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by Jessica Lussenhop

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For nearly three decades, long before the fall of Roe v. Wade, the blond brick Building for Women in Duluth, Minnesota, has been a destination for patients traveling from other states to get an abortion. They have come from places where abortions were legal but clinics were scarce and from states where restrictive laws have narrowed windows of opportunity.

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For many residents of northern and central Wisconsin, and the Upper Peninsula of Michigan, it was faster to head west toward the Minnesota border than to go southeast to clinics in Milwaukee, Green Bay or Madison. Over the years, thousands of pregnant people climbed the stairs of the Building for Women to get abortions at WE Health Clinic, on the second floor.

Treating travelers from other states is nothing new for WE Health or the other abortion providers around the state, but Minnesota’s role as a so-called abortion access island is. The state’s neighbors have either banned abortion, are poised to do so or have severely restricted the procedure.

Data kept by Minnesota shows that white people make up a larger share of those who travel from another state for an abortion than those who seek abortions in state, raising questions about whether certain groups — particularly people of color — will be able to make the trip.

The Building for Women is home to the WE Health Clinic. (Jenn Ackerman, special to ProPublica)

According to the state’s data, Minnesota residents seeking abortions are a fairly diverse group. From 2018 through 2021, on average, 31% of patients were Black, 9% were Hispanic, 8% were Asian and 2% were American Indian; an additional 6% were recorded as “other.” White patients accounted for 44%.

But among those coming from out of state, people of color made up a much smaller percentage on average of the patient population. White people made up 75% of out-of-state patients.

Experts say some of the disparity results from the fact that the states bordering Minnesota are predominantly white, particularly in the rural areas adjacent to the state. But this also describes Minnesota’s population. So at least some of the difference could be tied to access to transportation or money to travel.

“Minnesota is going to become a haven state, but for what percentage of people that actually need our services?” said Paulina Briggs, WE Health Clinic’s laboratory manager and patient educator. “That’s a huge thing.”

Paulina Briggs, WE Health Clinic’s laboratory manager and patient educator, said the facility was prepared for the estimated rise in out-of-state patients. (Jenn Ackerman, special to ProPublica)

When Roe was overturned in June, the small staff at WE Health Clinic was dismayed but not surprised. In fact, it was prepared to meet the estimated 10% to 25% increase in out-of-state patients.

“We’ve anticipated this for a long time,” Briggs said. “So it’s not like sudden news to us.”

While the clinicians in Duluth may have been prepared for the end of Roe, something much more unexpected happened 2 1/2 weeks later, when a district court judge delivered a surprise ruling that expanded abortion access in the state. Ruling in Doe v. Minnesota, the judge threw out measures that included a mandatory 24-hour waiting period before abortions, two-parent consent for minors and a requirement that physicians discuss medical risks and alternatives to abortion with patients. He also tossed out a requirement that only doctors were allowed to provide abortion care, including by telemedicine, and that after the first trimester, the care had to take place in a hospital.

In contrast to the tearful scenes that played out in many clinics after Roe fell, in Minnesota that Monday morning, abortion providers and their support staff celebrated. Laurie Casey, the executive director of WE Health, was behind her long, crowded desk, doing paperwork when she first got news.

“It’s like, ‘Oh my God, is this real?’” she said. “Something good happened?”

Briggs said: “I think I audibly cheered. Like: ‘Yeah. Hell yeah.’”

Laurie Casey, the executive director of WE Health. She and her staff celebrated a surprise ruling that expanded abortion access in the state. (Jenn Ackerman, special to ProPublica)

Lawyers for the plaintiffs in the Minnesota case, which was filed in 2019, had expected to go to trial at the end of August. Instead, the judge granted abortion supporters a big victory, leaving intact two measures: a requirement that abortion providers collect and report data on their patients to the state, and a law that dictates the rules for disposing of fetal remains.

Minnesota Attorney General Keith Ellison, whose office represented the state in the lawsuit, announced that he would not appeal the court’s decision. Ellison also pledged that he would not prosecute abortion-seekers from other states and wouldn’t cooperate with extradition orders from outside jurisdictions.

Minnesota Gov. Tim Walz signed an executive order making similar promises.

Both officials have made abortion access central tenets of their reelection campaigns.

