States across the country have passed laws that restrict abortion access or will further restrict access if the United States Supreme Court overturns Roe v. Wade, in full or in part.
A leaked opinion draft of the Supreme Court’s expected decision indicates an expected reversal of the case and has led to additional legislative moves. It is expected that if Roe v. Wade is overturned, 26 states will ban or further limit the procedure. Roughly 40 million people of reproductive age would be impacted.
For several women who spoke to the Greeley Tribune, the opinion draft instilled the fear they will not receive proper care, even for wanted pregnancies. The names of some sources have been changed to protect their privacy.
Colorado passed a law this year protecting the right to reproductive care, including abortions, prenatal and postpartum care. It also prevents any “fertilized egg, embryo or fetus” from having independent rights under state law.
That’s not the case in many nearby states, including Oklahoma and Texas, where laws can vary. Some explicitly say health care providers cannot be punished when providing care for miscarriages and medical emergencies. Others imply the law only applies to voluntary termination after a certain gestational age. These bills also say patients will not be held liable.
The women do not believe those clauses would actually protect them or ensure they could receive care. Criminalizing abortion has already led to arrests and investigations after miscarriages, stillbirths and medical emergencies, the Kaiser Family Foundation reported.
Hannah, an Oklahoma teacher in her mid-20s, would like to have one biological child, but health conditions put her at an increased risk of pregnancy loss. She is prepared to become one of Colorado’s many out-of-state patients, if necessary. She and her husband selected Colorado because it is the state closest to them and it has patient-focused laws.
“We would drive. We wouldn’t tell anyone, because we’d be worried someone would turn us in to jail,” she said. “We would stay with our friends who are EMTs that live in that area. We would keep it super down low. This would be if we had a miscarriage, ectopic pregnancy or if we did IVF and had a lot of embryos.”
Haylie Grammer, a mother and TikTok personality from Texas, delivered her daughter — who died within half an hour — at 25 weeks gestation due to a medical concern. If in that position again, she would go out of state.
Karissa, another Texas mother, would drive her daughters to Colorado or New Mexico and pay for the procedure. If they were experiencing a medical emergency, she would try to get them in with a Texas doctor first, but she is not opposed to going elsewhere.
Planned Parenthood of the Rocky Mountains has already seen a rise in patients since Texas passed its six-week ban in September, according to vice president and medical director Kristina Tocce. Some are voluntary procedures, but the organization has cared for patients experiencing a miscarriage or other medical situations that required an abortion.
Tocce said Planned Parenthood expects the numbers to grow significantly and expressed concern if these laws are fully implemented.
“If a Supreme Court decision comes with the worst-case scenario, as we are prepared to see based on the leak that came out last month, we anticipate seeing even more patients and having more demand for our services,” Tocce said.
What providers are expecting
Doctors in Colorado provided care for 11,580 induced abortions in 2021, according to the Colorado Department of Public Health and Environment. Roughly 13% of those were out-of-state patients.
CDPHE data says there was a jump of 1,700 induced abortions, which providers attribute to restrictive abortion laws around the U.S. It does not say if those numbers include treatment for other pregnancy complications, such as an incomplete miscarriage.
Those numbers are expected to rise, even if Roe is not overturned.
About 1 in 4 women of reproductive age will have an abortion by 45, data shows. For induced abortions, roughly half live below the federal poverty line, 60% have children already and about half used a form of contraceptive.
Clinics in the state, even if they are not with Planned Parenthood, have taken steps over the years to expand access for patients. They have implemented telemedicine for those seeking medication abortion, expanded services at clinics, and added more operating hours and new clinic sites. Many are attempting to hire more staff and purchase more equipment.
“Every avenue that we can utilize to expand access for patients, we are focused on doing that and getting that done as soon as possible,” Tocce said. “Based on the numbers that are projected and that we have actually seen from states like Texas and Oklahoma, we can’t possibly work fast enough to get good enough access for everyone who will need care. That’s really a horrible, horrible feeling as a provider to know that there will likely be patients who simply cannot access services.”
