[ The threat of prison time under Idahos near-total abortion ban
is forcing providers to leave the state — and pregnant people are
paying the price.]
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‘IMMENSE AND NEEDLESS SUFFERING’: IDAHO’S ABORTION BAN IS
CREATING A CRISIS OF CARE  
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Alanna Vagianos
April 26, 2023
HuffPost
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_ The threat of prison time under Idaho's near-total abortion ban is
forcing providers to leave the state — and pregnant people are
paying the price. _

Dr. Kylie Cooper was one of only nine maternal-fetal medicine
physicians in Idaho., NICOLE NERI FOR HUFFPOST

 

Panic was the first thing Dr. Kylie Cooper felt when her home state
of Idaho [[link removed]] implemented a
near-total abortion [[link removed]] ban
following the repeal of federal protections last year.

As a maternal-fetal medicine physician in the largest hospital in the
state, Cooper wasn’t used to feeling panicky. Her job working with
high-risk obstetric patients didn’t allow for anxiety or fear. She
was good at working under pressure, but this was different.

“Every time I was on call since the ban went into place, I had so
much anxiety. What if I get that call and they’re previable? What
are we going to do? There’s just fear there,” Cooper told
HuffPost. “And anytime you insert fear into medical decision-making,
it’s not a good situation.”

Cooper had worked for nearly five years at St. Luke’s hospital in
Boise, which saw between 350 to 400 births a month.

She started to have trouble sleeping. Lying awake at night, she
pictured her patients’ faces and remembered their circumstances:
some with complicated fetal abnormalities, others with pregnancy
conditions threatening their own lives. _What am I going to do if
that type of patient shows up again? How are we going to navigate
this?_ she thought, staring at her bedroom ceiling.

Her worst fears came true weeks after the ban went into effect, when
she had to tell a patient that her pregnancy had a significant fetal
abnormality. Cooper cried with the devastated couple in her office,
and realized her hands were tied. She couldn’t offer any more care
― they had to go elsewhere.

The “immense and needless suffering” set off by the ban was just
too much for Cooper to bear. It often rendered her helpless at work.
And personally, she was not comfortable raising her young daughters in
Idaho. “We cannot raise them here, a place where they don’t have a
right over what happens to their own bodies,” she said.

So Cooper and her family picked up and moved to another state seven
months after the abortion ban went into effect. It was not an easy
decision, but she felt it was a necessary one. There are only nine
maternal-fetal medicine specialists in the entire state of Idaho.
Cooper is one of five who have left or decided to leave since the
state’s near-total abortion ban went into effect last year.

A crisis of care is quickly unfolding in Idaho. There are two abortion
bans currently in place: a six-week ban that allows private citizens
to sue people who violate the law, and a near-total ban, also known as
the trigger ban, that carries criminal penalties and automatically
went into effect after the Supreme Court overturned Roe v. Wade.
Between them, the two abortion bans allow for few exceptions and carry
a slew of punishments for physicians. The penalties range from civil
suits with fines starting at $20,000 to the permanent suspension of a
medical license and the threat of felony charges that carry a maximum
of five years in prison.

The near-total ban was especially insidious in its first six months
because it included an affirmative defense law that essentially
asserted any doctor who provided an abortion was guilty until proven
innocent. (“Scary is an understatement,” Cooper said of the
statute.) A bill amending the trigger ban, which strikes the
affirmative defense statute and clarifies that removing a nonviable
fetus or an ectopic pregnancy does not qualify as an abortion, passed
this legislative session
[[link removed]].
Many medical professionals were critical of the amendment
[[link removed]],
noting that the law still includes felony punishment and there
continues to be no true exceptions for the life and health of the
pregnant person.

The feelings of helplessness and the threat of prison time for simply
doing their jobs are forcing some providers to leave Idaho. Nearly 50%
of maternal health doctors in Idaho are considering leaving the state
in the next year, according to a survey
[[link removed]] conducted
by the Idaho Coalition for Safe Reproductive Health Care
[[link removed]]. An additional 27% responded they are
“maybe” considering leaving the state.

