EDITOR’S NOTE: This is the first story in a three-part series about the impacts of South Dakota’s abortion ban. The second story examines the effects of South Dakota’s “life of the mother” exception, which some critics believe is ill-defined. The third story analyzes effects on the availability of women’s health care.
Nobody knows exactly how many women are traveling out of the state for abortions, but several advocacy groups say they’ve helped more than 75 South Dakotans with abortions in other states in the first three months of 2023, continuing a trend that predates the triggering of the state’s abortion ban last summer.
Some of those women sat in their vehicle just past the Minnesota or Wyoming borders as a doctor prescribed medication over the phone to end their pregnancy.
Others drove more than 10 hours round-trip to a clinic — taking off work and paying for a hotel and gas.
It is illegal in South Dakota to undergo an abortion, unless the mother’s life is in jeopardy. But that’s not stopping these women, said Kim Floren, co-founder and director of the South Dakota Justice Empowerment Network.
The organization, which started in 2020, provides funding for abortion procedures and practical support for South Dakotans and Midwesterners. JEN and other organizations retain lawyers for legal advice as they continue to operate.
“There are a handful of people who will continue their pregnancies, but most of the time if someone needs an abortion they’re going to get one,” Floren said. “They’re going to find a way and we’re going to help them.”
Majority of South Dakotans’ abortions sought out-of-state in 2021, reports show
In reality, South Dakotans have been traveling out-of-state for reproductive care for years. The majority of South Dakotans who received abortions in 2021 got them in other states, according to the latest abortion reports from the departments of health in South Dakota and surrounding states.
While 175 South Dakota women reportedly received abortions in-state, another 158 women received abortions in Minnesota, 145 in Colorado, 57 in North Dakota, 77 in Nebraska and 28 in Montana. Wyoming and Iowa do not separate non-resident abortion data by state residency in their annual reports.
South Dakota had one operating abortion clinic in 2021 located in Sioux Falls (the clinic no longer performs abortions but offers other family planning services).
In 2021, South Dakota had a 72-hour waiting period requirement, mandatory counseling and mandatory parental consent for minors, requirements that made it more difficult to get an abortion in-state rather than hopping over the border. The Sioux Falls clinic would often have week-long wait times to schedule an appointment as well. Clinics in surrounding states are closer for many South Dakotans outside of the southeastern part of the state, making out-of-state care more feasible.
The numbers show at least 72% of the South Dakotans who had abortions in 2021 received their care in other states — and likely more, given the lack of complete data.
Colorado and Minnesota have become designated safe havens for abortion and gender-affirming care in recent months. And in North Dakota, the Fargo clinic has hopped to the other side of the river in Moorhead, Minnesota — just 2 miles away from its former location.
In 2005, South Dakota passed a law that would make abortions illegal when the U.S. Supreme Court officially overturned Roe v. Wade. One of the largest impacts after the South Dakota trigger ban went into effect last summer has been on medication abortions in the state. Gov. Kristi Noem banned telehealth appointments in 2021 for medication abortion, and prohibited the pills from being delivered by mail or courier. She and Attorney General Marty Jackley announced in January the state would prosecute pharmacists who dispense abortion-inducing pills.
That means that South Dakotans can no longer pick up abortion medication at their nearby pharmacy or have it mailed inside the state without fear of prosecution. That’s why Minnesota-based Just The Pill has had 31 South Dakotans drive just across the border to Minnesota, Wyoming or Montana to receive abortion pills through the mail this year.
Patients will drive across the border for an initial telehealth consultation with a doctor who’ll prescribe them the medicine. Then they’ll either stay in a hotel or drive back across the border a couple days later to pick up the medication.
“There are lots of hoops still,” said Julie Amaon, medical director of Just The Pill. “You have to drive several hours, twice — for the appointment and to pick up the medication — when you really should get this care in the comfort and safety of your own home. It’s hard for a lot of patients to still do what we’re doing.”
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The cost of traveling out-of-state
The cost alone for Just The Pill’s medication is $350, Amaon said. Medicaid doesn’t cover such costs, and private insurance doesn’t typically cover it either.
But that doesn’t include the cost of gas, plane or bus tickets if the patient doesn’t have a vehicle, the cost of food, taking time off work, or arranging child care or lodging. Costs can often exceed $1,000.
“It can often cost more to get someone to the appointment than for the actual abortion procedure,” Floren said.
Access to abortion before and after the Dobbs decision, in which the U.S. Supreme Court overturned Roe v. Wade in 2022, has always “depended on what zip code you live in,” said Alison Dreith, director of strategic partnerships at the Midwest Access Coalition, based in Illinois.
Several organizations offer help to cover the cost of the abortion itself and additional support, such as the Justice Empowerment Network and Midwest Access Coalition.
Dreith said her organization has worked with more than 475 clients around the Midwest so far this year, with just two from South Dakota. Floren said she sees about 40 to 50 requests a month at Justice Empowerment Network, with about a third of those coming from South Dakota.
Given that there is more confusion about what is legal since the Supreme Court decision, Floren and Dreith said they’re seeing more abortions later in pregnancies. This means more invasive and costly procedures.
“They’re not going to not get abortions with these laws,” Floren said. “They’re just going to cost more, take more effort and be more difficult.”
For some of the women calling Floren, it’s a life or death situation.
“When you look someone in the eye and she has three kids and she’s saying she’s going to kill herself before she has another baby, you’re not going to say no,” Floren said. “You think about those people who are out there and don’t have any other options.”
Organizations vow to provide services ‘no matter what’
Figuring out how to provide abortion and support services since last summer has felt like whiplash for these organizations. Patients have expressed fear and confusion about what is still available and legal.
“It feels like everybody’s guessing,” Floren said.
It further complicates the issue since people generally aren’t aware of the restrictions and difficulty accessing abortion until they’re directly involved, she added.
“Most people in South Dakota are not thinking about this issue until they need an abortion or someone they love needs an abortion,” Floren said. “Then it’s there and they’re like, ‘I had no idea it was this awful. It’s 400 times more stressful than it needs to be.’”
The latest development in the political tug-of-war was the Supreme Court emergency-basis decision in April, maintaining Food and Drug Administration regulations that allow access to the abortion pill mifepristone.
The FDA policies made abortion pills easier to access by removing the requirement for in-person provider visits, but Texas-based U.S. District Judge had issued a ruling earlier in the month that threatened to halt authorization of the pill. After going through the 5th U.S. Circuit Court of Appeals, the Supreme Court issued a stay on the appeals ruling and reverted abortion access while the legal battle continues until the Supreme Court makes a final determination on the legality of the FDA rules.
But Amaon says Just The Pill will simply dispatch mobile clinics near the border if the FDA regulations require in-person appointments or change its medication regimen if mifepristone is restricted. Instead of providing two medications for the abortion (mifepristone and misoprostol), which is the typical medication abortion practice in the United States, they’ll simply prescribe misoprostol alone.
“We’re ready to keep providing service no matter what happens,” Amaon said.
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