Abortion care ‘a pretty overwhelming landscape’ in the West after Roe

While abortion remains legal up to 18 weeks in Utah, a ban on abortion clinics is set to go into effect in May and a lawsuit challenging a trigger ban is ongoing.

(Francisco Kjolseth | The Salt Lake Tribune) Founders of the Utah Abortion Fund gather to talk about their organization on March 9, 2023. The fund, which was started in 2019, connects individuals with the resources they need to get an abortion and provided over $135K in abortion funding last year.

It’s been nine months since the U.S. Supreme Court overturned the constitutional right to an abortion, leaving reproductive policymaking to states.

Yet the status of abortion access throughout the West remains fragmented, even on the municipal level, leaving pregnant people scrambling to know where to go as laws change by the day.

“We see some of the most beautiful moments in people’s lives, and we see some of the most devastating moments in people’s lives,” said Dr. Misha Pangasa, a Salt Lake City OB-GYN who provides abortions at Planned Parenthood.

“For us, to have to look at people and tell them that they don’t have options, and watch them suffer when we have the ability to intervene but just have our hands handcuffed — it’s a different kind of fear that’s really set in,” Pangasa continued.

[READ: Where Utahns can get an abortion after the clinic ban goes into effect]

Without a unified federal law, state legislatures and local municipalities are tailoring their own abortion rules, leaving courts to decide what is constitutionally allowed — and people, looking for health care, to navigate the ensuing confusion. In the absence of legal clarity, health care providers, nonprofits and activists are collaborating to close the gaps in care that new laws have created in states across the West.

Utah’s abortion clinic ban

Abortion is currently legal in Utah up to 18 weeks. But with Gov. Spencer Cox’s signature on HB467, titled “Abortion Changes,” the state is slated to stop renewing and issuing licenses for abortion clinics beginning May 3 — and will completely outlaw them in January 2024.

The future of abortion in Utah has become even more unclear in recent days after Planned Parenthood Association of Utah asked a district court judge to block the clinic ban, arguing that the law is the state’s way of reinstating the already-enjoined abortion trigger law.

That law, which was blocked shortly after going into effect last year, prohibits abortion, with limited exceptions for rape, incest, when the life of the mother is at risk or when there’s a fatal fetal abnormality. As the lawsuit continues, Utah Attorney General Sean Reyes’ office has appealed the injunction to the state Supreme Court.

HB467 moves all abortions to facilities that meet the state’s definition of a “hospital.” That definition includes general hospitals and clinics “certified by the department as providing equipment and personnel sufficient in quantity and quality to provide the same degree of safety as ... a general hospital licensed by the department.”

According to the recent court filing, the Utah Department of Health and Human Services “informed PPAU that only licensed hospitals and satellite clinics operating under a general hospital’s license would be eligible for the Clinic Ban’s expanded ‘hospital’ definition, despite that this limitation appears nowhere in the text of HB 467.”

Planned Parenthood Association of Utah’s interim CEO Sarah Stoesz told reporters that without a preliminary injunction against HB467, the organization’s clinics will stop offering abortions in May.

Utah’s hospitals don’t offer elective abortions, and in cases of medical emergencies, health care facilities can still legally deny abortion care on the basis of personal and institutional morals. And after five Utah hospitals were recently acquired by a Catholic-affiliated health care system, access to certain reproductive procedures is already shrinking.

“The reality is, most hospitals are not providing that care at all,” Pangasa said. “The ones that are, have strict restrictions about which types of abortions, or which reasons of abortion, are allowed within the hospitals.”

In instances when a hospital is willing to provide an abortion, the service is much more costly than at a clinic. Patients can be billed as much as $30,000 out of pocket.

Elsewhere in the West, the future of abortion policy is equally ambiguous. In Wyoming, for example, state lawmakers voted twice to outlaw abortions, and a judge put the laws on hold both times.

While Wyoming’s 2022 trigger ban remains blocked, lawmakers passed a ban this year that amends the state’s constitution — which guarantees adults the right to make their own health care decisions — to say abortion isn’t health care. A judge also blocked a ban on abortion medication passed this year.

Abortion is legal in Wyoming until viability, or 24 to 26 weeks into a pregnancy.

Like Wyoming and Utah, Idaho also has multiple abortion laws on the books. Abortion is completely banned there, with exceptions for the mother’s life and rape or incest.

While the ban doesn’t say it’s illegal to travel outside the state for an abortion, Idaho’s attorney general has said he views the law as prohibiting health care providers from referring people across state lines for an abortion. A regional Planned Parenthood affiliate and two doctors are suing over that interpretation. As of Wednesday, it will also soon be a crime to help a minor leave the state for an abortion without parental permission.

People can seek abortions in the four other states neighboring Utah — Arizona, Colorado, Nevada and New Mexico — where it’s legal, although the states have different gestational limits. Colorado and New Mexico allow an abortion throughout a person’s pregnancy, Nevada permits it up to 24 weeks and Arizona goes up to 15 weeks.

The patchwork of bans across the region could force patients to travel greater distances and face longer wait times for appointments in clinics where abortion remains legal.

“It’s a pretty overwhelming landscape,” said Christine Lichtenfels with Chelsea’s Fund, a nonprofit providing financial assistance to people from Wyoming seeking abortions.

In rural Wyoming, some physicians have relied on being able to refer patients that need more complex abortion procedures to Salt Lake City facilities.

Most patients with second-trimester anomalies who want to terminate are referred to Salt Lake City, said Dr. Giovannina Anthony, an OB-GYN at Wyoming’s sole clinic offering abortions, in February. “That would be a big loss.��

However, Utah’s 72-hour waiting period rule has created extra hurdles for those traveling from out of state.

