Jen and John Adkins never expected to have to send a package like this.
They were far from their home in Caldwell, Idaho, a suburb of Boise, after a surreal six-hour drive up Interstate 84 to Portland, Oregon.
Idaho’s abortion laws meant they had to seek care across state lines after receiving devastating news about a much-wanted pregnancy.
Stories like theirs have become increasingly common, as Jen and several other plaintiffs laid out in a lawsuit filed against the state of Idaho in September.
Dr. Julie Lyons, a family medicine physician across the state in Hailey, near Sun Valley, who’s also a plaintiff in the lawsuit, said she now discusses “life flight insurance” with pregnant patients in their first prenatal visits, in case they have a pregnancy complication that doctors can’t treat in Idaho.
“It’s a little bit terrifying to know that we can’t practice our full scope, that we are now needing to manage and triage patients, often outside of the state, to get the reproductive health care that they need,” Lyons said.
Six generations of Idahoans
The Adkinses had hoped for better from the state they loved. John’s family goes back six generations in Idaho, and they’re raising their 2-year-old son here.
Last year, they were overjoyed to learn that he was going to be a big brother; they’d always wanted a big family. But 12 weeks into the pregnancy, their plans were shattered during a routine ultrasound.
A genetic counselor and a maternal-fetal medicine specialist told Jen that it was very likely the fetus had Turner syndrome, a disorder in which a baby assigned female at birth is born with one missing or partial X chromosome.
Research shows that it results in miscarriage in more than 90% of cases and can cause abnormalities in the heart and kidneys, restricted growth and — most clear to Jen — excess fluid around the neck, called cystic hygroma, and severe swelling or edema, called hydrops.
“Essentially, they were surprised I was still pregnant, based on the severity of what they were seeing on the ultrasound,” Jen recalled.
The doctors told her they expected her to have a miscarriage, Jen said, but they didn’t know when. And, she says they told her, “The longer you stay pregnant, the more at risk you are of developing complications of your own.”
She said they were worried about something called mirror syndrome, meaning she could also experience edema, high blood pressure and preeclampsia, which she says she was told could all be life-threatening.
“So, I asked the question: ‘You know, then, what’s our option here?’” Jen said. “And they said, ‘well, because you’re in the state of Idaho, we cannot provide a termination for you. We cannot provide an abortion.’”
‘Sent home to grieve’
It had been less than a year since Idaho’s trigger abortion ban took effect, a law put into place in 2020 that would outlaw abortion in almost all circumstances if Roe v. Wade was overturned, as the US Supreme Court did in 2022. The law contains an exception for the life of the pregnant person but not for circumstances like Jen’s, where her health was at risk but her life wasn’t immediately threatened.
“I was sent home to grieve and mourn and call around to see if we could get an appointment out of state,” Jen said.
That’s how she and John ended up making the drive to a clinic in Portland, a trip they said ultimately cost more than $1,500 for travel and the procedure itself, which they could afford only with the help of two abortion access funds as well as family.
“For folks like us — you know, we’re regular Americans,” said John. “We don’t have those kinds of readily available liquid funds.”
The cost took him by surprise, he said. But that’s not all.
“We were really afraid that we were breaking the law by seeking this help,” John said. “We honestly felt like we were fleeing and had to do so under the cover of darkness. It was a really, really bizarre feeling … like we’re criminals that have to hide from the state.”
It’s legal in Idaho for adults to travel to another state for an abortion.
Jen said she and John also wanted to have testing on the fetus done to try to ensure that what had happened with this pregnancy wasn’t likely to happen again.
“We wanted absolute certainty that this was a fluke thing … that this wasn’t some genetic condition that we created by our two genes mixing together,” Jen said. “We felt it would be irresponsible of us to try again without trying to get as much information as we could.”
That’s how she ended up rushing out of the clinic in Portland, still feeling the effects of the anesthesia, carrying that package.
