Abortion access is imperiled in South Dakota. A large state with an expansive rural population, it has just one abortion clinic: a Planned Parenthood located in Sioux Falls. According to the Guttmacher Institute, 98 percent of South Dakota counties lack access to a clinic, and 76 percent of women live in those counties. Fewer than 300 abortions were performed in the state between 2018 and 2019, while at least 200 South Dakotans crossed state lines to access providers elsewhere.
The low numbers likely reflect a raft of obstacles posed by state laws. Although some of the more outlandish measures signed by the Governor—a 2018 bill obligating patients seeking abortion to visit a crisis pregnancy center before they can even undergo a mandatory, medically inaccurate counseling session with the abortion provider, for example—are not currently enforced, there are more than enough barriers on the books to send people to surrounding states.
Here's what South Dakota state law says about abortion:
- If Roe v Wade was ever overturned, abortion would be illegal in South Dakota, unless the pregnant person's life was at risk.
- A patient seeking abortion must wait 72 hours between their initial appointment, which includes state-mandated information intended to dissuade people from terminating, and the procedure itself. That 72 hours only applies to business days: weekends and holidays do not count.
- Insurance plans sold on the state’s Affordable Care Act market may only cover abortion in cases of life endangerment or severely compromised physical health.
- Medicaid insurance only covers abortion in cases of life endangerment.
- Telemedicine abortion is prohibited.
- Abortion is banned at 20 weeks post-fertilization, due to the medically unfounded assertion that fetuses can feel pain past this point. After that, it’s only legal in cases of life endangerment or severely compromised health.
- Abortions performed for the purpose of sex selection are banned, a measure mostly meant to stigmatize the procedure, as next to no one terminates based on fetal sex.
- Abortion clinics must meet the same physical requirements as ambulatory surgical centers, including certain standards for hallway and doorway width. This rule also limits the types of employees who can staff facilities.
How old do you have to be to get an abortion in South Dakota?
People under 18 must notify a parent or guardian 48 hours before the procedure can be performed or they can petition a judge that it's in the patient's best interests not to involve their parents in what's known as a judicial bypass.
How much does it cost to get an abortion in South Dakota?
Cost depends on how far along the pregnancy is and whether or not you have insurance that covers the procedure. You can ask on the phone before scheduling an appointment what the cost might look like. The National Network of Abortion Funds may be able to help with the cost.
Where can you get an abortion in South Dakota?
The only clinic in the state is the Planned Parenthood in Sioux Falls.
What is it like seeking an abortion in South Dakota?
This is one person’s story.
Caitlin found out she was pregnant in December 2015, one week after a missed period. Fortunately, she lives in the same city as South Dakota’s sole abortion clinic. So while getting to the clinic wasn’t a problem, a scarcity of providers complicated scheduling nonetheless. This interview has been edited for length and clarity.
When did you find out you were pregnant, and when did you decide to get an abortion?
It would’ve been December of 2015 that I found out. My period was late, so once it was a week late, I took a test and it said I was pregnant. Even before, when I was like, ‘I might possibly be pregnant,’ [abortion] was already on the table and it was really the only option for [me and my husband] at that point.
How long did it take to get an appointment?
I initially called and I wasn’t going to be able to get in until sometime in January. It might’ve been about a month [later], because I remember thinking, Oh God I have to get through Christmas now, being pregnant. And that was like the worst thing ever, because it’s not like I’m going to announce it to my family, but then I’ve gotta go through Christmas being tired and nauseous and just feeling yucky before I can deal with this. It was kind of devastating, honestly, to think that I might have to do that, so I called another clinic down in Sioux City, Iowa, which is about 90 miles south of Sioux Falls. They don’t have a waiting period in Iowa like they do in South Dakota, but their appointments were just as far out, so I kept the appointment in Sioux Falls. There are no doctors in South Dakota who will perform elective abortions: I think [Planned Parenthood has] three doctors who alternate, they fly in for their abortion procedures, and they literally just have one day a week when they do it.
They offer two different methods—a medication abortion and a suction abortion, but the medication abortion can only be done up to a certain point, and with how long I was going to have to wait, I was going to have to do the in-clinic abortion. But they had some cancellations and they called and said, "Can you get here in an hour for your consultation?" This was before Christmas and at that point, I was still able to do the medication abortion, which is what I preferred. My husband ran out and got a payday loan so we could pay upfront.
