Abortion surge from out-of-state clients continues to impact providers

Demand for abortions continues to tax Colorado providers, as out-of-state women travel here for services because of legal restrictions where they live, following last year's U.S. Supreme Court ruling on Dobbs v. Jackson Women's Health Organization.

About 2 in 5 women seeking abortion services from Planned Parenthood of the Rocky Mountains have been from out of state since the June 24, 2022, ruling, said Fawn Bolak, regional director of communications and marketing.

"It's been an all-hands-on-deck type of mentality since the Dobbs decision," she said.

A majority of justices held that the U.S. Constitution does not confer a right to abortion and overturned the 1973 Roe v. Wade ruling, which reverted control of abortion law to individual states.

As the first state to allow legal abortion in 1967, Colorado has a history of being an abortion sanctuary and today boasts one of the country's most lenient abortion laws.

The Democratically controlled Legislature further bolstered reproductive rights this year with three new laws that expand health insurance coverage for abortion, protect abortion and gender-affirming care patients and providers in Colorado from penalties from other states and prevent deceptive advertising at crisis pregnancy centers.

Lawmakers' approval of a ban on the use of "reversal pills" at pregnancy centers is on hold, pending a study from a review panel.

"There's an assumption that those of us in states like Colorado, where abortion is legal and protected in state law, are OK. We're not OK," said Laura Chapin, communications consultant for Cobalt Abortion Fund, which helps women pay for abortion-related expenses, including procedures, transportation, lodging, food and other costs.

"The Dobbs decision has thrown the health care system into chaos," Chapin said in an email. "Patients, many of them in medical, emotional and financial distress, are flooding Colorado from abortion-ban states."

Of the 640 clients the Cobalt Abortion Fund assisted last year, just 49 women, or 8%, were from Colorado, Chapin said. Of the total, 68%, or 435 women, came from Texas, which prohibits abortions after a fetal heartbeat can be detected, or about six weeks of gestation. Violators in Texas are subject to civil action.

Of Planned Parenthood's 11,268 clients who sought abortion services in Colorado in the past year, 37% have come from out of state, Bolak said.

"It's been steady, and steady on the increase," she said.

Out-of-state clients facing an unexpected pregnancy also are turning to Colorado Springs Pregnancy Centers, as they wrestle with their decision, said Rich Bennett, president and CEO of Life Network, which operates the three crisis pregnancy centers in town.

The nonprofit organization provides pregnancy testing, counseling, ultrasounds, parent coaching, gynecological services such as treatment for sexually transmitted diseases and an abortion healing program.

Phone calls, texts and visits from women and men from Texas and Oklahoma in particular have become commonplace, Bennett said.

"It's made us into a regional organization," he said.

The amount of donations Planned Parenthood and the Cobalt Abortion Fund have spent on helping women get abortions has increased in tandem with the demand.

Planned Parenthood's financial assistance fund for abortion clients, which pays for procedures, airplane tickets, hotels and other travel expenses, jumped from $1.5 million in 2021 to more than $7 million in the past year, Bolak said.

Last year, the Cobalt Abortion Fund provided $700,000 for practical expenses, such as travel, and procedural expenses, for 845 abortion-seekers in Colorado, Chapin said.

In the first five months of this year, the Cobalt fund already has disbursed half of that, with $356,770 spent on 220 clients, she said.

In addition to Texas, the majority of non-resident clients who have received money from the fund have been from Oklahoma and Louisiana, Chapin said, where abortion is now banned.

Demand pushes wait times

The surge skyrocketed wait times for women to obtain abortions to 28 days last summer after the fall of Roe v. Wade, Bolak said.

"Which is horrifying — that's such a long time for someone who is waiting for time-sensitive abortion care," she said.

That, in turn, increased wait times for women and men needing general medical appointments for mammograms, sexually transmitted disease testing and treatment, and urinary tract infections.

Planned Parenthood has reduced such wait times to 10 days now, she said, in part by expanding telehealth across the region. For example, people seeking treatment for sexually transmitted diseases or urinary tract infections can speak to a provider online, Bolak said, to ease scheduling.

Also, clinical staff have received training to administer chemical abortions, she said.

