Montana clinics preemptively restrict out-of-state patients’ access to abortion pills

All four states bordering Montana have ‘trigger laws’ in effect or pending now that the US Supreme Court has ended federal abortion protections, making the conservative Big Sky Country an unlikely haven for women seeking to terminate their pregnancy.

But Montana’s potential to become an abortion haven has been diminished — not by lawmakers and the governor whose attempts to restrict abortions were thwarted by the state constitution’s right to privacy, but by the operators of at least four of the state’s five clinics, which are preemptively limiting who can receive abortion pills.

Officials from Planned Parenthood of Montana, which operates three of the four clinics, said the intent was to ensure that they and their patients from states prohibiting induction — laws prohibiting or restricting abortion that were designed to come into force if Roe vs. Wade has been invalidated — are protected from criminal charges and prosecution. But the policy change is an added complication for women in neighboring states, like South Dakota, who want to end a pregnancy and face a rapidly narrowing field of options.

“It was a state that we hoped would be available,” said Kim Floren, director of the Justice Through Empowerment Network, a South Dakota abortion fund that provides financial assistance to people who need the procedure. . “At this point, it’s just more bad news on top of more bad news.”

Patients often prefer medical abortions to surgical abortions because they are less expensive, require less time in a clinic, and offer them greater privacy and control. The most common type of medical abortion is a two-part regimen of pills: first taken at the clinic if an in-person visit is needed; the second usually taken at home. In many states, medications can be shipped to the patient after a telemedicine appointment.

In 2020, medical abortions accounted for more than half of abortions in the United States for the first time, according to the Guttmacher Institute, a research organization that supports abortion rights. Proponents expect medical abortions to become the target of new state laws. In South Dakota, a law banning telemedicine abortions went into effect July 1.

A changing legal landscape

Planned Parenthood’s Montana policy change is a response to the changing legal landscape, said Jennifer Sandman, senior director of public policy and legal litigation for the national Planned Parenthood organization. “People are operating under conditions of extraordinary chaos and fear that have been instilled by where the Supreme Court has left us and by threats from anti-abortion politicians in some states,” Sandman said.

Planned Parenthood of Montana decided on June 30 not to provide abortion pills at its clinics in Billings, Great Falls and Helena to patients in states where trigger laws have gone into effect. At the time, bans were in place in South Dakota, Arkansas, Missouri and Oklahoma, but Planned Parenthood officials said they were seeing significant numbers of patients from South Dakota. Officials did not respond when asked how many South Dakota patients would likely be affected.

Montana’s other neighbors — Idaho, Wyoming and North Dakota — also have trigger laws, but they haven’t yet gone into effect.

Planned Parenthood of Montana President Martha Fuller wrote in an internal memo that the risks of cross-state service provision were unclear, citing concerns about the potential for civil and criminal lawsuits against those providing drugs. that would terminate a pregnancy. states with bans in place. The note was posted on Twitter by an independent journalist and later deleted. Planned Parenthood officials confirmed the policy change.

Montana’s three Planned Parenthood clinics will continue to offer abortion procedures to out-of-state residents. “At this time, we believe this is the best way to ensure that out-of-state patients are not afraid to access essential follow-up care they may need due to intimidation and fear of extremist anti-abortion politicians,” said Laura Terrill, spokesperson for Planned Parenthood of Montana.

Planned Parenthood’s decision came days after the Missoulian reported that the Blue Mountain Clinic in Missoula would only offer medical abortions to people with an address in Montana. Clinic officials did not respond to questions by phone and email.

The fifth clinic that offers abortions in Montana, All Families Healthcare in Whitefish, declined to answer questions about its policies for out-of-state patients.

Fuller said in his memo that Planned Parenthood’s policy may change as the legal risks become clearer. What is not mentioned in the memo is that Montana’s status as a state with legal access to abortion may soon change as well.

Montana’s Republican-majority Legislature and Republican Governor passed four state laws in 2021 intended to restrict abortions, but three were blocked by a judge, who cited a 1999 state Supreme Court ruling that abortion is a right under the Montana Constitution. The state attorney general is asking the Montana Supreme Court to reverse that precedent and let the laws go into effect. A decision is pending.

The Montana chapter is not the only Planned Parenthood network that is temporarily changing its policies regarding abortion pills due to the chaotic consequences of the actions of the United States Supreme Court. Planned Parenthood North Central States, which offers medical abortions in Minnesota, Iowa and Nebraska, said its patients must take the pills in states where abortion is legal.

South Dakota’s trigger law makes it a crime to prescribe or administer a substance that causes an abortion, but it does not target people who have abortions. Floren, of the Justice Through Empowerment Network, said he remains concerned that South Dakotans could be investigated or charged if they are caught on pills in the state or have to See a doctor for help due to a complication. “A lot of people really prefer this method and now it’s again taking people’s choice,” she said.

“Heartbreaking Decisions”

Providers in other states that have become islands for legal abortion disagree with policies limiting access for out-of-state patients. In Colorado, Dr. Nancy Fang, an obstetrician-gynecologist at Denver’s Comprehensive Women’s Health Center, said she understands the caution amid the uncertainty surrounding state abortion bans. But, she said, limiting access will harm patients and add stress to other clinics that continue to offer medical abortions.

“I think it really impacts the patient because it further restricts their autonomy to access health care, not being able to access a safe option based solely on their origin,” Fang said.

Planned Parenthood of the Rocky Mountains, which serves Colorado, New Mexico, Wyoming and parts of Nevada, does not plan to change its policies, although spokeswoman Neta Meltzer said her organization supports others affiliates like Montana’s “making heartbreaking decisions.”

“We serve all patients equally, those living in our own communities and those fleeing hateful bans in their home countries,” Meltzer said.

Abortion procedures are considered more effective than abortion pills, although by their nature they are 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. With the pills, people who have been abused by their partner can tell they have had a miscarriage because the amount of bleeding and other symptoms are similar.

As Planned Parenthood restricts the distribution of abortion pills in Montana, an organization called Just the Pill plans to expand. Patients can schedule telehealth appointments with Just the Pill medical providers and then pick up the pills in Montana, Minnesota, Wyoming, or Colorado.

After the Supreme Court ruling, the company said it would send a fleet of mobile clinics to state lines to provide services to women in states where abortion is banned. “By operating at state borders, we will reduce travel costs for patients in states with severe bans or limitations,” the company said in a statement.

Floren said she hopes Just the Pill will continue to provide services to people in South Dakota. 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 in which she expects lawmakers target those who give or distribute abortion assistance.

KHN Rae correspondents Ellen Bichell and Erica Zurek contributed to this report.

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