Overturning Roe v. Wade will harm people of color and burden Minnesota’s health care system, researcher says

A woman poses for a photo
Asha Hassan, a reproductive health researcher with the U of M’s Center for Antiracism Research for Health Equity.
Submitted

The potential overturning of abortion access nationally will harm people of color in Minnesota and tax the state’s health care workers, a University of Minnesota researcher said.

A leak in early May of a U.S. Supreme Court draft opinion indicated that the bench’s conservative majority are poised to overturn the landmark 1973 Roe v. Wade decision that legalized abortion. The move would send ripple effects across the state and country, said Asha Hassan, a reproductive health researcher with the U of M’s Center for Antiracism Research for Health Equity.

Asha warns that a potential reversal will disproportionately impact people of color in Minnesota and across the country. More than half of all people who seek abortions in the state and nationally are people of color, she added.

For that reason, I like to emphasize that they are racist policies,” she said of policies that limit or ban abortion. 

If abortion is banned, Minnesota and Illinois are the only states in the Upper Midwest whose current abortion access is expected to stay the same. This could make Minnesota a regional destination for abortion procedures in the near future, said Asha, who estimates that out-of-state patients could increase by 371 percent. She also predicted an increase in deaths among pregnant women who can’t receive abortions, particularly Black women. 

What will this potential future look like? Sahan Journal spoke with Asha about what’s likely to happen in Minnesota, and how communities of color will be impacted. 

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The following interview has been edited and condensed.

How will a potential overturning of Roe v. Wade impact Minnesota? 

We have historically been one of the states that has significantly more access to abortion care than, say, our neighbors in South Dakota or North Dakota, where there have been erosions of abortion rights for the past decade. In South Dakota, there isn’t a single abortion provider within the state. Minnesota providers fly into South Dakota to provide that service.

That means we have a lot of people who come in from out of state, and we absolutely expect that to increase. With an overturning of Roe v. Wade, we can expect to see as high as a 371 percent increase in patients coming from our neighboring states, which include Wisconsin, Iowa, and North and South Dakota.

With an overturning of Roe v. Wade, we can expect to see a 371 percent increase in patients coming from our neighboring states, which include Wisconsin, Iowa, and North and South Dakota.

How would an overturning of Roe v. Wade impact people of color locally and nationally?

Because of the way structural racism and structural poverty works, abortion patients are extremely diverse. The majority of all abortion patients are people of color. So, when restrictions happen, they do tend to disproportionately harm BIPOC [Black, indigenous, people of color] patients. 

Pregnancy is a very difficult thing. People die every single day in this country due to pregnancy-related issues, and we can for sure expect that to increase if there isn’t an option for them to care for those folks.

There’s some estimates that say that we can expect a 21 percent increase [nationally] in pregnancy-related deaths for all populations if Roe v. Wade is overturned. And for Black folks, we can expect to see up to a 33 percent increase, which is, of course, significantly worse. This is consistent with what we know: it’s disproportionately harming BIPOC folks.

With trigger laws, how many states will outright ban abortion, and will the procedure still be available when a patient’s life is in danger? 

It’s really hard to tell. States like Wisconsin, for example, have zombie laws. These are laws from a long time ago that have not been updated and are technically the law of the land if the federal government is no longer protecting Roe v. Wade. How that is going to actually play out is a little too soon to tell.

I know there has been a lot of confusion and medical inaccuracy in how state legislators across the country define abortion and define “medically necessary.” 

I think this has really popped up with the ectopic pregnancy debate. The treatment for etopic pregnancies is an abortion, and it is medically necessary. It’s an incredibly complicated issue that people are trying to distill down to “yes-no,” and it’s never that simple.

But even here in Minnesota, we have medical inaccuracies in some of the restrictions that we have in place. There’s a restriction for abortion care where providers have to provide a consent that includes scripted language that says that abortions are linked to breast cancer. We know that’s just not medically accurate or necessary to say to the patient. 

What other restrictions to abortion access in Minnesota come to mind?

We also have a restriction on who can provide abortions. Nurse practitioners can‘t provide abortion care, only medical doctors can. It’s different in other states. In some states, advanced practice clinicians, like nurse practitioners, can provide abortion care. 

Does this restriction on nurse practitioners include abortions administered through medication only?

Yes. By the way, that is what advanced nurse practitioners would be doing. They would be providing prescriptions for a medication abortion, not performing surgical abortions. Currently in Minnesota, four of the state’s eight abortion providers provide surgical abortions. The majority provide some form of medication abortion.

There are two different drugs: one is called misoprostol and one is called mifepristone. There used to be a requirement for in-person dispensing of the [prescription-only] meditation. Now, people can receive access to medication through mail. That’s available in Minnesota.

In more than 20 States, patients can access mifepristone by mail without ever stepping into a clinic. This is going to be a significant avenue of people within states where it’s still legal to have access.

If nurse practitioners are allowed to prescribe abortion medication, how much will the number of abortion providers in Minnesota increase? 

That would dramatically change things. I’m not sure what the exact number would be, but I personally know nurse practitioners who’ve practiced abortions in other states, moved to Minnesota, and no longer have that in their scope of practice. We are expecting a significant increase in patient volume. And with what has happened with the pandemic, the healthcare workforce is very different. There have been issues with staffing in health care. 

Clinics that provide abortion care services in this state are going to have to work hard to meet those needs of this significant increase in patients. Rolling back some of these restrictions would, of course, make that a little bit more manageable.

Even thinking about the enforced 24-hour waiting period for people to get abortions: If we’re having people coming from out of state and they have to book a hotel room, they have to figure out how they are going to take off more time from work, or more time for childcare–that is a significant burden. But it can be the difference between getting and not getting the care they need. 

If Minnesota is expected to get a lot of new patients seeking abortions, does that open up opportunities for new clinics or existing clinics to expand? 

They are strategizing to meet the needs of patients. What that actually looks like is still to be determined, and we’ll see how that shakes out.

If there’s no abortions being provided in South Dakota, maybe providing abortion services on the border is part of the answer. That’s a conversation that is happening nationally–moving more abortion care providers to the margins of the borders of states.

If there’s no abortions being provided in South Dakota, maybe providing abortion services on the border is part of the answer. That’s a conversation that is happening nationally–moving more abortion care providers to the margins of the borders of states. That is what I suspect is probably going to happen.

For the abortion pill, how many weeks of gestation is that effective for?

It’s 10 weeks or under. So, if someone is pregnant beyond 10 weeks, they would have to have a surgical abortion.

If we have this issue of people coming in from out of state, and they have to figure out how they’re going to get PTO [paid time off] and childcare and all kinds of those logistic pieces–that increases the amount of time. Days and weeks go by while they’re figuring out those things, which will limit their options of what type of abortion they could potentially receive.

Do we know the amount of abortions performed by medication versus surgery?

It’s changed a lot because of the pandemic. Before the pandemic, surgical abortions were more common. But now, 54 percent of all abortions [in the country] are medication abortion. It has become the primary method of abortion care. 

I do want to emphasize that what we know about how abortion bans function–how they actually manifest when they’re applied–they do disproportionately harm patients of color. And for that reason, I like to emphasize that they are racist policies.