New report details Dobbs’ grim effect on Pacific Northwest health care access

“Two Years Post-Dobbs: The Nationwide Impacts of Abortion Bans,” released July 11, draws on 80 interviews with abortion providers and advocates across the country, detailing the many ways the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health ruling has led to worse health outcomes for patients and legally complex situations for providers.

“At least 23 million women of reproductive age nationwide live in states with abortion bans,” said Sen. Cantwell of the findings. “That’s 23 million women who won’t have access to care if they become pregnant and need to have an abortion. Women … are in life-threatening situations and are being denied access to care.”

While the report focuses heavily on the impact in ban states, it draws one of the clearest pictures so far of how abortion bans have affected patients and providers in states like Washington that have affirmed access to abortion and have become destinations for abortion care.

“We’ve been flying out about a patient a week to Utah or Oregon or Washington, because the fetus is nonviable, or the life of the mother is at risk,” said Ed McEachern, co-chair of Idaho Physician Well-Being Action Collaborative, a physicians advocacy group.

Women traveling — or being transported — into Washington for abortion care now include patients needing care after miscarriages or for fetal anomalies, and after sexual assaults. Despite being technically eligible for abortion care in states whose abortion bans include nominal exceptions for rape and incest, the latter often opt to go out-of-state instead “because it was easier to travel than to navigate exceptions,” according to Kris Lawler, a Tampa Bay Abortion Fund board member who spoke with Senate Democrats.

The number of patients traveling for care continues to grow as more bans are enacted. In May, Florida’s six-week abortion ban went into effect. Within a week, Planned Parenthood Columbia Willamette, which provides abortions in Oregon and southwest Washington, reported its first patient from Florida — one of many who began traveling to the Pacific Northwest as soon as the ban became law.

The Northwest Abortion Access Fund, which provides financial and practical support to people seeking abortions throughout the Pacific Northwest, reported that patients reaching out to them from Florida increased ninefold under the six-week ban, compared to the same timeframe in 2023.

This influx of patients has also caused delays for providers and patients who live in the Pacific Northwest and Inland Northwest. Providers at Portland’s Oregon Health and Sciences University have reported treating patients from Washington who’ve traveled to OHSU due to delays at clinics where they live.

“We are getting a lot of patients from Idaho, and even more from states like California and Washington, where there are no bans, but people are struggling to get in to be seen in a timely fashion,” said Dr. Maria Rodriguez, who was interviewed as part of the Senate Democrats’ report. OHSU’s volume of abortion patients has doubled since Dobbs, and the hospital has seen a 20% increase in the number of abortion patients coming from Washington. Often, said Rodriguez, “[P]eople are far more likely to be in the second or third trimester due to delays, and a lot sicker.”

As has been the trend for years, much of the demand on Washington and Oregon providers is coming from Idaho, a development that pushed Planned Parenthood Columbia Willamette to open a new clinic.

But the crowds at OHSU are also a result of what’s happening in California, where out-of-state demand means long wait times for abortion. Many patients facing these delays are traveling to clinics like Seattle’s Lilith Clinic, said the organization’s director of public affairs Grayson Dempsey. “California itself is experiencing such a huge surge from places like Texas and Arizona, their wait times can be three to four weeks,” she said. “For people who have the resources, it may make more sense to buy an inexpensive plane ticket to Seattle to get the care they need.”

Further complicating this is an exodus of OB/GYNs from states with abortion bans, including Idaho, which has lost 22% of its OB/GYN workforce since Dobbs. From Texas to Boise, many doctors have moved their practices to Washington because of its laws shielding abortion providers and patients. Three were interviewed in the report, all citing legal and ethical concerns about continuing to practice in states where they were forced to let patients become extremely ill or even close to death before intervening in pregnancy complications and miscarriages.

“A mom can bleed to death from an incomplete miscarriage,” said Dr. Robyn Hitchcock, an emergency physician in Colville. “In Washington, I can complete that miscarriage and stop her bleeding. But if I am in Idaho and I do that same thing, I worry that I could go to jail for saving that person’s life.” In the past, Hitchcock would pick up shifts in a small Idaho hospital. She’s since relinquished her admitting privileges there.

