For abortion, Minnesota-North Dakota border is a divide

FARGO, N.D. – Tammi Kromenaker piled a box of office supplies into her minivan and drove away from the empty downtown abortion clinic where she’d worked half her life. On this cold, windy recent North Dakota morning, she headed toward something new.

It had been a chaotic several months since Kromenaker bought an old office building for the Red River Women's Clinic's new location. The day after she closed on the property in Moorhead, just on the Minnesota side of the Red River, the Supreme Court overturned Roe v. Wade. Even though state courts have for now blocked North Dakota's trigger law that would ban abortion after Roe was overturned, Kromenaker wanted to ensure that abortion access wasn't interrupted, so her new clinic opened 47 days later, on Aug. 10.

Kromenaker braked for a flock of wild turkeys, then she crossed into Minnesota. The border serves as one of the nation's starkest divides on abortion laws: North Dakota among the most restrictive, Minnesota one of the most permissive. For Kromenaker, moving to Minnesota has made life and work easier. Her new building has three times more space. And instead of patients walking past abortion opponents on the downtown Fargo sidewalk, the Moorhead clinic has a spacious parking lot. Now, as volunteer escorts shield patients with rainbow umbrellas, women only hear far-off shouting from the sidewalk: "It's not too late to let your baby live!" "God created that child in your womb!" "Please come back to us!"

But the move has not made it easier to digest how drastically the national abortion landscape has shifted since the ruling.

"I haven't moved on," Kromenaker said. "The day we moved, I was bawling my eyes out. It's bittersweet. [But] there's anger too. We fought long and hard to keep abortion legal in North Dakota … We're not just going to give up and give in."

Kromenaker pulled a leaf blower from her minivan and cleaned the parking lot, then walked into her clinic. The head nurse, Sarah Haeder, had already flipped on the lights and started the ultrasound machine. As Kromenaker got on a call with her attorney about the trigger ban, Haeder answered the main phone.

"Red River Women's Clinic, how can I help you?"

A woman from North Dakota had just found out she was pregnant. She wanted an abortion — but first, she asked if abortion was still legal. Haeder explained that the clinic, previously the only abortion clinic in North Dakota, had moved to Minnesota, and she explained two options: a suction procedure or a medication abortion.

Haeder hung up and sighed. Clinicians here are true believers in women's right to choose. Haeder, who has a 3-year-old daughter, had an abortion herself many years ago; on her forearm is a tattoo reading "Abortion is health care" that she got after Roe was overturned. Clinicians focus on making this feel like a place of routine medical care instead of the center of America's culture wars. But recently, the heaviness has worn on them. Most phone calls now come with a sense of urgency, and fear.

"Everybody's panicking," Haeder said. "A feeling of desperation. Of inequity. We're constantly feeling like we're living a dystopian novel or movie. Now, everyone is so much more emotionally involved."

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The distance between the clinic's old location and new location is barely 2 miles, but the abortion climate in the two states is worlds apart.

Minnesota is one of 10 states the Center for Reproductive Rights categorizes as "expanded access," where abortion access is easiest; Minnesota and Illinois are the only two not on the coasts. North Dakota is dubbed "hostile," the second-most restrictive category. If its trigger ban goes into effect, North Dakota will join a dozen other states, including South Dakota, where abortion is illegal.

Carol Tobias, president of the National Right to Life Committee, said the Minnesota-North Dakota border is in a select group that most starkly illustrates the divide: Texas's border with New Mexico, Missouri's with Illinois, Idaho's with Oregon and Washington.

"There are states that are going to become destinations," Tobias said. "Some states, depending who is in charge, might consider it attracting money like it is tourism."

Early data shows increases in abortions in states like Minnesota which are surrounded by states banning or severely limiting abortions. A recent study found that in July 2022, the first full month after Roe was overturned in Dobbs v. Jackson Women's Health Organization, there were 24% more abortions in Minnesota than in April 2022, the last full month before the leak of the Supreme Court opinion. That was the highest increase in the country.

"States like Illinois and Minnesota will have to carry that access for a large portion of this country," said Jennifer Pepper, president & CEO of CHOICES: Memphis Center for Reproductive Health, a women's health clinic that opened a new location in southern Illinois because of Tennessee's ban.

Nationally, monthly abortions decreased about 6% in July and August compared with April — more than 10,000 fewer abortions than expected. But those numbers don't explain the disparity between states, according to a recent study by the Society of Family Planning. In 13 states with trigger bans, abortions dropped by 95% — whereas in states where abortion remained legal with few restrictions, monthly abortions increased by 11%.

"These divides were already noticeable," said Elisabeth Smith, director of state policy and advocacy for the Center for Reproductive Rights. "These border divides are only going to become more and more extreme."

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Kromenaker is 50 years old — full of nervous energy, a devotee of "Star Wars" and the Minnesota Twins, married with a grown daughter and two grown stepchildren — who sits at the center of North Dakota's abortion debate.

She used to be on the opposite side. Raised Catholic in Plymouth, she went to Christian music festivals with her high school boyfriend, and she read anti-abortion books. A bumper sticker in her dorm room at Moorhead State read "God is pro-life."

Her freshman year, a close friend got pregnant. "It was just like a switch flipped: 'She can't have a baby!'" she recalled. "Just completely incapable of being a parent at that moment in her life. I had not thought about what it actually meant for real people." She interned at a shelter for abused women and eventually got a job at Fargo's first abortion clinic.

