Minnesota, where a third of abortions are funded by the taxpayers and there are more clinics than some of its neighboring states combined, is now surrounded by states with abortion laws more restrictive than its own.
South Dakota now mandates a 72-hour wait for abortions — excluding weekends and holidays — and requires doctors to inform women that abortion carries an increased risk of suicide. North Dakota, which now has some of the toughest laws in the nation, bans abortion after the sixth week, when a fetal heartbeat can first be detected by a transvaginal ultrasound.
Iowa just cut off most state funding of abortions for low-income women on Medicaid. The governor would have to personally sign off on payments in cases of rape, incest, fetal anomaly or when the life of the woman is at risk.
Minnesota advocates on both sides of the abortion issue are closely watching developments in these neighboring states, as well as high-profile abortion battles in places like Texas and North Carolina.
"It's both frustrating and energizing," said Bill Poehler, spokesman for Minnesota Concerned Citizens for Life, noting that the Minnesota Legislature has pushed or passed many of the same laws in recent years — blocking state Medicaid funds from being used for abortions, tightening regulations on clinics — only to have those bills vetoed by Gov. Mark Dayton. "This is not fringe legislation by any means. ... We really are of the same mind, they just don't get signed into law."
But for a long time, Wisconsin and Minnesota were "the shining stars in the Upper Midwest" on issues of women's health, said Linnea House, NARAL Pro-Choice Minnesota 's executive director. Then came the 2010 elections and several "very stressful" legislative sessions in both states.
"We can't get too complacent or feel too smug in our Minnesotaness, [thinking] this is how it's always been and this is how it always will be," House said. "Wisconsin is a classic example of that. We felt like we were partners in this together and now I feel like Wisconsin, and the way it's been treating the women in their state, is just absolutely appalling."
In the first six months of this year, legislatures in 17 states passed 43 new restrictions on abortion, according to figures compiled by the Guttmacher Institute, an abortion-rights advocacy organization that produces data cited by both sides in the debate.
Minnesota is one of 15 states that will cover the cost of an abortion for women on Medicaid, the result of a 1995 state Supreme Court ruling that found that if Minnesota offered coverage for prenatal care, it must also cover the cost of therapeutic abortions. Of the more than 9,700 abortions obtained by Minnesota residents in 2012, the state health department reports that 3,637 were funded through public assistance.
Minnesota has passed abortion restrictions in recent years, including a 24-hour waiting period, parental notification for minors, and a ban on late-term abortions. Four of the state's five clinics are clustered around the Twin Cities, with another in Duluth, leaving large swathes of the state with no easy access.
Aiming at the clinics
Many of the recent abortion restrictions proposed in Minnesota, and enacted elsewhere, are aimed at the clinics, rather than the procedure itself.
Abortion opponents call them common-sense measures to protect women's health and safety. Abortion rights advocates call these bills Targeted Regulation of Abortion Providers, or TRAPs. The 28 states with these laws on the book as of July 1 range from requirements that physicians have admitting privileges at nearby hospitals to rules on the size of rooms and the width of the corridors in abortion clinics.
Susan Armacost, legislative director for Wisconsin Right to Life, said women have the right to expect the doctor who performed her abortion will be at the local hospital if there are complications afterward.
"We're talking about surgery that's being performed," she said. "The abortion clinics really don't want to deal with that. They usually tell her, 'Oh just go to an emergency room.' Well, then that leaves the woman on her own to try to explain how the procedure was done and what might have caused the injuries. Only the doctor can do that. So for the protection of women, we think that's very necessary."
In some communities, doctors travel a long distance to perform abortions — some Minnesota doctors fly to the Dakotas to work at the clinics there. Getting admitting privileges isn't easy, critics say, which is why Wisconsin's provision is expected to force two of the state's four clinics to close.
"It just keeps ramping up," said Nicole Safar, public policy director for Planned Parenthood of Wisconsin, which operates three abortion clinics in the state. Planned Parenthood staffers had already begun canceling appointments at its Appleton clinic Monday, until a federal judge issued a temporary injunction barring the state from enforcing the law.
"We're going to fight this and I'm really optimistic that we're going to win," Safar said. After the court fight, she said, the next big battle will be the 2014 elections. "Regardless of what happens in the courts, the reality is that we're not changing Governor Walker's mind, we're not changing any of these Republicans' minds. ... It's up to us and up to the voters of Wisconsin to change their faces."
Another round of bills is heading to the Wisconsin Senate in the fall. One would ban public-employee insurance plans from covering abortions, another would ban sex-selective abortions in Wisconsin. Both have already passed the Wisconsin Assembly, the state's lower house.
"We've had some pretty dark years here in Wisconsin too," Armacost said, offering a word of encouragement to Minnesota's abortion opponents. "We sympathize. ... We're in a good situation here. We really are."
Advocates warn that restrictive laws elsewhere could simply drive more women to seek abortions here. Already, one out of every 10 abortions in Minnesota is performed on a woman from out of state.
Crossing the border
Last year, 743 Wisconsin women came to Minnesota to have an abortion. Sixty-two women came from North Dakota and 53 from South Dakota — states that have only a single clinic apiece. In all, there were 10,701 abortions performed in Minnesota last year, the lowest rate since 1975.
If Wisconsin's new admitting privilege requirements do force two clinics to close — one in Appleton, one in Milwaukee — pregnant women could face a choice between a long wait for one of the remaining clinics or a long drive to another city or state.
Long drives factored into U.S. District Judge William Conley's decision to issue a 10-day freeze on parts of the new law.
"You haven't driven those roads if you don't think it's a burden," Conley said during the hearing, after the state's attorney argued that women still had access to abortion services at the two remaining clinics in Madison and Milwaukee, or by heading to Chicago or the Twin Cities.
Conley will hold another hearing on July 17, the day before the injunction expires.