For more than two decades, the Red River Women’s Clinic, the only provider of abortion services in the state of North Dakota, occupied a small brick building in downtown Fargo. The clinic saw patients on Wednesdays, when an average of twenty to twenty-five people receiving abortions would arrive from places such as Minot, Bismarck, or Grand Forks. The clinic became a symbol of sorts: as long as it was open, abortion in North Dakota remained a legally protected option, a fact that no number of anti-abortion billboards along the interstates could override. But last June, a few days after the Supreme Court overturned Roe v. Wade, North Dakota’s attorney general, Drew Wrigley, certified a law banning abortion in most cases. A lengthy court battle would end up keeping abortion legal in North Dakota for several more months, but the Red River Women’s Clinic recognized that it could no longer operate in the state. Today, the practice’s logo is still painted on the side of the building, but the patients are gone, and a sign in the window that once read “This clinic stays open” has been taken down.
Yet, unlike many clinics in states where abortion has been banned in the past year, the Red River Women’s Clinic is still in business. It now operates in the neighboring city of Moorhead, Minnesota. I visited the Red River Women’s Clinic in its new home on a humid morning in early June. Fargo and Moorhead, although in separate states, are considered a single metropolitan area by locals, and the drive from the old site to the new one takes a little less than ten minutes. It’s a nearly straight line east, about two miles down one of the area’s impossibly flat streets. One passes the Hjemkomst Center, a history museum that has a replica of a viking ship; the Junkyard Brewing Company, one of many small breweries around town serving craft beer; a local drive-through called Burger Time; and at least two anti-abortion billboards. Aside from a “Welcome to Minnesota” chirped by the G.P.S. after crossing a low bridge over the green banks and slow-moving waters of the Red River, there is little indication that one has suddenly crossed a state border, let alone entered an alternate political reality. But in the past year, as North Dakota enacted one of the most restrictive abortion laws in the country, Minnesota has moved in the opposite direction, adding protections and removing barriers to access. These shifts have put the Red River Women’s Clinic in an unusual position. Forced to shutter in its home state, it can now provide care with greater freedom just a few minutes away.
The new location of the Red River Women’s Clinic is on the outskirts of downtown, near an auto-repair shop with some cars in its yard, a water-treatment facility, and a tilled field. The clinic occupies a two-story brick office building that faces a divided highway; pedestrian traffic is mostly limited to a nearby bus stop.
Tammi Kromenaker, who has owned the clinic since buying out her former bosses, in 2016, greeted me at the frosted-glass entrance. Kromenaker, who is blond and in her early fifties, told me that the anonymity of the setting was one of its primary advantages over the old site, which was in pedestrian-friendly downtown Fargo. In recent years, the downtown area of North Dakota’s biggest city has been revitalized into a pleasant place to hang out, with open-air concerts and yoga classes in the summer, and small boutiques and cafés along a walkable street, but abortion patients are not there to pick up used vinyl or a cappuccino. One of the most significant improvements of the new location, Kromenaker pointed out, is the parking lot. The clinic in Fargo didn’t have one, which meant that patients had to approach on foot, walking past protesters whose shouts urging them to change their minds would often leave them in tears.
Kromenaker began looking at properties in Minnesota when the Supreme Court took up Dobbs v. Jackson, in the fall of 2021. The leak of a draft opinion on overturning Roe, in the spring of 2022, convinced her that it was time to make an offer on the Moorhead building. She closed on it at three o’clock in the afternoon on June 23rd, less than twenty-four hours before the Supreme Court issued its opinion on Dobbs.
