Minnesota set to become ‘abortion access island’ in the Midwest, but for whom?

The blond brick Building for Women, Duluth, Minnesota has been a popular destination for women traveling from other states for nearly three decades to have an abortion. These patients have traveled from states where abortions are legal, but where clinics are scarce or where there is a narrow window of opportunity.

Many residents of the Upper Peninsula and northern Wisconsin found it faster to travel west towards the Minnesota border, than to go south to the clinics in Madison, Green Bay, or Milwaukee. Over the years, thousands upon thousands of women were able to climb the steps of the Building for Women on the second floor in order to have abortions at WE Health Clinic.

WE Health and other abortion providers in the state have been treating travelers from other states for years. Minnesota is a “abortion access island” that treats those traveling from other countries. State neighbors either have banned abortion or are poised to ban it, or severely restrict the procedure.

Minnesota data shows that more people travel from other states to have an abortion than they do in their home state. This raises questions about whether or not certain groups, especially people of color, will be able make it.

According to state data, Minnesotans seeking abortions are a diverse group. Between 2018 and 2021, 31% were Black, 9% Hispanic, and 8% were Asian. An additional 6% was recorded as “other.” 44% of the patients were White.

People of color, however, made up a smaller proportion of patients from outside the state. 75% of patients from out-of-state were white.

Experts believe that some of the disparities are due to the fact that Minnesota’s border states are predominantly white, especially in rural areas. This also applies to Minnesota’s population. Access to transportation and money could account for at least part of the gap.

Paulina Briggs is the laboratory manager at WE Health Clinic and patient educator. That’s a big thing.

The WE Health Clinic staff was shocked but not surprised when Roe was overturned. It was actually prepared to accommodate the 10% to 25% increase in patients from outside of state.

Briggs stated, “We’ve been anticipating this for a while.” “So it’s nothing new to us.”

The Duluth clinics may have been ready for Roe’s end, but 2 1/2 weeks later, a district court judge made a surprising ruling that allowed abortion access to be expanded in the state. In Doe v. Minnesota the judge rejected measures such as a 24-hour waiting period for abortions and two-parent consent for minors. He also required that doctors discuss with patients medical risks and alternative abortion options. He also removed the requirement that doctors only be allowed to give abortion care (including via telemedicine) and that the care must take place in a hospital after the first trimester.

Contrary to the tense scenes in many clinics following Roe’s fall, Minnesota’s Monday morning celebration saw abortion providers and their support personnel celebrating. Laurie Casey, executive director of WE Health was behind her cluttered desk, filling out paperwork when she received the news.

She said, “It’s almost like, “Oh my God, is that real?” “Something wonderful happened.”

Briggs stated that he audibly cheered. Like: ‘Yeah. “Hell yeah.

The Minnesota case was filed in 2019. Lawyers representing the plaintiffs had expected to be in court at the end August. The judge instead granted abortion supporters a huge victory. He left intact two measures: the requirement that abortion providers report information on patients to the state and the law that governs how fetal remains are disposed of.

The Minnesota Attorney General Keith Ellison announced that he will not appeal the court’s decision. Ellison pledged that he would not pursue abortion-seekers from any other state and wouldn’t cooperate in extradition requests from outside jurisdictions.

Minnesota Gov. Tim Walz signed an executive directive making similar promises.

Both officials made access to abortion a central tenet of their reelection campaigns.

It’s unclear who will be required protections in the early days of a post Roe reality. However, data can give clues.

States keep different records on demographic data about abortion. According to the Centers for Disease Control and Prevention (CDC), more than twenty-six states report publicly the race and ethnicity patients. Minnesota is the Midwest’s only access island state that publishes those numbers. The state also segregates that data into resident or nonresident figures.

Illinois is expected to take in far more out-of state patients than Minnesota. However, the health department doesn’t release statistics on the race or ethnicity of those who are aborted. Kansas permits abortion for up to 22 weeks, has a Constitution that protects abortion rights, and reports almost half of all out-of state patients. This is second only to Washington, D.C. Kansas’ state health department doesn’t combine demographic data with where patients are located.

According to the state health department, 13256 people who lived outside Minnesota were treated for abortions between 2008 and 2021. This is an average of approximately 950 people per year. The racial-ethnic breakdown of the patients within that population has remained fairly stable.

