Colorado abortion providers, protected by the state, strained by flood of patients from states limiting or ending reproductive rights

When Kansas voters rejected an amendment that would have removed the right to an abortion from the state constitution by a margin of 18 percentage points on Aug. 2, Adrienne Mansanares was so excited that she literally screamed out loud. 

Mansanares is the CEO of Planned Parenthood of the Rocky Mountains, which serves Colorado, Wyoming, New Mexico and southern Nevada. To her, the vote was a triumphant reminder of how many people support a women’s right to choose.

But later that night, Mansanares’ mood turned from elation into relief that the vote hadn’t gone the other way. If it did, “I don’t think we could pick up the slack,” she said.

That’s a sentiment echoed by healthcare providers across the metro area, who told The Sentinel that Colorado’s strong abortion protections haven’t been able to shield it from the strain being placed on the reproductive healthcare system in a post-Roe landscape.

Since the Supreme Court voted by a 6-3 margin on June 24 to overturn Roe v. Wade, the landmark 1973 decision conferring the right to an abortion, Colorado has seen an influx of patients coming in from out of state to receive the procedure. 

In 1967, Colorado became the first state in the nation to decriminalize abortion under certain circumstances, and it is currently one of just a few states with no term limits on abortion access. With the exception of New Mexico, it is now entirely surrounded by states where abortion is either heavily restricted or banned.

The state has a well-mobilized coalition of abortion rights groups, which have been fighting to preserve and expand access to reproductive healthcare in Colorado for years leading up to this decision. According to abortion advocacy group Cobalt, 44 attempts to restrict abortion access in Colorado have failed in the last decade.

Colorado abortion rights supporters got their biggest victory this spring, when the Colorado Legislature passed the Reproductive Health Equity Act, which guarantees the right to an abortion in state law. 

“Women’s right to choose is now protected in Colorado,” Gov. Jared Polis said as he signed the bill into law April 4. 

But the state’s strong abortion protections can’t protect it from the nationwide aftershocks caused by the fall of Roe v. Wade. Abortion advocates and healthcare professionals say that Coloradans are already feeling the brunt of the national restriction on abortion access in ways that will have a deleterious effect on the quality of reproductive care no matter where they live.

At a listening session at the CU Anschutz School of Medicine campus last week with Congressman Jason Crow (D-Centennial), Dr. Kristina Tocce, who works at Planned Parenthood of the Rocky Mountains, described the situation as a public health crisis.

“There is a ripple effect where if those appointment times are out three weeks it doesn’t matter if you’re from Texas, Nebraska, South Dakota or right down the street in Denver,” she said.

The stream of out-of-state patients started to increase at the beginning of the pandemic, when Texas used quarantine laws to heavily restrict abortion, Mansanares said. Then it widened when the state passed a law last September banning the procedure as early as six weeks, before many women even realize they’re pregnant. 

And since the overturn of Roe, the stream has become a flood. As of early August, she said one-third of patients coming to Planned Parenthood locations in Colorado for abortions were from other states, and fully one-half in New Mexico. 

Those numbers are borne out by data from Cobalt, which provides financial aid for abortions as well as associated transportation costs such as childcare, hotel rooms and travel expenses. In the first month after the Dobbs v. Jackson Women’s Health decision was released, the organization provided support to 168 people. Of those, 5% were Colorado residents and 64% were from Texas.

In the month after Dobbs, Cobalt provided over $50,000 for abortion procedures and over $100,000 in support for related expenses in what spokesperson Laura Chapin described in an email as an exponential increase.

Usually, Mansanares said she likes to schedule people for appointments at Planned Parenthood no later than three days after they reach out. But with the current volume of demand, providers say appointments for just about anything are about two to three weeks out.

“When we are literally overrun with patients who need abortion services, patients can’t get in to see us for birth control, cancer screenings, wellness exams, or emergency contraception,” Tocce said. “If our wait times are over three weeks to get an appointment, those patients are also waiting.”