“Providers are leaving and the bottom line is that women and
families cannot access quality pregnancy care if there are no
qualified providers to care for them,” Cooper said. “We are
already seeing the ripple effects from the abortion bans.”

[Cooper with moving boxes in her new home.]

Cooper with moving boxes in her new home.  NICOLE NERI FOR HUFFPOST

Idaho already has the lowest physician-to-population ratio
[[link removed]] in the country,
but it’s poised to get much worse. Dr. John Werdel, the medical
director for women’s services at St. Luke’s, said the abortion
bans are making it harder to recruit and retain physicians.

He estimates that at least 10 women’s health physicians, including
Cooper, have left or are in the process of leaving the state because
of the abortion ban.

“These laws are decimating our workforce,” he told HuffPost.

Werdel believes even more providers will eventually leave, but some
are holding out hope for a special legislative session this summer
that could offer opportunities to loosen criminal punishment for
doctors.

St. Luke’s is the largest employer in the state, with around 15,000
staffers. It has been a well-respected and sought-out hospital in a
community that many saw as great for raising a family, Werdel said.
Before the abortion ban, there were normally multiple applications for
one opening in an average OB-GYN group, and every applicant who was
offered a position would accept, he said. Now, the hospital has one,
maybe two, applicants for positions that have been open for over a
year.

“It was a pretty good place to come to, and now we have struggled to
find adequate candidates for positions that are open,” he said.
“Nobody is seeking out this location anymore.”

The cost of care is also increasing as a consequence of the near-total
abortion ban. Even when physicians know what to do, they may wait
another 24 or 48 hours to run more tests to ensure they are protected
against legal inquiries, Werdel said. This drives up the cost for a
patient who likely didn’t need another ultrasound or that extra
night at the hospital.

Laura Taylor, a labor and delivery nurse at St. Luke’s, has also
thought about moving out of Idaho. The threat of criminalization for
offering health care to pregnant people with complicated pregnancies
or life-threatening conditions can be all-consuming.

“I’m seeing a lot of nurses who are wondering if their license is
going to be put at risk just by helping patients, by providing the
standard of care in these situations,” Taylor told HuffPost, adding
that several of the nurses on her team have discussed leaving Idaho.

“In 10 years, I have never made a phone call to our legal
department,” she said. “In the last six months, I have had charge
shifts where I have been on the phone with legal more than once to
make sure that my nurses who are providing care are going to be
protected. Meanwhile, a patient is experiencing the worst day of their
lives. Meanwhile, you’re making a patient feel like a criminal for
showing up for care when they did nothing wrong.”

The current bans are affecting patients of all kinds. Idahoans with
very wanted pregnancies have been forced to continue nonviable
pregnancies, magnifying an already traumatic experience and
jeopardizing their health.

“Every week, an average of 30 patients present to our clinics and
hospitals with wanted pregnancies complicated by conditions that may
require an end to the pregnancy for a myriad of medical reasons,”
Werdel testified during a committee hearing last month on the bill
that amended the trigger ban
[[link removed]].

Others with unwanted pregnancies are traveling out of state if they
can, but many are forced to carry pregnancies to term ― a dangerous
and expensive feat in the U.S.

Taylor knows about that patient experience firsthand. She and her
husband have had four devastating pregnancy losses in recent years,
including one right after the near-total ban went into effect last
August. Taylor was around seven weeks pregnant when an ultrasound
showed slow and irregular cardiac electrical activity ― a sign she
knew meant something was wrong with the fetus.

Under the new law, Taylor was faced with an impossible decision: carry
the pregnancy until she miscarried, travel out of state to get an
abortion, or wait until the nonviable fetus was enough of a threat to
her own life that it warranted an exception.

