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Reproductive Care and Choice in Montana, Idaho, and Wyoming

Given the recent Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Womens Health Organization abortion case, we are exploring some particular US states and regions with respect to reproductive care, including the issue of the right to choose whether to terminate a pregnancy. Just to remind you, the Dobbs case involved a Mississippi law prohibiting abortions after 15 weeks gestation. Along with upholding the Mississippi law with 6 justices for and 3 against, the Dobbs decision also overturned the Roe versus Wade decision of 1973, 5-4. Written by Associate Justice Samuel Alito, the Dobbs decision reverses Roe v Wade by taking issue with what is known as substantive due process, a mechanism through which Roe v Wade applied the 14th Amendment to protect abortion as a privacy right. Rather than representing a sudden loss of abortion rights, the Dobbs decision, overturning Roe, was the latest of almost a 50 year process of chipping away at abortion rights. Today, our focus will be Wyoming, Montana, and Idaho, the states surrounding Yellowstone National Park.

For many years, Montana, the Treasure State, was a pro-choice state on account of liberal politicians, but the state has become more socially conservative, and thus and anti-choice in recent decades. In addition to anti-choice agendas carried by Governor Greg Gianforte and Attorney General Austin Knudsen, Montana is geographically challenging, due to its size, mountains, and snowy winters. This can make it difficult to travel through Montana for abortion care, although advances in telemedicine have made things easier in recent years. Favoring abortion rights are the presence of pro-choice judges on Montana’s courts and various legal and political hoops through which anti-abortion politicians would need to jump in order to restrict or prohibit abortion, but two Montana judges are up for reelection this November, so we need to keep an eye on this state.

Wyoming is called the Equality State, which is ironic, given the situation with respect to the right of women to control their bodies. Republicans have a supermajority in the Wyoming state legislature and consequently are working to close the few available abortion facilities. No trigger laws in effect —law against abortion that would have gone into effect instantly upon the overturn of Roe in the Dobbs case— but Wyoming’s anti-abortion politicians can implement prohibitive laws at any point in the near future. Consequently, if you have an abortion scheduled within the state Wyoming, check with your provider immediately and have your procedure done as soon as possible, or other wise, make plans to travel to a nearby pro-choice state, such as Colorado.

Idaho, the Gem State, also is not friendly to abortion rights. A new state law going into effect in August bans abortion after six weeks gestation, which is earlier than just about any woman would learn that she is pregnant. As we have discussed here on The Pulse, pregnancy does not even between until about the third gestational week, since gestational weeks are counted beginning on day one of the last menstrual period. The Idaho law has been delayed by some court cases, but it will apply both to medication abortion and procedural abortion.

A medication abortion is an  abortion that is achieved with medicines alone, without the need for instruments to be inserted into the uterus. Usually, a medication abortion consists of mifepristone, followed 36 to 48 hours later by misoprostol. For those beyond 77 days gestation, or who otherwise do not opt for a medication abortion, pregnancy can be terminated by way of a procedural abortion, also called a surgical abortion. The various procedure begin with dilation of the cervix, meaning that the cervix is encouraged to open. This can be done with an instrument that the OB/GYN pushes through the cervix, typically after medication has been applied hours earlier to help the cervix to relax. Alternatively, the OB/GYN can insert what’s called a laminaria stick. This is made of seaweed and it expands as it absorbs water. After a few to several hours, the cervix can be open enough  to allow a procedure. Following this step, there are a few options, depending on how advanced the pregnancy is. In one such procedure, called a D&C, which stands for dilatation and curettage, the inner lining of the uterus is scraped. D&Cs also are performed frequently for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining. D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception. Sometimes this can be done with a syringe, but often it requires power suction. A tube called a cannula is inserted through the opened cervix. Cannulae come in a range of sizes that are chosen based on how far along the pregnancy is, or was before it became inviable. In some cases, following suction, the doctor may then perform some curettage to extract any remaining products of conception. At some point during pregnancy, generally around the midpoint, suction is not enough to extract either a viable or inviable fetus. In such cases, the OB/GYN must use instruments to grab onto the fetus, or parts of the fetus. Such a procedure is known as a D&E, which stands for dilatation and extraction. The extraction includes not only the fetus, but also the placenta, as well as the membranes.

In cases of rape or incest in Idaho, the victim must report the event to the police and must present the abortion provider with the police report. Otherwise, the abortion provider could be prosecuted under the state’s harsh abortion law. If you live in Idaho and need an abortion, your best bet is to travel Oregon or Washington, which protect the right to choose. While most abortion facilities in Oregon are located in the western part of the state, where most of the people live, the state is going out of its way to fund and help abortion seekers from other states. As part of this, the state is working to set up an abortion facility very close to its border with Idaho.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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