those who require abortion care after the fact.

These clinics were unable to meet the demand even with Roe intact.

According to Emily Mohrbacher (director of client services at the Midwest Access Coalition), one to two clients each week travel to Minnesota to have an abortion. Many of them are from rural areas, where there are no facilities. They said that as abortion restrictions in the United States have increased, more people are arriving from Iowa, Nebraska and Texas. According to reports from the health department, these states reported collectively 69,295 abortions for 2020.

The coalition coordinates and pays for accommodation, food and transportation for women seeking abortion. Demand for their services has grown across the Midwest. It helped approximately 60 people per month last year; now it helps 80 to 130 people each month.

Mohrbacher stated that any increase in patients coming to Minnesota “will put a lot of pressure” on clinics.


Mounting pressure

Abortion providers have begun to hire in anticipation of a surge in demand.

Emily Bisek, spokesperson for Planned Parenthood North Central States said that it expects a 10%- 25% increase in abortions in Minnesota. “But, we also know there will be some people who can’t get to Minnesota and have very limited options for how they choose to handle their pregnancy,” she stated.

The Planned Parenthood affiliate isin Iowa and Minnesota. It performed 7,491 abortions in Minnesota between 2000 and 2020, which is more than three quarters of all state-recorded abortions. Minnesota had more than 19,000 abortions in 1980. This is due in part to the availability of better and more affordable birth control. However, resources are being stretched as abortion seekers migrate to states with reduced or no access.

Whole Woman’s Health Alliance opened its Bloomington clinic in 2005. Since then, it has seen many Minnesotans and visitors, even from Texas and the Dakotas.

“Just being 10 mins from the airport, and being able to, sometimes, get patients in that same day so they can fly home in time for the evening and have the opportunity to return to work in the morning, it has been enormous,” stated Sean Mehl who is the associate director of clinical service and oversees the Minnesota site. The clinic offers abortions starting at the end of a woman’s last period, but plans to expand the window to 24 week “in the next months.”

Although the clinic doesn’t accept insurance yet, Mehl stated that it works with national and state abortion funds to help patients pay for the procedure. The fees for the clinic are comparable to other providers, ranging from $400 for a medication-abortion procedure to $1,450 in-clinic second-trimester procedures.

The average wait time for appointments has been one week with the five doctors in their team. Mehl stated that one challenge is Minnesota’s requirement for clinics to provide state-mandated information by phone or in person to patients at least 24 hours prior to an abortion.

He said, “If they miss the phone call and we are unable to connect, it can potentially push their appointments.”

Just the Pill also works to increase access by opening mobile clinics that provide medication abortion and first-trimester procedure.

Amaon and others who support abortion rights are concerned that the increase in capacity will not meet demand.

Amaon stated that there has been an increase in the need before the Supreme Court decision. It’s quite devastating.

KHN (Kaiser Health News), a national newsroom, produces in-depth journalism on health issues. KHN, along with Policy Analysis and Polling are the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information to the nation on health issues.

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