Some abortion providers from Texas and other states with limitations on abortion have relocated to Colorado, increasing providers, which Bolak said were already in short supply before the legal landscape changed.

And California-based Kaiser Permanente, which operates in Colorado and is one of the nation's largest nonprofit managed health plans, has expanded its abortion services, according to a spokesperson who declined to be identified.

"We understand this is a complicated, sensitive and divisive topic," reads a statement the company sent in response to questions. "We also believe that expanding services to ensure that all members have access to safe, timely and appropriate care is consistent with our commitment to the overall health of our members."

Another move to accommodate the burgeoning call for abortions is that clients can be booked for an open appointment at any of the 14 Planned Parenthood locations statewide, Bolak said. The Colorado Springs and Denver centers have received the most out-of-state clients.

Of the 7,151 patients who used the Colorado Springs Planned Parenthood clinic in the past year, 2,500 women accessed abortion services, she said.

"One of the things that often goes unnoticed is the emotional toll of patients coming from out of state," Bolak said. "They've experienced a huge emotional and psychological burden to have to navigate finding care across state lines. We have patients coming in traumatized."

Removing abortion as a standard federal protection has left reproductive health care in a state of confusion for patients and providers, industry workers say.

Dr. Rebecca Cohen, an OB/GYN and medical director of a hospital-affiliated outpatient abortion clinic in Colorado, said in a statement that more patients are seeking abortions later in pregnancy, often because of weeks of delays. Some are flying across the country to Colorado, she said.

"Patients are grateful they can receive care in Colorado, but they feel scared, angry and frustrated by everything they have gone through by the time they reach us," Cohen said.

Said Bolak: "This has created a national health care crisis because places like Planned Parenthood also provide reproductive and sexual health care across the board, and most doctors' offices don't have the capacity."

Anti-abortion efforts also increase

The restrictive abortion law in Texas is linked to 9,799 additional live births, according to a recent analysis from the Johns Hopkins Bloomberg School of Public Health. Based on historical live-birth data and statistical modeling, the study shows a correlation Texas lawmakers had expected when stringent restrictions were passed in 2021.

Even with Colorado's protections that essentially allow abortion up to the time of birth, organizations in Colorado Springs that counsel and support women who choose to bring their pregnancy to term say they are seeing increased interest in their services.

More people have gotten involved in anti-abortion efforts over the past year, which they say is boosting the numbers of women facing unexpected pregnancy who decide to have the baby.

The ranks of sidewalk advocates, who speak about alternatives with women headed to the Planned Parenthood off Centennial Boulevard on Colorado Springs' westside, have grown and are having success, said Julie Bailey, director of the Respect Life Apostolate for the Catholic Diocese of Colorado Springs.

"People realized it was getting worse, not better, in Colorado, and want to volunteer," she said. "We see that as a positive."

A new ministry the diocese launched in the past year has trained 70 moms to "walk with moms in need," mentoring women with unexpected pregnancy to navigate services and support.

Mater Filius, a managed residence for pregnant women to live at for no cost while they gestate, is under construction in eastern Colorado Springs and expected to open soon, according to its website.

Supplies such as diapers, formula, maternity and baby clothing, food, housing and other assistance for pregnant women enables women to handle the situation, Bailey said.

"We can help and walk alongside them, not judging but supporting," she said. "We're going to continue to fight for life — it's what we do."

The nonprofit Life Network, which runs the three Colorado Springs pregnancy centers, has grown steadily in patient count over the past six years, Bennett said, performing twice the number of ultrasounds as in 2017. Some 1,800 patients last year underwent ultrasounds, free pregnancy testing, STD testing and treatment and other services.

Pregnancy care at its busiest center at 3700 Galley Road has expanded to include first-trimester care and facilitating access to Medicaid OB/GYN care, Bennett said. A new hire, a nurse practitioner, offers prenatal exams, labs and gynecological care.

"We're continuing to serve as many patients as we ever have," Bennett said.

Planned Parenthood's client base of non-Colorado residents has tripled since before Texas enacted its Heartbeat Act on Sept. 1, 2021, Bolak said, and the organization expects the demand to continue.

"As we head into the second year (of Roe v. Wade being rescinded) and more states move to eliminate or ban abortion, we can probably expect to see that number increase even more," she said.