Tocce said Planned Parenthood will work with patients who need to travel. It has a “patient navigation” program that assists with transportation, lodging, how to leave home and other variables.
It’s hard enough to try and find a state with safe access, Tocce said, but it’s even more difficult to get there. This is supposed to help reduce some of the barriers.
“For patients that are traveling from different states, I would say Colorado is working very hard to be able to offer more options and more access for patients who will have to travel to our state,” Tocce said. “We really have been able to assist so many patients already in that manner and we are committed to continuing that work, because planning an out of state trip or a medical procedure — a lot goes into that.”
‘It’s a health care procedure’
Grammer, from Texas, said abortion laws which were looser at the time made it difficult for her to obtain care during her first pregnancy in 2015.
She was excited about getting pregnant. There were no plans for an abortion.
Then, Grammer began having health problems. Well into the second trimester at 20 weeks, doctors found a tumor on the fetus. Doctors monitored her pregnancy for several weeks in hopes that it would remain the same size and could be removed after birth.
At 24 1/2 weeks gestation, doctors said the fetus — her wanted child — would not survive. The tumor had grown from the size of a walnut to the size of a volleyball and was depleting the fetal blood supply, impacting development and Grammer’s health.
Grammer had two options: deliver by 25 weeks, when it was still legal, or wait. At the time, there was a gray area in the law for what care was allowed between 25 weeks and 27 weeks. If she waited and things worsened, they would need to seek care in another state or she had to be actively dying for her doctors to deliver.
She opted for a cesarean section, hoping to hold her daughter for her short life, however long that might be. Neonatal intensive care unit physicians said they would not perform life-saving measures after birth.
By medical definitions, Grammer was having an abortion. By political definitions, she was having a late-term abortion; the American College of Obstetricians and Gynecologists says this phrase has no medical legitimacy.
Grammer and her husband went through mandatory counseling — which she said includes misinformation — the waiting period and submitted medical documentation to a judge for approval. Embree Eleanor was born on April 25, 2016.
It was hard enough to experience then. It would have been more challenging, Grammer said, under SB 8. She has shared her story in interviews, on her blog and in a TikTok video, which has received nearly 2 million views.
“If I needed one again, I would 100% not even attempt to try to do it here,” said Grammer, who later delivered another child. “I would go to a supportive state.
“The doctors are at a constant liability for being sued under this law, and I firmly believe it is going to affect their decision-making on when to make the call. Honestly, I’m not sure if our doctors would have taken on the liability or instead helped us find care in another state. I am leaning toward the latter as they knew we had the support and means to do so.”
Tocce, from Planned Parenthood, said it’s fairly common to see patients who obtain abortions for medical reasons. The organization has already seen out-of-state patients who could not obtain care in their home state.
One patient terminated due to a cancer diagnosis, because they could not receive chemotherapy and radiation while pregnant.
There have been patients who experienced a premature ruptured membrane before the pregnancy is viable, Tocce said. That complication requires an abortion to prevent infection, but the patient could not receive care unless they got sick.
“If you’re taking care of a patient with a ruptured membrane, you don’t advise travel. You advise the patient to stay close to their home and their health care providers,” Tocce said. “Coordinating a patient to fly here with that medical condition was just absurd from a medical perspective, but there was no other way around that.”
Those are extreme examples, but they also care for patients in need of care to complete a miscarriage or ectopic pregnancies, which can sometimes be treated with medication.
The Brookings Institute compiled research that shows a correlation between access to legal abortion and contraception to healthier communities.
The rates of teen pregnancy, teen brides, children born into abusive or impoverished situations decline. They increase the rates of education, career attainment and economic stability for individuals and communities.
