Abortion Options In North Dakota Are Dwindling

Tammi Kromenaker sits in the waiting room of the Red River Valley Women’s Clinic CREDIT: AP PHOTO/DAVE KOLPACK
Tammi Kromenaker sits in the waiting room of the Red River Valley Women’s Clinic CREDIT: AP PHOTO/DAVE KOLPACK

The only abortion clinic in North Dakota has stopped providing medication abortion, the non-surgical method of ending an early pregnancy, following a court ruling that upheld a state law restricting the use of the pills. In a state that has been plagued with attacks on abortion over the past several years, it’s just the latest example of women losing access to some of their reproductive health options.

The director of the clinic, Tammi Kromenaker, has been fighting hard to keep her doors open amid a mounting number of state laws that limit reproductive rights. She told the Associated Press that she can’t risk triggering legal action against the Red River Women’s Clinic for testing the new court ruling. To be safe, she instructed her staff on Wednesday to stop administering the abortion pill.

Now, some of her patients will have to seek other options. According to Kromenaker’s estimates, about 20 percent of the 1,300 abortions the clinic performs each year are medication induced. This week alone, eight patients were scheduled for medication abortions and will now need to find an alternative, like rescheduling a surgical procedure with one of the clinic’s three out-of-state physicians.

Late Tuesday night, the highest court in the state upheld a 2011 law that requires doctors to adhere to the FDA’s outdated protocol for administering the abortion pill. This legal challenge has been winding its way through the courts for the past three years. The medication abortion restrictions were temporarily blocked before they could take effect in 2011, and then permanently blocked in the spring of 2014. But Wednesday’s ruling from the state Supreme Court reverses those decisions.


Stipulating that doctors need to follow the federal recommendations for administering the abortion pill sounds logical on the surface. But the Center for Reproductive Rights, the group fighting against the law, says the measure “completely misconstrues the role of the federal Food and Drug Administration in approving drugs for the market.” It’s not uncommon for drugs to be prescribed for off-label use before the FDA’s official protocol catches up, and it doesn’t make sense to force abortion doctors to adhere to old regulations when women have been safely taking the abortion pill for years.

In reality, this type of requirement often functions as a back-door ban on medication abortion — which is exactly what’s playing out in North Dakota, where women no longer have this option for terminating a first-trimester pregnancy.

“The politicians pushing for these unconstitutional and downright dangerous restrictions have had only one goal in mind: prevent North Dakota women — whom already face incredible obstacles to the severely limited reproductive health care services in their state — from exercising their legal right to abortion,” Nancy Northup, the president of the Center for Reproductive Rights, said in a statement.

Nonetheless, this has become an increasingly popular method of restricting abortion that’s sparked similar legal challenges in states like Arizona and Oklahoma. Depending how the circuit courts ultimately rule, this particular issue regarding medication abortion could make its way up to the Supreme Court.

North Dakota lawmakers have the distinction of approving the harshest abortion laws in the country. In 2013, the state passed a six-week abortion ban, as well as stringent restrictions that threaten to close Kromenaker’s clinic. Both of those laws have so far been blocked from taking effect — but it doesn’t end there. The legislature also put a radical “personhood” measure on this year’s ballot that would extend rights to fertilized eggs, a policy that could have sweeping consequences for everything from abortion access to in vitro fertilization to inheritance rights. Voters head to the polls next week to decide whether to approve that initiative.


This environment has created a fundamental uncertainty about whether abortion is even legal in the state anymore. Some North Dakota residents think their legislators have already accomplished their goal and banned the procedure altogether.

Kromenaker has her work cut out for her as she tries to emphasize that she’s still open for business in some capacity. At the top of her clinic’s website, written in red type, two sentences try to get the message across: “Abortion is STILL legal in the state of North Dakota. Red River Women’s Clinic is OPEN, available for appointments and LEGALLY performing abortions in the state of North Dakota.”