“I didn’t think that I would be carrying a loss again,” she
said. “It continued to show definite signs that something was wrong
with the pregnancy, but nothing could be done about it in the state of
Idaho.”

She and her husband decided to wait. If she made it to 12 weeks, she
would get a genetic test that would likely show the fetus had some
form of lethal anomaly and they would possibly drive to Oregon to get
an abortion. For a few weeks in September, Taylor woke up, went to
work, delivered babies, cared for new parents, went home and then did
it all over again the next day. Everywhere she went, she carried her
“go-bag” stocked with menstrual pads and a toilet hat ― a
plastic bowl-like container normally used to collect urine samples ―
in case she miscarried into the toilet.

Throughout those weeks, Taylor kept getting ultrasounds, hoping
something had changed. But the scans continued to show the fetus was
growing abnormally and confirmed the pregnancy was nonviable. It was
heartbreaking.

“The pregnancy was very much wanted,” she said through tears.

There were times, she recalled, when her colleagues declined to take
care of patients who found out their pregnancies were nonviable. Women
who were 17 or 18 weeks along who just found out they were going to
lose their wanted pregnancies ― people having the worst days of
their lives ― and whose providers wouldn’t care for them because
of the very real threat of criminalization from the state’s abortion
ban.

“That felt deeply personal to me. I thought, ‘What if this
pregnancy makes it six more weeks and then I lose it? Will these
nurses refuse to care for me?’” she said. “These are my
colleagues and friends ― people I’ve known for 10 years.”

Taylor started miscarrying around the nine-week mark. She was able to
access misoprostol ― one of two medications used for abortion and
miscarriage care ― through the hospital system because her pregnancy
had officially been deemed no longer viable.

Idaho has always been a Republican state, but its fervor for
anti-abortion rhetoric and far-right ideology
[[link removed]] has
grown in recent years. The state’s more radical conservative faction
has infiltrated the legislature, pushing more and more extreme bills.

“It used to be that the Idaho Senate was a place where reasonable
debate was valued and minds could be changed, but not anymore,”
Democratic state Senate Minority Leader Melissa Wintrow told HuffPost.
“The last election drastically changed the makeup of the Senate from
more policy minded to politically motivated. There are a solid 10 very
conservative members who took out more establishment folks in their
primary. And that has forever changed the voting dynamics.”

Just last month, the legislature passed the first ban on interstate
travel for abortion care since Roe fell, banning minors from
traveling across state lines
[[link removed]] to
get abortions without parental consent. And this month, state Attorney
General Raúl Labrador released a legal opinion arguing that health
care providers in Idaho are prohibited from referring patients out of
state for abortions under the current ban. (Labrador has
since withdrawn
[[link removed]] his
initial opinion after Planned Parenthood filed a lawsuit
[[link removed]];
a federal judge in Idaho is expected to rule
[[link removed]] on
the suit in the coming days.)

Like Cooper, the physician who left Idaho, state Rep. Lauren Necochea
(D) said she has increasing concerns about raising a family in her
home state. Despite her parents, her three brothers and their families
all living in Idaho, Necochea can’t comfortably tell her daughters
to stay there.

“I can’t encourage my two daughters to settle in Idaho with the
laws we have on the books. I would be terrified to have my daughters
try to carry a pregnancy here,” she said through tears during
a debate
[[link removed]] on the
House floor over the current abortion ban. “This is not a safe place
to be pregnant. This statute is tearing families apart and is pushing
our OB-GYNs out of state.”

[Demonstrators attend an abortion-rights rally outside the Idaho State
Capitol in Boise, Idaho, on May 14, 2022.]

Demonstrators attend an abortion-rights rally outside the Idaho State
Capitol in Boise, Idaho, on May 14, 2022.  IDAHO STATESMAN VIA GETTY
IMAGES

Huge swaths of Idaho are likely to become maternity care deserts if
providers continue to leave the state, and rural areas are especially
vulnerable
[[link removed]].
Two Idaho maternity wards closed their doors in recent months, and at
least one closure was directly related to the abortion ban. Bonner
General Health in Sandpoint, Idaho, closed its maternity ward in
March, citing staffing issues.