Now, though, both Utahns and those who have come from Idaho and Wyoming may be looking at having to travel farther distances, foot higher expenses and deal with longer wait times as clinics in states where abortion remains legal deal with more congestion.

Bridging the gaps created by lawmakers

Abortion advocates have said the full impact of Utah’s “Abortion Changes” law is unclear. But the Utah Abortion Fund, which provided over $135,000 in abortion-related financial assistance last year, plans to keep operating until forced to close.

Although the fund is run by only three individuals, they have disbursed between $11,000 and $21,000 in funds each month since a draft of the Supreme Court’s Dobbs decision was leaked in May 2022.

“Our focus is less on trying to change a system that already does not care for the people that we care for, it’s filling the gaps that the system has created,” one of the fund’s co-founders said. “We’re constantly having conversations about changing our budget if this does happen. ‘What’s the average cost of gas or a flight? How many people are we gonna help? Where are we going to send them?’”

(Francisco Kjolseth | The Salt Lake Tribune) Utah Abortion Fund materials pictured at the home of one of the fund's founders on March 9, 2023. The fund connects individuals with the resources they need to get an abortion and provided over $135K in abortion funding last year.

The fund operates through its health line, which is how individuals who need help from the fund contact its volunteers to explain their needs. The Salt Lake Tribune has verified the identities of the fund’s volunteers, but is not naming them due to safety and privacy concerns for both them and the people they assist.

“If we have a lot of callers who are traveling out of state or something like that, and that takes a lot of hand-holding, a lot of support,” one of the fund’s co-founders said. She added that traveling for an abortion also involves additional costs someone “may not think about right away,” such as child care and lost wages.

But even now, before Utah has banned the procedure, clinics in surrounding states like Colorado, Nevada and New Mexico are becoming oversaturated with demand.

“We have been referring patients out of state even before the Dobbs decision happened… there were enough restrictions in Utah, that we were still not able to care for everybody,” said Pangasa, the Salt Lake City OB-GYN. “The reality is that I don’t think that we’re prepared for it … . Already, patients are struggling to navigate going to another state on their own with the help of organizations here.”

Last year, according to preliminary data provided to The Tribune by the Nevada Department of Health and Human Services and the Colorado Department of Public Health and Environment, 127 and 53 Utahns sought abortion care in those states, respectively.

If the abortion clinic ban goes into effect, those numbers will likely surge in 2023 and 2024, as most of Utah’s abortion care is outsourced.

According to Planned Parenthood Association of Utah, abortion clinics perform over 95% of abortions in the state. Operating three of the state’s four abortion clinics, Planned Parenthood alone provided more than 2,800 abortions last year.

And although Utah’s gestational age limit of 18 weeks is the country’s fourth-earliest (excluding states where abortion is completely banned), the loss of abortion access in Utah will prove detrimental to patients from other Western states.

“We’re seeing patients from Idaho, we’re seeing patients from northern Arizona, we’re seeing patients from eastern Nevada,” Pangasa said. “They’re going to be forced to wait longer because clinics in Colorado and New Mexico are sometimes booking several weeks out there. And sometimes there are going to be people who just can’t do it, because the abortion funds run out of money sometimes.”

As abortion care becomes more restricted in the West, the physician fears it may lead to gaps for basic obstetrics and gynecological care — like in the community of Sandpoint, Idaho, where a hospital had to outsource its labor and delivery care to a hospital an hour away, the Idaho Capital Sun reported.

“These types of restrictive legislation are going to really impact the physician workforce in these states,” Pangasa said. “We’re already seeing in Idaho what seems like a mass exodus, really, of OB-GYN providers, and hospitals closing because of it, and people not providing obstetric services anymore. And I think such a thing can definitely happen in Utah as well.”

A regional question

Abortion providers in neighboring western states with less strict abortion laws have been adjusting to welcoming patients from afar — mostly from Texas — since last summer’s Dobbs decision.

The CEO of Planned Parenthood Mar Monte, which covers part of California and three-quarters of the counties in Nevada, said that one-third of its abortion patients last year came from out-of-state.

Amanda Carlson, the director of Colorado’s Cobalt Abortion Fund, said the organization’s call volume tripled the day the U.S. Supreme Court issued its ruling last June.

“There were about 12 states across the country that had trigger bans, so the immediate scarcity of access was just so instantaneous,” Carlson said. She added, “We do anticipate our volume to increase and we are doing everything we can on our end.”

Back in Utah, Pangasa expects patients in many states will now have to rely on the pseudo-system of health care providers and grassroots organizations in order to find and obtain an abortion.

“I have more doctor’s cell phone numbers in other states than I ever thought I would,” Pangasa said. “I can’t say it’s good for the physicians as individuals, but I would say people in this community have the least personal boundaries, in terms of trying to — outside of their work hours, on weekends, at night — just trying to help coordinate this care for people.”

Health care workers, nonprofits and abortion rights activists aren’t the only ones who have been planning ahead of anticipated out-of-state travel for pregnant Utahns.

Without a law of the land, some anti-abortion activists are working to make patchwork prohibitions, not just state-to-state, but community-to-community.

On Utah’s border with Nevada, the West Wendover City Council is expected to consider an ordinance that would enforce a 150-year-old federal law to essentially ban abortion there.

The proposal was brought by Texas pastor Mark Lee Dickson after the body rejected an application from Planned Parenthood Mar Monte to build a clinic there. That decision was vetoed by the city’s mayor, leaving the permit request in limbo.

Dickson says his “Sanctuary Cities for the Unborn” movement doesn’t plan to stop there, and that leaders in several communities in both Utah and Nevada have expressed interest in putting forward similar ordinances.

If he’s successful, in West Wendover and elsewhere, such “sanctuary cities” will add to the confusion for people in need of reproductive health care, as what’s considered a fundamental right on one side of a border is a criminal act on the other.