In these early days of a post-Roe reality, it’s not yet clear who will need these protections, though the data can provide clues.

States track demographic data on abortion differently; according to the Centers for Disease Control and Prevention, more than two dozen publicly report the race and ethnicity of patients. Minnesota is the only access island state in the Midwest that releases those numbers; the state also separates that data into resident and nonresident figures.

Illinois is projected to accept far more out-of-state patients than Minnesota, but its health department does not release statistics about the race and ethnicity of abortion patients. Kansas allows abortion up to 22 weeks, protects the right to abortion in its Constitution and reports one of the highest rates of out-of-state patients in the country, at nearly 50% and second only to Washington, D.C. But Kansas’ state health department does not combine where patients are from with demographic data.

From 2008 to 2021, 13,256 patients who live outside Minnesota received abortion care there, an average of about 950 people a year, according to the state health department. Among that population, the racial and ethnic breakdown of patients has held fairly steady.

A number of factors play into the lack of diversity, said Asha Hassan, a graduate researcher at the Center for Antiracism Research for Health Equity at the University of Minnesota.

“There’s the obvious one that might be coming to mind, which is the effects of the way structural racism and poverty are interwoven,” Hassan said.

The bridge between Duluth and Superior, Wisconsin, often crossed by out-of-state pregnant people seeking abortion care in Minnesota. (Jenn Ackerman, special to ProPublica)

Caitlin Knowles Myers, a professor at Middlebury College in Vermont who studies the economics of abortion, added, “Obviously resources like ability to take time off, ability to get and pay for child care, etc., etc. — that obviously prevents poor women from making a trip.”

Then there is the cost of the procedure itself. In Minnesota, residents can use state medical assistance funds to pay for an abortion under certain circumstances; out-of-state residents cannot. According to Our Justice, a nonprofit that provides financial assistance for abortion care and travel to Minnesota, in-clinic abortion services can cost $400 to $2,000, depending on the gestational age of the pregnancy. A locally based telemedicine service and mobile clinic called Just the Pill charges $350 for abortion medication.

Shayla Walker, executive director of Our Justice, said her organization helps people work through the kinds of barriers to travel that pregnant people of color face every day. Undocumented patients, for instance, may not have a driver’s license or other form of identification, meaning that flying from states like Texas or Oklahoma is out of the question.

Of the out-of-state patients who come to Minnesota, residents from neighboring Wisconsin make up the vast majority. And like Minnesota and its neighboring states, Wisconsin is predominantly white: 80.4% of residents identified as such in the 2020 U.S. Census.

From 2008 to 2021, an average of 690 patients from Wisconsin received abortion care in Minnesota each year. The proportion of Wisconsinites has dropped over the years — in 2008, 80% of out-of-state abortion patients reported that they lived in Wisconsin, compared with 63% by 2021. Over that same period, South Dakota residents ticked up from 4% to 16%, and Iowa patients rose from 2% to 6%.

According to Myers, the lack of abortion providers in western and central Wisconsin likely drives the traffic across the border to Minnesota. These parts of the state are largely rural and mostly white. Wisconsin’s more diverse urban centers are concentrated in the southern and eastern parts of the state, much closer to the Illinois border.

“A lot of them are likely to end up heading south to the Chicago area,” Myers said. “The Chicago area also has a lot of providers and likely a lot of capacity. And the question for Minnesota is, if the Chicago area ends up unable to absorb an enormous influx of patients heading their way from all directions, then you would expect to see patients spilling over into Minneapolis.”

Leaders of the Options Fund, which provides financial help to pregnant people in rural central and western Wisconsin who are seeking abortions, said the majority of the money they provide is for care that takes place in Minnesota.

“Certainly it’s not that people of color don’t exist, of course,” said the group’s vice president, who spoke on the condition of anonymity out of concern for her safety. “But I think generally, the more rural we get, the more white it’s going to be.”

Of course, the data from Minnesota is backward-looking, from years when abortion was still legal, though restricted or sometimes difficult to access, in surrounding states. There are certain to be shifts in where patients travel from, most obviously North Dakota, where the state’s lone abortion clinic moved from Fargo to its Minnesota sister city of Moorhead, just across the border. And as reproductive rights supporters across the country respond to the end of Roe, abortion funds have reported huge increases in their donations, which may bring travel and abortion care in Minnesota within the grasp of more low-income pregnant people and people of color.

