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'It's a domino effect': Duluth sees impacts of national reproductive health care changes

WE Health Clinic has seen more out-of-state patients than in the past, and St. Luke's OB-GYN Jennifer Boyle said several patients have cited the Supreme Count rulings as reasons for wanting their

Laurie Casey, executive director at WE Health Clinic, takes a phone call
Laurie Casey, executive director at WE Health Clinic, takes a phone call Thursday in the office in the Building for Women in Duluth.
Jed Carlson / Superior Telegram
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DULUTH — WE Health Clinic, the only abortion provider in the Northland and surrounding region, has been fully booked for abortion appointments in the weeks following the U.S. Supreme Court's decision to overturn Roe v. Wade. Laurie Casey, executive director of WE Health, said there have been more patients coming from out of state, including one woman who drove from Texas to Duluth last week for an abortion.

Of the 17 appointments scheduled July 7, seven of them came from outside Minnesota — with several from Wisconsin, where abortions are now a felony, according to an 1849 law. Casey said the clinic has also received many phone calls from women in states with trigger bans inquiring about medication abortions, which can be sent in the mail with a telehealth appointment. However, patients must have a Minnesota mailing address to receive the medication.

Laurie Casey, executive director at WE Health Clinic, straightens up one of the exam rooms
Laurie Casey, executive director at WE Health Clinic, straightens up one of the exam rooms in the Building for Women.
Jed Carlson / Superior Telegram

“We’re still continuing to see people coming from the Minneapolis and St. Cloud areas because they’re having a harder time getting in down in the Twin Cities," Casey said. “If Iowa becomes illegal to have an abortion, we’re going to see people from Iowa traveling up to the Twin Cities, probably, and they’ll take up spots from people who would normally go to the Twin Cities, so that will probably push people up here. It's a domino effect, but we just don't know when the dominoes are going to fall and what's doing to happen. We're still just kind of waiting."

WE Health Clinic, the only abortion provider in northern Minnesota, northern Wisconsin and the Upper Peninsula, could become more in demand for out-of-state patients.

Casey said right now, the Duluth clinic still has about a one-week wait time for patients to get an appointment. WE Health can provide abortions for up to 15.6 weeks gestational age, and tries to schedule people as soon as possible so they don't get too close to the gestational limit. The Twin Cities' clinics can perform abortion later in gestational age, but are seeing about a monthlong waiting period because of high demand. WE Health can schedule about 20 abortion appointments on the one day a week they perform them, and are considering adding additional appointments for medication abortions with their OB-GYN on other days.

"If we need to, we would add another full day of abortions during the week," Casey said. "We’re still looking at adding some more staff, and just kind of waiting to see what happens.”

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Paulina Briggs, the lab supervisor at WE Health Clinic, checks a machine in the exam room
Paulina Briggs, the lab supervisor at WE Health Clinic, checks a machine in the exam room Thursday.
Jed Carlson / Superior Telegram

Right now, there are plans to hire at least one more nurse, a lab technician, a patient educator and possibly office support at WE Health. If necessary, the clinic may add an additional day of abortions each week, which Casey does not anticipate would impact other clinic services.

Notes are posted for clients at WE Health Clinic
Notes are posted for clients at WE Health Clinic in Duluth.
Jed Carlson / Superior Telegram

Emily Bisek, vice president of communications for Planned Parenthood North Central States, said Planned Parenthood defers to local clinics when assessing the need for services. She said right now, WE Health seems to have abortions covered, and they do not intend to begin performing abortions at the Duluth Planned Parenthood.

Planned Parenthood has expanded its telehealth services to provide medication abortions to anyone with a Minnesota mailing address for up to 11 weeks gestational age. Bisek said this service has had such a high demand, they are hiring more physicians to keep up.

"We’ll wait and see if there is an influx and where it would be needed for us to expand abortion, but right now we don’t have plans to expand any of our brick and mortar health centers,” Bisek said. “We’ve done these things, we’ve expanded a little bit — we don’t know if it will be enough for the surge. Right now, we're still waiting for the surge to really hit.”

Other reproductive services

Dr. Jennifer Boyle, an OB-GYN at St. Luke's, said it's too soon to tell if appointments for reproductive health care — including birth control, vasectomies or tubal ligation — have increased because of the Supreme Court decision, but she said anecdotally, department staff have observed some increases. Boyle said she had a patient in her 20s request her tubes tied — citing Roe v. Wade as her reason for requesting the procedure — and one midwife inserted four IUDs in one day this week, which is more than average.