Asha Hassan (a graduate researcher at University of Minnesota’s Center for Antiracism Research for Health Equity) said that there are many factors that contribute to the lack of diversity.

Hassan stated, “There’s an obvious one that may be coming to my mind, which are the effects of how structural racism and poverty interwoven.”

Caitlin Knowles, a Middlebury College professor who studies the economics and abortion, said, “Obviously resources such as ability to take time off, or ability to get and to pay for child care, etc. This clearly prevents poor women from going on a trip.

There is also the cost of the actual procedure. Minnesota residents have the option to use their state medical assistance funds to cover an abortion in certain circumstances. Out-of-state residents are not eligible. Our Justice, a non-profit that offers financial assistance for Minnesota abortion care and travel, reports that in-clinic abortion services can range from $400 to $2,000 depending on the gestational stage. Just the Pill, a local telemedicine and mobile clinic, charges $350 for abortion medication.

Our Justice’s executive director Shayla Walker said that her organization helps pregnant women of color overcome travel barriers. For example, undocumented patients may not be able to fly from Texas or Oklahoma because they do not have a driver’s license or any other form of identification.

Residents from Wisconsin are the majority of the patients who travel out of state to Minnesota. Like Minnesota and neighboring states, Wisconsin is dominated by whites: 80.4% of Wisconsin residents were identified as such in 2020’s U.S. Census.

Between 2008 and 2021, 690 Wisconsin patients received abortion care in Minnesota every year. Over the years, Wisconsinites have declined in number — 88% of out-of state abortion patients in 2008 reported they were from Wisconsin, while 63% of those in 2021 said they were from Wisconsin. Over the same time, South Dakota residents increased from 4% up to 16% and Iowa patients increased from 2% to 6.

Myers believes that the lack of abortion providers in central and western Wisconsin drives traffic to Minnesota’s border. These areas are mostly rural and predominantly white. The state’s most diverse urban centers, located closer to the Illinois border, are found in the eastern and southern parts of Wisconsin.

Myers stated that many of them will likely end up moving south to the Chicago area. “The Chicago area has many providers and probably a lot more capacity. Minnesota’s question is: If the Chicago area can’t absorb a large influx of patients from all directions, would you expect patients to spill over into Minneapolis?

Leaders of the Options fund, which offers financial assistance to rural Wisconsin women who want abortions, stated that the vast majority of their money is for Minnesota-based care.

“Certainly, it’s not because people of color aren’t there, of course,” stated the vice president of the group, who spoke under anonymity to protect her safety. “But, I believe that the more rural it becomes, the whiter it will be.”

The data from Minnesota is retrospective, and it dates back to years when abortion was legal in Minnesota, but not as easy or restricted as it was in other states. There will be changes in the location of patients, with North Dakota being the most obvious example. The state’s only abortion clinic moved from Fargo, North Dakota to Moorhead, Minnesota, right across the border. As reproductive rights advocates across the country react to Roe’s repeal, abortion funds reported significant increases in donations. This may allow Minnesotans to travel and receive abortion care, even if they are low-income and of color.

Patients at WE Health Clinic felt the effects the first week following Doe v. Minnesota. Casey stated that she was able tell a mother that her daughter, who is minor, could have an abortion without permission from her father or a judge. Briggs was allowed to schedule a next day abortion, which would have been illegal prior to the judge’s ruling.

A clinic worker looked through the intake folders and took out all forms that certify that patients had received “state mandated information”. These forms were then fed into the shredder of the office.

All of this will save WE Health Clinic staff hours each week by allowing them to complete their scripts and cancelling their physician calls 24 hours ahead.

The court ruling, which abortion opponents seek to overturn, has the potential to increase providers’ numbers. Advanced clinicians such as nurse practitioners and certain classifications of midwives might now be able get training and provide care via telemedicine and abortion care.

This momentous moment in Minnesota’s abortion care and across the country comes at a time of major change for WE Health. Casey will soon be retiring, so much of the work to adapt the clinic to meet patients in a post Roe world will be done by her staff, including Briggs.

Briggs began working at the clinic when she was 23 years old. After receiving an abortion at WE Health while a student, Briggs knew she wanted to work in this field. She found it both “empowering” and “nonchalant”.

She is disturbed by the disparities in who may be able to cross the borders and climb the steps of the Building for Women to receive the life-changing care she received. The care won’t be fair just because the doors are open.