Colorado reproductive health clinics say the number of patients from outside of Colorado has in some cases doubled in the two weeks since Roe v. Wade was overturned, triggering abortion bans in other states, and a fund that provides financial help for people seeking to terminate a pregnancy has provided money to 71 people, more than twice the number served in all of 2021.
Colorado providers say they’re preparing for the influx of new patients to continue, and to meet the demand, some are hiring and training midwives to help conduct abortions. Others are opening mobile clinics in border communities. One center is making room in the clinic for people who need surgical abortions by using telehealth appointments to see patients seeking to end their early pregnancies with medications.
“For us, it means we’re really trying to make sure that we can continue to provide the high-quality care that we always do in our abortion services — that we’re able to see the patients and accommodate them as best we can,” said Savita Ginde, a strategic health care consultant at Boulder Valley Women’s Health Center.
The Boulder clinic primarily provided abortions when it first opened in 1973, the same year the U.S. Supreme Court issued its decision in Roe v. Wade, the landmark case that generally protected a person’s right to choose to have an abortion.
Since the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe on June 24, Boulder Valley Women’s Health administrators say they have been working harder than ever to keep providing reproductive health care to Colorado clients who need it, while also serving the influx of out-of-state patients seeking abortion care. Some come to the clinic for abortions, but patients also are there for breast and cervical exams, gender-affirming care, routine annual exams and other preventive care.
The Dobbs v. Jackson Women’s Health Organization decision triggered abortion bans in at least nine states, including in Mississippi, where the case originated. More bans are expected in the coming weeks and projections by a New York Times tracker of abortion laws suggest that about half of all U.S. states will have restrictions or bans on the procedure.
Colorado was the first state to remove criminal penalties for terminating pregnancies and it is now one of a few states without any restrictions on when a person can choose to have an abortion. In April, Gov. Jared Polis signed House Bill 1279, which codifies access to abortion and birth control in state law.
However, the legislation can’t stop attempts to restrict abortion access in Colorado through the legislature or a statutory change via ballot measure. Advocates are planning to place a measure on the 2024 ballot to amend the state Constitution to protect access to abortion and birth control.
On Wednesday, Polis signed an executive order directing state agencies to continue protecting access to reproductive health care in Colorado. The order directs state agencies not to cooperate with any criminal or civil investigation initiated by another state for any conduct that would be legal in Colorado related to providing, assisting, seeking or obtaining reproductive health care.
“Banning abortion in certain states does not remove abortions,” Ginde said. “What it does is reduce the number of safe abortions, and that’s probably the biggest impact is that we’re going to end up seeing.”
People also are taking action to protect themselves from unwanted pregnancy, stockpiling the emergency contraceptive Plan B, and in some cases, considering moving from states where abortions are banned or restricted.
“We know in times of great stress, like during the Trump election, nearly seven years ago, and in the pandemic, with stay-at-home orders, more people chose to quickly get on birth control, or to delay their pregnancies,” said Adrienne Mansanares, president and CEO of Planned Parenthood of the Rocky Mountains. “We saw an uptick in patients who were scheduling for an IUD, for example, or patients who were coming in for birth control and wanted to leave with a year’s supply.”
Colorado reproductive health care providers are tracking the status of abortion access in nearby states, such as Utah, where abortion is banned except for when the pregnancy is caused by rape or incest.
But they’re more concerned about places such as Texas, where there are many people of child-bearing age.
Texas banned abortion at around six weeks of gestation, even in cases of rape and incest, in September, after which about half of the people seeking to end a pregnancy traveled to Oklahoma for the procedure. But then in May, Oklahoma passed legislation banning abortion beginning at fertilization, so people who would have traveled from Texas to Oklahoma traveled even farther to get to Colorado, New Mexico and Nevada, Mansanares said.
