Minnesota May Become “Abortion Access Island,” But Not Necessarily for Everyone

Fast three decades ago, well before the fall of Roe v. WadeThe blond brick Building for Women, Duluth (Minnesota), has been a popular destination for patients who travel from other states to have an abortion. They came from places where abortions are legal, but clinics are scarce, and from states with narrower windows of opportunity.

Many people in northern and central Wisconsin and the Upper Peninsula of Michigan found it quicker to travel west to the Minnesota border, than to travel southeast to Milwaukee, Green Bay and Madison. Over the years, thousands upon thousands of women were able to climb the steps of the Building for Women to obtain abortions at the WE Health Clinic on the second floor.

Treating travelers from other states is nothing new for WE Health or the other abortion providers around the state, but Minnesota’s role as a so-called abortion access island is. The state’s neighbors have either banned abortion, are poised to do so or have severely restricted the procedure.

Data kept by Minnesota shows that white people make up a larger share of those who travel from another state for an abortion than those who seek abortions in state, raising questions about whether certain groups — particularly people of color — will be able to make the trip.

According to the state’s data, Minnesota residents seeking abortions are a fairly diverse group. From 2018 through 2021, on average, 31% of patients were Black, 9% were Hispanic, 8% were Asian and 2% were American Indian; an additional 6% were recorded as “other.” White patients accounted for 44%.

However, the average patient population from out-of-state was much smaller than that of people of color. 75% of the patients were from outside the state.

Experts believe some of the disparity is due to the fact Minnesota borders are predominantly white, especially in the rural areas. But this also describes Minnesota’s population. The difference could be at least partially due to lack of transportation or money to travel.

“Minnesota is going to become a haven state, but for what percentage of people that actually need our services?” said Paulina Briggs, WE Health Clinic’s laboratory manager and patient educator. “That’s a huge thing.”

When RoeThe WE Health Clinic’s small staff was shocked when the ruling was overturned in June. It was actually ready to meet the 10% to 25% increase in patients from outside of state.

“We’ve anticipated this for a long time,” Briggs said. “So it’s not like sudden news to us.”

Although the Duluth clinicians may have been ready for the end of the Roe2 1/2 weeks later, however, something more surprising occurred when a judge of the district court made a surprise ruling which expanded abortion access in the state. Ruling Doe v. MinnesotaThe judge rejected measures that included a 24-hour waiting period before an abortion, consent from two parents for minors, and a requirement that doctors discuss with patients the risks and options to abortion. He also removed the requirement that only doctors could provide abortion care, even via telemedicine. The care must be provided in a hospital after the first trimester.

Contrary to the emotional scenes that took place in many clinics following, RoeOn Monday morning in Minnesota, abortion providers and their support staff celebrated. Laurie Casey, executive director of WE Health was behind her crowded desk, filling out paperwork when she received the news.

“It’s like, ‘Oh my God, is this real?’” she said. “Something good happened?”

Briggs said: “I think I 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 victory and left intact two measures: a requirement abortion providers report data to the state about their patients and a law governing the disposal of fetal remains.

Minnesota Attorney General Keith Ellison, whose office represented the state in the lawsuit, announced that he would not appeal the court’s decision. Ellison also pledged that he would not prosecute abortion-seekers from other states and wouldn’t cooperate with extradition orders from outside jurisdictions.

Minnesota Gov. Tim Walz signed a similar executive order.

Both officials have made access to abortion a central tenet in their reelection campaign.

In these early days, a post-conflict world was emerging.Roe reality, it’s not yet clear who will need these protections, though the data can provide clues.

States track demographic data about abortion differently. According the Centers for Disease Control and Prevention more than two dozen states report publicly the race and ethnicity patients. Minnesota is the Midwest’s access island state, and it releases those numbers. It also separates the data into resident figures and nonresident figures.

Illinois is expected to take in far more out of-state patients than Minnesota. However its health department doesn’t release statistics about the race or ethnicity among abortion patients. Kansas allows abortion for up to 22 weeks, has a Constitution that protects abortion rights, and reports the second highest rate of out-of state patients in the country, with nearly half of them being from Kansas. But Kansas’ state health department does not combine where patients are from with demographic data.

According to the state’s health department, there were 13,256 abortion patients outside Minnesota from 2008 to 2021. That is an average of about 955 people per year. The racial-ethnic breakdown of the patients has remained relatively stable among that population.

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.

“There’s the obvious one that might be coming to mind, which is the effects of the way structural racism and poverty are interwoven,” Hassan said.

