Minnesota may be the land of 10,000 lakes — but when it comes to abortion access, it’s more like an island.

That’s the message abortion rights advocates are reiterating as a wave of laws banning or restricting abortion passed state legislatures across the country over the last couple of months.

Alabama, Kentucky, Georgia, Ohio, Mississippi, Louisiana and Missouri have all passed laws this year effectively banning abortion. In fact, nearly 400 bills aimed at restricting or outlawing abortion have been introduced nationwide this year, according to the Guttmacher Institute, a national advocacy group that keeps track of such measures.

In the Midwest though, Minnesota has remained an outpost of reproductive rights, even as neighboring states have whittled away access to abortion through restrictive laws and ban attempts. Wisconsin and Iowa have passed laws banning abortion before the “viability” standard set by Roe v. Wade — although Iowa’s 6-week ban was deemed unconstitutional by its state supreme court last year.

Under those changing laws and the rising cost of health care, many abortion clinics in the Midwest have closed in the last decade, and abortion rights advocates say more women from out of state are coming into Minnesota to get their abortion needs met. Both North and South Dakota have just one abortion clinic remaining. (Depending on what a Missouri judge rules following a Tuesday court hearing, it could become the first state to have no abortion clinics at all.)

“We see Minnesota being a place where, within the Upper Midwest, we’re going to be a point of access for people,” said Andrea Ledger, executive director for advocacy group NARAL Pro-Choice Minnesota. “We’re confident that we’ll remain that point of access regardless of what happens nationally.”

Percentage of nonresident abortions rising

By law, Minnesota is required to keep track of the number of abortions performed in the state each year, which the Minnesota Department of Health compiles into annual reports.

An analysis of those reports shows that between 2007 and 2017, the overall number of abortions performed in Minnesota has gone down. But the percentage of nonresidents receiving those abortions during that same time period have steadily climbed, hitting nearly 10 percent of total abortions in the state for 2016, compared to less than 8 percent in 2007.

“We are definitely seeing more people coming in from other states,” said Sarah Stoesz, president and CEO of Planned Parenthood North Central States, the organization’s regional branch that includes Minnesota, Iowa, Nebraska and both Dakotas.

Planned Parenthood has two Minnesota clinics that provide abortions, and Stoesz said those locations have seen an increasing number of clients come from neighboring states. Last year, 575 of the abortions performed at those clinics were for women who didn’t live in the state. That’s up from 537 cases in 2017 and 485 in 2016.

At WE Health Clinic in Duluth — formerly Women’s Health Clinic — nearly a third of the patients receiving abortions at the clinic last year came from out of state, said Laurie Casey, the clinic’s executive director. Out of the 376 abortions performed at the clinic last year, 95 of those clients came from Wisconsin, and 10 from Michigan, she said.

In fact, every year, about a fourth of their total abortions performed involve women from Wisconsin, Casey said. That’s because Duluth is closer to many rural areas of northern Wisconsin than the state’s big cities like Milwaukee and Madison. But it’s also because restrictive laws passed under the state’s former governor, Scott Walker, have made access to abortions there more difficult, she said.

Stoesz agrees that restrictions in neighboring states are playing a major role in that trend. “Access has become more difficult in surrounding states,” she said, “and we expect that to continue more and more as states continue to adopt greater and greater restrictions.”

Restrictive bills introduced, but not passed

Minnesota is by no means a stranger to bills aimed at restricting or banning abortion. In the 2019 legislative session alone, at least eight abortion-related measures were introduced, including two that aimed to ban abortion after 20 weeks and 6 weeks, respectively.

Neither of those bills made it past the House floor and into committees, said Rep. Kelly Morrison, D-Wayzata, and vice chair of the state House of Representatives Health and Human Services Policy committee. “The House DFL has a pro-choice majority,” Morrison said, “and so there wasn’t a lot of appetite for hearing those restrictive bills.”

Even when that wasn’t the case, Minnesota avoided passing any bills restricting or banning abortion because of former Gov. Mark Dayton, who vetoed any bills that passed the Legislation during his time in office. Last year, Dayton vetoed a bill that would have required doctors to ask patients if they wanted to view the ultrasound before getting an abortion, and in 2017 he threatened to veto a bill that would have banned state dollars from funding abortion procedures.

Additionally, Minnesota has a constitutional protection for abortion because of the Doe v. Gomez case of 1995. So even if Roe v. Wade were overturned nationally, the right to an abortion could only be undone in Minnesota by amending the Minnesota Constitution.

Covering rising health care costs

Still, clinic operators and abortion advocates worry about preserving their ability to provide services, especially when it comes to ensuring that Minnesota’s current clinics continue to have the resources and capacity to serve both their Minnesota clients and those coming from out of state.

In 2008, Minnesota had seven clinics and 46 independent physicians who provided abortions services, according to the Department of Health. Today, the state has four clinics and 10 independent physicians who do so.

Stoesz said that’s mostly because of financial reasons, such as health care costs rising across the board while Medicaid reimbursements stayed flat. And those financial burdens are hitting rural, low-income areas hardest, she said.

“We have to figure out how to cover those costs,” Stoesz said, “and I just think it’s harder and harder for smaller clinics to cover their costs.”