The Planned Parenthood affiliate in Minnesota and the Dakotas is consolidating with the affiliate in Nebraska and Iowa, giving the new St. Paul-based organization stronger financial backing and regional political influence. The decision brings with it the challenge of providing abortions and advocating for the right to the procedure in two conservative states.

The newly named Planned Parenthood North Central States will operate 29 clinics serving 114,000 patients in the five-state region. While the consolidation has been planned for months, Planned Parenthood leaders said it comes at a pivotal time, following President Donald Trump's announced plans to strip federal family planning dollars from clinics that perform or provide referrals for abortion.

"We are not standing by as crucial women's health care services are threatened, including the newest attack on federal family planning funding," said Sarah Stoesz, the president and chief executive of Planned Parenthood of Minnesota, North Dakota, South Dakota, who will take charge of the new organization.

Although Planned Parenthood says the majority of its services involve contraception and cancer screenings, the organization has long been at the center of the battle over legal abortion. While abortions declined in Minnesota, from 14,450 in 2000 to 9,953 in 2016, Planned Parenthood reported an increase in the number of procedures it performed in the state. Its St. Paul clinic performed 5,629 abortions in 2016, according to the Minnesota Department of Health.

Planned Parenthood's Heartland affiliate, which currently covers Iowa and Nebraska, has been buoyed by strong philanthropic support but recently sustained losses of public grants that hastened discussions about a consolidation, Stoesz said.

Clinical and program revenue for the Iowa and Nebraska affiliate declined from $14 million in fiscal year 2012 to $9.8 million in fiscal year 2015, according to tax forms on By comparison, 2015 program revenue in Minnesota and the Dakotas totaled $25 million.

The decision to consolidate was seen as an encouraging sign by abortion opponents in Iowa, where the number of Planned Parenthood clinics has declined.

"Look at schools. Why do they consolidate? Because they don't have enough students to fill a classroom," said Maggie DeWitte, executive director of Iowans for Life. "I think the same thing is happening with the Planned Parenthood clinics.''

Stoesz said all of health care is consolidating under financial pressures.

"Planned Parenthood's health practice is not something that occurs in a vacuum or on an island," she said.

Iowa lawmakers recently approved one of the nation's strictest abortion laws, which bans nearly all elective abortions once fetal heartbeats can be detected, usually around the sixth week of pregnancy. The law is scheduled to take effect in July, but the Heartland affiliate, the American Civil Liberties Union and other organizations are suing to stop it.

Stoesz said the Iowa law is just another challenge in the history of the organization that started in 1928.

"Just because it's hard," Stoesz said, "would never be a reason for us to walk away."

Staff writer Shannon Prather contributed to this report.