Even after becoming director and owner of North Dakota's only abortion clinic, Kromenaker avoided publicity. North Dakota mandated a 24-hour waiting period in the early 1990s, and its trigger ban passed in 2007, but it wasn't until 2013 when Kromenaker publicly engaged. That year felt like a turning point in North Dakota: Her clinic won a lawsuit over a six-week abortion ban, but a 20-week ban went into place, and the next year, a personhood ballot measure, which would grant constitutional rights to the unborn, was rejected by North Dakota voters. A bill introduced in 2021 would have treated abortion as murder. That shifting landscape led Kromenaker to scout locations in Minnesota. A GoFundMe account started the day before the Dobbs decision raised $1 million for relocation.

On a recent afternoon, Kromenaker ushered a 29-year-old woman from Dickinson, N.D., into a waiting area. The woman, who declined to give her name, had simple reasoning to get an abortion: She fears pregnancy and motherhood would destroy her mental health; she already battles severe depression. And she fears bringing new life into what she sees as a darkening world. She had a previous abortion in Fargo seven years ago. The night before, her partner drove her four hours, and they split the $700 cost.

"I don't want to do this," she said. "You get the stigma, and the financial hit as well."

She had taken the first pill, called mifepristone, orally; that pill stops the embryo or fetus from growing. Before Dobbs, doctors here would have given her the second pill, misoprostol, to take at home one or two days later; that pill causes cramping and bleeding as the embryo or fetus is expelled from the uterus. But now clinicians worry about the legality of transporting abortion medication into states banning abortion, so at the clinic the woman inserted the second pill vaginally.

The woman stood to head home, relieved that the parking lot afforded privacy.

"Seeing the protesters — at the old clinic, they used to be right there and in your face," she said. "Here, I didn't even have to look at them. I didn't have to hear them. I know their intent is to make you feel like you're a disappointment. They're really trying to shame you. I get that. But a lot of me wants to be like, what do I care about your opinion? I have my morals, and I know I'm not doing anything against them."

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On the sidewalk 20 paces from the entrance stood Paul Letvin, a 39-year-old father of five and Fargo pastor. Letvin does not like being called an anti-abortion protester; that minimizes what he and a dozen others are doing here, he said. Letvin prays for the women and their pregnancies. He doesn't shout "murder"; instead, he tries to be a hopeful presence encouraging alternatives to abortion.

Letvin pulled out his bagpipes. A sign from another pastor showed a photo of disassembled fetal parts. Letvin began playing "Amazing Grace."

Here is why: A decade ago, Letvin's wife became pregnant. He wasn't ready for a baby, but it felt like his duty. Then his wife miscarried; they mourned. If my wife and I are weeping over this child we never met, he thought, how can people willfully take the life of their own child? They named their baby Sam, and Letvin played "Amazing Grace" at a memorial service.

Later, he met Jody Clemens, who had an abortion decades ago and is now one of the most prominent activists against abortion in North Dakota. He heard her speak at a "Post-Abortive Ladies" panel, where Clemens told of deep regret. Her words made him focus on the woman as much as the pregnancy.

"There's a forbidden grief — you feel, 'I chose this,'" Clemens said. "With abortion, you go in there thinking, 'It's harmless.' I came out thinking, 'If there's a heaven or hell, I'm destined to hell.'"

On the sidewalk, Clemens watched Letvin play bagpipes. Letvin wept as he thought about the women walking in, and about his own unborn child.

"I'm trying to bring reverence and honor," he said. "I want to give the children who are dying here a proper memorial and remembrance. It's not to make anybody feel bad. It's not to judge anybody. It's because I know life is being lost here."

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Haeder, the head nurse, popped into Kromenaker's office: "The last patient is now officially out of the building."

It was 6:18 p.m., and staff was clearing out. Twenty-nine abortions had been scheduled with women across diverse racial, economic and age groups. They performed 24; three appointments had been no-shows, one was too far along — the clinic's gestational limit is 16 weeks six days, and this woman was at 19 weeks — and one woman left after an emotional moment with Kromenaker.

When that woman had looked at her ultrasound, Kromenaker saw despair on her face. "My family is really against this," Kromenaker recalled the woman saying. The pregnancy was only 10 weeks along, and the woman lived locally. "Today's not the day," Kromenaker told her. Kromenaker connected her with a social worker to help with budgeting and finances if the woman decided to have the baby, or to help with family if she decided to have an abortion.

"We'll always find room for that person," Kromenaker said. "And if we don't hear from her, it was the right thing to do."

The clinic distills one of America's fundamental and intractable divides.

"I've talked to women for 29 years, listened to their stories, heard their very thoughtful, very considered reasons for obtaining an abortion," Kromenaker said. "Bottom line, I trust that person to know what's best for them. It's not my job to tell a person I met five minutes ago whether they should have an abortion."

Kromenaker stayed at the clinic well past dark: updating patient charts and doing accounting and ordering more intrauterine devices, a form of birth control. This has been the busiest, most turbulent time of her life; the day after her new clinic opened, her father died.

At 8:08 p.m., Kromenaker left. No one remained on the sidewalk. She drove home, had a gin and tonic, and at 9:28 p.m., went to bed. She watched an episode of “The Handmaid’s Tale,” and then she dozed off.