Dr. Alison Haddock, president-elect of the American College of Emergency Physicians, chose to move to Washington from Texas for similar reasons. “Criminal liability is not covered by malpractice. EMTALA liability is not covered by malpractice. The bounty-hunter law that they have in Texas is not covered by malpractice. There are layers and layers of new risks for physicians that are just not worth it. At some point, it’s too much,” she said.

But as physicians like Haddock depart, it’s increasingly unlikely anyone will replace them. According to Jessica Knoll of the Idaho chapter of the American College of Emergency Physicians, more than half of the physicians she’s interviewed have decided to practice in Washington or Oregon rather than Idaho, citing the health care environment in the state as the reason.

Medical students and residents are avoiding abortion-hostile states. Carmen Abbe, a graduate of Washington State University’s Elson S. Floyd College of Medicine, who was interviewed for “Two Years Post-Dobbs,” had wanted to continue her education with a residency in Idaho but was told abortion training could not be promised.

“They told me: We want you to learn abortion care because we think it’s medically important. But you can’t do that in our state,” said Abbe. While the residency offered students abortion training through another institution, it required out-of-state travel and the program couldn’t guarantee its availability.

Overall, applications for OB/GYN residents have dropped nationally, especially in states with abortion bans, a dynamic OHSU’s Rodriguez said could lead to problematic knowledge gaps among providers. “The reality is that if you don’t know how to provide an abortion, you certainly can’t manage a miscarriage in an evidence-based way,” she said. “What OHSU has seen is that the residents that come here from restricted states also have very limited knowledge about long-acting and reversible contraception.”

While physician departures have been well documented, many of the developments captured in “Two Years Post-Dobbs” extend to concerns advocates didn’t anticipate, including a pattern among some women with uncomplicated pregnancies of choosing to receive prenatal care and give birth in states with abortion protections in case of a complication. “I have had patients who have totally typical courses of pregnancy and choose to take up a second residence or live in a hotel post-viability because they are fearful of what might happen if they do have a complication,” said Jacquiline Blanco, a Seattle-based nurse.

Abortion restrictions have also had an outsized impact on survivors of gender-based violence and sexual assault. According to advocates who work along the Idaho/Washington border, some sexual-assault nurse examiners have denied patients emergency contraception, despite its legality and availability to people of all ages in Idaho. According to the report, the Washington State Coalition Against Domestic Violence has seen an increase of at least 20% in calls from Idaho.

Dobbs’ impact on birth control and emergency contraception access has also been tracked in a study from the University of Southern California that shows demand for emergency contraception in Idaho increased significantly in recent years. Since Dobbs, prescriptions filled for emergency contraception have increased by 148%, even as prescriptions for birth control fell by 19%. This aligns with reports from advocates of heightened demand for emergency contraception from Idahoans facing gender-based violence.

While the USC study findings, published in JAMA Network Open, did not include Washington, lead author Dima M. Qato shared her findings for the state with Cascade PBS. Compared to Idaho, the contrast is stark: In Washington, emergency contraception fills went up by just 1.9% after Dobbs.

Qato and her fellow authors posit that shifting rates of emergency contraceptive fills nationally reflect confusion about what forms of birth control and medication abortion remain legal, even in states without abortion bans. That too was a concern among advocates around the time Dobbs was decided.

Part of the problem, said Qato in a news release, could be due to closures of standalone clinics that had provided numerous reproductive health care services — including emergency contraception and birth control — in addition to abortion, a reflection of what states like Idaho have lost since the imposition of Dobbs. “Because 11% of women rely on such clinics for the provision of prescriptions for contraceptives — many of which are filled at outside pharmacies — these closures may have reduced access to oral and emergency contraceptives,” she said.

She said more efforts to broaden access to birth control and emergency contraceptives were necessary, especially in states where abortion is no longer legal.