Abortion bans across the country are forcing medical providers to choose between their obligation to their patients or possible lawsuits, loss of licenses and incarceration.
On March 17, Bonner General Hospital—in rural northern Idaho—announced it had made the “difficult decision to discontinue providing obstetrical services.” With this announcement, Bonner joins the steadily declining number of rural hospitals that have obstetrical units.
The trending loss of rural hospital-based obstetrical services is generally attributed to factors like the challenges of retaining and attracting medical staff, and declining birth rates. However, in its press release, Bonner General adds a new and chilling variable into the mix—namely “Idaho’s legal and political climate,” faulting it for the fact that “highly respected, talented physicians are leaving” who will be “extraordinarily difficult to replace.”
Although the announcement does not use the word “abortion,” there is no doubt it’s meant to call out Idaho lawmakers for enacting laws that “criminalize physicians for medical care nationally recognized as the standard of care”—a criminal regime that has earned Idaho the distinction of being one of the most abortion-hostile states in the post-Roe era.
Nearly all abortions are already banned in the state, and doctors who provide abortions are guilty until proven innocent. Now state-level Republicans are backing House Bill 242, which passed through the House and is likely to pass through the Senate. The law would create a new crime dubbed “abortion trafficking,” banning traveling out of state to get an abortion and criminalizing anyone transporting a pregnant minor seeking an abortion, outside of and even within the state. (“Technically, they’re not criminalizing people driving in [another] state with a minor. The crime is the time that someone is driving the minor in Idaho,” said David Cohen, a law professor at Drexel University.)
The current effort by local real estate companies to pitch rural Idaho as the ideal landing place for conservatives who are “fed up with liberal politics in blue states,” and weary of “out-of-control crime and forced masking” may also contribute to the inhospitable climate for abortion providers. For instance, “Flee the City,” a real estate consortium “for the vigilant,” which happens to be located in the same town as Bonner General, urges folks to return to the “days of old” when “the men would lead women would nurture”—proclaiming that this “is your right that awaits your flight.”
Dorothy Moon, the state’s GOP chairwoman, denies that the politics of abortion has anything to do with Bonner’s decision to close its obstetrical unit. But Caitlin Gustafson, a family-medicine physician and a member of the Idaho Coalition for Safe Reproductive Health Care, stresses that while recruitment for gynecological care providers was a challenge before the abortion ban went into effect, “now it’s basically exploding in terms of who we’re going to be able to maintain and recruit in the state to provide this care.”
This is no surprise, given that—as stated in Bonner’s press release—the consequences “for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.” And while this standard of care may well require the prompt termination of a wanted pregnancy in order to preserve the life, health or future fertility of a pregnant person, “medical providers say they are facing impossible situations that pit their ethical obligation to patients who are dealing with traumatic and dangerous pregnancy complications against the fear of lawsuits, loss of their medical licenses and incarceration.”
This is the fate that befell Idaho resident Carmen Broesder, 35, who detailed her harrowing health journey on TikTok. When Broesder was six weeks pregnant, she began experiencing heavy bleeding and intense cramping, resulting in multiple trips to emergency rooms at different hospitals. She was repeatedly denied a D&C, a standard abortion procedure in miscarriage management. As one physician explained to her, this was due to “’some trepidation’ about performing one in the wake of Idaho’s new abortion law.” After a nightmarish 19 days of bleeding, Broesder does not plan to risk another pregnancy, fearing that under Idaho law “if something similar happens, she could die due to fear from medical professionals about administering care.”
@geekynerdbitch ♬ original sound – Carmen Broesder
Stories like Broesder’s are abound in states with abortion bans. In the first of its kind lawsuit since the Supreme Court overturned Roe, five women have sued Texas after their harrowing experiences of being denied abortions in the face of potentially life-threatening risks to themselves and/or their fetuses. As detailed in the complaint, one of the plaintiffs Amanda Zurawski was denied abortion care after experiencing a premature rupture of membranes until she faced life-threatening sepsis, as a result of which a fallopian tube has permanently closed, compromising her ability to become pregnant again.
Anna Zargarian, another plaintiff, was refused an abortion after her water broke prematurely. Although there was no chance her baby would survive, she was told by the ER doctors that although a D&C was the safest course of action, “so long as her baby had detectible cardiac activity, Texas law barred them from performing an abortion, unless and until her life was in danger.” Though she feared she might go into labor on the plane, Zargarian flew to Colorado for an abortion, rather than risk going into labor while driving through Texas to reach New Mexico.
Zargarian, Zurawski and three other women denied care are joined by two board-certified obstetrician-gynecologists who have “seen the devastating impact of Texas’s abortion bans on [their] practice and on that of [their] colleagues.” As one put it, “I know most Texas doctors are scared to provide abortions in any circumstances or even say the word abortion. We need clarity on what kinds of patients we can help without losing our license or ending up in jail.”
It is thus no surprise that doctors are leaving Texas, which Charles Brown, chair of the Texas district of the American College of Obstetricians and Gynecologists, predicts will be “part of a bigger trend that’s going to be obvious pretty quickly.”
According to the Governmental Accounting Office, closures of hospital-based obstetrical services have been concentrated in “rural counties that were sparsely populated, had a majority of Black or African Americans, and were considered low-income.” It is all but inevitable that this pattern will exacerbate existing racial disparities, with Black women in the United States already being “three and four times more likely to die from pregnancy-related causes than White women,” and twice as likely to experience severe maternal morbidity.
A grim irony is at play here. Not only are states like Idaho and Texas robbing pregnant women of the right to choose not to have a child, the bans are exposing pregnant people to risks of death, injury and illness—making it less likely that every family who wants to bring children into the world will be able to do so and survive the experience.
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