Pro-lifing us to death

Where abortion is legal, abortion rates are lower; where it’s illegal, abortion is higher

By Katie Botkin
Reader Contributor

The U.S. Supreme Court is considering Idaho’s anti-abortion laws — laws that drove away the doctors who saved my baby’s life.

The question before the Supreme Court on April 24 was whether emergency rooms in Idaho are required to provide care to pregnant patients who need an abortion — to save their lives or, potentially, their reproductive systems. 

Although Idaho has banned abortion almost in totality, a federal law called the Emergency Medical Treatment and Labor Act, or EMTALA, requires hospitals that accept Medicaid to stabilize patients in need of emergency medical care. Since nearly all hospitals accept Medicaid, this means that most hospitals are required to provide emergency medicine to everyone in need of it. 

The federal government has specified that this applies to abortion in the limited situations where abortion is the standard of care necessary to stabilize the patient. For example, this would apply to life-threatening ectopic pregnancies, meaning pregnancies where the embryo is growing outside the uterus and can rupture organs.

Photo by Katie Botkin.

Idaho’s anti-abortion statute allows abortion in a few cases, including when the physician determines “the abortion is necessary to prevent the death of the pregnant woman,” and as long as, simultaneously, “the physician performs the abortion in a manner that provides the best opportunity for the unborn child to survive.” 

According to the statute, any stage of development from egg fertilization onward constitutes an “unborn child” under Idaho law. Since the law was originally passed, Idaho has specified that it is permissible to treat ectopic pregnancies and molar pregnancies, which are never viable. However, many other scenarios are not addressed. 

It is not legal to treat patients who need abortive care to prevent losing their organs to sepsis, for example. Pregnant people, no matter their age, are required by the state of Idaho to be potential ad-hoc organ donors for fetuses that may not even be viable. No word on if the state of Idaho will also start requiring fathers to donate organs if their otherwise totally viable children are at risk of dying.

Josh Turner, arguing on behalf of Idaho, was asked bluntly by Supreme Court justices if Idaho law allows doctors to perform abortions to save women at risk of losing their organs to sepsis. Turner attempted to skirt the issue by saying doctors “could in good faith” make a choice to save a woman’s life, but it was on a “case by case” basis.

“But some doctors couldn’t,” Justice Amy Coney Barrett replied. “Some doctors might reach a contrary conclusion.”

The reality is that many Idaho doctors have reached that conclusion, and left the state over it. The entire obstetrics ward that saved my life closed a year ago due to anti-abortion laws. I read the news on one of the OB nurse’s social media pages — the nurse who sprinted to get a bag of blood for me after I’d transferred the four blocks to Bonner General from my living room after an unsuccessful home birth. 

Amelia Huntsberger was on call when I arrived, the air outside scented with burnt-hay and hot asphalt. In the metaphorical arms of a warm and competent OB ward, I relaxed between the life-threatening complications of intra-amniotic infection and hemorrhage. I knew, as I retreated deep into the recesses of my blacked-out, labored breathing, that I could die; the world had faded, and was now in the hands of others. 

I’d seen my daughter briefly before passing out — long enough to know that she was vigorous and perfect.

When it shuttered the OB ward, Bonner General cited “Idaho’s legal and political climate,” among other factors. 

“Consequences for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines,” the hospital stated.

Bonner General was not talking about abortion as it’s commonly understood — the hospital has never performed “elective” abortions. However, Idaho’s anti-abortion laws potentially restrict many life-saving procedures for pregnancy complications. I say “potentially,” because a zealous prosecutor could argue that nearly any pregnancy-ending action is a felony.

According to Idaho law, abortion is defined as “the use of any means to intentionally terminate the clinically diagnosable pregnancy of a woman with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child.”

This (possibly) means that if someone’s water breaks at 23 weeks and they’re in immediate risk of developing sepsis, it’s illegal to induce labor. Idaho’s “reasonable likelihood” of fetal death isn’t defined; but, according to standard medical understanding, babies born at 24 weeks have only a 40% survival rate, and earlier than that, the results are even more dire. 