“Abortion care is legal in a lot of the states up in the northeast and New England,” she said. “But many, many patients choose either to drive on an east to west highway or to take a quick, more affordable flight to Colorado. So we’re looking at travel patterns across the entire country, and really looking at where people are located.”
Before Texas passed its abortion ban, about 5% of clients seeking treatment at Denver’s Comprehensive Women’s Health Center were from outside of Colorado. After the Texas ban, that number jumped to about 20%. “And over the last couple of weeks, since the decision, we’ve had days where we’ve had up to 50% of our patients come from outside of Colorado,” said Rebecca Cohen, the medical director there.
“It means that we really aren’t able to see everyone who calls,” she said. “Before, we were usually able to get people in when they called, within about three to five days. We’re looking at about two to three weeks at this point. We’re looking to add more appointments so that we can continue to get people in quickly.”
Since Roe fell, Boulder Valley Women’s Health Center has seen an increase in patients coming to Colorado from North Dakota, where abortions are banned except in cases of rape or incest or to protect the mother’s life, and from South Dakota, where there’s a total ban. Ginde said the clinic also has been receiving more calls from people hoping to get to Colorado for care from Texas, Oklahoma and Wyoming, which had a ban on the books that was triggered by the Dobbs decision. About half of patients currently seeking care at Boulder Valley Women’s Health Center are from outside of Colorado, Ginde said.
Over the past 40 years, most abortions have been safe and uncomplicated, Mansanares said. But some of the cases that clinics in Colorado see are fraught, such as when a child has become pregnant by rape. Mansanares cited a recent case, where a 10-year-old was denied an abortion in Ohio because she was more than six weeks pregnant.
Mansanares has not seen statistics that show an uptick in these cases nationwide but said her clinic has already seen a few more than usual.
“It creates a big weight for our staff teams, for the patients themselves, and for our public health infrastructure,” she said. “We can’t have a dozen states carry this health care on our backs. It needs to be across the country.”
Planned Parenthood of the Rocky Mountains has seen an increase in the number of people seeking medication abortion, in which two oral medications are used to end a pregnancy before 11 weeks of gestation.
Out-of-state patients are often further along in pregnancy because they usually can’t get to another state where abortion is legal quickly enough, Mansanares said. These patients typically opt for a surgical abortion at one of Planned Parenthood’s clinics in Colorado Springs, Denver and Fort Collins. And they often have more financial constraints and higher need for additional resources after traveling for hours to get to a clinic, Ginde added.
Those who disagree with Roe support reducing the number of abortions nationwide, but Mansanares and other Colorado abortion providers said the reversal will create the opposite trend.
“I have seen it in the faces of my patients: When people don’t want to be pregnant, they will not be forced into a situation where they have to give birth,” she said. “Birth slavery should be illegal in this country. We’ve fought over this. We’ve talked about this for generations, and for hundreds of years. When people don’t want to be pregnant, they will go through many, many, many obstacles to end that pregnancy, and when we put up barriers and stigma and shaming, it just makes the process that much more grueling for them.”
Abortion providers are already seeing an increase in patients who are living in poverty, who don’t have access to care and who are trying to piece together the resources to get an abortion, Mansanares said.
More people will likely stockpile emergency contraceptives in their medicine cabinets, she said. In the past, people without access to abortion have used herbal substances for self-managed abortions or other dangerous methods, such as coat hangers, to terminate their pregancies.
Mansanares expects to see more self-managed abortions, where people may be able to access mifepristone and misoprostol, abortion pills that aren’t well regulated. But patients may not know how many pills to take and may not have a health care provider to coach them through the process, she said. Others may resort to using dangerous herbs or physical harm, Cohen said.
“The end result of that is either, we’re going to have more maternal mortality, or bad outcomes,” Ginde said. “And I don’t think we as a country should be willing to tolerate that.”
So far, people who have traveled to Planned Parenthood of the Rocky Mountains from other states have been under a lot of stress, Mansanares said. Many factors often compound for them, such as mental health issues, economic stress, and a struggle to take care of the children they already have.
