Panic was the first thing Dr. Kylie Cooper felt when her home state of Idaho implemented a near-total abortion ban following the repeal of federal protections last year.
As a maternal-fetal medicine physician in the largest hospital in the state, Cooper wasn’t used to feeling panicky. Her job working with high-risk obstetric patients didn’t allow for anxiety or fear. She was good at working under pressure, but this was different.
“Every time I was on call since the ban went into place, I had so much anxiety. What if I get that call and they’re previable? What are we going to do? There’s just fear there,” Cooper told HuffPost. “And anytime you insert fear into medical decision-making, it’s not a good situation.”
Cooper had worked for nearly five years at St. Luke’s hospital in Boise, which saw between 350 to 400 births a month.
She started to have trouble sleeping. Lying awake at night, she pictured her patients’ faces and remembered their circumstances: some with complicated fetal abnormalities, others with pregnancy conditions threatening their own lives. What am I going to do if that type of patient shows up again? How are we going to navigate this? she thought, staring at her bedroom ceiling.
Her worst fears came true weeks after the ban went into effect, when she had to tell a patient that her pregnancy had a significant fetal abnormality. Cooper cried with the devastated couple in her office, and realized her hands were tied. She couldn’t offer any more care ― they had to go elsewhere.
The “immense and needless suffering” set off by the ban was just too much for Cooper to bear. It often rendered her helpless at work. And personally, she was not comfortable raising her young daughters in Idaho. “We cannot raise them here, a place where they don’t have a right over what happens to their own bodies,” she said.
So Cooper and her family picked up and moved to another state seven months after the abortion ban went into effect. It was not an easy decision, but she felt it was a necessary one. There are only nine maternal-fetal medicine specialists in the entire state of Idaho. Cooper is one of four who have left or decided to leave since the state’s near-total abortion ban went into effect last year.
A crisis of care is quickly unfolding in Idaho. There are two abortion bans currently in place: a six-week ban that allows private citizens to sue people who violate the law, and a near-total ban, also known as the trigger ban, that carries criminal penalties and automatically went into effect after the Supreme Court overturned Roe v. Wade. Between them, the two abortion bans allow for few exceptions and carry a slew of punishments for physicians. The penalties range from civil suits with fines starting at $20,000 to the permanent suspension of a medical license and the threat of felony charges that carry a maximum of five years in prison.
The near-total ban was especially insidious in its first six months because it included an affirmative defense law that essentially asserted any doctor who provided an abortion was guilty until proven innocent. (“Scary is an understatement,” Cooper said of the statute.) A bill amending the trigger ban, which strikes the affirmative defense statute and clarifies that removing a nonviable fetus or an ectopic pregnancy does not qualify as an abortion, passed this legislative session. Many medical professionals were critical of the amendment, noting that the law still includes felony punishment and there continues to be no true exceptions for the life and health of the pregnant person.
The feelings of helplessness and the threat of prison time for simply doing their jobs are forcing some providers to leave Idaho. Nearly 50% of maternal health doctors in Idaho are considering leaving the state in the next year, according to a survey conducted by the Idaho Coalition for Safe Reproductive Health Care. An additional 27% responded they are “maybe” considering leaving the state.
“Providers are leaving and the bottom line is that women and families cannot access quality pregnancy care if there are no qualified providers to care for them,” Cooper said. “We are already seeing the ripple effects from the abortion bans.”
Idaho already has the lowest physician-to-population ratio in the country, but it’s poised to get much worse. Dr. John Werdel, the medical director for women’s services at St. Luke’s, said the abortion bans are making it harder to recruit and retain physicians.
He estimates that at least nine women’s health physicians, including Cooper, have left or are in the process of leaving the state because of the abortion ban.
“These laws are decimating our workforce,” he told HuffPost.
Werdel believes even more providers will eventually leave, but some are holding out hope for a special legislative session this summer that could offer opportunities to loosen criminal punishment for doctors.
St. Luke’s is the largest employer in the state, with around 15,000 staffers. It has been a well-respected and sought-out hospital in a community that many saw as great for raising a family, Werdel said. Before the abortion ban, there were normally multiple applications for one opening in an average OB-GYN group, and every applicant who was offered a position would accept, he said. Now, the hospital has one, maybe two, applicants for positions that have been open for over a year.
“It was a pretty good place to come to, and now we have struggled to find adequate candidates for positions that are open,” he said. “Nobody is seeking out this location anymore.”
