Who's having abortions in North Dakota? Here's a by-the-numbers look

FARGO — Data tucked away on the state health department website provides a snapshot of women seeking abortions in North Dakota — women who will have to find other options if Roe v. Wade is overturned and the state’s so-called “trigger” ban prohibiting abortion takes hold.

A change to the landmark 1973 decision establishing a constitutional right to abortion appears likely, based on a leaked U.S. Supreme Court draft opinion published May 2.

North Dakota’s trigger law, similar to those in a dozen other states, would ban abortion within 30 days of Roe being overturned.

Anyone performing an abortion, other than the pregnant female on whom it would be performed, could face a Class C felony, except in cases of rape or incest or if the mother's life is in danger.
Abortion statistics are compiled by the North Dakota Department of Health Division of Vital Records. The most recent year for which complete data is available is 2020.

The “by-the-numbers” annual report, referred to as Induced Termination of Pregnancy Data, lays out details including age, education, race and marital status, along with week of gestation at the time of abortion, number of living children and number of previous abortions.

The 1,171 abortions performed in North Dakota in 2020 happened at the state’s only abortion-providing facility: the Red River Women’s Clinic in downtown Fargo.

Abortions are done by an out-of-state doctor each Wednesday, a day that also draws protest and prayer from people hoping to dissuade patients from following through with the procedure.

The North Dakota Catholic Conference pulls its own abortion statistics from the health department numbers, focusing on North Dakota women only.

Christopher Dodson, executive director and general counsel, said they do that to see how well organizations are doing at providing alternatives to abortion.

“That's what we're trying to figure out. How are we missing these women?” Dodson said. 
Most women seeking abortions in North Dakota already have children at home, according to the state health department data.

Red River Women's Clinic Director Tammi Kromenaker said that’s also true on a national scale.

“Who better than a mom to know what she can or cannot handle? These are people who know what parenting takes,” Kromenaker said.

Minors are a small percentage of those seeking abortion, and most have a parent who has provided consent.

Young people are becoming increasingly open to talking with their parents about such matters, she said, an outcome of changing parenting styles.

Abortion rates in North Dakota are lower now than in the late 1990s and early 2000s but have remained mostly steady over the past decade.

The highest number came in 2008 when 1,386 abortions were performed — 215 more than in 2020.

In Minnesota, abortion rates have also fallen from a high of nearly 13,000 in 2008 to 9,108 in 2020 but also have been leveling off.

Adjusted for total population, rates in the two states are about the same.

Dodson looks at the situation a little differently.

While abortion numbers are stagnant, the number of pregnancies in North Dakota is on the rise, he said, so those that end in abortion have actually fallen to 7%.

Angela Wambach, executive director of the Women’s Care Center, said more women have sought abortion alternatives since their agency moved to a new, more visible location in downtown Fargo a few years ago.

“We’ve tripled the number of women we’ve served on an annual basis,” Wambach said.

The agency is part of the statewide Alternatives to Abortion program, established by and funded through the Department of Human Services and managed by The Village Family Service Center in Fargo.

Statistics tracked by The Village indicate 1,300 women were served by 11 providers of Alternatives to Abortion programming in North Dakota from July 2020 to July 2021.

Program Director Sue Grundysen said of the 418 clients in that group who had been considering abortion, 21 later reported changing to “abortion not being an option.” 

Dodson said the statistics provide only a partial picture, however.

Due to confidentiality, agencies aren’t able to later contact clients to see if they followed through with their pregnancies, and not all pregnancy centers or maternity homes participate in the state program.

A majority of patients, more than 830, who sought abortions at the Red River Women’s Clinic in 2020 were North Dakota residents.

More than 275 were residents of Minnesota, and 57 lived in South Dakota.

Kromenaker said Alexandria, Minnesota, seems to be a geographical cutoff. People living north of there tend to go to the clinic in Fargo while those south of Alexandria seek appointments in the Twin Cities.

One reason South Dakota patients drive north is that they may be closer to Fargo than to Sioux Falls, the only city in that state where abortions are performed.

Also, South Dakota has a 72-hour waiting period for abortion, requiring multiple trips to the clinic in the same week, as opposed to North Dakota’s 24-hour waiting period.

“For some patients, that's completely out of reach,” Kromenaker said.

As for level of education, about half of those women seeking abortion in North Dakota had a high school diploma or less.

The vast majority, or 990 of the total 1,171, were not married.

In terms of race, most women seeking abortions in North Dakota identify as white.

Up until 2015, Native Americans had the second-highest number of abortions, followed by Black women. That year, Black women surpassed Native American women in that category and have remained there since, a reflection of the changing race makeup in the wider community, Kromenaker said.

The winter months and early spring tend to be busier at the Red River Women's Clinic.

April was the busiest month of 2020, which Kromenaker attributes to the start of the COVID-19 pandemic, when people stayed home and kept their social circles small.

Patients must receive counseling and those state-directed abortion alternative materials as part of the 24-hour waiting period in North Dakota and be offered an ultrasound prior to the procedure.

Abortions are performed in the state up until 20 weeks gestation; later than that, they are done only if the woman’s life is in danger.

A developing fetus is generally considered viable at 24 weeks gestation.

Kromenaker said 91% of patients receiving abortions at the clinic are at 12 weeks gestation or fewer.

Minors must get parental consent or, in its absence, a judicial bypass before an abortion can be provided.

Based on statistics Kromenaker kept, 37 minors sought abortions in 2021, representing 3% of all patients seen.

Of those, only seven did not have a parent involved in some way, she said.

That doesn’t mean no adult was involved, however, because an older sister, aunt or grandmother will sometimes fulfill that role.

The age group with the highest number of abortions is 20 to 24, because they typically are having sex more often than other age groups, Kromenaker said.

Women in their late 20s and early 30s make up the next largest groups.

Older women also sought abortions. In 2020, 40 women aged 40 and older had abortions in North Dakota.

Women that age who miss a period often think menopause has begun, only to learn they’re pregnant.

They’re often done raising their family and might even be sending children off to college or planning a wedding for them, Kromenaker said, and are not open to starting over with an infant.

The oldest patient to receive an abortion at the clinic was 52 years old.

“She was an outlier,” Kromenaker said.

More than 450 women who had abortions in North Dakota in 2020 had never given birth before.

But the rest, more than 60%, had one or more living children at home.

Kromenaker said those patients often tell her that adding another child to the family would be the breaking point.

The state also tracks the number of previous abortions a woman has had.

In 2020, more than 33% of women receiving abortions in North Dakota had one or more previously.

There were 26 women who had four or more previous abortions, the data shows.

Kromenaker said she’s not surprised when women have more than one unintended pregnancy, given their fertility can span a period of 30 years or more, and there’s a lack of comprehensive sex education and access to birth control in the state.

“That’s asking a lot for somebody who might not have resources, education or access,” she said.

If Roe v. Wade is overturned, Kromenaker said, Black and Native American women will be most impacted because they might not have the resources to travel for an abortion elsewhere.

Dodson plans to continue trying to reach those women and others, making sure they never consider the “perceived need” to go out of state for abortions.

Kromenaker aims to set up another abortion clinic across the Red River in Moorhead if the Fargo facility has to close.

“It is my hope to be able to pull that off. Whether we can or not, I don't know,” she said.