Planned Parenthood will consolidate some of its clinics and eliminate dozens of positions in the Upper Midwest, the organization's leaders announced Tuesday

Across Minnesota, Iowa, Nebraska and the Dakotas, 36 positions will be eliminated from Planned Parenthood North Central States, including nine staff members and 27 open positions.

The decision comes 19 months after the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional right to abortion and returning the power to regulate abortion to individual states. Since then, two dozen states, including the Dakotas and Nebraska, have moved to ban abortion or further restrict the procedure to earlier in the pregnancy than Roe's standards; courts have for now blocked bans in three of those states, including Iowa.

The nonprofit's leaders blamed the post-Roe landscape as well as other factors such as increasing costs and provider shortages for its decision.

"As the volatility in the health care landscape continues and the cost of providing care climbs, we have a duty to continually change and adapt so that we can continue to meet the essential needs of our patients and community," said Ruth Richardson, president and CEO of Planned Parenthood North Central States, in a statement. "This decision was not easy. Planned Parenthood is focused on creating a footprint that is sustainable long term, with reliable access to both medication and procedural abortion in every state where it is legal."

The organization will also consolidate some of its more than two dozen health centers across the five-state region while expanding abortion access and the size of other health centers.

In the coming year, the health center in Woodbury will consolidate into the Rice Street Health Center in St. Paul.

Planned Parenthood stressed that while its number of locations will decrease, the restructuring will increase its capacity for patients treated in person and virtually. Its flagship Vandalia health center in St. Paul will increase abortion patient capacity and appointment options. A health center expansion in Omaha will increase exam rooms from four to 12, and a consolidation of two health centers in Des Moines will expand abortion appointments to three to four days per week.

"It's obviously a concern anytime we lose providers or locations or access to service, especially in a moment when we have become sort of an island in Minnesota," said Sen. Lindsey Port, DFL-Burnsville, chair of the Reproductive Freedom Caucus. "I'm looking at this in the context of the broader health care crisis we're in. Consolidations, layoffs, difficulty hiring: These themes exist throughout the health care world at this point. Reproductive health care clinics across Minnesota are not just abortion providers, they're health care providers. It's an integral part of our lives."

Abortion opponents said Planned Parenthood's decision was more about shifting its resources to provide more abortions, especially in Minnesota communities bordering states with restricted access.

"Planned Parenthood is a business, and the decisions they make are business decisions, not morality," said Tim Miller, executive director of Minnesota-based PLAM Action, a sister organization to Pro-Life Action Ministries. "I don't buy it for a second that their bottom line is seeing a crunch. It's a strategic business decision. They look at the upcoming market and they're refocusing, like any shrewd business would do."

Planned Parenthood's decision comes less than three weeks after a recently formed union representing 430 employees of Planned Parenthood North Central States reached a tentative labor agreement with management. The new contract will provide a 15-year wage scale for union jobs, a minimum-wage increase of 4.5% the first year and 11.75% total over three years. Planned Parenthood's lowest-paid employees will get a 17% wage hike during the first year of the agreement.