In the wake of Dobbs

This story has been updated from its original version to update incorrect information provided to the Daily News.

One year after the U.S. Supreme Court ruled to overturn the constitutional right to abortion, Washington Planned Parenthood clinics saw a 56% increase in Idaho abortion patients.

The data from Planned Parenthood, compiled by Washington Sen. Maria Cantwell’s office, compares patient data from January to May of 2022 and the same months in 2023. It also showed out-of-state abortion patients increased by 36%, with an 18% increase in total abortion patients.

Washington is a “sanctuary state” for abortion, following a directive by Gov. Jay Inslee in 2022 barring police from cooperating with out-of-state investigations regarding abortion. Just this year, Washington also introduced five new pieces of legislation aimed at protecting access to abortion and gender-affirming care.

Iris Alatorre is the program manager for the Northwest Abortion Access Fund. NWAAF provides financial and travel assistance to people seeking abortions. Between June 2022 to June 2023, NWAAF saw a 61% increase in abortion funding it distributed, a total of $2,181,000, compared to the same period a year prior.

As more people are forced to travel for care because of state abortion bans, many of those patients have to delay care to secure funds, take time off from work and, in some cases, arrange child care, Allatore said.

“That’s an increase overall in the amount of money that is being spent on people accessing abortion care,” they said. “Someone who is maybe in their first trimester of pregnancy, delaying their abortion care and having to wait, maybe until their second trimester of pregnancy to be able to get the resources together.”

While some patients are able to travel without too much difficulty, Alatorre said, patients who are poor, rural or face bias because of factors like medical racism or gender identity often struggle to access abortions.

Alatorre said the organization helps people from all walks of life, including parents who are unable to provide for another child, or have pregnancies with fetal abnormalities that make the pregnancy unviable.

“We see a lot of unhoused people needing to access abortion care, people who use drugs,” Alatorre said. “We also, obviously, sometimes see minors. But also like, young, young girls.”

Abortion funds struggling to keep up

Since the Dobbs v. Jackson Women’s Health decision, Alatorre said, NWAAF received an outpouring of support from donors, including some state and local governments. Other abortion funds in states like Arizona and Utah often don’t have the same level of support.

“They have a much smaller budget to work with, and they’re having to spend that budget way quicker,” she said. “So, that means that people who are needing abortion care and calling their local funds to get care sometimes are turned away, because the fund has spent all of their money for that month.”

NWAAF primarily serves Washington, Alaska, Idaho and Oregon, but has helped people seeking abortions from 42 different states.

Last year, NWAAF served 762 people from Washington, 430 from Idaho, 404 from Oregon, 147 from Texas and 103 from Alaska.

Alatorre said NWAAF staff are dealing with new challenges because demand for assistance more than doubled in the last year.

“We have had to scale up so quickly, so fast, it’s hard to keep up,” she said. “We are understaffed and therefore the folks who are doing this work, we are burning out.”

Though the organization has been met with an influx of both funding and volunteers, training those volunteers is a lengthy process.

Volunteers are asked to commit a minimum of two years because of the time and energy it takes to train them.

Different people will also be able and willing to take on different levels of legal risk, she said. Laws like Idaho’s “abortion trafficking” law criminalize anyone who helps a minor obtain an abortion without parental consent.

“It is such a labor-intensive process for the folks who are doing the vetting and onboarding and training. It takes a while for us to do it the way we would like to do it,” she said. “That slows down the pace at which we can bring more people on.”

Karl Eastlund, CEO of Planned Parenthood of Greater Washington and North Idaho, said Pullman, Walla Walla and Kennewick clinics have seen the biggest increase in patients.

“The big shift was there was an abortion clinic in Meridian, outside of Boise ..." said Eastlund, referring to a clinic that remains open but no longer provides abortion services. "And those are the patients that are 100% displaced. They’re in Boise, used to going to Meridian, and now they have to go somewhere else.”

Across the board, Eastlund said, clinics have seen between roughly 70 to 100 new visits a month, accounting for somewhere between 20%-30% increases depending on the clinic.

Wait times have not significantly increased in Washington clinics, Eastlund said, though some clinics have had to expand hours, and prioritize abortion over other services on some clinic days.

“I think it was what many of us had feared was coming. And so we were already starting to get ready for an anticipated surge from Idaho,” he said.