Almost exactly a year ago, I visited the Red River Women’s Clinic at its Fargo location. After the state’s attorney general announced that the abortion ban would start in thirty days, Kromenaker, represented by the Center for Reproductive Rights, sued. At first, Kromenaker tried to keep her plans to renovate a new space under wraps. In May, 2022, a building under renovation in Casper, Wyoming—intended to be that state’s only full-service abortion clinic—was set on fire by an arsonist. (The clinic was rebuilt and opened this year.) Aware of such incidents, Kromenaker would take back routes to the new clinic, driving in a hat and a mask, and sneak in through a utility door. (Her concerns that anti-abortion sabotage would spill over state lines were not unfounded: in late May, 2023, a seventy-three-year-old man rammed his car into a planned clinic in eastern Illinois, near the state line with Indiana, where lawmakers have attempted to ban most abortions.) After anti-abortion activists discovered Kromenaker’s new site in Moorhead, there was no longer a need for secrecy. The practice would still resist restrictions in the courts, but it was time to leave Fargo: the Red River Women’s Clinic saw its last patient in North Dakota on August 3, 2022.
Tammi Kromenaker has owned and operated the Red River Women’s Clinic since 2016.Photograph by Natalie Keyssar for The New Yorker
The clinic opened in Minnesota a week later. Fargo-Moorhead is in a sparsely populated part of the country, and the Red River Women’s Clinic has only ever had enough demand to see patients once a week. (The clinic’s medical director, who does not do interviews with the press, drives eight hours, round trip, to provide care, and enters and exits the clinic wearing a bulletproof vest.) Kromenaker moved quickly to avoid an interruption in the clinic seeing patients. “The day before [opening], we were here for seventeen hours,” Kromenaker said, as she recalled lying on the floor installing coving in an exam room late into the night. One patient who’d had a medication abortion in Fargo came back for her one-week checkup in Minnesota.
On the first day of operating in Moorhead, Kromenaker sent a couple of “decoy” volunteer escorts to the old site in the hopes that protesters might be fooled (and in case a patient showed up to the wrong address). That morning, in Fargo, she passed a regular protester walking toward the old site. But by midday the protesters had figured out where to go, and they’ve been coming to Moorhead every Wednesday since.
On a sunny Wednesday morning in June, several of them stood on the sidewalk outside the new clinic as the first patients arrived for the day. “It’s a night-and-day difference from the downtown location,” Gary Lura, one of several volunteer escorts wearing rainbow vests and waiting for patients in the parking lot, told me, recalling the former gantlet of the public sidewalk. “The protesters are now one hundred feet away and can’t get to the patients,” he said. “If they do, they’re trespassing, and they’ve already been told it’s either a fine or jail time.”
Kromenaker has erroneously received mail for a crisis pregnancy center that she worries might open across the street. She intends to eventually put up a fence at the Red River Women’s Clinic, and perhaps add a picnic table for companions or children waiting for patients in the summer months.
When I met her last year, Kromenaker had told me that the new location was not her ideal. Within a few weeks of meeting their new landlord, the tenants she had inherited from the previous owner started moving out one by one. A curbside advertisement for the building still bore the ghosts of lettering from their old signage. Kromenaker had more or less expected this exodus, especially after she had tightened security and arranged for video cameras to be installed. She said that one tenant complained about having to use his key fob to get in and out of the building, then took his business remote.
Now, when we spoke, discussions about the old clinic could still bring her to tears, but she seemed otherwise happy to be out of Fargo. The few downsides include a smaller waiting room and the responsibility for snow removal. Last year, the snow was so heavy that, after one storm, a plow broke off from a truck in the parking lot.
For years, the sole challenger in legal battles over abortion in North Dakota was the Red River Women’s Clinic. Moving the practice a short drive east has meant that Kromenaker is no longer locked in near-constant opposition with her state’s Republican supermajority, which has tried a wide range of strategies over the decades to limit or ban abortion, just to stay in business. (It is notable that one such attempt, the “Right to Life of Humans at Any Stage of Development Amendment,” a 2014 ballot proposal that would have extended legal rights to fetuses, failed by a margin of nearly 2–1 when put directly to North Dakota voters.) In Minnesota, the attorney general, Keith Ellison, paid the clinic a visit during his reëlection campaign last fall, to highlight his support of abortion rights, and the Minnesota senator Tina Smith co-sponsored federal legislation that would protect the right to cross state lines for an abortion. In a press conference with reporters after his visit, Ellison promised to legally defend non-residents in the event that they face prosecution in their home states. “I will file motions in those states to have those cases dismissed because they have a right to travel to Minnesota, they have the right to get an abortion in Minnesota,” he said, calling the Supreme Court’s Dobbs decision “an affront to the basic liberties of our country.”