The first week after the Doe v. Minnesota decision, WE Health Clinic’s patients felt the impact. Casey said she was able to tell a mother that her minor daughter could receive an abortion without the permission of her long-absent father or from a judge. Briggs was able to schedule a next-day abortion, which would have been illegal before the judge’s decision.

A medical abortion kit from WE Health Clinic includes mifepristone and misoprostol as well as a home pregnancy test, lip balm, candy and other items. (Jenn Ackerman, special to ProPublica)

At some point, a clinic worker went through intake folders and pulled out all the forms certifying that “state mandated information” had been provided to patients. They were fed into the office shredder.

Tossing out their scripts, canceling the physician phone calls 24 hours in advance, no longer going down to the county courthouse to ask judges to grant their minor patients special permission to have an abortion — all of this will save the WE Health Clinic workers hours every week.

Beyond that, the court ruling — which abortion opponents are seeking to have overturned — has the potential to increase the number of providers, as advanced clinicians like nurse practitioners and some classifications of midwives may now be able to get training, and eventually provide abortion care and telemedicine.

This pivotal moment for abortion care in Minnesota and the country at large comes at a moment of major transition for WE Health as well. Casey is looking at retirement in the coming year, which means much of the work of adapting the clinic to serve patients in a post-Roe world will fall to her staff, including Briggs.

Briggs started working at the clinic six years ago, when she was just 23. She wanted to do this work after receiving her own abortion at WE Health as a college student, an experience she found at once “nonchalant” and “empowering.”

She is troubled by the disparities in who might be able to make it across the borders and climb the stairs of the Building for Women, to receive the kind of life-changing care that she did. Just keeping the doors open does not mean the care will be equitable.

Haru Coryne contributed data analysis.

Correction

Aug. 26, 2022: This story originally misstated the age of Paulina Briggs when she started working at WE Health Clinic. She was 23, not 21.

Thirty years ago today, Eric Clapton released what has become the best-selling album of his career, Unplugged. The 14-track acoustic live collection features performances from an episode of the MTV…

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If they auto-enroll everyone in their newly generous income-driven repayment plan, it will significantly take the sting out of resuming payments.

Democrats and Republicans support cannabis legalization by huge majorities, but Congress and President Biden can’t get it done.

Last year’s elections saw gains in use of the public campaign financing system among people of color, younger, and lower-income Seattleites, according to a new report.

by Abrahm Lustgarten

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The western United States is, famously, in the grips of its worst megadrought in a millennium. The Colorado River, which supplies water to more than 40 million Americans and supports food production for the rest of the country, is in imminent peril. The levels in the nation’s largest freshwater reservoir, Lake Mead, behind the Hoover Dam and a fulcrum of the Colorado River basin, have dropped to around 25% of capacity. The Bureau of Reclamation, which governs lakes Mead and Powell and water distribution for the southern end of the river, has issued an ultimatum: The seven states that draw from the Colorado must find ways to cut their consumption — by as much as 40% — or the federal government will do it for them. Last week those states failed to agree on new conservation measures by deadline. Meanwhile, next door, California, which draws from the Colorado, faces its own additional crises, with snowpack and water levels in both its reservoirs and aquifers all experiencing a steady, historic and climate-driven decline. It’s a national emergency, but not a surprise, as scientists and leaders have been warning for a generation that warming plus overuse of water in a fast-growing West would lead those states to run out.

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I recently sat down with Jay Famiglietti, the executive director of the Global Institute for Water Security at the University of Saskatchewan, to talk about what comes next and what the public still doesn’t understand about water scarcity in the United States. Before moving to Canada, Famiglietti was a lead researcher at NASA’s water science program at the Jet Propulsion Laboratory in Pasadena, California, and a member of the faculty at the University of California, Irvine. He pioneered the use of the Gravity Recovery and Climate Experiment satellites to peer into the earth’s mass and measure changes in its underground water supplies. The Colorado River crisis is urgent, Famiglietti said, but the hidden, underground water crisis is even worse. We talked about what U.S. leaders either won’t acknowledge or don’t understand and about how bad things are about to get.

Our conversation has been edited for length and clarity.