The cost of care is also increasing as a consequence of the near-total abortion ban. Even when physicians know what to do, they may wait another 24 or 48 hours to run more tests to ensure they are protected against legal inquiries, Werdel said. This drives up the cost for a patient who likely didn’t need another ultrasound or that extra night at the hospital.
Laura Taylor, a labor and delivery nurse at St. Luke’s, has also thought about moving out of Idaho. The threat of criminalization for offering health care to pregnant people with complicated pregnancies or life-threatening conditions can be all-consuming.
“I’m seeing a lot of nurses who are wondering if their license is going to be put at risk just by helping patients, by providing the standard of care in these situations,” Taylor told HuffPost, adding that several of the nurses on her team have discussed leaving Idaho.
“In 10 years, I have never made a phone call to our legal department,” she said. “In the last six months, I have had charge shifts where I have been on the phone with legal more than once to make sure that my nurses who are providing care are going to be protected. Meanwhile, a patient is experiencing the worst day of their lives. Meanwhile, you’re making a patient feel like a criminal for showing up for care when they did nothing wrong.”
The current bans are affecting patients of all kinds. Idahoans with very wanted pregnancies have been forced to continue nonviable pregnancies, magnifying an already traumatic experience and jeopardizing their health.
“Every week, an average of 30 patients present to our clinics and hospitals with wanted pregnancies complicated by conditions that may require an end to the pregnancy for a myriad of medical reasons,” Werdel testified during a committee hearing last month on the bill that amended the trigger ban.
Others with unwanted pregnancies are traveling out of state if they can, but many are forced to carry pregnancies to term ― a dangerous and expensive feat in the U.S.
“There are providers who can work anywhere. Why would you want to deal with this? Why would you want to have to look at a patient and say, ‘Well this is what needs to be done, but I can’t do it. I’m not legally allowed to provide you this care.’ Why would someone choose here?”
– Laura Taylor, a labor and delivery nurse at St. Luke’s in Boise
Taylor knows about that patient experience firsthand. She and her husband have had four devastating pregnancy losses in recent years, including one right after the near-total ban went into effect last August. Taylor was around seven weeks pregnant when an ultrasound showed slow and irregular cardiac electrical activity ― a sign she knew meant something was wrong with the fetus.
Under the new law, Taylor was faced with an impossible decision: carry the pregnancy until she miscarried, travel out of state to get an abortion, or wait until the nonviable fetus was enough of a threat to her own life that it warranted an exception.
“I didn’t think that I would be carrying a loss again,” she said. “It continued to show definite signs that something was wrong with the pregnancy, but nothing could be done about it in the state of Idaho.”
She and her husband decided to wait. If she made it to 12 weeks, she would get a genetic test that would likely show the fetus had some form of lethal anomaly and they would possibly drive to Oregon to get an abortion. For a few weeks in September, Taylor woke up, went to work, delivered babies, cared for new parents, went home and then did it all over again the next day. Everywhere she went, she carried her “go-bag” stocked with menstrual pads and a toilet hat ― a plastic bowl-like container normally used to collect urine samples ― in case she miscarried into the toilet.
Throughout those weeks, Taylor kept getting ultrasounds, hoping something had changed. But the scans continued to show the fetus was growing abnormally and confirmed the pregnancy was nonviable. It was heartbreaking.
“The pregnancy was very much wanted,” she said through tears.
There were times, she recalled, when her colleagues declined to take care of patients who found out their pregnancies were nonviable. Women who were 17 or 18 weeks along who just found out they were going to lose their wanted pregnancies ― people having the worst days of their lives ― and whose providers wouldn’t care for them because of the very real threat of criminalization from the state’s abortion ban.
“That felt deeply personal to me. I thought, ‘What if this pregnancy makes it six more weeks and then I lose it? Will these nurses refuse to care for me?’” she said. “These are my colleagues and friends ― people I’ve known for 10 years.”
Taylor started miscarrying around the nine-week mark. She was able to access misoprostol ― one of two medications used for abortion and miscarriage care ― through the hospital system because her pregnancy had officially been deemed no longer viable.
Idaho has always been a Republican state, but its fervor for anti-abortion rhetoric and far-right ideology has grown in recent years. The state’s more radical conservative faction has infiltrated the legislature, pushing more and more extreme bills.
“It used to be that the Idaho Senate was a place where reasonable debate was valued and minds could be changed, but not anymore,” Democratic state Senate Minority Leader Melissa Wintrow told HuffPost. “The last election drastically changed the makeup of the Senate from more policy minded to politically motivated. There are a solid 10 very conservative members who took out more establishment folks in their primary. And that has forever changed the voting dynamics.”