“As a physician and as a public health expert, I feel like the medical data and the epidemiologic data speaks so clearly, for the benefit of providing reproductive comprehensive reproductive health care for reproductive-age individuals,” Tocce said. “If the people who are behind these legislative acts can’t accept that very clear data, I don’t know how else to get through. These are not decisions being made in a rational, evidence-based fashion.”
People tell Grammer they are not fighting against her situation, or those Tocce mentioned, because they don’t consider those abortions. The medical community, however, does not use subjective feelings to dictate what is and isn’t an abortion.
“My response to these types of remarks is always the same. ‘I’m not sorry, because abortion isn’t a dirty word. It’s a health care procedure,’” Grammer said, noting the shameful rhetoric hurts women in similar situations. “It doesn’t matter the reason why the pregnant person decided to have an abortion. It isn’t anyone else’s business.
“I have always (had) the belief that abortion is a health care issue and not a moral issue. I know that I made the right choice for my pregnancy and myself, and what my medical paperwork says is accurate. Medical paperwork isn’t there to document emotions and feelings, it’s just supposed to create a record of the medical care the body has received.”
Doctors say restricting abortion — even with the exceptions in place — complicates situations, making it more difficult to receive care. Grammer said people should not have to jump through hoops or go out of state for it.
Roughly 10-20% of pregnancies end in miscarriage before 20 weeks, the Mayo Clinic reports. Second trimester pregnancy loss impacts about 2-3% of patients.
On average, 1 in 4 patients will experience a miscarriage at least once during their reproductive years.
“The challenge is that the treatment for a (voluntary) abortion and the treatment for a miscarriage are exactly the same,” Dr. Sarah Prager told NPR. Prager is a professor of obstetrics and gynecology at the University of Washington in Seattle and an expert in early pregnancy loss.
Grammer said expectant parents should not have to fear investigations, court proceedings or potential arrests. As the Kaiser Family Foundation reported, making abortion illegal has shown to impact patients experiencing pregnancy loss.
There have been arrests and investigations into miscarriages and stillbirths due to fetal harm laws, as well.
One Arkansas woman was arrested last week for “abuse of a corpse.” Police found a stillborn fetus in a toilet after her miscarriage.
An Oklahoma woman was sentenced to four years in prison, because prosecutors said a lack of prenatal care and drug use caused her miscarriage. The medical examiner did not assign those reasons to the cause of death.
Hannah, the Oklahoma teacher, doesn’t think the alleged protections for medical emergencies, like Grammer’s, or miscarriages will hold up, either. It’s why she will come to Colorado if a future pregnancy does not go smoothly.
“This state only cares about fetuses; they don’t care about protecting the mother or the trauma that would come from having to carry a stillbirth full term,” Hannah said. “I couldn’t even imagine that. I think many pregnant women, especially women of color, will be prosecuted. I find it hard to believe that Oklahoma would actually do something to protect women.”
How did we get here?
Current Supreme Court rulings give states the opportunity to regulate — not ban — abortion procedures. This is changing.
Roe v. Wade is the lawsuit that led to the 1973 Supreme Court decision that protected a patient’s right to obtain an abortion in the first trimester of pregnancy free of the government.
The conservative court voted 7-2 to leave abortion decisions in the first trimester between patients and doctors. It was based on an effort to balance a patient’s right to privacy and the “potentiality of life.” The court did not agree with the initial premise that abortion should be allowed at any point or by any method.
States can regulate abortion after the first trimester to promote the health of the patient “in ways that are reasonably related to maternal health,” the decision says.
After the point of viability, abortion procedures can be regulated or banned on the state level except when done in “preservation of the life or health” of the patient.
The precedent used in the case included cases that allowed for marriage, contraceptive access, raising and educating children without “unwarranted governmental intrusion.”
Planned Parenthood v. Casey, also addressed by a conservative court in 1992, allows states to further regulate abortion but not ban it.
States are allowed to implement regulations to ensure the health and safety of a patient seeking an abortion, the decision said, but they cannot “impose unnecessary health regulations that present a substantial obstacle to a woman seeking an abortion.”
