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When Alicia Kotz and her husband were ready to have children, she struggled to conceive. She miscarried before her first child arrived. She then experienced medical issues again, losing another pregnancy before finally having her second child.

Recently, her doctor told her if she got pregnant again, it would be too hard on her body and she could die. While she has no plans on getting pregnant, she also hasn’t entered menopause. She has painful periods that often mimic contractions, as well as uterine cysts. 

As she spent the last six months debating what to do, a major event impacted her choice — the reelection of Donald Trump as president.

“I thought no, I have to make a permanent decision now. I have to have it removed, I cannot risk getting pregnant again,” Kotz, of Shakopee, Minn., said about deciding to get a hysterectomy. “I expedited the decision because I am so scared of getting pregnant again.” 

Kotz isn’t alone in worrying about how Trump might impact the ability to access abortion, despite living in one of the most accessible states in the nation.

Planned Parenthood North Central States recently reported it has seen a 150 percent increase in patients scheduling appointments for long-acting birth control options like implants and intrauterine devices, or IUDs, since Trump won. 

Minnesota abortion clinics see out-of-state demand surge, post-Roe

Other Minnesota health care systems like Mayo Clinic, HealthPartners, Allina Health and more said it is too early to tell if their systems are experiencing the same increase.

WE Health, a reproductive clinic in Duluth that also provides abortion, said it hasn't had an influx of requests for long-acting birth control yet, but has been receiving more calls about advance provision, which is when the pills for medication abortion are provided before pregnancy.

Minnesota passed the PRO Act last year, protecting abortion access statewide. However, while

 Trump has said he will not sign a federal abortion ban

, he has not explicitly said that he would veto nationwide abortion restrictions.

Dr. Sarah Traxler, the chief medical officer with Planned Parenthood North Central States, said the increase in appointments has surpassed 2016 when Trump was elected to his first term, and 2022 when Roe v. Wade was overturned. 

“People are worried. There’s a lot of unknown about what’s going to happen with sexual and reproductive health care access across the country,” she said. “I believe that Minnesota has some really significant protections in place, but it remains to be seen what the Trump-Vance administration is going to do when they come into office in January.”

Planned Parenthood reports increase in vasectomy appointments

Traxler noted another increase: vasectomy appointments. There has been a significant number of people in Minnesota scheduling appointments for vasectomies, which Planned Parenthood only performs at three of its Minnesota locations: St. Cloud, Duluth and Little Canada. 

“I think the vast majority of the time, birth control falls on the partner that has a uterus. But I do think that there are people out there with a penis who are really taking charge,” Traxler said. 

“They are understanding it is a threat to them, as a partner, as a father, if their partner does not have a means to prevent pregnancy — it threatens their autonomy and freedom as well.”

Others seek long-term birth control as gender-affirming health care

The need for long-term birth control can go beyond pregnancy prevention. It can be used for medical reasons including gender-affirming care. 

James Hirsch, a transgender man, moved to Minnesota from Iowa for better access to health care. In 2023, Minnesota passed the “trans refuge” law that protects people in the state who are seeking gender-affirming care. 

A year after Minnesota became a trans refuge, ‘transplants’ make themselves at home

An important part of Hirsch’s gender-affirming health care is stopping his period, which he accomplishes through hormone replacement therapy, or HRT. But he worries about losing HRT as Trump attacks gender-affirming care for transgender people. So as a backup method to stop periods, Hirsch also got a hormonal IUD.

“It’s unfortunate because I just moved here to a more progressive state but the president could prevent that. They could make that decision almost null,” he said. 

 he would “sign an executive order instructing every federal agency to cease the promotion of sex or gender transition at any age.” 

It’s unclear what that could actually mean

Rae Rowe, a gender-fluid nonbinary person in Minneapolis, also has an IUD in part to stop periods for gender-affirming reasons, and in part for medical reasons. They got their first IUD after surviving a bilateral, massive pulmonary embolism and deep vein thrombosis in their legs. After that, medical professionals cautioned that having too heavy of a period could cause them to bleed out. 

Rowe has had an abortion in the past and knows firsthand that even in places where abortion is protected, the cost of one can still make it inaccessible. But their fears go beyond that.

“I believe that there will be kind of a domino effect in additional forms of contraception being viewed as abortives through this next administration, which will make them very, very challenging to access,” they said. 

Minnesotan living in Texas laments access 

Isabelle Peterson, who lives in Dallas but is originally from Minnesota, has an IUD that expires near the end of December. She said she can’t find any in-network OBGYNs there accepting new patients. 

“I am at a loss of options right now. It’s very different here than in Minnesota,” she said. “It’s stressful and scary. If it gets to a point where I cannot make an appointment in my network and it is the middle of December I’m just going to have to front it. And they’re not cheap: it’s $1,000.” 

Texas passed a strict abortion ban in 2021, banning nearly all abortions and enacting penalties for doctors who perform them including losing their medical license and sending them to prison. 

A report from Manatt Health released in October found that 44 percent of OBGYNs surveyed in Texas said they’ve thought about or already changed how and/or where they practice as a result. The report found "historic and worsening shortages" of access in the state. 

While Peterson’s IUD will not be ineffective immediately, it will lose its effectiveness over time. She says regardless of the future Trump presidency, she plans to move back to Minnesota soon for better access to care.

Sam Stroozas

Author

While Minnesota passed the PRO Act last year protecting abortion access statewide, residents say they are still worried what the upcoming Trump-Vance administration could do.

Kerem Yücel | MPR News

Derek Montgomery for MPR News

Signs say "Prayer is nice, but birth control works."

A group of people holding signs watches on.

Minnesotans seek long-term contraception after Trump win, worry about abortion access

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