Sarah Stoesz , CEO of the Planned Parenthood affiliate serving five Midwestern states including Minnesota, will step down next year after leading the organization for 20 years.

Stoesz is expected to remain as leader of Planned Parenthood North Central States until a new CEO is selected, which could be in early fall 2022.

The leadership change comes at a time when the national landscape of abortion rights faces an uncertain future. A conservative majority on the U.S. Supreme Court could strike down or alter the landmark 1973 Roe v. Wade decision that made abortion legal nationwide.

Overturning or weakening Roe could mean that Minnesota will become a destination for abortion services because at least two-dozen states are expected to outlaw the procedure if constitutional protections are eliminated.

"We are surrounded by states that will restrict abortion in some way," Stoesz said. "We will be welcoming people from other states to Minnesota. We've been planning for this for many years and we have been carefully building our clinic infrastructure."

The court is reviewing a Mississippi law that would ban abortion 15 weeks after conception, and a decision in that case could come next summer. A Texas law that allows anyone to sue those who receive or provide abortions after six weeks was allowed to remain in effect by the high court as legal challenges proceed in lower courts.

Unless there is a significant political shift in the Legislature and the governor's office, abortion will remain legal in Minnesota under a state Supreme Court ruling.

The future of Roe was not a factor in her decision to step down, Stoesz said.

"It is time for me and it is time for the organization. I feel quite confident that this is the right thing to do," she said. "I actually never thought I would be here 20 years."

During Stoesz's tenure, St. Paul-based Planned Parenthood has grown from serving two states to becoming one of the largest affiliates in the country. It serves more than 100,000 patients annually, including those from North Dakota, South Dakota, Iowa and Nebraska.

Most of Planned Parenthood's work involves family planning and health education services, including birth control, HIV and cancer screenings, as well as sex education and prevention of sexually transmitted diseases.

Stoesz said that even before the current challenge to Roe, Planned Parenthood has been facing other "existential" challenges. They include a decision by the Trump administration to withhold federal family planning funds, known as Title X, from organizations that counsel or refer patients to abortion services.

"It still didn't stop our critics from assuming and alleging incorrectly that Title X was somehow underwriting abortion services," said Stoesz who, along with the board, decided to pull out of the Title X program.

To fill in the gap, Planned Parenthood turned to its donors to maintain patient access to family-planning programs.

"It has been a very difficult time to balance the books at Planned Parenthood without Title X because we are committed to our mission of not turning people away and we didn't want to do that," Stoesz said. "We are now much more reliant on fundraising than we had been in the past in order to meet patients' needs."

The Biden administration has reversed the Trump policy, and Planned Parenthood is now in the process of re-entering the Title X program.

More than a decade ago, Stoesz was among a group of officials from Planned Parenthood affiliates that helped start a drug manufacturing company dedicated to providing affordable contraception.

That company, Afaxys , now serves more than 10,000 health centers across the country.

"That is pretty creative and it is pretty bold," said U.S. Sen. Tina Smith, D-Minn., who has worked closely with Stoesz for many years. "Sarah just inherently believes that there is a solution to every problem, and that is borne out of her optimism."

Smith was on the Planned Parenthood board when Stoesz was first hired, but she later became an employee after Stoesz recruited her to take a senior staff position.

"The organization had really significant business challenges and she has worked so hard to put the organization on a sound financial footing to make sure that health care delivery at Planned Parenthood was really worthy of the patients that came in the door," Smith said.

Prof. Rachel Hardeman , a reproductive health equity researcher at the University of Minnesota School of Public Health, said Stoesz shares her interest in eliminating inequities that lead to high rates of maternal and infant mortality in mothers and infants who are Black or people of color.

"I believe in her leadership and her commitment to being a voice for progress for the rights of women and reproductive health," said Hardeman, who sits on Planned Parenthood's board. "The fight is not over — that is for sure — but she has definitely created a path for possibility and for change, and I am grateful for that."

Stoesz is well known within political and health care circles, serving four years as a senior advisor to the late U.S. Sen. Paul Wellstone, working in Gov. Rudy Perpich's administration and a six-year stint as a public affairs executive at Allina Health.

"If you were to look at her progressive politics in the state, I would bet that one way or another you are only two or three degrees separated from Sarah Stoesz," Smith said. "Never underestimate the power that Sarah has with the top health care leaders in the state on what we need to do to expand health care access."

Stoesz said she is not sure about her next step, but that decision most likely will come after she leaves Planned Parenthood.

"The one thing about Planned Parenthood is that it is all-consuming. I want to have a little time to think about something else," she said. "I am not withdrawing from the world by any means. There are certainly a lot of interesting problems out there."