It was a terrifying moment: A woman began leaking fluid during her pregnancy. She was diagnosed with preterm premature rupture of the membranes, a pregnancy complication in which the amniotic sac surrounding the baby breaks. Once the sac breaks, the risk of developing a serious infection is high. Her health care team told her it was very unlikely that her baby would survive and recommended she get an abortion; however, because she was in Idaho, she was not able to receive the recommended care.
A new law in Idaho bans health care professionals from ending someone’s pregnancy. She would have had to wait for the fetus to have no detectable heartbeat, or to experience a medical emergency like a life-threatening infection — risking her own life and future ability to have children.
To receive the care she needed — the care she knew was right for her and her family — she was forced to go to Oregon, which required time and resources to manage travel, accommodations and coverage for work and childcare. Even though she has insurance, Idaho’s abortion ban meant that she paid for everything out-of-pocket.
Although the care team at Oregon Health & Science University was able to treat her, it was a tragic outcome: Not only did she have to deal with the sudden loss of a desired pregnancy, but she also was forced to do it away from her home, community and support system.
OHSU providers are seeing these types of circumstances every week as Oregon experiences a significant influx of out-of-state patients seeking abortion care in the year since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade — ending 50 years of federal abortion protections in the United States. Since then, many states have passed laws like Idaho’s, implementing total abortion bans or other extreme restrictions on abortion care.
These dangerous policies have:
- Resulted in abortion services becoming increasingly unsafe and inaccessible, despite the fact that abortion care is essential to safely managing pregnancy complications — a critical public health issue for the U.S., given its already high and increasing maternal morbidity and mortality rate.
- Further reduced access for patients who already face significant barriers to health care, including people of color, immigrants, low-income individuals and LGBTQ+ people.
- Put health care providers at risk of civil and criminal penalties, including jail time and the loss of their license to practice.
- Forced many patients to either travel to states like Oregon for care, or choose to stay in their home states and experience harm to their health or to continue an undesired pregnancy.
“We know that when someone wants to have an abortion but cannot get one, they face significant consequences to their physical, financial and emotional health,” said Alison Edelman, M.D., M.P.H., professor of obstetrics and gynecology and division director of Complex Family Planning in the OHSU School of Medicine. “Looking at the data we have available from the past year, it’s devastating to think about the many individuals who have not been able to receive the care they so desperately want and need.”
According to data from the Society of Family Planning’s #WeCount, a national abortion reporting effort that aims to capture the shifts in abortion access by state, the Dobbs decision has resulted in significant, nationwide impacts on abortion access. Most notable has been the national decrease in the average monthly number of abortions performed: From July 2022 to March 2023, there were 25,640 cumulative fewer abortions compared with the average monthly number of abortions observed in the pre-Dobbs period.
In Oregon, it’s the opposite: Providers are seeing an average of 100 to 300 additional abortions performed per month since the Dobbs decision. The majority of abortion care in the state is performed by a small handful of providers, so any increase has a significant impact on health system capacity.
Prior to Dobbs, OHSU providers mainly cared for individuals from Oregon and Washington, and occasionally a neighboring state, if the patient had a family tie or other connection to Oregon. However, last year, the majority of OHSU’s out-of-state patients were from Idaho and Texas — states with some of the most restrictive laws. OHSU also for the first time saw individuals from states such as South Dakota, Oklahoma, Louisiana and Florida.
And, some individuals came from states where abortion is still legal, like Colorado and California — but due to capacity issues and long wait times for appointments caused by the influx of out-of-state patients, they were forced to travel further from home to receive care.
For those out-of-state patients who do make it to Oregon, Edelman notes it’s rarely an easy journey.
“These individuals are extensively delayed in receiving care due to financial constraints, managing time off work and childcare, travel logistics and health care system barriers,” she said. “As you can imagine, individuals who do make it to us are often confused, scared and experiencing significant trauma. Managing this increase in demand for services requires additional time and resources, but we will always be a safe haven for these individuals.”
OHSU: Abortion is health care
OHSU has been steadfast in its position that, as an academic health center guided by a mission firmly rooted in health, science and a commitment to the well-being of all people, it will provide reproductive health care — including abortion — to all patients who seek it, and will educate the next generation of clinicians and advance groundbreaking research.
In the face of continued attacks on reproductive rights, OHSU has been a leader in reproductive health care and education, including:
- Working to provide access to abortion services for both Oregonians and out-of-state patients.
- Advising on international efforts to improve reproductive health.
- Offering abortion training for medical residents who live in states where abortion is banned or restricted, and, therefore, don’t have access to clinical experience with abortion care as part of their family planning training.
- Launching the Center for Reproductive Health Equity, which will investigate key disparities affecting reproductive health research, education and clinical care.
“The personal decision when or whether to bear a child is both a fundamental human right and a critical factor in health and well-being,” said Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Reproductive Health Equity. “The past year has been a very frightening reality. We’re now seeing the very real consequences that the Dobbs decision, and all the other policies aimed to restrict reproductive health, are having on individuals across this country.”
Rodriguez emphasized the critical role sanctuary states like Oregon have in the fight for reproductive justice: “Here in Oregon, we certainly feel an increased responsibility to ensure people from out-of-state are able to access the critical care they need. We will continue to do everything we can to ensure that everyone has access to safe, legal abortion care.”