Let’s start with the Colorado River because it’s in the news. The federal government has put some extraordinary numbers out there, suggesting water users cut between 2 and 4 million acre-feet of water usage starting this year — roughly 40% of the entire river’s recent flow. How could that possibly happen?

It’s going to be really hard. We’re looking at drastically reduced food production and the migration of agriculture to other parts of the country and real limits on growth, especially in desert cities like Phoenix. My fear is that groundwater will, as usual, be left out of the discussion — groundwater is mostly unprotected, and it’s going to be a real shit show.

Remind us how that happens. States and farmers cut back on the Colorado River, and California and Arizona just start pumping all the water out of their aquifers?

Yeah. This started with the drought contingency plan [the 2018 legal agreement among the states on the Colorado River]. Arizona had to cut nearly 20% of its Colorado River water. To placate the farmers, the deal was that they would have free access to the groundwater. In fact, something like $20 million was allocated to help them dig more wells. So, it was just a direct transfer from surface water to groundwater. Right away, you could see that the groundwater depletion was accelerating. With this latest round, I’m afraid we’re just going to see more of that.

Some of that groundwater actually gets used to grow feed for cattle in the Middle East or China, right? There’s Saudi-owned agriculture firms planting alfalfa, which uses more water than just about anything, and it’s not for American food supply. Do I have that right?

There’s been other buyers from other countries coming in, buying up that land, land grabbing and grabbing the water rights. That’s happening in Arizona.

What about in California? Groundwater depletion has caused the earth to sink in on itself. Parts of the Central Valley are 28 feet lower today than they were a century ago.

California passed the Sustainable Groundwater Management Act in 2014, which mandated an extraordinarily long time horizon: two years to form the Groundwater Sustainability Agencies and then five years for each GSA to come up with its sustainability plan. So that’s now: 2022. And then 20 years to come into sustainability. My fear is that the slow implementation will allow for too much groundwater depletion to happen. It’s sort of the same old, same old.

But could it work?

I don’t think we’re talking about sustainability. I think we’re talking about managed depletion. Because it’s impossible to keep growing the food that we grow in California. It’s agriculture that uses most of the groundwater. The math just isn’t there to have sustainable groundwater management. If you think of sustainability as input equals output — don’t withdraw more than is being replenished on an annual basis — that’s impossible in most of California.

Will we run out of water? Are we talking about 10 years or 100 years?

Yes. We are on target to. Parts of the Central Valley have already run out of water. Before SGMA, there were places in the southern part of the valley where I would say within 40 to 50 years we would run out or the water is so saline or so deep that it’s just too expensive to extract. SGMA may slow that down — or it may not. I don’t think the outlook is really good. Our own research is showing that groundwater depletion there has accelerated in the last three years.

Then what happens? What does California or Arizona look like after that?

It looks pretty dry. Even among water users, there’s an element that doesn’t understand that this is going to be the end for a lot of farming. Farmers are trying to be really efficient but also magically want the supply of water to be sustained.

We focus on the big cities like Phoenix and Las Vegas, but it’s farms that use 80% of water. They grow crops that provide huge amounts of the winter fruits and vegetables and nuts for the entire country. Is there any way that farming in California and Arizona can continue even remotely close to how it is today?

I don’t think so. It has to drastically change. We’ll need wholesale conversion to efficient irrigation and different pricing structures so that water is better valued. We’ll need different crops that are bred to be more drought tolerant and more saline-water tolerant. And we’ll probably have a lot less production.

What does that mean for the country’s food supply?

This is the big question. I don’t want to be flippant, but people don’t understand the food-water nexus. Do we try to bring more water to the southern high plains, to Arizona, to California, because if the food system’s optimized, maybe that’s the cheapest thing to do? Or does agriculture move to where the water is? Does it migrate north and east? It’s not just food production. What about the workers? Transportation? If we were to move all of our agriculture to northern California, into Idaho, into North Dakota over the next decade, that’s a major upheaval for millions and millions of people who work in the ag industry.

It’s really interconnected, isn’t it? The nation essentially expanded West beginning in the 19th century in order to build a food system that could support East Coast growth. The Homestead Act, the expansion of the railroads, was partially to put a system in place to bring stock back to the meat houses in Chicago and to expand farming to supply the urban growth in the East.

