Idahoans by the hundreds are seeking abortions in neighboring states. What we know
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Gabe Barnard, Idaho Statesman
BOISE (Idaho Statesman) — Idaho’s abortion ban has driven scores of women across three different borders to seek care in the year since it went into effect.
For someone from Boise, that can mean a trip of hundreds of miles to a clinic that can provide the procedure. Some have packed their families into cars to go to health care appointments in Montana, said a Planned Parenthood spokesperson in the state. Some people have had to save money to travel for an appointment.
They join thousands of people leaving their home states across the country to seek abortions where it’s still legal, according to data from the Society of Family Planning and from Planned Parenthood clinics in neighboring states. Washington, Oregon and Montana have seen spikes in the number of Idahoans traveling to clinics there, necessitating staffing and training changes in some cases to keep up with demand.
“It’s just a fundamental access issue,” said Kenji Nozaki, interim CEO of Planned Parenthood Columbia Willamette, which manages many Planned Parenthood clinics in Oregon, in a call with the Idaho Statesman.
The shift also has public health implications beyond abortion, experts said. Many patients are able to travel out of state for the procedure, but the added distance imposes extra obstacles. Those barriers prevent some from traveling at all. And the harsh penalties doctors face under Idaho’s ban have caused some fear about treating complicated pregnancies.
“It’s hard not to think about the stories behind the numbers,” said Caitlin Myers, a professor of economics at Middlebury College who researches reproductive policies, in a call with the Statesman. “And the stories behind the numbers are people who want reproductive health care services that they cannot access because of distance and other factors in their lives.”
BORDERING STATES TAKE NEW ABORTION PATIENTS
Idaho’s abortion ban — outlawing the procedure except in cases of rape and incest or to save a mother’s life — went into effect on Aug. 25, 2022, shortly after the U.S. Supreme Court’s June ruling in Dobbs vs. Jackson Women’s Health Organization removed federal protections for the procedure. The Idaho law made performing an abortion punishable by up to five years in prison.
The Planned Parenthood clinic in Boise closed just before, in June 2022, according to previous Statesman reporting. The organization’s clinics in Meridian and Twin Falls remain open, offering services such as contraception, pregnancy testing and testing for sexually transmitted diseases.
A surge of patients seeking abortions has flowed into Washington, Oregon and Montana since then. The average number of abortions in Idaho dropped from 170 per month in April and May 2022 to 33 per month for July 2022 through March 2023, according to a report from the Society of Family Planning, a nonprofit that researches abortion and contraception.
Planned Parenthood clinics in central and eastern Washington saw an overall increase of 56% in abortion patients from Idaho from January through May compared with the same months in 2022, according to a report released in June by Democratic Sen. Maria Cantwell of Washington state.
Two southeastern Washington clinics in particular — in Kennewick and Walla Walla — absorbed dramatic increases in the the number of incoming patients. Between January and May 2022, the Walla Walla clinic saw one Idaho abortion patient and the Kennewick clinic saw two. In the first five months of 2023, Walla Walla saw 20 and Kennewick 91.
“It has been a profound change, without a doubt,” said Karl Eastlund, CEO of Planned Parenthood of Greater Washington and North Idaho, which manages those clinics, in a call with the Statesman.
In Oregon, the story was similar. The number of Idahoans receiving abortions at clinics operated by Planned Parenthood Columbia Willamette, one of two Oregon affiliates of the national organization, increased to 400 between January and July 2023 from 31 in all of 2022, Nozaki said. That includes its centers in Bend, Salem and northwest Oregon.
The organization hosted a soft opening for a clinic in March in Ontario, Oregon, just across the border from Payette. The clinic, now the closest Planned Parenthood clinic to Boise that offers abortions, remained in its soft opening phase in July. The closest clinic before that was the clinic in Walla Walla, a roughly 250-mile drive.
“We expect to see the trend going up and up now that we’ve established care out in that area,” Nozaki said.
In Montana, patients from Idaho make up the largest increase in abortion procedures for people traveling from other states since the Dobbs ruling, said Mary Sullivan, communications coordinator for Planned Parenthood in the state. As of July, the number of Idaho patients seeking abortions in Montana had increased by more than 200% since March 2023, she said.
A spokesperson for Planned Parenthood of the Rocky Mountains, which manages facilities in Nevada, wrote in an email to the Statesman that the organization did not have data to share on patients from Idaho seeking abortions there.
NORTH IDAHO HAD NO ABORTION PROVIDERS BEFORE
It’s not new for Idaho patients to travel out of state for abortions, said Myers, the Middlebury economics professor — it’s just that more people are traveling now. Before the state’s ban, the only abortion providers were in southern Idaho.
“If you were in northern portions of the state, you were already heading for Washington or Montana,” Myers said.
Alison Norris, co-chair of the Society of Family Planning’s research on abortion counts, said in a call with the Statesman that roughly 30% of abortions for Idahoans were obtained out of state in 2017.
And people don’t always have to travel. Kimra Luna, co-founder of Idaho Abortion Rights, a mutual-aid organization, said in a call with the Statesman that the organization helped more than 600 Idahoans obtain access to abortion pills, which can be mail-ordered, between August 2022 and July 2023.
It’s not just Idaho women traveling out of state for abortions. Neighboring states are fielding an increase in out-of-state patients from across the country.
Comparing the volume of abortions performed in 2022 before and after the Dobbs ruling, the average number of abortions performed per month increased from 1,735 to 1,926 in Washington, 820 to 987 in Oregon and 175 to 187 in Montana, according to the Society of Family Planning report.
