BOISE, Idaho — On any given day, the atmosphere at Idaho abortion clinics is tense. Whether it’s protesters yelling outside the building or clinic staff comforting patients through difficult procedures, the work is often accompanied by a layer of managed stress.
But abortion advocates say one fear, in the past few months, has been more stressful than all those factors combined: the possibility of losing abortion access altogether.
This year, women could see abortion access severely curtailed in Idaho. Some Idaho bills already have threatened to hamper access to the procedure, and more could be on the way. Idaho abortion advocates said they’re already hearing from more patients who are worried about abortion access, unsure whether the procedure remains legal in Idaho and even attempting to end pregnancies on their own.
That has providers concerned about those who rely on Idaho’s already sparse resources. Neighboring states’ abortion clinic staffers said they’re already preparing for an influx of Idaho patients who could stretch their clinics to capacity.
Any ruling that returns abortion decisions to states could trigger laws in several states, including Idaho, that would essentially outlaw the procedures. One Idaho law already on the books makes abortion a felony if Roe v. Wade is overturned.
Last year, Idaho legislators passed a bill similar to one in Texas outlawing abortion when a heartbeat is detected — but the law goes into effect only if an appellate court upholds a similar heartbeat law. The only exceptions would be pregnancies that endanger the life of the mother or those that come from reported rape or incest.
The national abortion debate largely focuses on two laws. The first, passed in Mississippi, is in the U.S. Supreme Court and bans abortion after 15 weeks of pregnancy. The Supreme Court is expected to rule on the case in June, and justices have indicated that they may be willing to alter or even overturn Roe v. Wade, the 1973 ruling that legalized abortion nationwide.
The second law is the Texas bill that bans abortion when a fetus’s heartbeat is detectable — typically around six weeks of pregnancy, so early that experts said it’s often before women know they’re pregnant. Several lawsuits are pending against the Texas law, which also allows citizens to bring a lawsuit against anyone who performs abortions or aids someone in getting an abortion.
Once federal courts rule on abortion laws, Idaho courts would need to determine whether the state can enact its new laws.
State Sen. Patti Anne Lodge, R-Huston, who co-sponsored last year’s heartbeat bill, expects more abortion-related bills to be introduced early in the session and said they’ll include “some adjustments to (Idaho’s) trigger law to coincide with decisions in other states.”
Blaine Conzatti, Idaho Family Policy Center president, told the Idaho Statesman that his organization is poised to push legislation inspired by the citizen enforcement component in Texas. It would “add a similar private enforcement mechanism” to last year’s heartbeat bill.
While Texas allows anyone — including people outside of the state — to bring a lawsuit over abortion, Conzatti said the Idaho legislation would be narrower, allowing the family of an aborted fetus to sue abortion providers as the family has been “directly harmed by the abortion.”
Conzatti said this provision would go into effect 30 days after the bill is signed into law, without the need to wait on higher courts’ decisions. He expects support from the Republican-dominated Legislature and Idaho Gov. Brad Little. He said it would prevent more abortions in Idaho while the U.S. Supreme Court weighs the Mississippi case.
“We’re on the cusp of fixing (Roe v. Wade), but the question is, what do we do until then?” Conzatti said.
Little’s office already has signaled approval for the Mississippi law by signing an amicus brief in support of the legislation.
Emily Callihan, Little’s spokesperson, told the Statesman in an email that Little is “pro-life and supports states’ rights.” She said the governor is in favor of undoing Roe v. Wade, which has been the law of the land since a 7-2 decision by the U.S. Supreme Court in 1973.
“Gov. Little welcomes a ruling by the U.S. Supreme Court that would clarify there is no constitutional right to an abortion and restore state sovereignty by allowing states to regulate all abortions,” Callihan said.
Dr. Kara Cadwallader, chief medical officer for the Planned Parenthood Great Northwest, Hawaii, Alaska, Indiana, Kentucky, said the organization worries legislators could remove the trigger language in last year’s heartbeat bill. Such a law would essentially outlaw abortions, she said.
“If that happens, the vast majority of women don’t know they’re pregnant (at six weeks),” Cadwallader said. “The vast majority of women coming into our clinics will be too late to receive care.”
Four clinics in Idaho provide abortion services, all of them in the southern part of the state. Three of the four clinics are run by Planned Parenthood, one in Twin Falls and the others in the Treasure Valley. The fourth is a private Boise OB-GYN.
