‘It’s Not a Shelter’: Minnesota Clinics with Limited Abortion Care

Bloomington, Min. – A few minutes west of Minneapolis-St. Paul International Airport sits in a brick, one-story building with opaque windows. From the freeway in the vicinity, most drivers do not recognize it as the location of one of the few clinics in the state that provides abortions.

If they go to its entrance just off Interstate 35 on-ramp, they will see anti-abortion placards against pine trees on the border of the parking lot. Those who arrived on Wednesday faced announcements that included “claims to see your ultrasound,” “pregnant? We’ll help you,” and “abortion kills a man.”

Inside, they’ll find Minnesota Hole Women’s Health, a clinic that opened in late February because of the uncertainty surrounding its future. Rowe vs. Wade And the right to abortion nationwide. The nonprofit Whole Women’s Health Alliance – which also operates clinics in Indiana, Virginia and Texas – has opened the Bloomington location, in part, to provide abortion care to residents outside the state where access is already significantly restricted.

This is the kind of asset redistribution that has become commonplace in recent months: increasing the available abortion capacity in the states that suppliers and lawyers believe the U.S. Supreme Court will rescind access to abortion after the constitutional right to abortion expires on June 24.

In Minnesota, abortion is protected by the state constitution and is legal up to the point of efficacy, which usually begins at 24 weeks, when the fetus is thought to have survived outside the womb. Abortion after the point of fetal function is only allowed to preserve the life or health of the mother. Minnesota is also one of 16 states where Medicaid covers the procedure outside of the limited circumstances approved by federal law, a policy designed to increase access for low-income women.

Yet the reality of abortion in Minnesota is complex. There are only eight clinics in Minnesota that provide abortion. Most twins offer abortions in or near the city and only in the first trimester. One, a planned parenthood clinic in St. Paul, arranges abortions after 20 weeks of pregnancy.

Those who work with Minnesota who want an abortion say the barrier, both legal and practical, forced some to travel to Colorado, Nebraska, New Mexico, Washington, DC and Wisconsin even before the Supreme Court decision.

“It’s not a shelter,” said Shaila Walker, executive director of the Minneapolis-based Abortion Assistance Fund Hour Justice. Nonprofit patient care costs, which can exceed $ 1,000, and help cover related costs such as accommodation. “Just because other people have bad laws doesn’t mean our laws are good.”

Physicians and abortion rights advocates say Minnesota patients regularly wait at least two weeks for appointments at state clinics – a delay that could push people out the window if abortion is an option.

“Even working with abortion funds and clinics here this year, they’re sending people from Minnesota to other states because there aren’t enough appointments,” said Megan Peterson, executive director of Gender Justice, a nonprofit that supports gender equality. By.

“I don’t think states like Minnesota are ready for that flow,” she said as the abortion ban was extended.

A power problem

Minnesota lawmakers, like their counterparts elsewhere, have spent the past five decades imposing restrictions on abortion. In the 1970s, the state enacted a law that only physicians could provide abortion services. In the 1980s, lawmakers established parental notification requirements for minors. And in 2003, they made it mandatory for anyone seeking an abortion to receive information about abortion and the risks associated with their pregnancy, then wait at least 24 hours before the procedure.

Physician bans are problematic for people who need drug abortions and do not live near any supplier, says Walker of Our Justice, a plaintiff in an ongoing lawsuit filed against the state in 2019 for challenging such a rule.

This forces patients living outside of Twin City who can form a relationship with a midwife in their community to sometimes travel hours-long distances to see a doctor, she said, adding that “basically your midwife can do the same thing. “

Medication abortion in the first 10 weeks of pregnancy is an option and involves taking two pills. Its use has increased dramatically. According to the Guttmacher Institute, a research organization that supports the right to abortion, pills were used in 54% of U.S. abortions in 2020, with first-year drug abortions responsible for most abortions.

Reflecting national trends, most Minnesota abortions occur in the first trimester – 91% in 2020, according to a recent report by the state legislature of the Minnesota Department of Health. According to the report, 91% were for Minnesota residents but patients also reported living in Iowa, Michigan, North Dakota, South Dakota and Wisconsin, along with other states.

