At the end of this month, an Idaho labor and delivery unit will shutter its doors. It's not exactly an anomaly; it's the third such closure in the state following the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health, which triggered laws in the state that criminalize physicians who provide abortion care and make access to the procedure impossible.
As of April 1, 2024, West Valley Medical Center in Caldwell, Idaho, will no longer deliver infants. According to a statement on the hospital’s website, the closure was an outcome the institution “worked for years to avoid.” While West Valley Medical Center didn’t cite restrictive abortion laws as the reason for the closure, Dr. Kara Cadwallader, who is a family medicine physician in Idaho, told Salon in a phone interview that providers feel as if their “hands are tied” and they can’t do their jobs in a state where abortion is completely banned (with only a narrow exception in which an abortion is "necessary to prevent the death of the pregnant woman") and where physicians face jail time for providing a standard part of care.
“These really restrictive abortion laws or other health care laws tend to disproportionately impact the most vulnerable in your communities,” Cadwallader said, referring to those who are low-income, have disabilities, mental health disabilities and those who already have difficulty accessing care. “I think the Caldwell closure will demonstrate that even more because that's a hospital that is utilized by a lot of the more rural folks who live in the western part of the state.”
Cadwallader said people who relied on that hospital will now be another 40 miles from high-quality maternal care, which people might not be able to access on a regular basis — especially those who don’t have a car or have to rely on public transportation.
The news of the clinic’s closure comes at a time when the state of Idaho is struggling to retain and recruit obstetrician-gynecologists. According to a report published last month by the Idaho Physician Well-being Action Collaborative (IPWAC), a group of physicians in Idaho whose mission is to improve quality of life for Idaho physicians — including Cadwallader — the state has lost 22 percent of its practicing OGBYNs in the 15 months following Dobbs. The report also found that 55 percent of the state’s high-risk OB-GYNs have left the state, leaving less than five in the entire state to treat patients.
“In a time when we should be building our physician workforce to meet the needs of a growing Idaho population and address increasing risks of pregnancy and childbirth, Idaho laws that criminalize the private decisions between doctor and patient have plunged our state into a care crisis that unchecked will affect generations of Idaho families to come,” Dr. Caitlin Gustafson, an OB-GYN and the board president of the Idaho Coalition for Safe Healthcare Foundation, said in a news release about the report.
Cadwallader provided an example of how a lack of high-risk OBGYNS in the state could directly affect a pregnant patient, based on a story that one of her colleagues experienced firsthand. A pregnant woman’s water broke when she was 19 weeks pregnant, a time when the fetus is very unlikely to survive outside of the uterus. The pregnant patient is also at a high risk of developing a severe infection like sepsis when this happens. A typical potential treatment would be to terminate the pregnancy — or refer the patient to a maternal-fetal medicine (MFM) specialist who can closely monitor the situation.
“But you can’t have a termination, and there are no MFMs to take care of her [in Idaho],” Cadwallader said. “Or they don’t want to take care of her because they can’t do their treatment that’s recommended, and so that patient is on their own, care is delayed, and we know that prompt attention for high-risk conditions is what prevents maternal mortality.”
In the coalition’s report, the authors warned that the OB-GYN exodus puts the state’s own maternal mortality rate at risk. Previous data has shown that Idaho is in the 10th percentile of maternal pregnancy outcomes in the country — meaning that 90 percent of the country has better pregnancy outcomes than Idaho. Doctors in the coalition are worried the post-Dobbs landscape will only worsen these outcomes.
Cadwallader shared another anecdote about a patient who possibly had an ectopic pregnancy to illustrate how much more easily a pregnancy-related death can occur post-Dobbs. The patient, Cadwallader described, needed emergency treatment as she was pregnant and bleeding. The results from her blood work showed that her hormones were declining, which indicated that the pregnancy wasn’t going to be successful and doctors were concerned. In order to prevent the potential ectopic pregnancy from rupturing in the fallopian tube, which can lead to severe bleeding or death, a doctor would usually go in and aspirate the contents of the uterus.
“So they called me to come do that, and I said, ‘Well, I'm happy to do that, but is it legal?’” she told Salon. “And so we had to spend about an hour talking to attorneys and the decision was that I could be prosecuted for causing abortion.”
They had to send the patient out of state.
“I have no idea what happened to that patient,” Cadwallader said. “I don't know if she ever got care. A very simple five minute procedure was the care that she needed, and again, we had to send someone away with possibly an ectopic pregnancy and say, ‘I can't help you.’”
Cadwallader said this will only worsen the maternal mortality crisis in the United States, too. Indeed, the U.S. is an outlier among its counterparts when it comes to maternal mortality rates. In 2020, the average maternal mortality rate of all high-income countries was 12 deaths per 100,000 live births. For the U.S., it was 24 deaths per 100,000 live births. While a majority of OBGYNs believe that Dobbs has exacerbated pregnancy-related deaths, actual data is hard to come by for a variety of reasons. It’s not just Idaho that’s experiencing a massive decline in quality care for pregnant people. As Salon has previously reported, abortion laws are driving an exodus of women's health specialists in many red states.
Joelle Puccio, the director of education at the Academy of Perinatal Harm Reduction, told Salon via email she's concerned that this will affect neonatal mortality rates as well. "If infants have to be transported to a facility with ability to provide higher levels of care, it can delay vital procedures," they said. "This trend will cause long lasting harm to our entire population. You can’t have healthy citizens without healthy babies."
Puccio noted that this problem is unlikely to stay confined to Idaho. "I don’t think people in this region of Idaho will go to Oregon, because eastern Oregon is also experiencing a dearth of providers and staff, causing many Oregonians to seek care in Boise. But in similar cases in other states, yes, definitely people will have to travel long distances for care, or just forgo care altogether," Puccio said.
“I think Oklahoma, Mississippi, Texas, are in the exact same boat,” Cadwallader said, adding that Idaho is surrounded by states like Oregon and Washington who support high-quality healthcare. “But I look at the south and these states are completely surrounded by other states that don't provide high-quality maternal care anymore, and so I think in a way, it’s hard to imagine, but they might even be worse off.”