I don’t think a lot of people really realize that, right? When I go to the grocery store in Saskatoon, my berries are coming from Watsonville, California. The lettuce is coming from Salinas, California.

Farmers in the West are fiercely independent. So, in California, Arizona, do they lose the ability to choose what to plant?

Right now, there’s freedom to plant whatever you want. But when we look out a few decades, if the water cannot be managed sustainably, I don’t actually know. At some point we will need discussions and interventions about what are the needs of the country? What kind of food? What do we need for our food security?

Let’s discuss California. Its governor, Gavin Newsom, has advanced a lot of progressive climate policies, but he replaced the water board leader, who pushed for groundwater management across the state, and last month the agency’s long-serving climate change manager resigned in protest of the state’s lax water conservation efforts. What does it mean if a liberal, climate-active governor can’t make the hard decisions? What does that say about the bigger picture?

There has been a drop off from the Jerry Brown administration to the Newsom administration. Water has taken a step lower in priority.

Is that a sign that these problems are intractable?

No. It’s a sign that it’s just not as high a priority. There are tough decisions to be made in California, and some of them won’t be popular. You can see the difference between someone like Brown, who was sort of end-of-career and just like, “Screw it, man, I’m just going to do this because it needs to be done,” and someone like Newsom, who clearly has aspirations for higher office and is making more of a political play. We’re not going to solve California’s water problem, but we could make it a lot more manageable for decades and decades and decades. (Newsom’s office has rejected the criticism and has said the governor is doing more than any other state to adapt to climate change. On Aug. 11 his administration announced new water recycling, storage and conservation measures.)

Water wars. It’s an idea that gets batted around a whole bunch. Once, negotiating water use more than a century ago, California and Arizona amassed armed state guard troops on opposite banks of the Colorado River. Is this hyperbole or reality for the future?

Well, it’s already happening. Florida and Georgia were in court as was Tennessee. There’s the dispute between Texas and New Mexico. Even within California they’re still arguing environment versus agriculture, farmers versus fish, north versus south. Sadly, we’re at a point in our history where people are not afraid to express their extreme points of view in ways that are violent. That’s the trajectory that we’re on. When you put those things together, especially in the southern half or the southwestern United States, I think it’s more of a tinderbox than it ever has been.

That’s hopeful.

You’re not going to get any hope out of me. The best you’re going to get out of me is we can manage our way through. I don’t think we’re going to really slow global change. We have to do what we’re doing because we’re talking about the future. But a certain number of degrees warming and a certain amount of sea level rise is already locked in, and all that’s happening in our lifetimes. The best you’re going to hear from me is that we need to do the best we can now to slow down the rates of warming that directly impacts the availability of water. We’re talking about the future of humanity. I think people don’t realize that we’re making those decisions now by our water policies and by our climate change policy.

When people think about water, they think of it as a Western problem, but there’s water shortages across the High Plains and into the South, too.

I don’t think most people understand that scarcity in many places is getting more pronounced. Nationally, let’s look at the positives: It’s a big country, and within its boundaries, we have enough water to be water secure and to be food secure and to do it in an environmentally sustainable way. A lot of countries don’t have that. That’s a positive, though we still have the same problems that everyone else has with increasing flooding and drought. What I really think we need is more attention to a national water policy and more attention to the food, water and energy nexus. Because those are things that are going to define how well we do as a country.

What would a national water policy look like?

It recognizes where people live, and it recognizes where we have water, and then it decides how we want to deal with that. Maybe it’s more like a national water/food policy. Moving water over long distances is not really feasible right now — it’s incredibly expensive. Does the government want to subsidize that? These are the kind of things that need to be discussed, because we’re on a collision course with reality — and the reality is those places where we grow food, where a lot of people live, are running out of water, and there are other parts of the country that have a lot of water. So that’s a national-level discussion that has to happen, because when you think about it, the food problem is a national problem. It’s not a California problem. It’s not a Southern, High Plains, Ogallala, Texas Panhandle problem. It’s a national problem. It needs a national solution.

Is this a climate czar? A new agency?

Something like that. We’re failing right now. We’re failing to have any vision for how that would happen. In Canada, we’re talking about a Canadian water agency and a national water policy. That could be something that we need in the United States — a national water agency to deal with these problems.