The clinic’s battle over the constitutionality of North Dakota’s abortion laws entered a new phase in April, when the state’s Republican governor, Doug Burgum, signed State Bill 2150, one of the most restrictive abortion bans in the country. Supported by huge majorities in the state legislature, the legislation bans abortion throughout pregnancy, with exceptions for rape or incest only up to six weeks’ gestation. It also carves out an exception for patients facing serious health risks. An anti-abortion lawmaker in the North Dakota legislature expressed some concern that the law went too far. “We need to watch that we don’t get so carried away with moving in a direction that will prevent everything from being done that we really endanger some other people in this picture,” Judy Lee, a Republican state senator from the Fargo suburb of West Fargo, said, on the Senate floor. A few days after my visit this year, the Red River Women’s Clinic challenged this law, too. This time, the clinic has been joined in its lawsuit by several physicians who practice in North Dakota, including maternal-fetal-medicine specialists. Among their legal objections is the fact that the new ban “fails to provide a discernible standard for when physicians may legally provide abortion care.”
North Dakota, like the country as a whole, has wide disparities in access to maternal health care. According to the March of Dimes, a pregnant person of Native American descent in North Dakota is fifty-four-per-cent more likely to experience a preterm birth than the over-all population in the state. Another analysis found that more than twenty per cent of North Dakotans live in counties that lack hospitals with obstetric care, ob-gyns, or certified nurse-midwives. In the past year, North Dakota passed a number of bills designed to support pregnancy and new motherhood: eliminating a sales tax on baby diapers; offering tax credits for adoption or for contributions to so-called pregnancy-help centers, maternity homes, and child-placement agencies. Of these measures, an extension of Medicaid coverage for new mothers from sixty days to twelve months would appear to be the most substantial. Others are more ideological in nature, such as a new law mandating that health-class curricula in the state’s school districts include “a high-definition ultrasound video, at least three minutes in duration, showing the development of the brain, heart, sex organs, and other vital organs in early fetal development.”
Amid the focus on laws and logistics, the psychological effects of such laws are sometimes forgotten. While in Fargo, I met with Audra Maurer, a doula based in Moorhead, with whom I’d also spoken the year before. Maurer works with patients undergoing miscarriages or choosing to have abortions, as well as those who give birth. She told me that nobody has sought assistance from her for an abortion since the passage of the law, the year before, and she worried that patients will start avoiding doctors or keeping their reproductive histories secret out of fear. “I’ve never gone this long without getting reached out to,” she said. “Watching things happen across the nation makes people scared.”
Meanwhile, the past year has seen a wave of changes in Minnesota protecting abortion rights, including a court ruling in 2022 that overturned a mandated waiting period, parental-consent requirements, and a rule that abortions had to be done by a doctor. Then, in last year’s midterm elections, Democrats, some of them campaigning on the issue of abortion rights, flipped the Minnesota Senate, after six years of Republican control. More abortion protections have followed, including a bill codifying the right into state law and adding legal protections for non-residents who get abortions in Minnesota. There are also fewer clinical restrictions in Minnesota than there were in North Dakota at the time that Roe was rolled back.
“We spoke recently with somebody from North Dakota who referred a patient who got a bad diagnosis—they got a trisomy diagnosis,” Kromenaker said, referring to a family of congenital conditions that result from having three copies of a chromosome instead of two. “Now the patient doesn’t have to travel to Minneapolis-St. Paul, which is what they had to do in the past, because North Dakota had a law that said if the sole reason for termination was a genetic abnormality, we couldn’t do it.”
