When Jennifer Adkins and her husband were considering having a second child in Idaho, they vaguely thought how the state’s near-total abortion ban could affect them. But Adkins’ first pregnancy had gone so smoothly, she didn’t even use an epidural when she gave birth. Her next pregnancy, she expected, would be similar.
But in April 2023, 12 weeks into her second pregnancy, an ultrasound scan shattered that hope.
The ultrasound indicated a litany of issues with the fetus, whom Adkins and her husband had taken to calling “Spooky”, since Adkins’ due date was Halloween. Spooky, Adkins learned, showed multiple signs of a chromosomal disorder as well as dangerously severe swelling. Together, these conditions usually lead to a miscarriage or death shortly after delivery, Adkins’ doctors told her. And if the pregnancy continued, Adkins herself was at risk of developing life-threatening pre-eclampsia and swelling.
As the mother of a toddler son, Adkins was not willing to take that chance.
“I don’t think that you understand, until you are in that situation, how scary and how awful that actually is,” Adkins said during a recent interview at a coffee shop outside Boise.
Under Idaho law, abortions are permitted in medical emergencies. But although Adkins’ health was in jeopardy, her doctors didn’t believe her case was enough of an emergency to legally end the pregnancy. They were too afraid of Idaho’s ban to even refer her to an out-of-state abortion clinic.
So Adkins and her husband frantically called clinics in Washington, Oregon and Utah, trying to find somewhere within driving distance that was not booked up for weeks with other patients fleeing the abortion bans now blanketing the US. The couple also scrambled for financial support to pay for the procedure and travel. If they had to shoulder all those costs on their own, the family would be at risk of being unable to afford their mortgage.
“We’re thinking about all these logistics when all you want to think about is grieving the loss of a baby that you really wanted,” Adkins said. “None of us feel good about making that decision. But it is a loving choice that we should be able to make for our family.”
Adkins is far from the only woman to come forward to say she was denied a medically necessary abortion in the two years since the US supreme court overturned Roe v Wade and paved the way for more than a dozen states to ban almost all abortions. Although these bans technically permit the procedure in emergencies, their exceptions are worded so vaguely that doctors across the country say it’s not clear when they can legally intervene. Fearful of the criminal consequences of violating bans, doctors are forced to wait and watch as patients get sicker and sicker – and then attempt to pull them back from the brink of death.
As the home of what may be the strictest abortion ban in the country, Idaho is a cautionary tale about what can happen when the right to abortion disappears: droves of doctors have fled the state, which already had rising rates of maternal and infant mortality, and the state has become a laboratory for testing other laws meant to limit support for abortion patients.
“Those opposed to abortion access and reproductive healthcare access have had a playbook for a really long time, and Idaho is a textbook example of their playbook,” said Jessica Waters, an American University professor who studies reproductive rights. “Everything that’s happening in Idaho is a playbook, I think, for what could happen in the rest of the country.”
What a Trump administration could mean for abortion nationally
If Donald Trump wins the presidency in November, even abortion access for women in blue states may be under threat. Although Trump – who appointed three of the justices who overturned Roe – recently claimed that he would veto a national ban, he has repeatedly flip-flopped on the issue. And a Trump administration would not need Congress to wreak havoc on abortion access nationwide or to in effect ban the procedure.
Project 2025, the controversial policy playbook for a future conservative administration, proposes using the Comstock Act, an 1873 anti-vice law that outlaws the mailing of abortion-related materials, to ban people from shipping abortion pills. These pills currently account for about two-thirds of US abortions; they can also be used to safely self-induce an abortion in the first trimester of pregnancy.
Some anti-abortion activists believe the Comstock Act can do even more: if enacted to its fullest extent, it could not only ban pills but the very equipment that clinics need to do their jobs.
Without ever involving Congress, Trump could use the Comstock Act to implement a nationwide de facto abortion ban. And if he doesn’t, the courts could: anti-abortion activists have begun to seed lawsuits throughout the country that cite Comstock, while the supreme court’s far-right justices, Clarence Thomas and Samuel Alito, both brought up the 151-year-old law in recent arguments.
Trump could also step back from enforcing a federal law that protects access to emergency abortions. Over the last year, Idaho has been at the center of the debate over this law, a debate that recently made its way to the US supreme court.
The law – the Emergency Medical Treatment and Labor Act, or Emtala – requires hospitals to stabilize patients who show up at their doors in the midst of a medical emergency or transport them to a hospital that can do so. But Idaho’s abortion ban only permits abortions in medical emergencies when a patient’s life is at stake – an exception, the Biden administration argued to the supreme court, that is so narrow it violates Emtala. Idaho pushed back, arguing in part that the federal government can’t compel doctors to offer care that is illegal under state law.
The supreme court essentially punted on whether Emtala extends to emergency abortions. The justices restored a lower court order that lets Idaho doctors perform a broader range of emergency abortions, but left the door open to reconsider Emtala in the future.
Without a Democrat in the White House to fight it, Idaho’s interpretation of Emtala could end up becoming a widespread standard.
‘These are not normal conversations’
Many doctors have left Idaho rather than work under its ban. In the 15 months after Idaho’s ban took effect, 22% of Idaho obstetricians stopped working in the state, according to a report by the Idaho Physician Well-Being Action Collaborative and the Idaho Coalition for Safe Healthcare. Three labor and delivery wards have closed. More than half of the state’s nine maternal fetal medicine specialists have left or stopped working in the state full-time.
Dr Kylie Cooper is one of them.
