MOORHEAD, Minn. — At 3 p.m. on June 23, 2022, Tammi Kromenaker signed the paperwork to move her abortion clinic to Minnesota. Seventeen hours later, the Supreme Court overturned Roe v. Wade. 

The Red River Women’s Clinic was North Dakota’s only abortion clinic for more than 20 years. During that time, staff juggled how to operate amid changing state laws, limited local partner support and a challenging physical location. 

June 24 marked two years since the Supreme Court’s landmark decision in Dobbs v. Jackson Women’s Health Organization changed the landscape for abortion policy on the state level. Largely, those working in the abortion ecosystem have reported how their jobs have become more complicated and difficult. 

But at Red River, the staff is experiencing relief.

Kromenaker began searching for a new location for her Fargo, N.D.-based clinic in the fall of 2021, feeling uneasy about the future as the North Dakota legislature entered a special session and the Supreme Court announced it would hear the Dobbs case. Following the May 2022 leak of the opinion, she buckled down to secure a new space in Moorhead, about 2 miles away.

“It is beyond night and day between providing abortion care in North Dakota to Minnesota,” said Kromenaker, the clinic’s owner and director. “What I haven’t gotten used to is not constantly feeling like there’s a target on our back.”

Nine other staff members and volunteers independently expressed a similar sentiment during a series of interviews in June.

“I’d say being in Minnesota, it’s a lot less stressful,” said Jaden Witt, a registered nurse. “Just knowing we have that support and not always just questioning when the next lawsuit is going to come from North Dakota to our clinic.”

For staff, the fact that the Minnesota location has a private parking lot has been a game-changer. The downtown Fargo location, jokingly nicknamed “the Gauntlet,” meant patients and staff often had to park farther away and navigate through protesters on the public sidewalk to reach the clinic. The Moorhead lot is limited to clinic staff, patients and their rides.

Downtown Fargo was more stressful, more chaotic and less predictable, said Gary Lura, a volunteer clinic escort since 2016. 

“You don’t know who is walking down the sidewalk,” he said.

“We would have patients coming in that were literally shaking and crying,” said Hilary, who withheld her last name for privacy reasons. She has been a clinic escort for eight to nine years and had an abortion in 1987.

On a Wednesday in June, the clinic escorts drag snow shovels across the asphalt to drown out nearby protesters. The temperature is in the 80s, but that hasn’t dissuaded a bus of about 45 people who’ve driven from about two hours away.

As patients drive up, the demonstrators attempt to flag down their cars with flyers, chants and prayers urging them to make a different decision. Among them is Geianna Meade, 19, who said the new parking lot has made things more difficult.

Meade was born at Saint Gianna and Pietro Molla Maternity Home, in Minto, N.D. That experience and her connection to the home are integral to some of her oldest memories opposing abortion. The maternity home, she says, helps women establish regular habits and offers counseling to improve their well-being.

“It’s frustrating that we can only do so much,” said Meade.

By 11:50 a.m., the group is gone. There’s a lull before another crop of protesters arrives.

“The thing that I struggle with is not engaging,” said Hilary. “But that’s what we’re here for. We’re here for the patients.”

‘Right next door’

Seventy percent of the clinic’s patients are still from North Dakota. The rest mainly come from South Dakota, Minnesota and sometimes farther.

Multiple staff members pointed to the support they’d received since moving to Minnesota. Sen. Tina Smith and Lt. Governor Peggy Flanagan, both Democrats, have both visited the clinic to show support. 

For administrative services manager Jennifer Bjornson, it’s bittersweet.

“It just sort of makes me sad that we can’t provide the service in that state. But I’m happy that we’re right next door,” said Bjornson, a lifelong North Dakota resident who has been with the clinic since 2012.

“Having that support, it just makes you feel more normalized,” she said, adding it’s also been easier to connect mentally and professionally in Minnesota, where they’re one of 13 abortion clinics. The clinic is also still a part of an ongoing case challenging North Dakota’s near-total abortion ban over its emergency exceptions. The trial is set for August.

Regardless of the outcome, Kromenaker isn’t jumping to reopen the Fargo location.

“The fact that we’re in Minnesota, we’re not under duress all the time anymore, and they don’t have to work through the protesters,” she said, ticking off North Dakota’s laws related to mandatory 24-hour waiting periods, parental involvement and ultrasound requirements. “Until all those other things are taken away, no.”

A gap in North Dakota

That gap left by Dobbs is still felt, just west in Fargo and the rest of North Dakota.

“The last two years have been the worst of my life. I’ve taken on a lot of this and [am] kind of hoping for like a life preserver,” said Destini Spaeth, who chairs the Prairie Abortion Fund, a North Dakota-based organization that provides individuals with practical support and funding to get an abortion. 

Spaeth volunteers for the fund outside of her full-time job doing clinical research at a local hospital, but the hours she logs dealing with crises have increased.

People “talk about burnout, and you just don’t have a choice but to keep going,” said Spaeth, who said she isn’t sensing a respite. She hopes fund personnel can get their feet under them to be prepared when the biennial North Dakota legislature meets next year.

For state Rep. Karla Hanson, a Democrat who represents North Fargo, the issue is personal.

Hanson said she had two incomplete miscarriages that required emergency medical attention years ago.

“I have a lot of empathy for the patients who might be encountering medical emergencies, who might not be able to get the services they need,” she said. “I can’t even imagine the, you know, stress and anxiety when you hear the stories about women having to sit in the parking lot until they reach a certain critical state.”

‘More helpful for patients’

In the coming months, things may change.

The Fargo clinic used to neighbor an abandoned building. That abandoned building was recently demolished, and construction will begin on a crisis pregnancy center from the Women’s Care Center. Such centers typically maintain the goal of persuading women not to have abortions. WCC did not agree to an interview request.

Barely a block from the clinic’s former location, a billboard still advertises the WCC. Red River still owns the Fargo building, which is nondescript, save for a small sign on the side of the building. 

Kromenaker isn’t concerned.

“I’m not worried about it. I don’t anticipate any real change, except it actually might be more helpful for patients to find us,” she said. 

This story is part of a series supported through the Rosalynn Carter Fellowship for Mental Health Journalism.