Caitlin Knowles Myers, a professor at Middlebury College in Vermont who studies the economics of abortion, added, “Obviously resources like ability to take time off, ability to get and pay for child care, etc., etc. — that obviously prevents poor women from making a trip.”

Then there is also the cost of actual procedure. Minnesota residents can use their state medical assistance funds to cover an abortion in certain circumstances. Out-of-state residents cannot. Our Justice, a non-profit organization that provides financial assistance for Minnesota residents who travel to Minnesota for abortion care, estimates that in-clinic abortions can cost anywhere from $400 to $2,000 depending upon the gestational age. Just the Pill, a mobile clinic and telemedicine service based locally, charges $350 per abortion medication.

Our Justice’s executive director Shayla Walker said that her organization helps pregnant women of color overcome travel barriers. Undocumented patients, for instance, may not have a driver’s license or other form of identification, meaning that flying from states like Texas or Oklahoma is out of the question.

Out-of-state patients come to Minnesota from Minnesota mainly from Wisconsin. Like Minnesota and its neighboring states it is predominantly white. In the 2020 U.S. Census, 80.4% of Wisconsin residents identified themselves as such.

Between 2008 and 2021, 690 Wisconsin patients received abortion care in Minnesota every year. The proportion of Wisconsinites has dropped over the years — in 2008, 80% of out-of-state abortion patients reported that they lived in Wisconsin, compared with 63% by 2021. Over the same period, South Dakota residents increased from 4% to 16% and Iowa patients rose between 2% and 6%.

Myers says that traffic from Minnesota to Wisconsin is likely to be driven by the absence of abortion providers in Wisconsin’s western and central regions. These areas are mostly rural and predominantly white. Wisconsin’s more diverse urban centers are concentrated in the southern and eastern parts of the state, much closer to the Illinois border.

“A lot of them are likely to end up heading south to the Chicago area,” Myers said. “The Chicago area also has a lot of providers and likely a lot of capacity. And the question for Minnesota is, if the Chicago area ends up unable to absorb an enormous influx of patients heading their way from all directions, then you would expect to see patients spilling over into Minneapolis.”

Leaders of Options Fund, which provides financial aid to rural Wisconsin mothers who are seeking abortions, explained that most of their money goes towards Minnesota-based care.

“Certainly it’s not that people of color don’t exist, of course,” said the group’s vice president, who spoke on the condition of anonymity out of concern for her safety. “But I think generally, the more rural we get, the more white it’s going to be.”

The data from Minnesota is retrospective, and it dates back to years when abortion was legal in Minnesota, but was sometimes restricted or difficult to access in the surrounding states. There are certain to be shifts in where patients travel from, most obviously North Dakota, where the state’s lone abortion clinic moved from Fargo to its Minnesota sister city of Moorhead, just across the border. And as national reproductive rights supporters respond to the end, RoeAbortion funds reported massive increases in donations. This may allow Minnesota to offer abortion care to more low-income women and people of colour.

The week immediately following the Doe v. Minnesota decision, WE Health Clinic’s patients felt the impact. Casey stated that she was able tell a mother that her daughter could have an abortion without the consent of her father or a judge. Briggs was able to schedule a next-day abortion, which would have been illegal before the judge’s decision.

At some point, a clinic worker went through intake folders and pulled out all the forms certifying that “state mandated information” had been provided to patients. These forms were then fed into a shredder in the office.

Tossing out their scripts, canceling the physician phone calls 24 hours in advance, no longer going down to the county courthouse to ask judges to grant their minor patients special permission to have an abortion — all of this will save the WE Health Clinic workers hours every week.

Beyond that, the court ruling — which abortion opponents are seeking to have overturned — has the potential to increase the number of providers, as advanced clinicians like nurse practitioners and some classifications of midwives may now be able to get training, and eventually provide abortion care and telemedicine.

This pivotal moment in Minnesota abortion care and nationwide comes at a crucial moment for WE Health. Casey will be retiring in the next year. This means that much of the work to adapt the clinic to better serve patients in a post-abortion world will be done by Casey.RoeHer staff, including Briggs, will bring down the entire world.

Briggs began working at the clinic when she was 23 years old. She wanted to do this work after receiving her own abortion at WE Health as a college student, an experience she found at once “nonchalant” and “empowering.”

She is disturbed by the disparities in who may be able to cross the borders and climb the stairs at the Building for Women to receive the life-changing care she received. The care will not be equitable just because the doors are open.