The opinion said allowing the “undue burden” standard did not contradict or overturn the central decision of Roe v. Wade, because states still could not “prohibit any woman from making the ultimate decision to terminate her pregnancy before viability.”
Now, the Supreme Court is expected to rule on Dobbs v. Jackson Women’s Health, which involves a Mississippi law banning abortions after 15 weeks, which goes against a key portion of Roe v. Wade.
The law does not give exceptions for rape or incest. It says abortions can only be performed to save the life of the patient or if “the continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function.” Abortion may be performed if there are fetal abnormalities that would not allow the fetus to live outside the uterus.
ACOG says no fetuses can live outside the uterus at 15 weeks. The medical consensus is that healthy fetuses cannot live outside the uterus until roughly 24 to 28 weeks, depending on the individual patient.
Mississippi is effectively asking the Supreme Court to overturn the right to abortion or allow states to ban some abortions before viability if it does not create a burden for a “substantial number of women,” the Kaiser Family Foundation states.
“I don’t think I can speak to exactly what motivates individuals who are putting these harmful restrictions into place. It definitely feels like there is an element of trying to control an individual’s choice and health outcomes,” Tocce said. “That’s not appropriate in any aspect of medicine. There shouldn’t be an outside influence. The driver of medical decisions should always be the patient, their support system and their medical providers. There’s there’s no room for for legislative control in any in any aspect of medical care, like we’re seeing here with abortion care.”
‘Don’t take away someone else’s right because you don’t like it’
The women who spoke to the Tribune expressed frustration with the rhetoric and legislation surrounding abortion. They all, at one point, identified as Christians. Some still do, even though some of the loudest voices against abortion use religion to condemn the procedure.
Nationally, more than half of abortion patients identify as Christian or Catholic, according to data from the Guttmacher iInstitute. In 2020, that number was roughly 54%, and it was about 62% in 2016.
Hannah, who considers herself a Christian and wants a child, does not believe in blanket legislation nor that abortion should be a taboo topic.
She also expressed anger toward self-described “pro-lifers” who support these laws, but vote against universal health care, paid family leave, education funding, enacting gun reform and services to ensure children cared for once born.
“Don’t take away someone else’s right just because you don’t like it,” Hannah said. “That Jesus you follow and claim to be so ‘pro life’ for? He advocates for everyone,” she said. “He loves everyone. Practice what you preach. Love your neighbor. You may not agree with them, but you can love them like Jesus does.”
But even in the best circumstances, Hannah and the other women know abortion care will always be necessary, and patients should have bodily autonomy. Just as they cannot be forced to donate an organ to another person to save a life. They do not believe a person should essentially donate their uterus for pregnancy.
“I’m angry that we as a society have let a few people with a large bank account and an agenda put us in a place where my daughter is growing up in a world where she has less rights than I, my mother, and my grandmother did,” Grammer said of her second child. “I’m scared for my 5-year-old daughter who is growing up in a state and a country that does not see her as a person who should have full rights over her own body. That is terrifying.”
Tocce said she will continue to advocate for current, former, future and potential patients, whether they’re from Colorado or coming from somewhere else. She is not ashamed of her work or what the state has done.
“We are a state that time and time again, we have validated medical decisions remain between patients and their health care provider,” Tocce said. “I think that will be a long term ramification for Colorado and something that we should be proud of — that we are a state that respects that.”
What do the abortion bills say?
Texas and Oklahoma passed some of the most restrictive abortion laws in the country in the last 10 months:
- Senate Bill 8, commonly known as SB 8, bans abortion in Texas in nearly all cases after fertilization when a “fetal heartbeat” can be detected. It does not provide exceptions for rape or incest. Medical emergencies must be documented to receive approval. The bill does not mention miscarriage or ectopic pregnancies, which are never viable. Texas requires a 48-hour waiting period, there may be insurance restrictions and parental involvement is required for minors. SB 8 does not provide specifications about contraceptives.