“We have patients who have never been on an airplane before. So they’re calling to say, ‘Can I get support?’” Mansanares said. “You’ve got things like consent forms, education, figuring out how you want to pay for it.”
Meeting increased demand
In less than four days after the Dobbs decision, Just The Pill had more than 260 online appointment requests, up from the usual 20 to 25 per day, said Dr. Julie Amaon, medical director for the organization, which works to expand access to medication abortion and other health services in underserved communities.
Planned Parenthood is the largest provider of abortion care in Colorado, with 18 offices across the state. Like many other providers, the organization has been preparing for a reversal of Roe for almost seven years, Mansanares said.
“As soon as Donald Trump was elected as president, he made it very clear that he would work to support an anti-abortion care agenda and was going to shift the composition of the Supreme Court,” she said.
Planned Parenthood of the Rocky Mountains has expanded telehealth to people seeking services at its offices in Colorado, New Mexico, Wyoming and southern Nevada.
Organization leaders are also making health center waiting rooms more inviting; they’re working to ensure there are enough exam rooms so that health care providers can see as many patients as possible to help lower wait times; and they’re offering training and resources for staff development to help increase recruitment and retention, such as by ensuring that benefits align with competitive wages, Mansanares said.
“And then we’re looking at expanding with a new building in Albuquerque,” she said. “And then thinking about the ways in which we can also expand in more populated areas throughout our region.”
Planned Parenthood of the Rocky Mountains is working with Planned Parenthood of Greater Texas to consider opening a health center in the international border region around Las Cruces, New Mexico, El Paso, Texas, and Juarez, Mexico, Mansanares said. The health center would not only help patients in El Paso, where millions of people live, but it would help serve people flying into El Paso International Airport from other areas who need reproductive health care, she said.
At Comprehensive Women’s Health Center, a smaller clinic in Denver, administrators are working to expand telehealth services to people in Colorado who can receive health care without coming into the building. This will free up time and space for people traveling to Colorado for in-clinic care including surgical abortion, Cohen said.
Her office is also working to expand the role of advanced practice providers and will soon train certified nurse midwives who want to provide abortions, early pregnancy ultrasounds, and understand how to assess for any concerns or complications following an abortion. Many certified nurse midwives already do early pregnancy ultrasounds but Cohen said her office will be able to train those who don’t.
“Our goal is to have about three or four (midwives), so that we’re able to double our clinical capacity,” Cohen said.
The center is also advertising to hire at least three more medical assistants and other support staff, which has proved difficult, especially during the COVID-19 pandemic.
“We have had meetings with other clinics in the Denver area, just because we also want to understand what everybody’s needs are, and how we can work best together as a field to serve patients,” Cohen said. “And everybody’s having similar issues. It’s just difficult finding staff, figuring out how to best support patients that are traveling from out of state, and how best to schedule, because we know, we’re essentially seeing two to three times the volume.”
Just The Pill has already hired three new clinicians and it is adding four additional support staff members, Amaon said. The organization is also fundraising to expand its number of clinics and geographic reach over time, she said.
Just The Pill has opened new mobile clinics. The first medication abortion clinic, which is in Colorado, is up and running. It has technology for telehealth consultations and has a secure delivery system for medications.
The second clinic will, for the first time in U.S. history, offer surgical abortions in a mobile setting, Amaon said. It will serve patients who are at 11 weeks of gestation or more, who are not eligible for medication abortion, or who choose the procedure for other reasons. The clinic also offers same-day contraception, including IUDs, and treatment for sexually transmitted infections, she said.
Patients will schedule appointments in advance only. The mobile clinics will travel to parts of the state, where the need is greatest, traveling along the border in states where abortion is not restricted, with the ability to care for patients coming from nearby states that have banned abortion, she said.
“Our intention is to provide access to patients who are unable to access services in their state. We are not disclosing more details beyond information about states generally, for the safety and security of our staff and patients,” she said.
