By Zoe Han
The only abortion provider in North Dakota is leaving the state.
After 21 years at its current location in downtown Fargo, N.D., Red River Women’s Clinic will be moving to Moorhead, Minn. The new location is a 15-minute drive away across the Red River, which forms the state border between Minnesota and North Dakota.
Last Friday, the U.S. Supreme Court overturned the landmark Roe v. Wade ruling that had guaranteed federal abortion rights since 1973. Now states can make their own abortion laws, and North Dakota is among 13 states with so-called “trigger laws” designed to automatically ban abortions if Roe fell. Now that day has come, and North Dakota’s ban will go into effect on July 28, the state’s attorney general said Tuesday .
That means the clock is ticking for Red River and its patients.
“We are trying to continue to provide abortion care, and answer patient questions and deal with our own emotions,” Tammi Kromenaker, clinic director of Red River Women’s Clinic, told MarketWatch. Everyone at the clinic feels overwhelmed, she said; the Supreme Court ruling left the staff shocked, angry and sad. They are catching up with emails, and media requests, as well as navigating the changing environment for providing abortion care.
Kromenaker said patients were worried and feared that their appointments would be canceled after the ruling came out. She and the staff texted all the patients who were on the schedule for this week that their appointment was still valid.
The plan is to provide legal abortion care as long as they can, hopefully with little or no disruption before the new location is ready to see patients, Kromenaker said. But it’s going to be hard: The new space was not originally set up as a clinical space, so it needs renovation, and moving to a new state will require meeting new state requirements. On top of that, they’re working to minimize their patients’ confusion, especially about the timeline of their last days in Fargo.
“It’s gonna be an enormous burden,” Kromenaker said. “I think what it comes down to is that we shouldn’t have to be put in the position. We shouldn’t have to be doing this.” (Republican lawmakers say they oppose “taxpayer-funded abortion,” and anti-abortion groups say the unborn have a right to life on moral and religious grounds.)
Red River Women’s Clinic has been planning to move for almost a year. After Texas passed the S.B. 8 bill last fall — also known as the Texas Heartbeat Law — banning abortion after cardiac activity is detected in the embryo, usually after six weeks of pregnancy, Kromenaker said she and the clinic staff worried North Dakota lawmakers would put similar restrictions on abortion. They’ve been on the lookout for a new location in Minnesota ever since.
Abortion is currently legal under state law in Minnesota to the point of viability, which usually happens by the 24th week of pregnancy. Fargo-Moorhead is a Twin City on the border of the two states, so it makes sense to find a place in Moorhead to avoid patients traveling extra miles. The new location was a mixed-use office building, without the sinks that clinical space needs. Even though it is not the most ideal situation, they secured the space after the May leak of the draft Supreme Court opinion, first reported by Politico , suggesting Roe would be overturned.
Being on the border of North Dakota and Minnesota, and close to the border of South Dakota, Kromenaker said they’ve been providing care for local patients since they started.
In 2020, Red River Women’s Clinic provided 1,171 abortions; 833 were for North Dakota residents, 276 were for patients from Minnesota, and the clinic served 57 patients from South Dakota, according to state data . The majority of the patients had never had an abortion before, and most patients already had at least one child. Most of the patients were in their 20s and early thirties.
But the pandemic has increased demand at the clinic. More patients from South Dakota needed abortion care after that state’s only abortion provider paused operations for seven months during the pandemic. The Planned Parenthood health center in Sioux Falls, S.D. had reopened with a decreased care schedule, but it has now stopped providing abortions because South Dakota’s “trigger law” went into effect immediately after the Supreme Court ruling. The health center still provides birth control and other reproductive health services.
In the past few weeks, the Red River clinic has also seen many patients from the Minneapolis area who turned to it because of the long wait time for abortion appointments in the region. In some cases, the wait time was up to a few weeks, Kromenaker said.
The wait time is partly because clinics are short-staffed, a problem that many medical facilities have faced during the pandemic, said Emily Bisek, the vice president of strategic communications at Planned Parenthood in the North Central States. In anticipation of Roe v. Wade being overturned, Planned Parenthood has expanded service in states such as Minnesota in the past few months to support patients in bordering states where “trigger laws” were poised to restrict abortion.
As an independent private provider, Red River Women’s Clinic does not have financial support from an umbrella national organization such as Planned Parenthood. Although the clinic’s website welcomes donations to be made to support its finance, the primary source of income has been patient fees.
For years and like many other abortion providers, Kromenaker said the clinic tried to provide affordable prices for patients. In fact, she said that based on a cost survey they had participated in a few years ago, it suggested that what they charged for patient fees couldn’t cover the estimated costs. The survey suggested one medication abortion should charge at least $700 to $750, she said, whereas, at the time, Red River Women’s Clinic was providing the service starting from $650. Kromenaker said the staff has been “as frugal as we possibly could be” to keep the doors open for all these years, using as many cost-saving measures as they can and running on thin margins.
“Part of this worry and stress about opening in Moorhead was how are we going to do this without raising our fees to our patients,” she said. At the moment, both a medication abortion and an in-clinic suction abortion cost $700, the cheapest kind and they take care of pregnancy up to 11 weeks. Kromenaker said the clinic raised the price early this year because the cost of supplies went up. With the money needed for renovating the new place and operating the old one at the same time, she feared patient fees might need to go up even more.
Fortunately for the clinic, North Dakota Abortion Defender set up a GoFundMe page on behalf of the clinic, and as of Wednesday morning, close to 11,000 people made a contribution to the campaign and raised more than $915,000. Kromenaker said she’s still in disbelief about the progress and the support they got. The page said the funding will go towards renovations and furnishings, as well as implementing telehealth medication abortion service, a new service that was not possible before but is legal in Minnesota.
Kromenaker said in the long run, the new location might also be more ideal. The reporting procedure to the government, although different from North Dakota and requires navigation, in some ways, is less burdensome. The new location has parking, which the current one does not have. It makes it convenient for the staff, and for patients too. “Protesters are not going to be able to be right in our patients’ face,” Kromenaker said.
But there is work to do at the moment as the clinic moves to a new state. That includes the current slogan for the clinic, “Still Blooming in a Red state”. Kromenaker said it’s something to ponder, “but low on the priority list for now.”