In the Inflation Reduction Act we finally have some legislation that will help cut emissions. There’s plenty of other talk about infrastructure and adaptation — seawalls and strengthening housing and building codes and all of those sorts of things. Where would you rank the priority of a national water policy?

It’s an absolute top priority. I like to say that water’s next, right after carbon. Water is the messenger that’s delivering the bad news about climate change to your city, to your front door.

We don’t usually mix concern over drought with concern over contamination, but there was a recent study about the presence of “forever” chemicals in rainfall and salt washing off the roads in Washington, D.C., and contaminating drinking water. Can these remain separate challenges in a hotter future?

It doesn’t get discussed much, but we’re seeing more and more the links between water quality and climate change. We’ve got water treatment facilities and sewers close to coasts. During drought, discharge of contaminants is less diluted. The water quality community and the water climate communities don’t really overlap. We’ve done a terrible job as stewards where water is concerned.

Globally, what do you want Americans to think about when they read this?

The United States is kind of a snapshot of what’s happening in the rest of the world. There’s no place we can run to. Things are happening really, really fast and in a very large scale. We as a society, as a country or as a global society are not responding with the urgency, with the pace and the scale that’s required. I am specifically talking about rapid changes that are happening with freshwater availability that most people don’t know about. The problems are often larger than one country. A lot of it is transboundary. And we’re just not moving fast enough.

News flash.

Around the world the water levels have just continued to drop. In the Middle East or India. In fact, they’re getting faster. It’s actually a steeper slope.

So, the Colorado River is the least of our worries.

Globally? It’s not even as bad as the others. Arizona doesn’t really show up as much compared to some of these places.

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Listen to an episode about Bevo Mill on our Here’s History podcast with KDHX. While its architecture might seem like whimsical fun today, south St. Louis’s Bevo Mill was once a carefully crafted piece of propaganda in a life-and-death struggle. When early 20th century calls for the prohibition of alcohol threatened to leave the nation permanently “dry,” …

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ALTON - Enjoy the sounds of smooth jazz and the taste of great wine as the successful Alton Jazz & Wine Festival returns to Liberty Bank Alton Amphitheater on Saturday, September 3, 2022 with gates opening at 6pm. The Alton Jazz Confluence, featuring up and coming Alton/Godfrey student musicians, will again kick off this year’s festival. Following this exciting group of future jazz stars will be The Kendrick Smith Trio. The headliners for this year’s Alton Jazz & Wine Festival will be Mardra and Reggie Thomas. “The Alton Amphitheater Commission is excited to again bring great jazz to Liberty Bank Amphitheater with this popular and growing event,” said Dan Herkert, Amphitheater Commission Chair. “We’re particularly proud to again feature some of our local student musicians at the beginning of the festival.” “We are also thrilled to bring back the intimate jazz club setting where tables will be on the stage surrounding the artists as

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Holland Construction Services has announced the addition of three new employees to its growing team. The new employees include Kent Richardson as Senior Virtual Design and Construction Engineer, Ashleigh Loehring as Project Administrator and Garrison West as Project Manager. “2022 has been an outstanding year of growth for Holland Construction Services despite all of the […]

Brian Baybo of St. Peters, MO joined the Real Rock Army today

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LGBTQIA+ communities have been contributing to St. Louis’s history for centuries. Now the Gateway to Pride virtual exhibit will begin to uncover the rarely-shared or

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Comptroller Darlene Green said same incentives should also to be made available for other first responders as well as teachers and nurses.

Brian Rayford is charged in the death of Moline Acres police Sgt. Herschel Turner.

From St. Louis Business Journal:  Aegion Corp., a Chesterfield-based infrastructure repair company, bought a Boston-based business that provides underground and vacuum excavation, among other services. Aegion said it has acquired Next Level Environmental, which also provides other services to manage aging infrastructure, including pipe inspections, trenchless cured-in-place pipe repairs, pipe location services, and sewer and […]

In the New York Times today, Maia Szalavitz writes about how Seattle finally tackled chronic homelessness. A few years ago Lisa Daugaard, a lawyer, developed a program called LEAD: Instead of re-incarcerating homeless people who typically already have long histories of minor arrests, police departments that participate in LEAD refer them to case management services. ...continue reading "Here’s how to get the hard-core homeless into homes"

Some are content with the plan while others question whether the amount is enough to address certain groups' needs.

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