Cadwallader said Idaho’s laws are often the biggest obstacle to accessing abortions. The state requires patients to wait 24 hours after mandatory counseling with an abortion provider before they can have the procedure.
Idaho also allows only doctors to perform abortions, limiting the number of providers and the volume of procedures they can perform. In other states, physician assistants and nurse practitioners can perform abortions.
Cadwallader said Idaho’s Planned Parenthood locations will continue to provide other services that make up the bulk of their work — family planning, contraception, breast cancer screenings, STD testing — even if they’re required to shut down abortion services. But she worries about patients who want to end their pregnancies.
The impacts of laws restricting abortion access in Idaho go far beyond the state’s borders. Abortion providers and advocates in neighboring states say any further restrictions will lead to more Idahoans traveling to neighbor states’ clinics, which are already busy serving their own residents.
Some Idaho residents already travel out of state for services to such states as Washington, Wyoming and Montana, where providers are much closer. Further restrictions on abortion, though, could mean those living in some of Idaho’s largest cities could have to make the same long trips for services.
Idahoans drive an average of 21 miles one way to receive services, but a total ban on abortions would increase that distance to 250 miles each way, according to a study by the Guttmacher Institute, a nonprofit abortion-rights advocacy organization.
The costs of such travel can add up quickly. Advocates said gas, airplane tickets, hotels and food can all cost someone hundreds to thousands of dollars, further complicating access for lower-income individuals.
Abortion funds can often provide financial assistance to those who need to travel for care. Jade Pfaefflin Bounds, volunteer coordinator for the Northwest Abortion Access Fund, said their organization is expecting a significant spike in calls. While donations and awareness have also increased, the organization might have to be more frugal with how they provide help.
“We might not be able to be quite as generous or help everyone to the extent that we would like to,” Pfaefflin Bounds said. “Even our fundraising needs would probably go up.”
For Boiseans, the nearest clinic outside of Idaho providing surgical abortions is in Kennewick, Washington, about four and a half hours away by car.
Washington could see a flood of new patients because it has some of the least-restrictive abortion laws in the U.S., according to the Guttmacher Institute. That could lead to longer wait times and additional pressures on staff working in Washington’s clinics. Abortion providers are already seeing a high demand for services from those in their local area.
“The impact would be absolutely devastating to patients,” said Paul Dillon, a spokesperson for Planned Parenthood of Greater Washington and North Idaho. “We’ve already seen patients from Texas.”
Dillon said Planned Parenthood will be lobbying the Washington Legislature to provide funding for additional staff at abortion providers to better handle new patients from other states.
Blue Mountain Clinic, which provides abortions in Missoula, Montana, receives about 10-12 patients from Idaho per year. Nicole Smith, the executive director, said the clinic expects more Idaho residents to travel to Missoula if abortion restrictions go into effect.
Smith serves on the board for the Susan Wicklund Fund, which provides financial aid for those traveling for abortions, and said the organization has seen an increase in out-of-state patients asking for assistance. She said the financial burden of finding care can dissuade some from trying altogether.
“People that live in rural parts of this country, who already have a hard time accessing health care, are (going to be) required to travel even further,” she said. “There’s going to be a lot of people who do not end up accessing the care that they need.”
But that doesn’t mean people won’t get abortions. Some are resorting to desperate measures months before a possible Supreme Court decision. Already, Planned Parenthood clinics in Idaho have seen an uptick in women trying to “self-manage” abortions, Cadwallader said.
“Before Roe v. Wade, we’ve all heard stories of back-alley abortions, or coat hangers, or taking herbs to try to cause an abortion,” she said. “Now women are often getting (abortive) medication from the internet. … There’s no one supervising their care at all, counseling them about what to expect. If they have a complication or problem, they have no one to watch out for them.”
Cadwallader said without proper guidance, abortion pills can lead to infection or severe bleeding, which can end in infertility for some people.
She said she worries about a chilling effect on women who seek safe abortions. Cadwallader said the Texas law, which Conzatti hopes to emulate, could create a “fear-mongering” environment of “vigilante justice.”
“That’s a big fear, that even if Roe v. Wade isn’t overturned, it will be so gutted and women will be so scared, they’ll try to take things into their own hands,” she said.
Cadwallader urged abortion-rights opponents to reconsider their view of people who pursue the procedure — many of whom are low-income and already have children to support, she said.
“It’s easy to depersonalize it and think these women are bad people,” Cadwallader said. “These are our sisters, our mothers, our daughters. They’re real people who are seeking health care like anyone else.”