MOORHEAD — On Wednesdays, women come to the Red River Women’s Clinic in Moorhead, Minnesota, to terminate their pregnancies.
On these mornings, a handful of pro-life demonstrators station themselves at the entrance of the clinic’s private parking lot. They go no further, to avoid risking a federal offense. They do, however, call out to patients, invoke God, claim to want to “help moms,” shout and display photos of dead fetuses. Volunteers shield the women with rainbow umbrellas and engage them in conversation.
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Everyone plays their part in this tiresome choreography that has been repeated a thousand times.
Tammi Kromenaker knows all the anti-abortion activists by name. “This is Jodie. And that’s Bonnie on her knees, praying. I think she’s getting paid for this,” she points, her finger on the screen of her video surveillance tablet. It would take more than that to impress this woman, with a round face and blonde curls and whose intense gaze shows her determination. Kromenaker has been at the helm of this abortion clinic for 26 years.
Trigger laws
Until June 2022, it was the last abortion clinic in North Dakota. This Midwestern state is a bit like the end of the world for Americans. A rectangle on the great American prairie, frozen in winter and carved into vast farms, with oil fields on the edge of Canada.
Abortion became illegal there two years ago, following the U.S. Supreme Court’s June 24, 2022 Dobbs v. Jackson Women’s Health Organization decision. In it, the court ruled that states were free to ban abortion locally, overturning the landmark 1973 Roe v. Wade decision, which protected women’s right to seek an abortion.
Since then, four states have banned abortion after six weeks of pregnancy, and 14 states have banned it from the moment of conception. Most, like North Dakota, had “trigger laws” passed in advance to automatically trigger the ban when Roe ended.
“We’re now seeing women from Texas, Nebraska and Iowa who didn’t come to us before.”
So the Red River Women’s Clinic left Fargo, North Dakota, with its spacious houses, its majestic elms, its collection of bars. It crossed the Red River that gave it its name and reopened 3 miles away, in a soulless business park in Moorhead, Minnesota.
The governor of this state of lakes and forests, with its rich and diversified economy, is none other than Tim Walz, Kamala Harris’ running mate. This liberal has pushed through a series of social reforms that have rural, religious and conservative Dakota in a tizzy. It was also in Minnesota that Harris visited a Planned Parenthood clinic in March — the first in the history of the U.S. vice presidency.
“Moving was a horrible experience. But we were five minutes away from a state that has removed many restrictions on abortion rights,” Kromenaker says. Those restrictions include parental authorization for minors, a 24-hour waiting period, the obligation to consult a doctor (not a midwife) in person.
Traveling farther
In Moorhead, the clinic’s activities have resumed as before, with a few more patients. A total of 1,200 medical and surgical abortions are carried out here every year, up to 16 weeks of pregnancy.
What’s new isn’t the 3 extra miles for North Dakota patients. It’s the distances now covered by those denied the right to abortion in other U.S. states. Those living along the Mississippi take refuge in Illinois. Those living along the country’s central axis travel as far as Minnesota.
“We’re now seeing women from Texas, Nebraska and Iowa who didn’t come to us before,” says Kromenaker, who estimates these women represent 10% of admissions in her clinic.
Since the great backwards step in 2022, abortion rights advocates and patients have organized. As a result, there were 1 million abortions in 2023, an increase of 11%. Activist associations, such as Just The Pill, have taken mobile abortion clinics to the borders of Kentucky, Missouri and Tennessee to meet patients. And online reproductive health consultations have soared.
More American women are getting online prescriptions for the two abortion pills, mifepristone and misoprostol. Sometimes they have them delivered from India for a few dozen dollars. Women’s groups hold information meetings on self-administered medical abortion (SASS), following the World Health Organization protocol.
More than 1 in 10 women in the U.S. attempt abortions outside the medical framework, using drugs, but also herbs, alcohol or blows to the stomach — at their own risk.
Dwindling funds
For decades, activist funds have been helping women in the United States to finance their abortions. That is because U.S. law prohibits reimbursement of procedures from public funds, and private insurers don’t necessarily pick up the slack.