Kromenaker feels confident assuring worried patients that crossing state lines is safe. She recalled Justice Brett Kavanaugh’s supporting opinion in Dobbs, in which he referred to “the constitutional right to interstate travel,” and also the reality that Fargo and Moorhead are already intertwined. (In April, Idaho passed a law that made helping a pregnant minor travel to another state for an abortion without parental permission punishable with two to five years of prison.)
“There’s at least three bridges over the river from Fargo to Moorhead that I myself might cross four or five times a day, depending on where I’m going to go grocery shopping or which Target I’m going to,” Kromenaker told me. “What, are they going to have the National Guard stationed on the bridge, and a person who appears female and of reproductive age has to submit to a pregnancy test? I mean, come on—let’s get real about this.” Then there’s the fact that Fargo is about three times the size of Moorhead and has the area’s only hospitals. “Crossing state lines for medical care in this region specifically is routine,” she said.
A bulletin board at the original location of the Red River Women’s Clinic.Photograph by Natalie Keyssar for The New Yorker
Kromenaker is well aware that her clinic’s clientele might continue to change. In the past year, abortion has also been effectively outlawed in South Dakota and Wisconsin, and in Nebraska after twelve weeks. Abortion remains legal until twenty-two weeks in Iowa (with a mandated twenty-four-hour waiting period), but legislators may propose a bill to outlaw it, after the state’s Supreme Court recently refused to reinstate abortion restrictions that an Iowa judge had blocked in 2019. Should Iowa restrict abortion access as much as its neighbors have, Minnesota will be something of an island in its part of the Upper Midwest.
One impact of these changes is clinical. Previously, patients who chose a medication abortion went home with misoprostol, the second medication in the protocol, to take later. Now the misoprostol dose for patients from states where abortion is banned is administered on site, as a suppository, on the same day.
There have been other shifts. Kromenaker described March and April of 2023 as Red River’s busiest months in her recollection, despite successive snowstorms that shut down I-94. (Some patients arrived the night before and stayed in hotels; one staff member snowshoed her way out of an impassable road to get to work.) The increase in numbers was small—twenty-five to thirty patients a week instead of twenty to twenty-five—but patients came from as far away as Texas (there are direct flights from Dallas to Fargo) and Nebraska. In other respects, the clinic’s demographics mostly remain the same: some two-thirds of the patients come from North Dakota; they drive an average of two to three hours each way; and a majority of them already have children. Should the numbers continue to go up, however, Kromenaker has considered adding another day of clinical practice, and she also hopes to offer medication abortions via telehealth for patients from Minnesota.
Across the river, in Fargo, Kromenaker has leased the old space to an artists’ collective that rents out shared studios and runs an all-ages D.I.Y. venue. What used to be the clinic’s waiting room now has a small stage where punk and hardcore bands come to play. On a recent visit, Kromenaker passed through a studio that was once an ultrasound room and showed its new occupant how the dimmer light worked. Many of the artists who work in the building identify as L.G.B.T.Q.; in late May, the space hosted a “Trans Birthday Party,” with nail painting, art projects, and cake.
Renting space to this demographic was intentional on Kromenaker’s part. Along with legislation to ban abortion, last year also saw the passage of several laws in North Dakota targeting trans people, especially minors. In March, the state banned gender-affirming care for trans youth and enacted a series of mandates for teachers, including one requiring them to inform parents if a student identifies as transgender at school. (The superintendent of the Fargo Public Schools, Rupak Gandhi, has said that his district will not enforce these restrictions unless told otherwise by the school board. “We will not openly ‘out’ any student because of one law, if we know that is going to cause harm to that child.”)
An Abortion Clinic One Year Later
Source: News Flash Trending
0 Comments