Arguably, inducing any preterm birth comes with a “reasonable likelihood” that the baby would die, at least if you’re a particular kind of prosecutor. 

This hits close to home for me, because my water did break early, and the subsequent infection did get bad enough that sepsis was a concern — even though the doctors didn’t delay inducing me once I’d made it to the hospital. Anytime your water breaks early, the protective barrier is breached, and infection can set in. 

I remember my own vividly, the foggy heat of my fever and the erratic heartbeat of my daughter on the monitor, that tiny flicker of life threatening to go out. And here’s the kicker: If state law supersedes EMTALA, there’s no reason that hospitals have to take on the risk of navigating situations like this. They can merely deny care to women like me. And again, without that kind of care, I would be dead. My daughter would be dead. 

So, is there any law requiring that doctors treat patients in labor in order to save babies, even if the situation is not ideal? Yes. The law is called EMTALA. It’s the same law that Idaho is arguing to dismantle.

“If the Supreme Court guts EMTALA, hospital administration will just start refusing to provide uninsured care, because it’s a huge money loss and the reason for the law in the first place,” said Nathan Anderson, a physician with a background in emergency medicine and Critical Care Air Transport in the Air Force. 

He confirmed that without EMTALA, hospitals would likely consider denying care to high-risk pregnancies in any situation, given that it could also save them insurance premiums and lawsuits. 

The Supreme Court is expected to reach a decision about EMTALA by June.

John M. Werdel, a medical director at St. Luke’s, stated that as many as 45% of OB doctors have considered leaving Idaho over the abortion ban. 

St. Luke’s is a nonprofit Catholic hospital system in Idaho — even Catholic hospitals that never provide abortion (as commonly understood) are hindered from providing necessary care to pregnant patients. 

“[P]roviders are terrified and constantly second-guessing their decisions … because they can no longer safely manage and advise their patients who have pregnancy complications,” Werdel said.

And this is something that comes up frequently. 

“Complicated pregnancies are not rare; the average is 30 per week for the St. Luke’s Health System alone,” Werdel said.

Huntsberger, one of my doctors, gave an interview on This American Life about her choice to leave Idaho. 

“Per the total abortion ban, I need to wait until [a patient is] really sick. I can’t act just to protect her health. I should be waiting until I’m saving her life,” Huntsberger said, describing having to consult with legal counsel over her routine treatment of a life-threatening condition. “This is totally opposite of my medical training.” 

Huntsberger is now practicing in Oregon.

Since the Dobbs v. Jackson decision in 2022, and the subsequent abortion bans in many states, maternal mortality has risen, according to OBGYNs, and abortion rates have not declined. National abortion rates have merely shifted, going into states where abortion is legal. Medicated abortions using pills have increased. 

According to recent data from the Guttmacher Institute, making abortion illegal does not decrease abortion — it actually increases it over time. In countries that restrict abortion, the percentage of so-called “elective” abortion has increased during the past 30 years, from 36% three decades ago to 50% more recently. 

Excluding India and China, where large populations and other factors skew the data, abortion rates and abortion legality are inversely proportional.

Meaning that where abortion is legal, abortion rates are lower, and where it’s illegal, abortion is higher.

Although this may seem counterintuitive, it actually makes sense. The question Idaho women will be asking themselves is, “Am I willing to risk death, organ loss and financial ruin to have a child?” 

And as with most questions with these potential outcomes, the answer will increasingly be, “No.” This is not opinion, it’s fact. Statistically, according to maternal mortality rates and the availability of social services, women do face greater risk of death and financial ruin being pregnant in Idaho than being pregnant in Washington or, say, the Netherlands. 

And as a general rule, people don’t want to die if they can avoid it.

Katie Botkin is a freelance writer based in Sandpoint.

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