Matt Volz / Kaiser Health News
The four states bordering Montana have “trigger laws” in effect or pending as the U.S. Supreme Court has ended federal protections for abortion, making the conservative Big Sky Country an unlikely refuge for women seeking to end their pregnancies.
But Montana’s potential to become an abortion haven has been diminished — not by the lawmakers and governor whose efforts to restrict abortions have been thwarted by the state’s right to privacy, but by the operators of at least four of the five clinics. of the state, which preventively restrict who can get abortion pills.
Officials from Planned Parenthood of Montana, which operates three of the four clinics, said the intent is to ensure they and their patients are out of trigger-ban states — laws to ban or restrict abortion that were meant to go into effect. to act as Roe v. Wade was brought down — be protected from criminal prosecution and lawsuits. But the policy change is yet another complication for women in neighboring states like South Dakota who want to terminate a pregnancy and face a rapidly shrinking field of options.
“That was a state we hoped would be available,” said Kim Floren, director of the Justice Through Empowerment Network, a South Dakota abortion fund that provides financial aid to people who need the procedure. “Right now it’s just more bad news on top of even more bad news.”
Patients often prefer drug abortions over surgical abortions because they are cheaper, take less time in a clinic, and offer them more privacy and control. The most common type of medication abortion is a two-part pill regimen: the first one taken in the clinic if a face-to-face visit is required; the second is usually taken at home. In many states, the drugs can be shipped to the patient after a telemedicine appointment.
In 2020, drug abortions accounted for more than half of abortions in the US for the first time, according to the Guttmacher Institute, a research organization that supports abortion rights. Proponents expect drug abortions to become a target of new state laws. South Dakota passed a law on July 1 banning telemedicine abortions.
A shifting legal landscape
Planned Parenthood’s policy change in Montana is a response to the changing legal landscape, said Jennifer Sandman, senior director of public policy litigation and law for the national organization of Planned Parenthood. “People are acting under extraordinary chaos and fear instilled by where the Supreme Court left us and threats from anti-abortion politicians in some states,” Sandman said.
Planned Parenthood of Montana decided on June 30 not to provide abortion pills at their clinics in Billings, Great Falls and Helena to patients from states where trigger laws have come into effect. At the time, bans were in effect in South Dakota, Arkansas, Missouri and Oklahoma, but Planned Parenthood officials said they are seeing a significant number of patients from South Dakota. The officials did not respond to the question of how many patients in South Dakota were likely to be affected.
Montana’s other neighbors — Idaho, Wyoming, and North Dakota — also have trigger laws, but they haven’t come into effect yet.
The president of Planned Parenthood of Montana, Martha Fuller, wrote in an internal memo that the risks of cross-border service provision were unclear, citing concerns about the potential for civil and criminal action against those dispensing drugs that would terminate a pregnancy. from people from states with a ban. The memo was posted to Twitter by a freelance journalist and later deleted. Planned Parenthood officials confirmed the policy change.
The three Planned Parenthood clinics in Montana will continue to offer abortion procedures to out-of-state residents. “Right now, we believe this is the best way to ensure out-of-state patients are not afraid to access the essential follow-up care they need because of the harassment and fear mongering from extreme anti-abortion politicians,” said Laura Terrill, a spokesperson for Planned Parenthood of Montana.
The decision on planned parenthood came days after the Missoulian reported that Blue Mountain Clinic in Missoula would only offer drug abortions to people with addresses in Montana. Clinic officials did not respond to questions by phone and email.
The fifth clinic to provide abortions in Montana, All Families Healthcare in Whitefish, declined to answer questions about its policy for out-of-state patients.
Fuller said in her memo that Planned Parenthood policy could change as the legal risks become more apparent. Not mentioned in the memo is that Montana’s status as a state with legal access to abortion could also change soon.
Montana’s Republican-majority legislature and the Republican governor passed four state laws in 2021 designed to restrict abortions, but three were blocked by a judge, who cited a 1999 Supreme Court ruling that abortion is a constitutional right. from Montana. The state attorney general is asking the Montana Supreme Court to reverse that precedent and let the laws take effect. A decision is pending.
The Montana chapter isn’t the only Planned Parenthood network to temporarily change its abortion pill policy amid the chaotic aftermath of the US Supreme Court’s actions. Planned Parenthood North Central States, which offers drug abortions in Minnesota, Iowa and Nebraska, said its patients should take the pills in states where abortion is legal.
South Dakota’s trigger law makes prescribing or administering a substance that causes an abortion a felony, but it doesn’t target people undergoing abortions. Floren, of the Justice Through Empowerment Network, said there is still fear that South Dakotans will be investigated or charged if caught within the state with pills or if they have to see a medical provider because of a complication. “A lot of people really prefer that method and now this is just taking people’s choice again,” she said.
Providers in other states that have become islands for legal abortion do not agree with policies restricting access for out-of-state patients. In Colorado, Dr. Nancy Fang, an OB-GYN with the Comprehensive Women’s Health Center in Denver, says she understands caution in light of the uncertainty surrounding state abortion bans. But, she said, restricting access will harm patients and stress other clinics that continue to provide drug abortions.
“I think it really impacts the patient because it further limits their autonomy to access healthcare, because they don’t have access to a safe option, just based on where they come from,” Fang said.
Planned Parenthood of the Rocky Mountains, which serves Colorado, New Mexico, Wyoming and parts of Nevada, has no plans to change its policies, although spokesperson Neta Meltzer said her organization supports other affiliates, such as those in Montana, “who made heartbreaking decisions.” to take”.
“We serve all patients equally, those living in our own communities and those fleeing hateful bans in their home states,” Meltzer said.
Abortion procedures are considered more effective than abortion pills, although they are naturally more invasive. The procedure requires a patient’s cervix to be dilated using surgical tools, and patients often take anti-anxiety medications or intravenous sedatives. Pills allow people who have been abused by their partners to say they have had a miscarriage, as the amount of bleeding and other symptoms are similar.
Because Planned Parenthood restricts the distribution of abortion pills in Montana, an organization called Just the Pill plans to expand. Patients can make telehealth appointments with Just the Pill medical providers and then pick up the pills in Montana, Minnesota, Wyoming, or Colorado.
Following the Supreme Court’s decision, the company said it would send a fleet of mobile clinics to state lines to provide services to women from states with abortion restrictions. “By operating at state lines, we are reducing the travel burden for patients in states with banned or strict limits,” the company said in a statement.
Floren said she hopes Just the Pill will continue to provide services to South Dakotans. Justice Through Empowerment Network has seen an influx of donations and volunteers, and Floren said the abortion fund is preparing to organize people to attend an upcoming special legislative session where she expects lawmakers to target those who donate or distribute abortion assistance. .
KHN correspondents Rae Ellen Bichell and Erica Zurek contributed to this report.