“Highly respected, talented physicians are leaving. Recruiting
replacements will be extraordinarily difficult,” Bonner General
Health said in a press release
[[link removed]] last
month. “The Idaho Legislature continues to introduce and pass bills
that criminalize physicians for medical care nationally recognized as
the standard of care.”

The closure means providers who are willing to continue helping
patients in Idaho will lose jobs in their specialty and may have to
relocate. At least 16 OB-GYN nurses will lose their jobs due to Bonner
General’s maternity ward closure, Werdel said.

Of the 13 other states that have near-total abortion bans, Idaho is
the only one that declined to expand
[[link removed]] postpartum
Medicaid coverage this year. The Republican legislature tabled a bill
[[link removed]] last
month that would have expanded critical coverage before the body
adjourned for the year.

Idaho’s Maternal Mortality Review Committee was established
[[link removed]] by
the Idaho Department of Health in 2019 to track, review and analyze
deaths caused by pregnancy-related complications. In 2020, in its
first report, the committee found that the state had a maternal death
rate that was almost double the national average
[[link removed]].
Idaho lawmakers declined to renew the committee this session, citing
budget issues. The Maternal Mortality Review Committee only cost the
state $10,000, writer Jessica Valenti reported
[[link removed]].

“A lack of support for policies that help pregnant women has been
exacerbated by continued efforts to criminalize medicine, which put
our physician workforce in jeopardy,” Dr. Loren Colson, a family
medicine physician in Boise, wrote in an op-ed
[[link removed]] in
the Idaho Capital Sun. “What will happen when there’s more
pregnant people due to the abortion ban and less physicians to care
for them?”

“It will be more important than ever to review circumstances where
the medical system failed and troubleshoot how to prevent the same
events from happening again. Yet we will be left without one of our
greatest tools to do so by no longer having a Maternal Mortality
Review Committee.”

The provider exodus from Idaho is also impacting those who don’t
leave.

“For the physicians that stay, they’re dispirited and have a
low-level anxiety which increases their burnout,” Werdel said.
“It’s an inability to recruit, an inability to retain, it harms
the workforce and it creates risk and harm to our citizens of Idaho
that don’t deserve this and don’t understand it.”

Taylor, the labor and delivery nurse, is starting a program in June to
become a midwife. She’s excited at the opportunity to offer
empathetic care as a full-time provider to her patients, who she hopes
can benefit from her own experiences with pregnancy loss.

She’s optimistic her next step as a provider will be enough for her
family to stay in Idaho, but she understands why medical professionals
don’t want to come to her home state anymore.

“There are providers who can work anywhere. Why would you want to
deal with this?” she said. “Why would you want to have to look at
a patient and say, ‘Well this is what needs to be done, but I
can’t do it. I’m not legally allowed to provide you this care.’
Why would someone choose here?”

As for Cooper, she feels like a weight has been lifted off her
shoulders since moving. “I didn’t feel safe in Idaho,” she said.
“I don’t think it was something I consciously thought about but
now that I’m out of there, I realize I didn’t feel safe there and
I didn’t feel that my daughters were safe there either.”

She recently started her new job, which comes with all the daily
stressors and responsibilities she’s used to. But now she can just
go to work and care for her patients without fear of being thrown in
jail.

“I’m able to go back to helping people in the way that I can and
the way that they deserve,” she said. “That’s a huge relief.”

_Alanna Vagianos (she/her) is a senior national reporter at HuffPost.
She covers gender and politics with a focus on gender-based violence
and reproductive justice. Previously, she worked at BUST Magazine and
The Feminist Majority Foundation.  Alanna can be reached at
[email protected]._

* abortion bans
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* Idaho
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* doctor exodus
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