Abortion and Reproductive Care in the Dakotas

As you know by now, if you have been reading my posts here on The Pulse, we are exploring the United States, state by state, region by region, because of what the Supreme Court of the United States (SCOTUS) did last June. On the Dobbs versus Jackson Women’s Health Organization case on abortion, the SCOTUS upheld a Mississippi law prohibiting abortion after 15 weeks of pregnancy. This means 15 weeks counting from the first day of bleeding of the last menstrual period. Although six of nine justices voted to uphold the Mississippi law, this was not the end of it. Rather, five of those six justices also joined onto a majority opinion written by Associate Justice Samuel Alito overturning the 1973 Roe v Wade decision that protected the right to choose. As a consequence, the US is now a patchwork of different situations, when it comes to the legality of abortion and access to abortion. In places where the right to choose abortion is not protected, there also are implications for pregnancy care overall. In some cases, fertility treatment is being threatened as well.

States that are very supportive of abortion and reproductive rights include New York, Connecticut, Illinois, Oregon, New Mexico, Washington, and North Carolina, and various others. Of such pro-choice states, many protect the right to choose up to the point of fetal viability (24-26 weeks gestation) or close to that point. There also are many states with laws extremely hostile to abortion, and with it reproductive health overall. Such states include Mississippi, Tennessee, Georgia, Alabama, Arizona, and Missouri. Meanwhile, there are states with strong majorities of anti-choice Republican politicians in the state legislatures and governors, because of the state constitution, or because of the court system. Such states include Kansas, Alaska, Montana, and Ohio.

Today, we are headed to the Great Plains, and specifically to the Dakotas. The situation is not good for abortion rights and access in the Dakotas, but it’s slightly better in North Dakota compared with South Dakota, as of early November when I’m writing this. North Dakota is known as the Peace Garden State, but don’t confuse it with the Garden State, New Jersey, which is very prochoice. Prior to the Dobbs decision, North Dakota permitted elective abortion was up to 22 weeks gestation. A trigger law was on the books, however, that would ban abortion outright from six weeks gestation, which is just about a complete ban. Unlike the law in neighboring South Dakota, the North Dakota law would allow exceptions for rape and incest. Currently, the North Dakota courts are blocking the trigger law, so actually you could get an abortion in the Peace Garden State. However, right to abortion is on shaky ground in North Dakota and subject change based on the political situation. Only one abortion clinic is actually operating in the state and North Dakota does not permit abortion by way of telemedicine. This means that you would have to go in person to the one clinic, a clinic that is fighting to stay afloat in a state that is geographically very large. As for minors seeking an abortion, North Dakota requires permission from both parents, if both are living, or both guardians.

As for South Dakota, the Mount Rushmore State, this state also had a trigger ban on abortion, but that trigger ban is now enacted law. This means that abortion is not permitted in South Dakota. No exceptions are allowed for rape or incest. This means that your best option, if you are in South Dakota and have an unwanted pregnancy, is to travel out of state. Minnesota could be a possible choice, if you need to drive, but there are organizations to help with travel and lodging for any needed travel for abortion. Given the scarcity of abortion services in North Dakota, you might also need to travel out of state from there, even though technically abortion in North Dakota is still legal.

As a last resort, there is a possibility to obtain a medication abortion by way of a telemedicine visit with an out-of-state abortion provider. This is possible, if you will not be more than 77 days (11 weeks) pregnant (counting the first day of bleeding of your last menstrual period as day 1) by the time that you begin the treatment that will be mailed to you. It is important that you do not reveal your medication abortion to anybody who works for South Dakota, nor to any healthcare provider who helps you with the aftermath, who might face legal consequences for helping you. In most cases, women who undergo medication abortion, guided by telemedicine providers, do not need any in-person care. Understanding of the medications and the abortion process is advanced enough that asking you about your symptoms, and asking follow-up questions, via phone or videoconference reveals enough to be sure that all of the products of conception have been expelled and that you are not in any danger. In a certain fraction of cases, however, there may be persistent symptoms, such as extensive bleeding and/or a fever, making an ultrasound exam necessary to make sure that the products of conception have indeed been entirely expelled. Some recipients of medication abortion also may want to visit a healthcare facility for reassurance.

It is very important for you to know that, medically, the abortion that you would experience as a result of the medication would be indistinguishable from a spontaneous abortion (miscarriage). Doctors and nurses know this and most of them want to help you and don’t have any objection to you terminating your pregnancy. But in states like South Dakota, they don’t want you to reveal the reason for your abortion. They want to be able to document in the records that you received care for a spontaneous abortion. They are at risk of getting into trouble —getting prosecuted and/or losing their licenses— only if you declare that your abortion was self-induced. But they may or may not warn you about this, so just go in with the idea that you are miscarrying and leave it at that.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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