That’s been a blow to Mansanares, who said it takes away from the walk-in community oriented approach that Planned Parenthood tries to provide.

“I want people in Aurora to be able to go shopping in (Town Center of Aurora mall) and walk across and get the healthcare that they need,” she said. “That is not, unfortunately, our current reality.”

It’s a change that haunts Roy Taylor. At the listening session, he spoke about a visit he and his wife, Christina, made to CU Anschutz five years ago for the 20-week ultrasound of their third child. Instead of the routine procedure they were expecting, the couple found out their son had bilateral renal agenesis, a rare and fatal disease where the kidneys fail to develop in utero.

The couple got an MRI to confirm the diagnosis as soon as possible, and they decided to have an abortion procedure called induction and delivery, which would not have been legal at the time in their former home in Texas. Christina was induced and their son died shortly after the procedure.

“If we had that same situation now, how long would we have to wait for each step?” Roy said he wonders. The couple had insurance, support and what Roy described as stellar care from their team at Anschutz, but it was still an extremely difficult experience. The procedure being illegal or much slower to receive would have made it so much worse.

Since the ordeal, the Taylors have gone on to have two more children, and have shared their experience with the press to help publicize the realities of abortion.

“The notion of the state coming in and intruding on these moments is so abhorrent and scary,” Roy said.

Drawing medicine into elections 

The repeal of Roe has also changed the political landscape, as politicians’ views on the procedure have become a flashpoint in the upcoming midterm elections. Polis, who is running for re-election as a Democrat, condemned the repeal and in July signed an executive order strengthening protections for abortion providers who may be at risk of prosecution in other states. 

His opponent, Republican Heidi Ganahl, says on her campaign website that she is pro-life but supports exceptions in “the rare and terrible instances of rape, incest, and the life of the mother and child.” The website describes RHEA, the new state law, as “disgusting” and says that if elected Ghanal “will do everything in her power to change our current abortion law,” but does not discuss what alternate legislation she would like to have in place, if any.

Abortion has been most discussed in the Colorado Senate race, where Democratic incumbent Michael Bennet is campaigning against Republican Joe O’Dea. O’Dea has taken heat from both the right and the left for his views on abortion. During the primary, he was criticized by his far-right opponent Ron Hanks for being too lenient on the issue, and in the general the Bennet campaign is currently claiming that he is presenting himself as more moderate on abortion than he actually is.

In August, O’Dea told the Colorado Sun that he supported abortion being legal through 20 weeks of pregnancy and afterward only in cases of rape and incest or when a mother’s life is at risk. He also told the Sun that he voted for a failed 2020 ballot measure that would have limited the procedure to 22 weeks without exceptions. He was criticized for the admission by pro-choice politicians and activists.

“The new revelation that O’Dea voted to impose an abortion ban in Colorado without exception for rape or incest only underscores how his misleading campaign rhetoric clashes with his true record,” Colorado Democrats said in an Aug. 23 statement to reporters.

O’Dea’s campaign website says that he opposed Roe v. Wade being overturned and that he supports abortion early in pregnancy but opposes “elective late-term abortion” and taxpayer funding for abortion and supports a parental notification requirement for minors.  The site also lists a letter from pro-life Republicans urging voters to support O’Dea in the primary even if they believe his views on abortion are too moderate. 

At the listening session, Crow said that he is an “unequivocal supporter of women’s rights to healthcare and privacy and autonomy” and that he would continue to advocate for abortion access at the national level. In Congress, he said he is currently exploring data privacy protection and working with colleagues to ensure that women in the Armed Forces have access to abortion care. 

Navy veteran Steven Monahan is currently running against Crow in the race for Colorado’s 6th Congressional District. Monahan, a Republican, does not have any information about abortion listed on his campaign website.

Even women with rights experiencing abortion restriction wrongs

Anxiety and fear. Those are the two words that come to mind when Dr. Nanette Santoro considers the impact of the abortion bans being implemented in states across the country.

“This has set off not just a constitutional law bomb but just a bomb within the medical field,” said Santoro, who is the chair of CU Anschutz’s Obstetrics & Gynecology department.