Destini Spaeth, a volunteer on the board of directors of the Prairie Abortion Fund, which covers both North and South Dakota as well as Minnesota, confirms to the strong mobilization of post-Dobbs donors. “Two years ago, we doubled the sums in out bank account thanks to ‘rage donations,’ with 70% from small donors. But now, we could use some regular donations, as our costs have gone up a lot.”
Sometimes you have to wait three or four weeks for an appointment.
Indeed, there are more abortions than in 2022, but the number of specialized clinics has been cut in half. As a result, patients are jostling for appointments.
“Sometimes you have to wait three or four weeks. That can be enough to tip you over into late care, which means you have to travel further, with costs that can range from ,000 to ,000,” Spaeth says. In July, the national Justice Fund, which had been covering half the costs, decided to lower its participation to 30%. That has left local funds like Prairie to pay for the difference, which they are not always able to do.
The existence of the funds has always been precarious, in a country where abortion is demonized for religious reasons.
Trump’s social regression
In Texas, a 2021 law introduced a prison sentence for those who helped a pregnant woman leave the state to have an abortion. This legislation was struck down for being unconstitutional. But in the meantime, Texan funds have faltered. The so-called “pro-life” Republicans have succeeded.
“I am pro-life. They are anti-abortion and anti-choice,” says Kromenaker, who has come a long way herself. As a student, she denounced those who “kill babies,” out of Catholic conviction. “But when my friend had an unplanned pregnancy, that was the turning point for me,” she says.
In 1996, she was hired by a feminist abortion rights pioneer, Jane Bovard, who sold Red River Clinic back to her in 2016. Kromenaker owns the walls, because landlords don’t want to get into trouble with abortionists. She is careful not to put her name on the bills, to avoid protests outside her home.
Trump bragged about appointing to the Supreme Court justices who overturned Roe.
A majority of Americans agree with her. Two years after the end of Roe, 63% believe that abortion should be legal in most cases, according to Pew Research. It’s also what 4 in 10 Republican voters think. Yet 39% of those polled said abortion would be difficult where they live.
The Trumpist right has paid the high price of this social regression. Then President Donald Trump bragged about appointing to the Supreme Court justices who overturned Roe, voters punished his candidates in November 2022 midterm elections in November 2022.
During the current presidential campaign, Trump, the Republican candidate, has avoided the issue, while Harris, his Democratic opponent, has strongly defended “women’s freedoms”.
Two high-profile deaths
In September, for the first time, the press reported on two preventable deaths of women who had undergone illegal abortions: two black women from Georgia. They had taken their abortion pills alone, but had not expelled all the fetal tissue. In the case of Amber Thurman, the doctors waited until the infection had progressed to protect themselves from a criminal conviction, but they operated too late. Candi Miller, however, didn’t even dare go to the hospital and died in her room.
Harris was quick to attack Trump. She had already stated her intention to sign Roe into law once at the White House. When U.S. voters go to the polls on Nov. 5, abortion rights will once again be a powerful political issue. It will be one of the driving forces — if not the driving force — of Democratic mobilization. All the more so, as it will be the subject of a dozen ballot referendums.
Kromenaker has not petitioned for a referendum in North Dakota. It takes at least a million dollars to finance such a campaign, she says. Her thing is lawsuits. She has already filed a dozen of them. In September, with the support of the Center for Reproductive Rights, they won a resounding victory: A North Dakota court simply invalidated the local anti-abortion law.
The exceptions were so vague and confusing that doctors didn’t know how to apply them.
“The exceptions were so vague and confusing that doctors didn’t know how to apply them,” says attorney Marc Hearron, who worked pro bono on the case. Thanks to the decision, he explains, North Dakotans suffering from serious abortion-related complications will be able to be treated, and doctors will treat them without risking jail time.
“But since the last clinic was moved to Minnesota, the patients who need abortions for other reasons will continue to have to leave the state,” he says.
Ultimately it is women who suffer from the legal uncertainty that reproductive health specialists find themselves in. Wherever abortion has been banned, gynecologists and midwives have gone into exile, complicating access to care for young girls, mothers-to-be and women going through menopause.
In Idaho, 50 obstetricians, or 20% of the workforce, have left in nine months. And 5 out of 9 fetal medicine specialists have vanished, according to The Atlantic. In North Dakota and elsewhere, it will take years to rebuild this medical fabric.