In 2022, the Pullman Planned Parenthood clinic reported seeing its Idaho-based patients jump from 62% in June to 78% in July, despite Idaho’s abortion ban only taking effect Aug. 25, according to Cantwell’s office.

The closure of Idaho clinics, including the one in Meridian, have also limited access to nonabortion OB-GYN care for Idaho patients.

That impact isn’t just at clinics that provide abortion services. Two Idaho hospitals, Bonner General Health in Sandpoint and Valor Health Hospital in Emmett, closed their labor and delivery units this spring, citing challenges recruiting skilled doctors and nurses. Bonner General specifically cited Idaho’s political climate as a challenge in OB/GYN recruitment.

“Highly respected, talented physicians are leaving,” the March news release stated. “Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care. Consequences for Idaho Physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.

Changing medical landscape

A survey this spring of Idaho doctors who work in maternal fetal health asked physicians if they were considering relocating. Of respondents, 48 said yes, 42 said no, and 27 said maybe. Among the doctors considering leaving, 73 out of 75 said the state’s abortion laws contributed to their possible departure.

Dr. Loren Colson is a full-spectrum family medicine doctor in Boise who provides outpatient, inpatient and obstetrics care. He said he’s considered leaving, though hadn’t made the decision to do so yet.

“There’s a point where just ethically, I cannot continue providing care if there are too many restrictions on the way that I provide that care, because I can’t live up to my ethical medical standard,” Colson said.

Colson said he’s worried if further restrictions are passed on contraception, it might be impossible to meet those standards. The state’s tightening restrictions have also changed his approach to care for patients who could get pregnant.

“We always offer emergency contraception, and told our patients that there’s over-the-counter emergency contraception too. But now, we just try and identify folks that are of reproductive potential, and then just prescribe it to them. And tell them, ‘It’s probably best just to have this on hand.’”

Idaho’s Defense of Life Act leaves doctors open to prosecution for assisting in an abortion. This has also left doctors uncertain of whether they can safely or legally talk to their patients about resources outside of the state.

A March letter by Idaho Attorney General Raul Labrador stated that Idaho medical providers referring patients across state lines for abortion or prescribing abortion pills for patients to pick up in another state would be considered assisting in an abortion.

Labrador later withdrew the letter after a lawsuit was filed by Planned Parenthood, and he suggested it was not intended as a guiding document. However, it’s continued to have a chilling effect, Colson said.

“It’s really hard,” he said. “People come to us expecting to be able to have a frank conversation with their physician and get whatever care that they need. And that is something that we can’t provide them with now.”

Training Idaho’s medical workforce

Abortion restrictions are making it harder to recruit new medical providers, and train the medical workforce in states with bans. A residency program in Boise had to stop abortion training through a Planned Parenthood clinic.

Those residents now have to travel to Spokane, or farther, without support from their program.

A survey by the Association of American Medical Colleges found applications for U.S. senior doctor of medicine OB/GYN residencies decreased by 10.3% in 2023 in states with complete bans, with a 5.2% decrease across the U.S. The same survey found a drop in applicants seeking residencies in other areas likely to be impacted by the bans, such as a 21.4% dip for emergency medicine and 3% decline for family medicine.

Colson said medical residents he knows are troubled by not being able to access some kinds of training.

“I think for medical students and for residents, we know that this is a big issue for them,” he said. “Even if they’re not interested in necessarily training in abortion, I think the idea of practicing in states that are limiting medical care is very concerning.”

Idaho has continually struggled to provide adequate health care for its residents. A 2022 report by Idaho Business for Education found the state had around 9,000 unfilled health care positions.

Dr. Sarah Prager is a professor of obstetrics and gynecology at the University of Washington. She said some students are reconsidering plans to practice in states with strict abortion bans.

“Students who potentially always planned to go back to their home state of Idaho or Wyoming or Alaska or farther afield, who now are deciding if they can be the kind of provider that they wanted to be in their home state,” Prager said.

Colson said abortion bans affect providers across the state, even if they don’t specialize in obstetrics, gynecology or maternal health.

“There’s physicians out there saying, ‘This doesn’t affect me, because I don’t provide abortions.’ But it does affect you, because it affects who you can refer to,” he said. “It affects whether doctors want to stay in the state, it worsens our already large health provider shortage that we have in Idaho.”

Sun may be contacted at rsun@lmtribune.com or on Twitter at @Rachel_M_Sun. This report is made in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.