Boyle, Jennifer 4X6V.jpg
Dr. Jennifer Boyle.
Contributed / Jeff Frey

“People really need to think about birth control," Boyle recommended. "If you’re not ready to have a pregnancy, we have really great birth control now that we didn’t have 20, 30 years ago. IUDs are just as good as having your tubes tied, as far as effectiveness, and those can be put in anytime and it’s a pretty quick office procedure.”

Birth control is available from several health care systems in Duluth, including St. Luke's, Essentia, Planned Parenthood and WE Health. Planned Parenthood, St. Luke's and Essentia perform vasectomies; and St. Luke's and Essentia perform tubal ligation and hysterectomies.

St. Luke's urology department did not report any changes in vasectomy appointments. Essentia was unable to provide any information about recent service demand.

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Boyle said during pregnancy, there are countless scenarios that could happen that may cause a pregnancy to be terminated, including ectopic pregnancy, where the fertilized egg implants outside the uterus, usually in the fallopian tube. The condition can cause internal bleeding and can potentially kill the mother if the pregnancy is not removed in time.

It’s a domino effect, but we just don’t know when the dominoes are going to fall and what’s going to happen. We’re still just kind of waiting.
Laurie Casey, executive director, WE Health Clinic

“It is a pregnancy, and oftentimes it has a heartbeat, but it’s going to kill the mother if you don't treat it," Boyle said. “With all of this, it’s really not black and white. If it’s not happening to you, you don’t really think of all the different scenarios. You can't just say all or none.”

Essentia also said in a statement that the health care system does not consider the termination of pregnancies during life-threatening situations an abortion because there is no chance of the pregnancy continuing, such as with an ectopic pregnancy.

"When emergency care is required for women whose lives are in danger during pregnancy, a termination of pregnancy is sometimes necessary to save the life of the mother," Essentia said in the statement. "For situations in which the mother’s life is at risk — and where time allows — we consult our Ethics Committee, which performs a thorough review and assessment to determine ethical principles and compliance with the Ethical and Religious Directives for Catholic Health Care Services. Each situation is different and demands thoughtful consideration."

Paulina Briggs, the lab supervisor at WE Health Clinic, works at her desk
Paulina Briggs, the lab supervisor at WE Health Clinic, works at her desk Thursday .
Jed Carlson / Superior Telegram

Boyle also gave the example of anencephaly, where babies do not develop parts of the brain or skull during pregnancy. This condition, and other lethal anomalies, usually aren't picked up on ultrasounds until about the middle of the second trimester. In instances where the baby will have no chance of survival, parents can opt to terminate the pregnancy at St. Luke's instead of carrying to term.

“It’s up to the woman. She could continue the pregnancy if she wants to, but a lot of women are pretty traumatized by it, knowing that they’re going to deliver a baby that’s not going to live,” Boyle said. “By terminating the pregnancy with a known lethal anomaly, then that woman can go on. It’s obviously a desired pregnancy, but not going to work. So then they can start over faster than if they had to go through the entire rest of the pregnancy.”

When asked if the Duluth hospital systems would ever consider providing abortions if patient demand in Minnesota increased, Essentia said it will not, citing its Benedictine and Catholic heritage. St. Luke's did not provide a comment.

Community support

Casey said despite the concerning political climate surrounding abortion and reproductive health care access in the United States, she has felt encouraged by the amount of support she's seen from people. The clinic has received countless messages from people in the Northland, Twin Cities and Wisconsin offering donations and volunteer help. Many people have donated to the clinic's H.O.T.D.I.S.H. Militia abortion assistance fund or purchased items on the clinic's Amazon wishlist.

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“It’s been great," Casey said. "The support has been really outstanding, and just people reaching out and sending a message saying, ‘We’re glad you’re here, thank you for the work you do.”

She also noted the support for the Red River Women's Clinic in Fargo, which is still operating, but is fundraising to move across the North Dakota-Minnesota border to Moorhead. As of July 13, a GoFundMe fundraiser is just over $50,000 away from reaching its $1 million goal. The clinic is the only abortion provider left in the Dakotas.

Work needed at the new clinic location in Moorhead includes replacement of an outdated heating, ventilation and air conditioning system. The new site will also need a security system with cameras

Casey said people who want to help WE Clinic can donate money or Visa gift cards, or purchase items from the Amazon wishlist. People who wish to volunteer as clinic escorts should contact Pro-Choice Minnesota in St. Paul. And another big help, she said, is to get out and vote in local elections.

“We’re just taking one day at a time and just trying to assess, every couple of weeks, where we think we’re going to be in the future," Casey said. "I think everyone is really energized to continue to provide the care that we do.”

Laura Butterbrodt covers health for the Duluth News Tribune. She has a bachelor of arts in journalism from South Dakota State University and has been working as a reporter in Minnesota and South Dakota since 2014.
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