Dr Julie Amaon, medical director of Just the Pill, a telehealth clinic that provides drug abortions for $ 350, said one reason for limiting access to second-tier services in the state was “not enough documentation to get here.”

Only Peel began seeing patients in Minnesota in October 2020 and expanded to Montana and Wyoming last year. The agency saw about 1,300 patients in 2021; In the first five months of this year, it has already logged 1,000 patients.

Until recently, Amaon was its only physician. She is able to mail drug abortions to 60 to 70 people a week.

The FDA’s decision in late 2021 to allow patients to receive abortion pills by mail “opened many doors for humans,” he said. Yet “we still need our brick-and-mortar clinic,” for patients taking care of abortions after pregnancy.

With though Rowe vs. Wade Intact, those clinics struggled to meet demand.

Emily Moharbachar, director of client services at the Midwest Access Coalition, says one to two of her clients visit the Minnesota Clinic every week for abortions. Mostly from rural parts of the state, which do not have facilities But as abortion bans spread across the center of the country, people are coming from Iowa, Nebraska, Dakotas, Texas and Wisconsin, they said. In 2020, these states reported a total of 69,295 abortions, according to the Department of Health.

North Dakota, South Dakota and Texas have so-called trigger laws that ban almost all abortions after a Supreme Court decision is overturned. Rowe vs. Wade. In Iowa, the state Supreme Court on June 17 overturned the abortion protection guaranteed by a 2018 state court decision, and Wisconsin has an 1849 law that criminalizes the practice in almost all cases.

The coalition, which coordinates and finances people for accommodation, food, transportation and other expenses for abortion, has increased demand for its services across the Midwest. Last year, it helped about 60 people per month; This year which has increased from 80 to 130 per month.

Moharbachar said any arrival of patients in Minnesota would “put a lot of pressure on clinics.”

Mounting pressure

In anticipation of increased demand, abortion providers are hiring.

Emily Bisek, a spokeswoman for Planned Parenthood North Central States, said it forecast a 10% to 25% increase in abortions in Minnesota. “But we also know that there will be some people who can’t go to Minnesota and who have very limited options for what they will do with their pregnancy,” she said.

Planned Parenthood Affiliate operates clinics in Iowa, Minnesota, Nebraska, North Dakota, and South Dakota. It delivered 7,491 abortions in Minnesota in 2020 – or more than three-quarters of the state’s recorded abortions. In 1980, Minnesota recorded more than 19,000 abortions. Large drops are partly due to better and widely available birth control. Nonetheless, resources are being pressured as people migrate for abortion to reduce or relocate from excluded states.

Since opening the Bloomington Clinic, the Hole Women’s Health Alliance has seen patients and travelers from Minnesota, including Texas and Dakota.

“Being just 10 minutes away from the airport and in some cases, taking patients in and out on the same day where they could fly home in the evening and go to work the next day, it was huge,” he says. Shawn Mehl, associate director of the agency’s clinical services who oversees the Minnesota location. The clinic arranges abortions for a woman from the last menstrual period to 18 weeks, but plans to extend the “in the coming months” window to 24 weeks.

Although the clinic does not yet accept insurance, Mehl says it works with state and national abortion funds to help patients carry out the procedure. Its fees are consistent with other providers – from $ 400 for a drug abortion to $ 1,450 for an in-clinic second-trimester abortion procedure.

Its team of five doctors usually maintains a one-week waiting period for appointments. One challenge is the Minnesota requirement that clinics provide state-directed information to patients by phone or in person at least 24 hours before an abortion, Mehl said.

“If they miss that phone call and we can’t connect, it could potentially push their appointments,” he said.

Just the Pill is also working to increase access by launching a mobile clinic that will provide drug abortions and first-trimester procedures.

But Amaon and other abortion rights advocates fear that the power increase will not meet demand.

“We’ve already seen a crazy increase in need,” Amawn said before the Supreme Court decision. “It’s pretty devastating.”

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