Do you remember how much it cost?
The insurance we had at the time covered some of it, but the [clinic] still asks for, I think it’s $300 up front, just because insurance companies can be a pain to deal with. We actually ended up getting a check for $300 back from them, after they processed my insurance. I want to say [it’s] around $600 or $650 if you pay out of pocket.
Can you tell me a little bit about what it was like in the clinic?
It’s like any other medical clinic, other than when you first come in and you’re in this kind of entryway and there’s a glass partition, and you have to show an ID and tell them why you’re there before they’ll buzz you into the actual building. The entrance is in the back, and there are very few windows. Every person I interacted with at the clinic asked me if I had a long drive, so that suggests to me that they’re used to people traveling long distances.
In South Dakota, we have a 72-hour waiting period. I was at the clinic for two to three hours, just for the initial consultation, and we have a lot of laws about things they have to say to us, things they have to ask, information they have to give us, so a lot of it was red tape before we could get to the actual appointment. They draw blood, they check your iron, they do an ultrasound, and they do ask you if you want to look, which I did.
What was the counseling session like?
I had to confirm, in writing and verbally, that I was not terminating based on gender, which, I was seven weeks along, so there’s no way I would’ve known the gender, but that’s a law in South Dakota. They’re required to tell us that we are terminating the life of “a whole, separate, unique human being.” They’re required to give us information about the crisis pregnancy center, to say that this place exists; they’re required to inform you that the father is legally obligated to support you financially if you choose to have the baby. They’re required to go through stages of pregnancy and conception.
I already have three children and I’m a doula, so it was really redundant for me to be told that. And at one point, the doctor gives you a piece of paper and a pen, and they have to leave the room and you have to write down any questions you have about the procedure, and then that piece of paper is added to your medical file. That’s a law in South Dakota, that they have to do that. It’s also required that the doctor performing the procedure has to be the one going through these things with you. It can’t be a nurse or anything, it has to be the same doctor who either will prescribe the pills or perform the procedure.
It’s pretty clear that [the doctors and nurses are] frustrated by it. They obviously got into their line of work to help people and provide medical care, so it’s pretty obvious when stuff like that comes up that they would rather just be doing their job and not reading off these statements or asking these pointless questions. But they’re legally required, so they do it.
How long did the second appointment take?
The second one doesn’t take long at all, it’s just taking that [mifepristone] pill, and then they go over what’s going to happen in the process of taking the next pill, misoprostol. You have to wait another 24 hours after taking the first pill before you can do the misoprostol.
Then they schedule your follow-up, because that’s the other thing: If you do the medication abortion, they want you to come back in a week to make sure it worked.
What was it like ending the pregnancy at home?
They prescribe a painkiller and an anti-nausea medication. It starts off as a lot of cramps: It’s essentially like a miscarriage, so there’s a lot of bleeding, a lot of clots, there’s pain. I did throw up at one point. I ended up sitting on the toilet with a garbage can in my lap, throwing up. It’s painful but it lasts for maybe a few hours, and then the next morning, it was done. All symptoms of pregnancy, any nausea, all of that was just 100 percent gone.
Anything else you want to share?
It feels very infantilizing, all of the statements they have to tell you, all of the things they have to ask you, the waiting period, because you’re supposed to think about it, like you haven’t done that before the appointment. It just feels silly, and it’s preventing health care professionals from doing their jobs effectively. It’s telling people that we don’t trust you to make your medical decisions, we don’t trust you to understand what this procedure is and what’s happening.
My dad had open-heart surgery about two months ago, and he didn’t have to go through as much red tape as I did to have an abortion. He didn’t have to write down his questions and have them added to his medical chart beforehand. It’s just frustrating.
The waiting period was absolutely the worst part. Because you go through this whole process, knowing what you want to do, you’ve done this three-hour appointment, and now you’ve gotta wait three more days before you can even get the pills to finish this.
Another thing I will say is that I was incredibly fortunate. I didn’t have to worry about travel expenses. I’m a stay-at-home mom, so I didn’t have to worry about missing work. I have an incredibly supportive family. My dad picked up my kids from school, because my husband came with me to the initial consult. And my dad knew. I said, "I have to go to Planned Parenthood," and he was like, Okay just call me when you’re done. I had it easy compared to what a lot of people have to go through to access it in South Dakota.
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This article originally appeared on VICE US.