Supporters of the campaign to overturn one of the US’s toughest abortion bans would rather not talk to Idaho voters about abortion. Instead, they want voters in their redder-than-red state to think about doctors.
Proposition 1, on the ballot in November, would establish a right to abortion until foetal viability and afterwards in medical emergencies. But that’s not how the unlikely Idaho ballot measure is being sold in the conservative state.
Instead, as opponents of abortion focus on the ban’s success in ending the procedure, abortion rights proponents are talking about healthcare broadly, as Idaho weathers a steep decline in the number of doctors providing obstetrics care amid a population boom.
In the four years since Idaho criminalised doctors who perform the procedure, the number of obstetricians and gynecologists practising in the state has fallen sharply. A study published last year found that Idaho had lost 94 of the 268 physicians who were practising obstetrics when the ban took effect, a 35 per cent decline in the first two years, even after accounting for doctors who arrived in the state. About half of Idaho’s 44 counties lack a practising obstetrician-gynecologist.
The result, according to healthcare professionals: longer waits, higher costs and less access to preventive care for all Idahoans, not just pregnant people.
“Most of what obstetricians do is not obstetrics,” said Dr Edward McEachern, who led the study. “It’s just taking care of women.”
Conservative lawmakers and activists who pushed the state’s anti-abortion laws focus on the intended result: The number of in-person abortions in Idaho fell to almost none, from about 80 a month before the laws.
“Idaho is a pro-life state, and our laws reflect that,” said Blaine Conzatti, president of the Idaho Family Policy Center.
Idaho is a conservative state and growing more so. Over the past two decades, Republican supermajorities in the state legislature, fortified by an influx of conservative voters from across the west, have enacted spending cuts and some of the country’s toughest restrictions on transgender healthcare, public restroom access and scholastic sports.
“We’ve been a lighthouse for the rest of the country,” said Conzatti, whose organisation helped craft much of that legislation. He said he’s not at all worried about Proposition 1 passing.
But organisers believe they stand a chance. Other conservative states, including Kansas and Missouri, have overturned recent abortion bans or upheld abortion rights. More than 57 per cent of Floridians voted in 2024 to legalise abortion over the will of the legislature, but 60 per cent was needed under that state’s referendum rules.
A Boise State University survey in January found that 60 per cent of Idaho residents supported establishing a right to make private reproductive healthcare decisions, including abortion until foetal viability and in medical emergencies. More than 110,000 people signed petitions to put Proposition 1 on the ballot.
Beyond abortion, Proposition 1 would enshrine rights to contraception and fertility treatment. Organisers view it as a chance to rebuild Idaho’s healthcare system, and, more expansively, as a referendum on the state’s hard-right swing of the past decade.
“This is the one way we have to say ‘enough,’” said Melanie Folwell, the proposition’s campaign manager.
Idaho’s abortion restrictions date to before the US supreme court in 2022 overturned the Roe v Wade ruling which provided for a constitutional right to abortion.
The state’s 2020 law, designed to take effect after Roe’s repeal, criminalises nearly all abortions. A separate law prohibits abortion after embryonic cardiac activity can be detected and allows certain family members to sue providers who perform prohibited abortions. Exceptions for rape and incest are limited to the first trimester and require that the crime be reported.
The legal burden falls on providers, not women seeking care.
“It makes the performance of an abortion a crime, a felony,” state senator Todd Lakey, the sponsor of the ban, said when it came to a final vote in March 2020.
During legislative debates, Democratic lawmakers and healthcare groups warned that criminalising abortion could cause doctors to flee. Republicans dismissed the concern; Lori Den Hartog, a legislator from Ada County, challenged “the notion that the taking of a human life is healthcare.” Idaho’s attorney general briefly threatened to prosecute doctors who referred patients to states where abortion remained legal.
Healthcare professionals say legislators misunderstood how pregnancy care works. Medical records, for example, can use terms such as “spontaneous abortion” to describe a miscarriage, even though Idaho law does not prohibit care during and after a miscarriage. That reality has created confusion and fear among doctors.
Amy Klinger, a physician assistant in rural Stanley, Idaho, described providers second-guessing their treatment plans for pregnant women in life-threatening situations – or pausing to call their hospital legal team. “If you can go somewhere else and just focus on caring for your patients, why wouldn’t you?” she asked.
Supporters of the ban are eager to focus the proposition fight on abortion, arguing that the referendum could allow them much later in pregnancy than Idaho did before Roe v Wade was overturned. The proposition’s definition of viability as a “significant likelihood” of sustained survival outside the uterus “without extraordinary medical measures” could permit elective abortions into the seventh or eighth month, they say. Repeal organisers dispute that interpretation, noting that medical authorities generally place viability around 24 weeks.
During a legal fight over ballot language, Idaho’s attorney general and secretary of state, both Republicans, pushed to include references to the lives of “unborn” and “preborn” children. The final ballot features both.
If voters throw out the state ban, Republican state legislators could restore some version in 2027. Healthcare professionals say that even if state laws are loosened, it could be years before the state’s medical field returns to the levels it saw when abortion was legal.
“It’s a generational thing,” said McEachern, the chief medical officer at St Luke’s Health Plan, an Idaho-based insurer. – This article originally appeared in The New York Times.
