Hevan Lunsford, a nurse in Alabama, was five months pregnant when a doctor told her that her fetus was severely underdeveloped and had only half of a heart. She was told the boy, whom she and her husband decided to name Sebastian, would need care to ease his pain and several surgeries. He may not live long, they were told.
Lunsford, devastated, asked about ending the pregnancy. But the doctor said Alabama law prohibits abortions after five months. He handed Lunsford a piece of paper with information for a clinic in Atlanta, Georgia, a roughly 180-mile drive east.
“The procedure itself was probably the least traumatic part of it,” Lunsford said. “Most of the laws I navigated, there was no reason for them. None of them prevented my abortion. It just made it where I had to travel out of state.”
Lunsford is one of thousands of women in the U.S. who have crossed state lines for an abortion in recent years as states have passed ever stricter laws and as the number of clinics has declined, according to an Associated Press analysis of data collected from state reports and the U.S. Centers for Disease Control and Prevention.
Although abortion opponents say the laws are intended to reduce abortions and not send people to other states, at least 276,000 women in the U.S. terminated their pregnancies outside their home state between 2012 and 2017, according to the AP’s data analysis.
About 2,800 to 3,000 of those were Idaho women, crossing state lines for procedures or medication-induced abortion.
According to previous Idaho Statesman reporting, since 2000, the highest annual number of abortions in Idaho was 1,650 in 2009. The lowest: 801 in 2000. In 2017, the most recent year available, Idaho reported 1,285 abortions.
Nevada to Idaho, Idaho to Nevada
While abortions across the U.S. are down, the share of women who had abortions out of state rose slightly, by half a percentage point, according to AP’s analysis.
The AP found some states had notable increases over the six-year period, but Idaho wasn’t one of them.
The share of Idahoan abortions done out of state rose slightly, from 28% in 2012 to 28.6% in 2017, according to numbers from the Idaho Department of Health and Welfare, which gathers detailed abortion data each year.
There was a discrepancy between those numbers and the AP’s data, with the AP showing an increase from 36.4% in 2012 to 39.4% in 2017. The Statesman was unable to identify the reason for the large discrepancy. It’s not uncommon for federal and state data to mismatch.
The data analyzed by the AP also may be incomplete. The AP data showed almost no women from other states receiving abortions in Idaho in the past decade. But in 2017 alone, the Idaho Department of Health and Welfare’s records showed 50 abortions provided in Idaho to out-of-state residents.
Katie Rogers, communications director for the Planned Parenthood affiliate that includes Twin Falls, said that city’s clinic regularly sees Nevadans for abortion care. The Idaho Department of Health and Welfare said Nevadans received 15 abortions in Idaho in 2017.
There were only two cases of Idahoans going to Nevada that year, according to the AP’s data.
Idaho women go to Washington. But why?
Hundreds of Idahoans each year receive abortions in Washington. Others go to Oregon, Utah or Montana. Several have gone to Colorado or Nevada, and two of the abortions were performed in Kansas and Maine.
Based on the AP’s database, the share of Idaho women whose abortions are done in other states is triple the U.S. average. Three or four of every 10 Idaho abortions were performed out of state since 2012, according to the AP data.
That may be due, in large part, to geography.
Three Planned Parenthood clinics provide abortions as part of their health care services in Idaho. They are in the Treasure Valley and Magic Valley. The Statesman was unable to find any other clinics in Idaho that offer abortion services. For Idahoans elsewhere in the state, the clinics in eastern Washington, northern Utah or western Montana may be easier to get to.
Health insurance in Idaho doesn’t cover most abortions, which lessens the need for an Idaho woman to stay in-state for care. Idaho law bans insurance plans from covering abortion, except in cases of rape, incest or to save the woman’s life. All of Idaho’s neighboring states, except for Utah, either allow or require health plans to cover abortion, according to the Kaiser Family Foundation.
Medicaid waiver ripple effect
Idaho is seeking to further change how Medicaid pays for family-planning services. Idaho Medicaid, like other insurance, does not pay for abortions. But the Idaho Legislature this year directed state agencies to seek a waiver from the federal government — one that would require women to get a referral for family planning services from a primary care provider.
