Holly Alvarado was 22 and just weeks from deployment in the U.S. military when she realized she was pregnant. She knew she wasn’t in a place emotionally or financially to have a child. She called a Planned Parenthood and asked how—and where—she could get an abortion.
At the time, Alvarado was stationed in Grand Forks, North Dakota, a city on the Minnesota border just 90 miles south of the Canadian border. The sole abortion clinic in the state, a two hour drive from her home, wasn’t able to see her before her departure. The next closest provider was more than four hours away in Minnesota.
Seeing no other options, Alvarado hit the road. There was no money for a hotel or meals; the cost of the abortion would empty her savings, leaving $15 in her bank account by the time she was deployed. So Alvarado filled her tank with gas and slept in her Honda CRV, subsisting on Gatorade and saltines she’d bought at the on-base grocery store before she left.
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“I was exhausted and tired and I was more scared than anything,” Alvarado, who asked that her full name not be used, recalled in an interview with The Daily Beast. “ It was a really crazy moment where I’m like, I don’t know what the hell I’m going to do, but this needs to happen.”
Alvarado’s story isn’t unique in this part of the country. North Dakota, one of six states with just one abortion provider, is home to some of the most restrictive abortion laws in the country. It’s vast, rural size and lack of public transit has contributed to another basic, yet often even more consequential barrier for women seeking abortion: travel.
Women seeking abortion in North Dakota faced journeys of 151 miles on average in 2014, compared to a national average of just under 11 miles, a report published in The Lancet Public Health journal in 2017 found,. One in five women in North Dakota traveled more than 280 miles for their procedure. Another study, published in April of 2018, identified North Dakota’s capital of Bismarck as one of 27 large cities deemed “abortion deserts” in the United States. Women there must travel 196 miles to get an abortion, researchers with University of California, San Francisco’s Bixby Center for Global Reproductive Health found. The findings highlight that while high-profile battles over abortion rights and clinic closures in Texas and across the South capture headlines, the combination of geography, harsh laws and limited clinic numbers have greatly decreased access in the midwest as well.
“If you look at the proportion of women of reproductive age living in the states to the number of clinics, [the midwest is home to] the highest number of women per clinic,” Alice Cartwright, a lead author on the abortion desert report and project director of the university’s Advancing New Standards In Reproductive Health program, said. “That’s sort of not part of the narrative, a lot of times the focus was on the South.”
Now, as all eyes turn to how the outcome of the confirmation battle over President Donald Trump’s Supreme Court nominee Brett Kavanaugh could affect abortion rights, advocates and providers in the upper midwest region and beyond are preparing for the possibility that such ratios and the travel needed for abortion-related care will grow. North Dakota and South Dakota, which also has one clinic, are two of the four states with so-called “trigger laws” that would automatically outlaw abortion if Roe v. Wade, the 1973 ruling protecting a right to abortion, is overturned. Under that scenario, there would be no legal providers within the states’ combined area of 149,548 square miles — a swath of land twice the size of New England.
“Women are traveling on average right now hours and hours just to get to the one abortion clinic in North Dakota,” Tammi Kromenaker, director of Red River Women’s Clinic, the state’s sole abortion provider, said. “If Roe were to fall and the ban were to become a reality, those women would travel even farther.”
The access drought would spread beyond the Dakotas. A Supreme Court vote to overturn Roe v. Wade would likely render large portions of the country legal abortion deserts. At least 23 states are considered at high risk of outlawing legal abortion in a post-Roe world, according to a report by the Center for Reproductive Rights. As a map produced by the center shows, the makeup of those states would leave large portions of the country without legal abortion.
“There would undoubtedly be a large number of women who would simply be unable to make those trips,” Janet Crepps, a senior counsel for CRR who has argued against some of North Dakota’s stringent abortion restrictions, said. “Even a reduction in the constitutional right to abortion, much less an outright loss of that right, is going to put abortion out of reach for million women.”
Kromenaker has already seen the effect a lack of access can have. The Fargo clinic, which offers a range of women’s reproductive health services, averages 20 to 25 abortions on the one day a week it offers the procedure. It’s not unusual for those patients to drive from towns four or six hours away. Some even travel from as far as Rapid City, South Dakota, an eight-hour drive, she said. The cost of that travel can be burdensome for many; Kromenaker estimates that half of the patients receive some sort of financial assistance.
“Women have to miss work, they have to arrange child care. For those women who are in abusive or controlling relationships, it’s difficult to be gone for that long,” she said. “It takes resources and energy to go that distance. The most vulnerable women in the society — poor women, women of color — it puts those women at greater risk.”
Kromenaker worries that the risk for women living in states like hers will drastically increase if abortion and more women are forced to travel farther or seek alternative means for terminating pregnancies. Given the stakes, she said she and other abortion rights supporters in the state are starting to work together to ensure the state’s U.S. Sen. Heidi Heitkamp “hears our concerns.” Heitkamp, who is facing a tough re-election challenge in a state won by Trump, was one of three Democratic senators to vote for the GOP president’s first Supreme Court nominee, Neil Gorsuch.
“We are at a time right now where we are facing the possibility that women in different states have different rights and it’s just simply not okay,” she said. “ I think folks need to really realize what that could do and what that devastation could be.”
That’s something Alvarado, now 31 and living on the West Coast in a state with much more permissive abortion laws, is thinking about a lot these days. She says her life wouldn’t have been the same had she not been able to have an abortion. Looking back, she says “no amount of miles between me and that clinic would have stopped me.” “It could have been 12 damn hours and I would have done it. I just don't know how I would have done it,” she said.
But she knows for many other women, that might not be an option.
“When I think of the women in North Dakota who have to drive six hours for any of this, it’s just heartbreaking,” she said. “What do these women do? What do they do if they don’t have a car, if they need child care, if they can’t get a day off their job? That’s what keeps me up at night.”
