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Medical professionals who provide abortions in Montana, along with the groups that helped underserved communities access and pay for them, said Monday they worry that state lawmakers and the incoming Trump administration will continue trying to restrict abortion access even after 58% of Montana voters approved an amendment enshrining abortion care in the state constitution last month.
Constitutional Initiative 128 will go into effect in July. While it provides a right to abortion as part of a person’s right to make their own decisions about their pregnancy and prohibits the government from interfering in an abortion when it’s necessary to protect the health or life of the mother, it still carries a guardrail of allowing government regulation after a fetus is viable, widely regarded in the medical community as 24 weeks’ gestation.
While data from the U.S. Centers for Disease Control and Prevention show 93% of abortions occur before 13 weeks, and just 1% occur at or after 21 weeks, three people involved in abortion care in Montana said the viability language still means that people who face complications from a pregnancy or who are seeking an abortion close to the viability date could face extra hurdles and complications if politicians continue to try to cut down on abortion access around the edges of Montana law and its constitution, or on the federal level.
Further, said Nicole Smith, the executive director of Montanans for Choice, the portion of the amendment that allows abortions after viability to protect the health or life of the mother is not clearly defined and could lead medical professionals to err on the side of denying that care, lest they face punishment.
“Montanans and people across the country who live in states with viability limits are forced to leave their home to access essential care later in pregnancy, and those who are unable to travel, are left without care, and some suffer life-ending consequences,” Smith said. “We are advocating for the complete decriminalization of all pregnancy care.”
Smith, Helen Weems of All Families Healthcare, and Erin Case, the executive director of the Montana Abortion Access Program, said they also expect to see ongoing efforts to prevent people from getting abortion drugs through the mail, for governments to deny the use of Medicaid funding to pay for an abortion, and a continuing increase in people from Montana’s neighboring states coming here to receive abortion care because of bans or restrictions in their states.
“It is a frightening time for abortion seekers and abortion providers. We will face each of these challenges as they come,” Weems said.
The group said other states’ restrictions or bans have shown to be harmful. After Texas’ six-week abortion ban went into effect, a Johns Hopkins study found a 13% increase in infant mortality in the year afterward. In Wyoming, where abortion remains legal but there is one full-service clinic, 55% of patients this spring went through telehealth appointments to get their care, Smith said.
Maternity care has fallen in those states as well, she said, as providers of prenatal, birthing, and postpartum care have fled because of the restrictions. Case said 15% of abortion patients in Montana now come from out of state, and they and others in especially eastern Montana often need assistance paying for the care, travel and support if they can’t do a telehealth appointment.
Many of those people can’t afford to miss work, and some are teenagers, people with disabilities, or in abusive relationships, which could all prevent them from seeking the care they want or need, Case said. Some come from disadvantaged communities that often have the lowest levels of sex education and access to contraceptives, she said.
Her organization provides that financial support and works with all six of Montana’s current clinics. She said the Montana Abortion Access Program spent more in the last fiscal year supporting people seeking abortions than it had in the past nine years, that applications for support had more than doubled during the past three years, and that applications have gone up by 60% since June.
“With the legislative session coming up, and the new administration coming into office in January, we expect to see a sustained increase in applications and in need,” Case said.
Weems said that the U.S. Food and Drug Administration’s effort to reduce restrictions for people wanting to obtain medical abortion drugs through telehealth and the mail has “revolutionized” access in the country during the past 24 years. But she said that health system and those drugs – mifepristone and misoprostol – are in the “crosshairs” of the Trump administration and Montana Legislature.
She said All Families Healthcare can now serve anyone in Montana after an in-person visit requirement was dropped in order for people to obtain the drugs. Weems said the clinic served patients from nearly 50 counties in Montana, as well as from Idaho, North Dakota and Wyoming this year, and that 52% of its care provided now involves the mail.
“There is no question that abortion by mail increases the number and diversity of people we are able to serve,” Weems said. “… There’s no doubt it will be a primary target of the Trump administration, and we will continue to see anti-abortion politicians in Montana attacking it every turn.”
She said she expected Donald Trump’s administration to conduct a “relentless” attack on allowing abortion drugs to be mailed either by having the FDA reverse approval of the drugs, rolling back changes made by the FDA to make the drugs more accessible, utilizing the Comstock Act to prevent the drugs from being mailed, or seeking to implement some sort of federal ban or time restriction on abortions that could override Montana’s protections.
Smith said she did not believe anything in Montana would change about the legal status of abortion between now and when CI-128 goes into effect because of existing privacy protections but that she did anticipate the Republican-held legislature to continue passing abortion restriction bills as they did the past two sessions – nearly all of which have been blocked by Montana courts. Weems said the groups would be “forced to fight these new laws in court at tremendous taxpayer expense.”
The group said they believed their organizations and others were prepared to fight more abortion restrictions at the legislature and others were ready to do the same at the federal level, but that they hope the country gets to a place again where abortion is protected nationally to reverse efforts made in at least 13 states now to ban abortion outright.
“For now, we will continue to provide safe, evidence-based abortion care,” Weems said. “We know that people will always have abortions, and so we will be here fighting for our patients’ safety and rights.”