Minnesota reported a 2% increase in abortions since 2019, a tally that could just be the start if more women travel to the state from locations where most terminations of pregnancies are now or soon to be illegal.

The 10,136 abortions in 2021 were driven by the rising use of medications for that purpose, which for the second year in a row exceeded surgical procedures, according to Friday's report from the Minnesota Department of Health.

The long-term trend has been downward since Minnesota reported 19,028 abortions in 1980, and advocates lauded goal-setting and family planning training among other efforts for reducing unwanted pregnancies among teens.

The recent landmark U.S. Supreme Court ruling could reverse the trend, though, because it removed the constitutional protection of abortion procedures nationally and allowed states to impose their own limits or bans. Trigger laws have since banned abortions in South Dakota and will ban most abortions in North Dakota on July 28. A Wisconsin ban is tenuously in effect as well.

"We're hiring as fast as we can to staff up," said Sarah Stoesz, president and chief executive of Planned Parenthood North Central States, which expects a 25% increase in abortions at its Minnesota clinics.

Minnesota's abortion statistics are published by July 1 every year, often with no announcement and modest attention after the legislative session. This year, the numbers were released a week after the Supreme Court repeal of Roe v. Wade, and in the buildup to a Minnesota governor's race, where abortion is now a key election issue.

Gov. Tim Walz on Twitter this week called Republican challenger Scott Jensen a "dangerous, far-right extremist that would ban abortion and bring Minnesota back to the 1950's." Jensen retorted that "Walz is the extremist" and questioned whether his support for abortion access is "out of step with most Minnesotans."

The 2021 annual report also corrects errors in the 2020 report and changes the impact of the pandemic on abortions.

One year ago, the state reported an 8% decline and advocates assumed the pandemic had reduced unplanned sexual encounters or discouraged women from seeking abortions. The Star Tribune discovered the report had undercounted abortions provided by Whole Woman's Health, which moved its clinic from Minneapolis to Bloomington.

Friday's update showed that abortions actually increased in Minnesota from 9,922 in 2019 to 10,339 in 2020 before declining slightly in 2021.

The takeaway is that COVID-19 had minimal influence, though it hastened a trend toward telemedicine abortion visits and the use of medications such as mifepristone, said Scott Fischbach, executive director of Minnesota Citizens Concerned for Life.

Abortions using medications increased in Minnesota from 3,522 in 2016 to 6,157 in 2021, while surgical procedures declined from 9,128 to 3,977 in the same time period.

Those abortions happen at home, Fischbach said, and "if there are complications, you're not in any type of medical setting to receive the care you might need."

Providers countered that medications are safe and that women choose them to reduce travel or because they fit into their work and life schedules. More than 60% of abortions in 2021 involved women who had given birth before.

Planned Parenthood expanded its telemedicine appointments this spring in response to wider geographic demand. Abortions have declined since 2015 among women in Hennepin, Ramsey and Dakota counties, but increased 13% among residents of all Minnesota counties.

Just The Pill sends abortion medications to eligible patients by mail in Minnesota and three Western states. The telemedicine provider reported 53 abortions at the end of 2020 but more than 1,300 in 2021.

Half of women said they didn't want children at the time of their abortions in 2021. And 13% cited economic reasons, far below the 37% rate in 2007 at the start of a recession. More than one-third of women in 2021 either didn't know their reasons or declined to answer on required medical forms, a much higher rate than in past years.

"Economic reasons remain the primary cause for people seeking an abortion. They were very much the reason that I chose to have an abortion," said Caitlin Anderson of South Dakota. She added during a Planned Parenthood press event on Thursday that an unplanned fourth child would have stressed her marriage and reduced educational and other opportunities for her three children.

At the same event, Marcy Peltz of Iowa said she wouldn't have been able to start her own business or raise four kids if she hadn't had an abortion because of life-threatening fetal anomalies that could have resulted in lifelong medical expenses.

Watching access in other states

Abortions have also been declining over time in Minnesota's border states, though Iowa's numbers increased 42% from 2018 to 2020. Iowa Gov. Kim Reynolds hired private attorneys last week to try to reinstate abortion restrictions that have been tied up by court rulings.

An influx of women from states with abortion bans could challenge Minnesota's capacity. The number of named clinics in the state report declined from seven to four over the past decade, though unnamed independent physicians provided about 7% of abortions last year.

St. Paul-based Planned Parenthood saw its share of abortions in Minnesota increase from 33% in 2011 to 71% in 2021.

"It should not be just on the backs of Planned Parenthood and the independent abortion clinics in Minnesota to take care of the influx of people that will be needing our care," Stoesz said. "I am hoping we will begin seeing other OBGYN practices and health systems stepping into the breach."

Whole Woman's Health closed its clinic last year, but reopened under a new organizational structure in February and anticipates that its proximity to the Minneapolis-St. Paul airport will result in an influx of patients from out of state.

Abortions over the past decade have declined among females in Minnesota younger than 29 but increased among older women. A Hennepin County program appeared to have an influence, teaching teenagers to set future goals and consider how unplanned pregnancies could disrupt them.

Fischbach said further declines could be achieved by providing counseling or birth control alternatives to women who undergo multiple abortions. The report showed they made up 42% of abortions in 2021. He predicted that Minnesota's counseling requirement and 24-hour waiting period would reduce the number of women coming from other states.

"To say we are going to become an abortion mecca or abortion hub is wrong," he said.