Each mobile clinic has the capacity to see 55 patients daily, with the ability to do about 16 surgical abortions a day. Amaon said based on volume estimates from other clinics, the mobile clinic could see 988 patients in 26 days of service.
While Boulder Valley Women’s Health is focused on providing abortion care, it is working with philanthropic organizations, such as Cobalt and the National Abortion Federation to create a “one-stop-shop” for patients, Ginde said. Cobalt and the National Abortion Federation are helping patients who need transportaton, child care services and other support while they’re traveling into Colorado for abortions.
Since Roe fell, Cobalt has spent $25,883 on practical support to assist 71 clients, compared with 34 clients and $6,000, in all of 2021, said Amanda Carlson, the organization’s abortion fund director.
People in rural areas, and those without access to a car, the internet or a credit card, for example, will be among those who struggle the most, logistically, when seeking an abortion, Ginde said. “Layer on top of that, someone who doesn’t speak English as a native language, and might need translation services. That’s just another obstacle.”
Moving away from Roe
Anti-abortion advocates said pro-choice supporters are making many of the same arguments now after Roe as they did after Texas’ abortion ban in September.
“And we haven’t seen those (trends) play out – the kind of mass amounts of women, now all of a sudden dealing with death or health complications, because they aren’t able to get the abortions,” said Jeff Hunt, director of the Centennial Institute at Colorado Christian University. “I think a lot of it is fear mongering.”
Hunt said he expects to see Colorado turn into a “tourist destination for abortion.”
“Right now we’re averaging about 33 deaths a day, from abortion in the state of Colorado,” he said, according to most-recent data from the Guttmacher Institute. “That’s about a classroom size of children that die every single day, and I think that’s just going to skyrocket.
Although pro-life people in Colorado are celebrating the end of Roe, Hunt said the group has a major challenge ahead. Colorado’s pro life movement needs groups that can help reach women before they go to organizations like Planned Parenthood for help, he said.
“Our perspective is that Planned Parenthood does not provide quality care,” he said. “They tend to push only one solution to a crisis pregnancy, and that’s abortion.”
Instead, women should have more access to and more awareness about pregnancy crisis centers, also known as pregnancy resource centers. When someone is seeking an abortion, those facilities provide information about adoption, or resources for housing, food, clothing, employment and diapers, said Nicole Hunt, Jeff Hunt’s wife.
“Many times women are in desperate situations and they just don’t have the support that they need to make a decision for life,” said Nicole Hunt, who has volunteered at a pregnancy resource center for years. “It’s a holistic approach of ‘How can we help the mom and save the baby?”’
The husband and wife said they support an almost total ban on abortion, except for in cases where the mother’s health is jeopardized. In cases where a person becomes pregnant from rape, the perpetrator should be punished to the fullest extent of the law, but the violent crime should not be met by another act of violence, such as abortion, they said.
Now, as states continue implementing abortion bans, pro-life organizations are moving away from nationwide actions to state-based actions, Jeff Hunt said.
Hunt said signatures are being gathered for Initiative 56, a ballot measure that would define abortion as the murder of a child. But it is not widely supported, even by people in the Colorado pro-life movement, because it does not specify that women will not be penalized for seeking an abortion, Hunt said.
“No one is seeking to put a woman in prison for getting an abortion,” he said. So it remains to be seen whether the initiative will gain traction, he added.
There’s a lot of optimism among pro lifers in Colorado, though, Nicole Hunt said.
“We know here in Colorado, it’s an uphill climb to be able to change hearts and minds on the issue of abortion, but we’re emboldened by the fact that there is an opportunity now,” she said. “There are 12 states who’ve already moved to protect lives and ban abortions. Colorado is not one of them, but we aren’t deterred from the cause. We do believe that this is a human rights issue, and we want to help the mom and we want to save babies, and so this is something that we’re motivated by internally.”