Abortion providers in Washington are preparing to care for more patients should Roe fall

Some Washington health care providers are looking at expanding their abortion services to serve those who might travel to get procedures from other states, in anticipation of the U.S. Supreme Court potentially overruling Roe vs. Wade.

Planned Parenthood, the only surgical abortion provider in the Inland Northwest, anticipates a 385% increase in people seeking abortion care in Washington.

The Planned Parenthood clinics in Eastern Washington, specifically, are preparing for a potential influx of patients from Idaho, which passed a so-called trigger law in 2020 that would ban all abortions except in cases of rape, incest or to preserve the health of the mother 30 days after Roe falls.

“We are definitely going to be hiring, and we’ll be looking at what that looks like for patient navigation as well as our internal clinic operations,” said Paul Dillon, vice president of public affairs at Planned Parenthood of Greater Washington and North Idaho.

Currently, abortion is legal in Idaho; a law passed this year that would ban abortions after six weeks and creates a mechanism for family members to sue abortion doctors, is tied up in state court. Clinics remain open in Idaho, including in Meridian, which still offers surgical abortions.

Some patients in certain parts of Idaho without abortion care are already crossing the state line to seek services, however, and Planned Parenthood is preparing for more to do so.

In the Puget Sound, physicians who perform abortions are already seeing an increase in out-of-state patients, especially from Texas, after a six-week ban was passed there in 2021.

Providers like Dr. Sarah Prager, an OB/GYN at the University of Washington Medical Center, likely will need more nurses, medical assistants and more surgical space if they begin to see an increase in women with medically complicated pregnancies seeking abortions.

Patients from Eastern Washington are already referred to Prager and other providers at UW for high-risk pregnancies that need to be terminated .

Abortion care in the Inland Northwest

Planned Parenthood is the Inland Northwest’s only abortion provider, offering both pill and in-clinic abortion procedures.

Spokane’s two large health care providers, MultiCare and Providence, do not offer medication abortion, surgical abortion or referrals for abortion in their affiliated hospitals, data submitted to the Department of Health show.

These restrictions, however, do not extend to MultiCare Rockwood outpatient clinics, according to spokesperson Kevin Maloney.

MultiCare providers in their clinics can offer abortion services or referrals at their own discretion, although they are not required to do so.

“Everyone should have full access to the health care services they need, including reproductive medicine,” MultiCare CEO Bill Robertson said in a statement earlier this week. “We believe that the decision to have an abortion – whether that be an in-person surgical procedure or an oral medication prescription – should be one made by the pregnant individual and their provider.”

At Providence, which is a Catholic health care system, abortions are not provided or referred for, at either their clinics or their hospitals.

Advocates, including the American Civil Liberties Union, have fought to get state laws passed to increase access for patients in areas where they have few options beyond a religiously affiliated provider.

“Not all providers working in those religiously affiliated facilities agree with the restrictions that are put on them, but because so much and so many of the jobs in Washington state are at these religiously affiliated hospitals, a lot of people don’t feel like they have an alternative,” Prager said.

Treating risky pregnancies

Pregnancy can be risky.

“It is much riskier to continue a pregnancy to term for any person, even a healthy person, than it is to have an abortion and that is a point frequently missed by people who suppose that carrying to term and adopting out is a viable option,” Prager said.

The United States has the highest maternal mortality rate of wealthy countries in the world. From 2018 to 2020, the number of women in the United States dying as a result of pregnancy increased from 658 to 861.

Maternal mortality counts include only the number of women who died “from any cause related to or aggravated by the pregnancy or its management,” according to the Centers for Disease Control and Prevention, not from an accidental or incidental cause.

Abortions are sometimes necessary even for people who wanted to give birth, such as when a fetus is not viable or when their own health is at risk. In cases like miscarriages and ectopic pregnancies, which happen when an egg implants outside the main uterus cavity, medical procedures can be critical to keeping the pregnant person alive.

Erica Goldblatt Hyatt, a social work professor at Rutgers, had to end a pregnancy at 20 weeks’ gestation due to a deadly fetal anomaly that showed up on an anatomy scan. The baby would have been born brain-dead.

She opted for an abortion and was able to have it as an outpatient procedure, with a physician’s support.

Goldblatt Hyatt realized soon, however, that not all people have the luxury of receiving as compassionate care as she did, and her career path changed because of it.

Now, she develops practice models for clinicians working with people who are wanting to end pregnancies. She also studies how women access reproductive health care they need if they have to seek referrals outside of the health system of which they are a part.

“There are quite a few Catholic (surgery) centers, and they cannot refer patients explicitly for abortion,” Goldblatt Hyatt said.

This leads patients to either not know it’s an option or lands them with social workers at a hospital, who can then refer them to abortion clinics. Goldblatt Hyatt said patients recalled their traumatic experiences being more centered around the circumstances of the abortion and the hard work it took to get it.

“It’s fragmented, patchwork care,” Goldblatt Hyatt said.

In Washington, the ACLU and other advocates tried for years to get legislation passed to protect physicians who might need to perform abortions or other medical procedures for pregnant people at the risk of violating their hospital or employer’s policy.

Some women were being turned away from hospitals for procedures if a fetal heartbeat was still detected, an ACLU report found.

Many hospitals, including Providence and MultiCare in Spokane County, have some carve-outs for certain procedures a pregnant patient may need. At MultiCare, providers can induce nonviable babies but will not perform surgical abortions.

At Providence hospitals in Spokane, treatments that “have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman (patient) are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”

After collecting stories of patients who had to drive across the state to get care for a miscarriage or ectopic pregnancy, advocates pushed for a law that would allow providers to treat patients regardless of these carve-outs without punishment or retribution from their employers.

“The legality of abortion doesn’t ensure access to abortion,” said Leah Rutman, policy counsel at ACLU of Washington.

In 2021, the Washington Legislature passed the Protecting Pregnant Patients Act, which gave protections to some providers treating pregnant patients with complications. The law covers providers treating pregnancy complications from miscarriages to ectopic pregnancies, when the patient’s life is at risk or there is the possibility of irreversible complication or impairment to any patient’s organ or body part. Providers in Washington performing these procedures cannot be fired, disciplined or discriminated against for providing that care.

Rutman said it’s still too early to know what the impact of that legislation has been for pregnant people in Washington.

What’s ahead

Medication abortion makes up the majority of abortions in the Inland Northwest and North Idaho, according to data from Planned Parenthood.

In 2021, 65% of abortions provided in the region were medication abortion, while 35% were surgical. So far this year, 70% of abortions are medication, and 30% are surgical.

Telehealth during the pandemic helped increase access to medication abortion. Dillon said that service has been vital to patients in rural areas like Moses Lake and Wenatchee.

Medication abortion remains popular, but Prager said the need for in-clinic abortions will remain for patients preferring to be seen in person.

Some GOP-led states are targeting the abortion pill in their next legislative efforts to reduce access.

For many people living in states with restricted abortion access, barriers like transportation, funding and timing already play a role in what care they can receive.

“I think we really have to focus on how we protect patients and providers and increase infrastructure and ensure patients here still have access,” Rutman said. “Having the right (to abortion) is great, but we need to make sure in practice people can access the care.”