- Oklahoma recently passed multiple bills effectively banning the procedure. The most notable is House Bill 4327, which bans abortion in nearly all cases after fertilization. It allows exceptions for rape or incest but only if reported to law enforcement. HB 4327 says abortions can be performed to save the life of the patient, such as treatment for miscarriage, intrauterine pregnancy failure and ectopic pregnancy. Despite the bill considering fertilization as the beginning of pregnancy, it does not prohibit “the use, prescription or selling of Plan B, morning after pills, contraception or emergency contraception” that may prevent a fertilized egg from implanting in the uterus.
Abortion is still legal in the United States under Roe v. Wade, but these are laws are allowed because they do not rely on government enforcement. They rely on civilians to sue medical providers and those who “aid and abet” pregnant patients that are seeking one. Fines in both states, if awarded, are set at $10,000. Civil lawsuits can’t be brought against the person who impregnated the victim through rape, incest, sexual assault or other illegal actions.
- Missouri has a trigger ban, HB 126, that would make most abortions illegal except in cases of medical emergency. It makes no exceptions for rape or incest. Medical professionals could be charged with a Class B felony and possibly have their medical license suspended or revoked. Missouri’s HB 2810 passed this spring. It contains multiple anti-abortion measures, including a provision that makes it a felony to distribute or administer abortion-inducing drugs or tools in a way that violates state or federal law.
- Nebraska has a ban on abortions after 20 weeks, except in medical emergencies. The state banned dilation and evacuation procedures, and a ban on dilation and extraction has been blocked by the courts.
- Kansas, Wyoming and Utah would implement bans if Roe is overturned.
Local opposition to Colorado’s new law
After state officials passed Colorado’s new reproductive health care law, one Weld County commissioner attempted to pass a “pro-life sanctuary” resolution.
Lori Saine presented the resolution in April to work around the state, using zoning laws and building codes.
It said, “regardless of the Board’s position regarding abortion, it is the Board’s belief that (the bill) unlawfully restricts local governments’ exercise of their legitimate land use authority and enforcement of their police powers to ensure the health, safety, and welfare of their citizens.”
Commissioner Perry Buck voted in favor, while commissioners Mike Freeman, Scott James and Steve Moreno abstained. County attorney Bruce Barker said when the first resolution was presented, it would have no legal effect.
James said he personally agreed with Saine’s sentiment, but the board does not have power to declare the county a “pro-life sanctuary.”
“To ask me to move into a space where this county has no authority is asking me to break my oath to uphold the law,” James said in a previous meeting. “I can’t do that.”
Saine has indicated she plans to reintroduce the resolution, but a second draft has yet to make it to the board’s agenda.
Glossary of terms
Definitions are based on multiple sources, including the American College of Obstetricians and Gynecologists, Merriam-Webster medical dictionary, the Mayo Clinic, Johns Hopkins and various academic journals.
- Abortion: the termination of a pregnancy after, accompanied by, resulting in, or followed by the death of the embryo or fetus. This can be the spontaneous expulsion of a human embryo or fetus or it can be induced (voluntary).
- Spontaneous abortion: the expulsion of a human embryo or fetus without outside intervention. This is often synonymous with miscarriage. This occurs in 20 to 25% of all pregnancies. There is some disagreement on the time frame for spontaneous abortions, as some definitions say they occur before 12 weeks and other consider any pregnancy loss up to 20 weeks as a spontaneous abortion.
- Miscarriage: spontaneous expulsion of a human fetus before it is viable and especially between the 12th and 28th weeks of gestation, according to Merriam Webster. Some doctors consider all non-induced pregnancy loss to be a miscarriage.
- Missed abortion: when a pregnancy ends naturally but does not expel from the body. This must receive medical care to prevent sepsis.
