Three questions with an ob-gyn who left Idaho

Since 2022, the number of ob-gyns practicing in Idaho has plummeted. On the day of the Supreme Court ruling on Idaho v. United States, I spoke to one.

Dr. Amelia Huntsberger, an ob-gyn in Sandpoint, Idaho, was deeply conflicted. She was devoted to the community where she and her husband were raising their three children. But last summer, she and her husband decided that for the sake of their family, they needed to leave the state. 

Since 2022, the number of ob-gyns practicing in Idaho has dropped by an alarming 22%. The staffing shortages have caused at least three Idaho hospitals to close their labor and delivery rooms. And the remaining facilities are struggling. Several report needing to airlift hemorrhaging pregnant women out of state to access urgent abortion care.

Across the United States, reproductive health care has continued to be ensnared by conflicts between restrictive laws and what professional organizations like the American College of Obstetrics and Gynecology (ACOG) consider to be ethical practice. 

In Oklahoma, where half of the counties are already considered maternity care deserts, a staggering 75% of ob-gyns said they are planning to leave or would consider leaving. New doctors of all specialties are seven times less likely to apply to states with restrictive abortion policies for their residency training.

The rapidly changing and still evolving reproductive health landscape is also sowing confusion, among doctors and patients alike. A Kaiser Family Foundation tracking poll showed that most adults are either unsure or incorrect about what forms of care are allowable in their state. 

At least for those in Idaho, last week many expected the Supreme Court to provide more clarity. The closely followed case pitted Idaho abortion laws against a federal rule known as EMTALA, obligating hospital emergency rooms to treat people in distress, regardless of their ability to pay, including those who are pregnant. The court, however, dismissed the case, punting the decision back to the lower courts, and leaving doctors and patients without clear guidance about what is allowable.

I asked Dr. Huntsberger to help me understand what this means for the people who need care, for the people who aim to provide it.

Some would say yesterday’s ruling is a bit of a head scratcher. How are you thinking about the Supreme Court’s decision?

This is not a win for pregnant patients. This is just a delay in clarification. It's not as though this decision or lack of a decision provides crystal clear clarity for emergency room physicians, ob-gyns, pediatricians, family medicine doctors…it leaves us in this toxic limbo. And that ambiguity is very powerful. 

You moved away from Idaho nine months ago now. Can you talk a little bit about your decision to ultimately leave?

My husband is an ER doctor, so that's the lens we bring to this as a couple who provides emergency room care and reproductive health care. We knew that one or both of us was going to be in a circumstance where our professional obligation to take care of our patient to the best of our ability was going to conflict with the state law. It wasn’t a matter of will this happen, it was a matter of, if you stay there it will happen. It will happen. Then there’s the psychological costs of knowing that you will have to decide who you prioritize. There’s also what that meant for me as a mom—I was potentially sacrificing my personal liberty and my ability to parent my children. My personal liberty, my medical license, my mental health, and my finances were all at risk in Idaho. There's civil enforcement in the abortion ban too. For any abortion performed after there is a heartbeat present, a family member of the fetus can sue you for a minimum of $20,000. You’ve got eight brothers and sisters? Well, line them up and sue. So these were real, potential threats to my financial, physical, and personal freedom. 

My husband and I did not have a particular event that caused us to decide to leave. It was the constant knowing that something could happen, that somebody is going to walk in the door of the ER, and having that dual vulnerability as a two physician family. We really came to the decision at the same time. 

What is the state of women’s and family healthcare in Idaho right now? 

This ruling creates a very narrow window of protection for people undergoing a medical crisis, where their health may be affected by the continuation of pregnancy. That is really helpful, but it’s still a small swath of people. 

This ruling does not help the 26-year old who was raped and didn't report it to police. Oh, you didn't report? Well, abortion is not available to you.

It does not help the mom with cancer, whose primary contraception failed. She's got two kids, just got a new diagnosis of cancer, and has a pretty good chance with treatment. But in Idaho, she has no immediate threat to her health, so she doesn't have abortion available to her. And not only does she not have abortion available to her, she may not have access to cancer treatment, because it might harm her pregnancy. What is she supposed to do? 

Or let's take the victim of incest. She may be young, she may have not had very many periods in her lifetime, and was raped by a family member, and then didn't realize she was pregnant, and now she is 14 weeks along. Abortions in instances of incest are only available in Idaho during the first trimester, so there’s no care available to her. And because she’s a minor, anyone who helps her could be at risk for aiding and abetting felony charges under the abortion trafficking law in Idaho. This Supreme Court decision doesn't help any of those patients. These circumstances are happening in Idaho, they’re happening in Texas, and they’re happening in restricted states across the U.S. 

If you’d like to learn more about Dr. Amelia Huntsberger’s work advocating for her patients in Idaho, her decision to leave, or what reproductive health care looks like on the ground, you can read more in the Guardian, on This American Life, or in her own wrenching op-ed for the Idaho Capital Sun. 

Plus, more things my team is reading, thinking, and building against:

• Nicole Miller shared her story with the New York Times of needing to be flown from Idaho to Utah to receive care, all while experiencing a miscarriage with heavy bleeding. The story also quotes Dr. Allison Haddock, President-elect of the American College of Emergency Physicians who, like Dr. Huntsberger, is leaving her home state because of the difficulty of working under the Texas abortion ban.

• Last week Iowa became the latest state to impose a ban on abortions after six weeks. Most people do not know they are pregnant until four to five weeks at the earliest, and doctors are often not able to tell if it is a viable pregnancy until after the fifth week. 

• The Guttmacher Institute maintains a map of the United States showing the variation in abortion policies, coloring those that are restrictive in orange and those that are protective in blue. The visual contrast is striking, illustrating why last year alone it was necessary for hundreds of thousands of people to travel hundreds of miles for care–at considerable financial and emotional expense.

• The Brigid Alliance is a nonprofit organization that provides funding and support to those in need. At Maven, we are continuing to partner with employers who are offering travel reimbursement as a benefit. And we continue to counsel all members about their options, just as we always have.