Since the Dobbs, decision, many US states have moved to recriminalize abortion, while others have taken steps to legally protect abortion rights. Only 20 states have adopted laws or policies that “protect” the ability to obtain an abortion, by enshrining abortion rights in state constitutions and repealing gestational age limits. Even within these states, access to abortion is not equally distributed. Rural populations in states like Minnesota continue to face geographic and logistical barriers to receiving abortion care, evidence that while state law is a critical aspect of the fight for reproductive justice, law alone will not be enough to guarantee comprehensive access to reproductive health care.
Minnesota Protects Legal Right to Abortion
In 2023, Minnesota Governor Tim Walz signed the “Protect Reproductive Options” Act (PRO Act). The Act stipulates that “every individual has a fundamental right to make autonomous decisions about the individual’s own reproductive health” and that “Every individual who becomes pregnant has a fundamental right to continue the pregnancy and give birth, or obtain an abortion, and to make autonomous decisions about how to exercise this fundamental right.” In practice, this means that no Minnesota municipality can legally restrict whether one can perform or seek reproductive healthcare, and that those who travel to Minnesota for abortions cannot be prosecuted by their home state for exercising these rights within Minnesota. In 1995, Minnesota also began providing Medicare coverage for abortions and removed gestational age limits following ,Doe v. Gomez, a landmark Minnesota Supreme court case which set the legal stage for the 2023 PRO Act.
During then presidential candidate, Kamala Harris’ historic visit to a Planned Parenthood in Saint Paul, Minnesota, in 2024, Dr. Sara Traxler, Chief Medical Officer at Planned Parenthood North Central States, praised the state’s support for abortion providers and patients. However, in the same speech, Dr. Traxler nuanced perceptions of abortion experiences in the state, describing patients who travelled great distances from rural areas or had to drive across the state in blizzard conditions for their appointment.
Place-based disparities in reproductive healthcare
Dr. Traxler’s words highlight a common difficulty in accessing reproductive health care: the lack of abortion providers in rural locations.
Nationally, the average distance to an abortion clinic is 86 miles, with 14% of people living more than 200 miles from a clinic. Even within states that have moved to legally protect abortion, rural abortion-seekers struggle to access such care.
Urban/rural divides in reproductive healthcare access have long been a concern for medical and public health professionals. In Minnesota, as of the summer of 2025, there were seven clinics providing surgical and medication abortions. Of these clinics, four are located within the Twin Cities metro area, and the other three are in the cities of Rochester, Duluth, and Moorhead. Depending on their location, many individuals in the state have to drive two to four hours to reach the clinic nearest to them. As of 2023, Minnesotans in over half of the state’s counties live 50+ miles from an abortion-providing facility.
While some states have attempted to criminalize interstate travel for the purposes of abortion, the courts have provided some tenuous protections for abortion seekers. In the aftermath of Dobbs, we know that travel for the purposes of seeking abortion has increased. The geographic concentration of providers in large metro areas results in logistical and financial challenges for patients, including financial barriers and access to transportation and lodging. Travel for abortion is generally associated with a significant emotional cost, such as increased feelings of shame and pressure to disclose information about one’s abortion. Financially, those traveling over 50 miles for abortion care often pay at least $100 for non-procedure related costs (gas, bus fare, hotel costs, child care).
Making Abortion Accessible for Rural Populations
How can we reduce urban/rural disparities in reproductive health care access and assist patients seeking abortion care? First, rural abortion-seekers need digital resources and patient navigators in order to better understand their options. In 2021, the Guttmacher Institute developed a map which generates the driving distance to the nearest abortion clinic from a user’s home state. However, the map only allowed users to input their state of residence as the starting point and has since been replaced by a map that only highlights state-level policies on abortion. As clinics relocate along state borders to better serve rural and traveling populations, it is imperative to provide abortion seekers with accurate information about the nearest clinics.
And yet, publicly available information about abortion providers poses safety issues. After the tragic assassination of Sen. Melissa Hortman and attempted assassination of Sen. John Hoffman in Minnesota in June of 2025, media outlets reported that the shooters’ “hit list” of other potential targets included a significant number of abortion activists and clinicians. At the start of his second term, Donald Trump pardoned anti-abortion protesters previously charged under the FACE Act (Freedom of Access to Clinic Entrances Act) for blocking entrances to abortion-providing clinics, calling them “peaceful pro-life protesters.”
As threats to clinics increase, the availability of clinic and clinician information is a double-edged sword. In this environment, investing in confidential patient-navigation programs is vital.
Sometimes called “abortion travel agents,” patient-navigators support those seeking abortions by connecting them to financial resources, booking airfare or bus tickets, coordinating volunteer drivers, or arranging lodging. These workers also help clarify the legality of abortion options based on a patient’s geographic location. Existing programs like this in Minnesota, such as the Midwest Access Coalition, tend to serve rural residents of the state.
In the long run, it is imperative to establish and support abortion providers in rural communities, reducing the need for travel. Minnesota does not require abortions to be provided in hospitals; instead, abortions can be provided in birthing centers and patients can access medication abortions through telehealth appointments. As of 2023, abortions are not required to be provided by physicians; nurse practitioners are licensed to perform in-clinic abortions and prescribe abortion medication. However, U.S World News reports that only 271 nurse practitioners in Minnesota specialize in women’s health/obstetrics and gynecology, and advance practice clinician trainings (nurse practitioners, physician assistants, and certified nurse-midwife) rarely include abortion care training.Research addressing urban/rural abortion disparities in Australia shows that nurse-led abortion care may be central to bridging gaps in care, particularly as nurses are more likely to be long-term community members in rural areas, bolstering trust from patients.
Increased training in abortion services for nursing students, both in Minnesota and beyond, may help to make abortion care more accessible in rural areas.
Increased access to abortion requires additional funding. Minnesota and other abortion-protective states should look to the “New York State Abortion Access Program” for inspiration to further financially invest in rural healthcare providers. Introduced in the summer of 2025, the program provides $24 million in state grants towards reproductive healthcare and abortion providers, including investment in clinic infrastructure and security, and funds to reimburse up-front costs associated with providing abortion care. A similar bill was introduced in the Minnesota state house in 2024, with an emphasis on increasing reproductive health equity but it did not garner enough committee support to warrant a vote. Allocating funding through a proposed budget may decrease resistance and simplify implementation, particularly under pro-abortion state legislatures. Particularly as federal funding for reproductive healthcare services is being significantly cut, such state-level provisions are vital to the daily operations of abortion clinics.
Expanding access to abortion medication and telehealth services is another vital strategy for rural communities. In addition to brick-and-mortar clinics, Minnesota is served by a digitally based abortion medication organization, Just the Pill. Medication abortions, where patients take two pills, often at home, to stop a pregnancy from continuing and then empty the uterus, are widely considered safe and effective. However, medication abortions are only effective for terminating pregnancies during the first 12 weeks and are not generally effective for those with ectopic pregnancies. As such, the expansion of telehealth must be paired with greater training in abortion care and clinic-based care in rural areas to transform Minnesota from a protective state with limited access, to a state that truly guarantees reproductive justice for all.