“They didn’t know exactly what they could and couldn’t do for us,” John said. “They gave us basically a kit.”
It contained the “product of conception,” he explained — the remains of “this child that we wanted.”
They had to ship it that afternoon, they were told, “or they won’t be able to test it.”
“So my memory is of walking into that first Walgreens and holding a brown paper bag that had our child in it and all the hopes and dreams and everything we wanted,” John said. “It was just such an ugly, dehumanizing experience that we didn’t need to have. It didn’t need to be that way.”
Jen said they asked her doctors what the experience would have been like if it had happened before Roe v. Wade was overturned and Idaho’s trigger law took effect.
“They said, ‘we would have referred you to a private clinic in downtown Boise,’” she recalled. “They would have done all the testing themselves, and it would have been a much more humane and dignified experience, and we would have been able to be around friends and family.”
Still, the Adkinses were able to get the testing done in time. The results confirmed “what our doctors had already diagnosed,” that “this is Turner syndrome; it just happens at conception.”
They weren’t at any higher risk than anyone else of having it happen again, they discovered.
“Another maternal-fetal medicine specialist said, you know, ‘lightning struck your pregnancy,’” Jen said. “It certainly felt that way.”
‘An ethical and moral dilemma’
It’s not just patients who are feeling the effects of Idaho’s abortion law. Lyons, the family medicine doctor in Hailey, said many of her colleagues who treat higher-risk pregnant patients have left the state.
“Many of my colleagues felt like they could not practice the standard of care in Idaho anymore and that they were put into an ethical and moral dilemma as to how to help a woman who is in crisis,” she said.
As of May 2022, there was one ob/gyn for about every 3,100 women of reproductive age in states where abortion is legal, compared with one for about every 4,500 in states where it is banned. Estimates from the Bureau of Labor Statistics capture employment data for obstetricians and gynecologists from 40 states; Idaho is among the 10 states that do not have data. Of those 10, abortion is banned in five states, it remains legal in four, and one has a gestational limit.
The lawsuit from Jen Adkins, Lyons and other patients and their doctors, which was filed by the advocacy organization the Center for Reproductive Rights, seeks clarity on the medical exceptions in Idaho’s abortion bans. Lyons’ employer, St. Luke’s health system, is not a party to the suit.
The statement disputed claims that doctors are leaving the state because of the law.
“There is no evidence that there are fewer doctors in Idaho today than before these laws were put in place,” the statement said. “Our healthcare system is stronger and better serves women and children when our doctors prioritize saving two lives rather than prioritizing abortion on demand.”
There are no legal restrictions on abortion in Oregon. Before the move, Lee said, he had “some very targeted conversations regarding the potential legal exposures given the abortion ban. … I did have some serious concerns about the impact upon patient care and the potential conflict between providing appropriate medical care to my patients … and violating Idaho law.”
He said he’d “strongly disagree” with any assertion that doctors and other health-care providers in his field aren’t leaving the state.
“This is absolutely not my impression during my brief time in practice in Idaho,” he said.
He said two of the maternal-fetal medicine specialists, referred to as MFMs, in the practice he joined six months ago had left before he arrived, “reportedly due to the abortion ban,” and that “the other established MFM practice in town only has minimal staffing currently due to the departure of several of their MFMs prior to my arrival.”
“I think the math is clear that MFM subspecialists have been leaving Idaho,” he said, and that “has significantly impacted access to care for high-risk pregnancy services – in a state/region in which access to these services had been already limited.”
Jen has experienced that impact herself, she said, as she and John are now expecting again.
“We are already experiencing canceled appointments and rescheduled appointments and going to different clinics because of availability,” Jen said. “The availability of just regular routine appointments has become scarce.”
Fortunately, John added, “everything looks good now.”
But anxiety remains.
“I have friends that are pregnant at the same time as me here in the state, and we all kind of share the same sentiment,” Jen said. “We all just hope that we get through this pregnancy unscathed.”