That waiver could change the numbers of pregnancies and abortions, said Hannah Brass Greer, chief legal counsel for the Planned Parenthood affiliate that operates clinics in Boise, Meridian and Twin Falls.
Many women go to Planned Parenthood for birth control, women’s health and other non-abortion services. They sometimes choose Planned Parenthood because it specializes in women’s health care. But some go there because they don’t want to share certain intimate details of their life with their family practice doctor, Brass Greer said.
“When you have to go to a family practice provider for a referral, that defeats the purpose of that for that patient,” she said.
Brass Greer acknowledged that a primary care provider is best equipped to help a patient when they have a full picture of that patient’s health needs. She said Planned Parenthood providers try to do that on their end, taking a full health history when they meet patients.
The waiver would keep those patients from going to Planned Parenthood, or getting family planning services at all, she said.
“If the shared goal of Idaho policy makers and health care providers, including Planned Parenthood, is to reduce unintended pregnancies, this is the exact opposite of the thing you want to do,” she said. “You are going to have patients fall through the cracks and not get care, then ... you’re going to have unintended pregnancies because of that.”
One of Idaho’s most well-known abortion opponents says Idahoans come to her organization for privacy, too.
“We see clientele fairly consistently from out of state coming here,” said Brandi Swindell, who runs Stanton Healthcare. The organization has clinics in Boise and Meridian that provide services such as pregnancy testing and adoption referrals. “A lot of times, that’s just a privacy thing. Or a confidentiality thing. We’ll see women from Ontario and different places like that.”
Swindell said Stanton averages 20 to 30 clients a week.
She said she supports legal restrictions that keep taxpayer funding from going to abortion providers — even if that money would pay for family planning, not abortions, she said.
“It’s paying to keep the lights on in the abortion clinic,” Swindell said. “Why should the American people, or why should Medicaid, be covering or underwriting the abortion industry? It’s going into the same pot.”
Stay tuned for abortion laws
In pockets of the Midwest, South and Mountain West, the number of women terminating a pregnancy in another state rose considerably, particularly where a lack of clinics means the closest provider is in another state or where less restrictive policies in a neighboring state make it easier and quicker to terminate a pregnancy there.
Lawmakers passed 58 abortion restrictions this year primarily in the Midwest, Plains and South — almost half of which would ban all, most or some abortions, according to the Guttmacher Institute, a research organization that supports abortion rights.
Idaho so far hasn’t passed a law to ban all or most abortions. But some Idaho lawmakers vowed to take up abortion when the Idaho Legislature convenes in January, the Statesman has reported.
Abortion opponents say the intent of laws limiting the procedure is not to push women to another state but to build more time for them to consider their options and reduce the overall number of abortions.
“I have been insistent in telling my pro-life colleagues that’s all well and good if the last abortion clinic shuts down, but it’s no victory if women end up driving 10 minutes across the river to Granite City, Illinois, or to Fairview Heights,” said Sam Lee, director of Campaign Life Missouri and a longtime anti-abortion lobbyist.
Brass Greer, the lawyer for southern Idaho’s Planned Parenthood affiliate, said she expects Idaho lawmakers to pitch the same kinds of restrictions that passed in other states.
“What we often see in Idaho is the legislators (who) make it a priority to restrict access to abortion oftentimes follow what’s happening in other legislatures, and they wait a year or two to take what they did in other states” and propose similar laws in Idaho, she said.
Advocates say that if the U.S. Supreme Court upholds the latest restrictive laws, it will become more common for women to seek an abortion in another state.
“The intent of these lawmakers is to completely outlaw abortion and force people not to have abortions. But in reality, it pushes people farther and wider to access the care they want and need,” said Quita Tinsley, deputy director of Access Reproductive Care Southeast, a group that supports women seeking abortions in six states.
A third of women calling the group’s hotline for assistance end up traveling out of state for abortions, Tinsley said.
Associated Press Data Editor Meghan Hoyer contributed to this report. Also contributing were AP writers John D. Hanna in Topeka, Kansas, and Susan Montoya Bryan in Albuquerque, New Mexico.