- Sepsis: the body’s response to an infection attacks healthy parts of the body. It can lead to damaged tissues, organ failure and death.
- Ectopic pregnancy: gestation elsewhere than the uterus, such as the fallopian tube. May also be called an extrauterine pregnancy or tubal pregnancy.
- In vitro fertilization (IVF): Fertilization by mixing sperm with eggs surgically removed from an ovary followed by uterine implantation of one or more of the resulting fertilized eggs. Fertilization is done in a laboratory dish or test tube.
- Fertilized egg: When the sperm and egg meet; conception. This happens in the fallopian tube.
- Implantation: when the fertilized egg travels to the uterus and begins the process of attaching to the uterine wall for pregnancy. This takes place 5-6 days after fertilization. An average of one half (30-60%) of all fertilized eggs are lost and do not implant.
- Embryo: the developing human individual from the time of implantation to the end of the eighth week after conception. The earliest stages of growth, including the creation of fundamental issues, formation of “primitive organs and organ systems.”
- Fetus: an unborn or unhatched vertebrate especially after attaining the basic structural plan of its kind, specifically a developing human from usually two months after conception to birth
- Pregnancy: When the fertilized egg implants in the uterus, despite the gestational age being determined by date of the last menstrual period. This is done to avoid confusion and variables that may lead to differences in ovulation and implantation.
- Gestational age: how pregnancies are dated and due dates are estimated, based on the last day of the most recent menstrual period. This is done because fertilization and implantation may occur at different times for different people. Fertilization does not typically occur for at least two weeks after. Implantation often does not occur until the third or fourth week. During weeks before fertilization or leading up to implantation, the person is typically not considered pregnant.
- Medication abortion: the use of prescribed drugs to end a pregnancy. These can be used to induce or complete an abortion. Mifepristone (mifeprex) and misoprostol are the most common drugs used in medication abortions. They are most commonly used before the 10th week and 99.6% effective.
- Mifepristone (Mifeprex): A pharmaceutical drug that stops the body’s production of progesterone, which is a hormone necessary in the development of pregnancy. Without it, the pregnancy ends.
- Misoprostol: A pharmaceutical drug that was initially introduced to prevent stomach ulcerts when taking NSAIDs. It induces cramps, bleeding in the uterus and softens the cervix. This is not only used in induced abortions. It can be used to complete miscarriages that have not expelled, before IUD insertions or other gynecological procedures, to start labor and treat postpartum hemorrhaging when other options are unavailable.
- Dilation and curettage (D&C): a procedure that can be performed regardless of pregnancy status. It opens the cervix and removes the contents of the uterus with a spoon-like curette. It can be used for induced abortions, the completion of a miscarriage, to diagnose potential uterine diseases, to investigate infertility and after birth.
- Dilation and excavation (D&E): a procedure typically performed in the second trimester of pregnancy. It opens the cervix and removes the contents of the uterus. It relies on vacuum aspiration, though forceps may be used. This is used in voluntary termination and to complete a miscarriage.
- Dilation and extraction (D&X): This is commonly known as a “partial birth” abortion, which is a political term that has no medical bearing. It is a procedure typically performed in the second trimester and removes the intact fetus. This method is used because abortions after the first trimester can carry a higher risk. Labor induction and c-sections can be alternatives.
- Heartbeat bills: Legislation that bans abortion when a fetal heartbeat can be detected at roughly six weeks. ACOG says it is “clinically inaccurate” to call the sound heard on an ultrasound in early pregnancy as a heartbeat, because the heart and its chambers are not formed until 17 to 20 weeks into pregnancy. What patients hear is electronic impulses, known as fetal cardiac activity. The ACOG says the bills should be referred to as “gestational age bans,” or by their limit, such as a “six-week ban.”
https://www.greeleytribune.com/2022/06/18/wanted-pregnancies-impacted-abortion-bans-out-of-state-patients-colorado/ Colorado doctors expect more abortion patients, even for wanted pregnancies