Just last month, the legislature passed the first ban on interstate travel for abortion care since Roe fell, banning minors from traveling across state lines to get abortions without parental consent. And this month, state Attorney General Raúl Labrador released a legal opinion arguing that health care providers in Idaho are prohibited from referring patients out of state for abortions under the current ban. (Labrador has since withdrawn his initial opinion after Planned Parenthood filed a lawsuit; a federal judge in Idaho is expected to rule on the suit in the coming days.)
Like Cooper, the physician who left Idaho, state Rep. Lauren Necochea (D) said she has increasing concerns about raising a family in her home state. Despite her parents, her three brothers and their families all living in Idaho, Necochea can’t comfortably tell her daughters to stay there.
“I can’t encourage my two daughters to settle in Idaho with the laws we have on the books. I would be terrified to have my daughters try to carry a pregnancy here,” she said through tears during a debate on the House floor over the current abortion ban. “This is not a safe place to be pregnant. This statute is tearing families apart and is pushing our OB-GYNs out of state.”
Huge swaths of Idaho are likely to become maternity care deserts if providers continue to leave the state, and rural areas are especially vulnerable. Two Idaho maternity wards closed their doors in recent months, and at least one closure was directly related to the abortion ban. Bonner General Health in Sandpoint, Idaho, closed its maternity ward in March, citing staffing issues.
“Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult,” Bonner General Health said in a press release last month. “The Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care.”
The closure means providers who are willing to continue helping patients in Idaho will lose jobs in their specialty and may have to relocate. At least 16 OB-GYN nurses will lose their jobs due to Bonner General’s maternity ward closure, Werdel said.
Of the 13 other states that have near-total abortion bans, Idaho is the only one that declined to expand postpartum Medicaid coverage this year. The Republican legislature tabled a bill last month that would have expanded critical coverage before the body adjourned for the year.
“I didn’t feel safe in Idaho … and I didn’t feel that my daughters were safe there either.”
– Dr. Kylie Cooper, a maternal-fetal medicine physician
Idaho’s Maternal Mortality Review Committee was established by the Idaho Department of Health in 2019 to track, review and analyze deaths caused by pregnancy-related complications. In 2020, in its first report, the committee found that the state had a maternal death rate that was almost double the national average. Idaho lawmakers declined to renew the committee this session, citing budget issues. The Maternal Mortality Review Committee only cost the state $10,000, writer Jessica Valenti reported.
“A lack of support for policies that help pregnant women has been exacerbated by continued efforts to criminalize medicine, which put our physician workforce in jeopardy,” Dr. Loren Colson, a family medicine physician in Boise, wrote in an op-ed in the Idaho Capital Sun. “What will happen when there’s more pregnant people due to the abortion ban and less physicians to care for them?”
“It will be more important than ever to review circumstances where the medical system failed and troubleshoot how to prevent the same events from happening again. Yet we will be left without one of our greatest tools to do so by no longer having a Maternal Mortality Review Committee.”
The provider exodus from Idaho is also impacting those who don’t leave.
“For the physicians that stay, they’re dispirited and have a low-level anxiety which increases their burnout,” Werdel said. “It’s an inability to recruit, an inability to retain, it harms the workforce and it creates risk and harm to our citizens of Idaho that don’t deserve this and don’t understand it.”
Taylor, the labor and delivery nurse, is starting a program in June to become a midwife. She’s excited at the opportunity to offer empathetic care as a full-time provider to her patients, who she hopes can benefit from her own experiences with pregnancy loss.
She’s optimistic her next step as a provider will be enough for her family to stay in Idaho, but she understands why medical professionals don’t want to come to her home state anymore.
“There are providers who can work anywhere. Why would you want to deal with this?” she said. “Why would you want to have to look at a patient and say, ‘Well this is what needs to be done, but I can’t do it. I’m not legally allowed to provide you this care.’ Why would someone choose here?”
As for Cooper, she feels like a weight has been lifted off her shoulders since moving. “I didn’t feel safe in Idaho,” she said. “I don’t think it was something I consciously thought about but now that I’m out of there, I realize I didn’t feel safe there and I didn’t feel that my daughters were safe there either.”
She recently started her new job, which comes with all the daily stressors and responsibilities she’s used to. But now she can just go to work and care for her patients without fear of being thrown in jail.
“I’m able to go back to helping people in the way that I can and the way that they deserve,” she said. “That’s a huge relief.”