Santoro said the hospital’s family planning clinic, where it administers abortions, has seen a rise in people coming in for long-term birth control and she expects to see a spike in people receiving medication abortion, which is effective in the early weeks of pregnancy.

Anschutz has a diverse faculty, and she said not everyone on staff has the same beliefs about abortion. However, she said they are largely in agreement that it should not be a legislative matter.

“Taking it out of a doctor-patient relationship is very worrisome to many of us,” she said.

As one of the most comprehensive hospitals in the region, Santoro said Anschutz already saw many difficult cases that other hospitals were not equipped to care for. Now, some of the treatment they provide would be illegal in other states. She specifically noted the case of twin-to-twin transfusion syndrome, where in severe instances one fetus in utero has to be aborted to keep both of the twins from dying.

There are many situations where a pregnancy can become dangerous very rapidly, Santoro said. If doctors don’t have the necessary skills on how to perform an abortion or don’t know if they legally can without threat of arrest, the mother’s life could be placed in danger.

“It can be a very acute, sudden situation and you don’t have a lot of time to take care of business,” she said.

With the new laws going into effect in some states, Santoro said many patients are arriving to receive abortion care later in their pregnancies, which increases the risks of complications. There’s also a lot of fear from both patients and doctors about whether they could be at risk of facing prosecution in states that have now banned the procedure. She doesn’t always know what to tell them.

“My job as a chair is to protect my doctors and keep them safe,” she said. “We don’t know from our end whether a neighboring state might choose to go after one of my doctors if they set foot in that state.”

Some doctors in states that now ban abortion have simply closed their practices out of fear, and she’s worried that the Roe overturn will drive down maternal health outcomes across the board. A recent study from the University of Colorado found that banning abortion could increase maternal deaths in the U.S. by 24%, with larger increases for Black women.

The school’s OBGYN department teaches how to administer abortions as part of its rotation (with individual students having the right to opt out), something that medical students in places where abortion is now banned will have to scramble to access.

Anschutz assistant professor Dr. Aaron Lazorwitz said that the department has already been contacted by schools in other parts of the country asking if it can help educate their OBGYN residents.

“We’ve had programs from Texas and Oklahoma reach out to ask, can you help train our residents? Because we can’t train them anymore,” he said. “And unfortunately we can’t.”

The school is looking into ways it can help, but it can only safely accommodate a certain number of residents at a time and its first priority has to be to its own residents, he said. The school expects to see an increase in applications in the coming year as medical school students and residents gravitate towards programs in non-restrictive states.

That’s how he ended up at Anschutz — a native of Texas, Lazorwitz went to medical school in Dallas but knew in order to receive the abortion training he wanted as part of the care he hoped to provide, he’d need to go out of state. That was back in 2012. Now, he said the situation is much worse.

The desire to receive abortion training is what brought Kara Motley to the Denver metro area as well. A first year OBGYN resident physician from St. Louis, Mo., Motley started her internship the week that the Dobbs decision was announced.

She was anticipating that Roe would be overturned when she was applying for residencies last fall, and specifically asked programs how they would teach residents about abortion if it became illegal.

“I was framing a lot of my questions in terms of, when Roe is overturned, what is your plan for getting your residents abortion training?” she said. “And some of the programs were able to answer that and some of them weren’t.” 

Colorado’s strong abortion protections were a large part of what drew her to the state. As much as part of her wanted to go home, the training she needs is now no longer legal in Missouri.

From her perspective as a doctor, Motley said it’s been frustrating to see abortion be taken out of the realm of healthcare and into the realm of politics. There are many times where abortion is necessary to save the life of a pregnant person, she said, which makes it dangerous to restrict being taught.

“It’s like if you had a GI doctor who didn’t learn how to do colonoscopies,” she said. “It’s been so stigmatized politically that it’s become this thing that people are so afraid of talking about, but from our perspective it’s just another part of the care we provide every single day and we should be able to provide that care without restriction.”