“It was a very real concern of mine that a situation would come up that somebody requires abortion care that I cannot provide, or that I am providing and at risk of being charged with a felony and going to prison,” Cooper said. “I lost a lot of sleep over it.”
Cooper and her husband tried to game out the logistics of Cooper being arrested. Would she go to jail immediately? Could she get bail? What would that mean for their small children? Eventually, Cooper thought: “What are we even doing?
“These are not normal conversations. These are not conversations that I ever anticipated having in my medical career, in my life,” she continued. “Thinking about myself and my family and my future patients, we made the really difficult decision to leave the state because of the bans.”
She now works in Minnesota.
In interviews by the Guardian with nearly a dozen Idaho-based OB-GYNs and family medicine physicians – two specialties that tend to handle pregnancy – over the last year, every one said that they had considered leaving the state, if not the country. Experts are still trying to calculate the impact of abortion bans on infant and maternal mortality, but one study linked a Texas abortion ban to a 13% increase in the number of infants who died in their first year of life.
At least two women, Amber Nicole Thurman and Candi Miller, died after being unable to access legal abortions in their home state of Georgia, which bans abortions after six weeks of pregnancy, according to recent reporting by ProPublica. Experts deemed both of their deaths “preventable”.
Idaho has also sought to limit access to abortion in other ways. In 2023, the state created the crime of “abortion trafficking” when it passed a law banning people from taking minors across state lines for legal abortions if their parents had not consented. That same year, Idaho’s Republican attorney general, Raúl Labrador, issued a legal opinion claiming that Idaho law blocked medical professionals from even referring people for legal out-of-state abortions.
Separately, Idaho professors and teachers’ unions sued over a law that makes it a crime to use public funds to “promote” or “counsel in favor of abortion”. .
Courts have since blocked the abortion trafficking law and the attorney general’s legal opinion from taking effect, while dismissing the teachers’ lawsuit after Labrador said academic speech about abortion was not prohibited under Idaho law. However, four other states have since introduced abortion trafficking legislation. One of those states, Tennessee, has passed it.
‘It’s scary and it’s disappointing’
Rebekka Schaffner lay on an exam bed in an Idaho clinic, pale pink and blue straps curving over her pregnant stomach, as she listened to the rapid “whoosh”-ing of her in-utero baby’s heart.
Because Schaffner’s pregnancy is high risk, the 34-year-old mother regularly undergoes tests to check that all is well. The threat of Idaho’s abortion ban, and how it may affect her life if the pregnancy goes wrong, weighs on Schaffner. She’s already felt the effects of the ban – twice.
Last year, Schaffner had a miscarriage that left fetal remains inside her body, she said. Before Roe fell, doctors might have treated Schaffner with a routine procedure known as a dilation and curettage, or D&C – but Schaffner said they were too fearful of Idaho’s ban to perform the procedure. She ended up in the hospital with an infection, Schaffer said. “Had they handled it properly prior, I wouldn’t have gotten sick,” she said.
Dr Loren Colson, a family medicine doctor in Boise, Idaho, said that abortion laws are so confusing, some medical providers are unwilling to treat miscarriages. When his own wife had a miscarriage, Colson said, a pharmacist refused to fill a prescription to treat it.
“Even if it does seem clear cut, some people are like: ‘If the punishment is jail time, I’m just not going to do this,’” Colson said. When he’s working with patients, “if there’s any concern that a patient might need an abortion or might need a D&C for stabilizing care, we don’t even come close to that line. We send them out to Seattle or even Utah, [which] has better laws.”
When Schaffner realized she was pregnant again, she became profoundly anxious. “I didn’t want to potentially end up having another miscarriage and be right back in that position again, of being told what I could and couldn’t do, what was available to me,” she said.
Twenty weeks into her pregnancy, Schaffner’s cervix started to dilate, she said. Her doctors stitched her cervix closed to keep her from delivering too early, but the procedure carried a small risk of breaking Schaffner’s water too early. Had that happened – a condition known as premature prelabor rupture of membranes, or PPROM – Schaffner’s pregnancy would have been in effect over, because there would be no way for her to deliver a healthy baby.
Complications from untreated PPROM can be deadly, but since Roe fell, many women have been denied treatment for the condition. When one Texan woman, Amanda Zurawski, developed PPROM, she was unable to get an abortion, contracted sepsis and ended up spending three days in the ICU. Other women have suffered life-threatening blood loss after doctors delayed treating their miscarriages.
Should she develop PPROM, Schaffner said, she planned to go out of state for care.
“It’s scary and it’s disappointing, knowing that if something went wrong in the process of trying to save the baby, that there wasn’t anything else they could do,” she said. “I would have to be sent to another state to have my daughter and lose her.”
Adkins was ultimately able to get an abortion at a clinic in Oregon, a six-hour drive away from her home in the Boise area, in April 2023. An abortion fund helped her cover the costs, but being away from her home state and the providers who knew her was wrenching. As she spoke, Adkins started to cry. “It’s an incredibly cruel side-effect of these bans, to put bereaved parents through a loss like that.”
In September 2023, Adkins became one of four women to sue Idaho over being denied a medically necessary abortion. Her lawsuit urges the state to clarify the scope of its medical exceptions, but it has not yet gone to trial. A similar lawsuit, in Texas, was shut down in May by the state’s supreme court.
Adkins has since given birth to a second child. Afterward, Adkins got an IUD.
“Now that the stakes are extremely high with this election, we decided to take a little bit firmer stance on how we were going to prevent pregnancy from happening,” said Adkins, as she nursed her infant. “I don’t know what kind of access to care I’m going to have.”