CLINICS BOOST STAFF TO HANDLE SURGE OF WOMEN
Eastlund said Planned Parenthood of Greater Washington and North Idaho has added 10 staff members to its clinics since Idaho banned abortion, allowing the clinics to extend their hours on some days.
A small number of staff members — fewer than five — had left Washington clinics by July because of fear about abortion rhetoric, Eastlund said.
One such comment cited by Eastlund was a legal opinion issued, then rescinded, by Idaho Attorney General Raúl Labrador — which has since been formally struck down — asserting doctors violate the state’s abortion ban by referring patients to a state where abortion is legal. Some staff members live in northern Idaho, near the Planned Parenthood clinics in Pullman and Spokane, and commute across the border. They had concerns about how they might be affected.
“It’s just part of our lives to go back and forth between Washington and Idaho,” he said.
Planned Parenthood Columbia Willamette added staff members at its location in Bend in preparation for Idaho’s abortion ban, a spokesperson for the affiliate said. The clinics also added training for their staffs to keep wait times down, Nozaki said.
PREGNANCY CENTERS SAY MORE WOMEN SEEK THEIR SERVICES
Pregnancy centers around Idaho that provide alternatives to abortion also reported an uptick in women using their services.
Samantha Doty, director of clinical services for Stanton Healthcare, which provides free ultrasounds, pregnancy tests, baby supplies and other maternity care, said in a call with the Statesman that office visits to Stanton increased more than 65% by July 2023 after Idaho’s abortion ban went into effect. Baby supply requests increased almost 40%, she said.
Stanton has locations in Boise and Meridian, and a mobile clinic.
Doty said Stanton has also seen an increase in clients seeking abortion-pill reversal, which the organization also offers. The American College of Obstetricians and Gynecologists, the leading professional organization for doctors providing health care for women, says abortion reversal, which relies on taking the hormone progesterone, is not supported by science.
Robin Watters, the executive director of Lifeline Pregnancy Care Center in Nampa and Caldwell, said the number of women using the clinic hasn’t increased, but the share of people coming to the clinic saying they’re considering having an abortion has.
The clinic offers pregnancy tests, gift bags, clothing and ultrasounds. Waters said the clinic sees about 1,200 clients a month. Of those, it served 12 clients who said they were considering an abortion between July 2021 and July 2022, and 26 between July 2022 and 2023.
When a client comes in thinking about an abortion, the clinic asks them about their support system, shows them short videos and schedules an ultrasound, which shows how far along the pregnancy is, Watters said. She said the center is not judgmental and supports women’s decisions.
FREE MATERNITY HOME SERVES HOMELESS WOMEN
Lifeline opened a maternity home called the Nesting Place in February, where women can live for free while carrying a pregnancy, Watters said. It had served five women by July, all of whom were homeless, she said.
The Reliance Center, based in Lewiston, also provides free services for women with unexpected pregnancies. In addition to tests and ultrasounds, the center helps pregnant women find housing, escape domestic violence and pay for rent or day care. It also refers them to drug addiction recovery services, said Heather Lawless, the center’s founder and CEO.
“We figure out what the barrier is to the woman choosing life,” she said.
The center had seen a 63% increase by July in the number of women coming in saying they were considering an abortion, she said. The clinic also saw three women referred by Planned Parenthood because they had received abortions but couldn’t be scheduled for follow-up care for months.
The centers said Idaho’s abortion ban was giving women time to pause and consider all their options before going through with the procedure.
“The bottom line is that, from what we see every single day, most women don’t want an abortion,” Doty said.
RESEARCH: 1 IN 4 WOMEN IN PLACES WITH BANS CANNOT GET TO ABORTION CLINIC
The shift in abortions signals public health impacts that aren’t obvious on the surface of the data, Myers and Norris said.
Myers’ research at Middlebury into the effects of travel distance on abortions estimates that, for an average county in the U.S. affected by an abortion ban, roughly a quarter of people who want abortions can’t get to a clinic to have the procedure, she said.
To get to one, they may have to find someone to take care of their children, to take time off work, to have access to a car, and to be able to afford both the trip and the procedure, which isn’t always covered by insurance, said Norris, of the Society of Family Planning.
“For people who are not well-resourced, you put a few layers of those various burdens and the person just cannot obtain an abortion,” Norris said.
Those prevented from doing so are more likely to be young, poor and already parenting, Myers said. Some self-manage abortions by ordering medication through the mail, she said, but others likely give birth.
“This is a big financial shock,” she said. “And a household’s financial well being and stability is intimately tied to measures of health. You can’t separate these things.”
Giving birth also carries a higher risk of mortality for mothers than having an abortion, Norris said, and that risk is distributed unevenly across races. The risk of death is up to three times higher for Black women than for white women, she said.
“With each one of these pathways, you can see that there’s an unequitable distribution of the burden,” Norris said.
Even those who are able to travel abortion don’t have it easy.
“It often requires marshaling even more financial resources, revealing their decision and their travel to other people who they might not have wanted to reveal it to, like a boss or a partner,” Myers said.
Abortion bans like Idaho’s have also created confusion and fear among health care providers about whether they can provide the best care for complications in giving birth, such as an ectopic pregnancy, Myers said. An ectopic pregnancy happens when a fertilized egg grows outside the uterus, most often in the fallopian tube, according to the Mayo Clinic. The pregnancy can’t proceed normally and could cause life-threatening bleeding.
Eastlund, of Planned Parenthood of Greater Washington and North Idaho, pointed to Bonner General Health’s March 2023 decision to stop labor and delivery services at the Sandpoint hospital, citing the state’s political climate as a factor.
“Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult,” the hospital wrote in its announcement. “The Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care.”