Pro-choice activists demonstrate outside the Supreme Court on Oct. 4, 2021, in Washington, D.C. (Kevin Dietsch/Getty Images)
With states like Texas imposing abortion restrictions, and concern that more will follow, a greater number of out-of-state women are coming to Colorado to seek abortions.
Historically, women have come from all over the country to Colorado, which is sometimes called a “safe haven“ for abortion, to get abortion care.
Maleeha Aziz is one of those women.
Aziz was 20 years old when she had her abortion almost eight years ago. About a year before, she had moved from Pakistan to Texas.
When she found out about the pregnancy, Aziz went to a crisis pregnancy center. “Unfortunately, I didn’t know any better at the time, and they basically told me some lies about abortion in Texas, making me feel that it was illegal.”
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Crisis pregnancy centers almost always oppose abortion, and are usually associated with a religious organization. Some centers offer services such as free pregnancy tests, counseling, and resources like diapers.
Aziz said her family members were supportive. She called clinics in Oklahoma, Louisiana, and Colorado. The Planned Parenthood in Colorado Springs was the easiest to communicate with, and it had an appointment available sooner than other places.
Aziz was almost 10 weeks pregnant when she had her abortion. The biggest barrier to having an abortion for Aziz was the crisis pregnancy center, she said. “Had they not lied to me, I would have probably been able to have my abortion in Texas. But they did lie to me, and at the time, I didn’t know any better.”
Cost would have been a barrier for Aziz, but she said she was “very blessed and grateful” to have a family member who paid for her procedure and the travel cost associated with the abortion. The total cost was almost $2,000.
“There were some terrible protestors, saying terrible things,” Aziz said. “Even as I walked into the clinic in Colorado, I had tears streaming down my face and I could not stop crying. I was crying so bad that the doctor doing my sonogram was worried I was being coerced into having an abortion, and I told her that’s not the case, ‘I very much want this abortion, I’m just very overwhelmed by all the nasty things being said to me by those people I just walked past.’”
“While walking into the clinic, protestors called me a murderer and yelled horrible insults at me,” Aziz wrote in a Sept. 30 testimony to the House Committee on Oversight and Reform for a hearing to expand abortion access. “I remember being unable to fight back the tears as I did not have the confidence back then at 20 years old that I do now. I remember having to undergo a mandatory but medically unnecessary transvaginal ultrasound. It was very triggering and felt like sexual retraumatization.”
Now, Aziz works at the Texas Equal Access Fund, a nonprofit for low-income women seeking abortions who need financial assistance.
Last month, Stephanie Dworak and her husband, Dave, traveled from Omaha, Nebraska, to Boulder to get an abortion.
“I was not able to get an abortion in Nebraska because by the time I found out the extent of the deformities my baby had, I was already 20 weeks along, and there’s only one clinic in Nebraska that will perform abortions up to 22 weeks, and the doctor at that clinic is only there every three weeks,” Dworak said. “So there just wasn’t time between when I found out the extent of my baby’s deformities. It was not compatible with life.”
Dworak decided to go to Colorado for an abortion because it was the closest option. She said her only other options were New Mexico or Maryland.
Dworak tried to get an abortion in Minneapolis and Iowa City, Idaho, but because of the restrictions preventing abortion after a certain number of weeks, Dworak was unable to get one there.
“By the time I could have gotten an appointment, I would have been too far along,” Dworak said.
“Between the restrictions on how far along you can be and a lack of clinics to perform abortions, I had no choice but to go to another state.”
Between the restrictions on how far along you can be and a lack of clinics to perform abortions, I had no choice but to go to another state.
– Stephanie Dworak
The trip was expensive. Dworak’s doctor recommended that she fly to Colorado, because as her abortion was a surgical procedure, if something were to go wrong on the trip back, it would not be ideal to be in a car in the middle of Nebraska, so Dworak and her husband had to purchase plane tickets for themselves. The Dworaks have a 3-year-old daughter, so they also had to figure out child care for her.
Dworak had to rent a car in Colorado, pay for four nights in a hotel, and pay for the procedure, she said. The abortion itself was $4,000.
“There were (anti-abortion) protestors with signs that were loudly praying the rosary,” Dworak said.
Dworak said seeing the protestors was awful.
“Luckily, the clinic that we went to has a very large privacy fence out front, so that you’re mostly shielded from the protestors once you are in the lot, but (the protestors) are still there, and they are still very loud,” Dworak said.
Erika Christensen also traveled to Colorado for an abortion.
Christensen lived in New York. In 2016, she traveled to Boulder to get an abortion because of a fetal diagnosis that she did not find out about until the third trimester.
“This was before New York passed the Reproductive Health Act; however, post-Reproductive Health Act, people are still flying out of New York in cases just like mine, so there remains work to be done in New York,” Christensen said.
The Reproductive Health Act was passed in 2019 and legalized abortion in New York after 24 weeks if the woman’s health or life is at risk. Prior to the act, abortion was legal after 24 weeks only if the woman’s life was at risk.
“Further into pregnancy, the price of care goes up, the number of providers go down, and more and more restrictions go into effect,” Christensen said.
Christensen picked Colorado because her doctor in New York had sent other patients to Colorado to get an abortion, and they had good results, she said. “Information is not readily available, and disinformation is incredibly readily available, and so patients navigating these systems just rely on where their doctor tells them to go.”
People get and need abortions later in pregnancy for the same reasons they do earlier in pregnancy, Christensen said. “However, people find themselves pushed later because of one of two paths that they find themselves on.”
“The first (path) is new information that they couldn’t possibly have known before they knew it,” Christensen said. “So in my case, that was a fetal diagnosis that we didn’t find out until the third trimester. For most later abortion seekers, it’s that they are pregnant. Later recognition of pregnancy is just far more common than people think.”
“I recognized my third pregnancy later, at 16 weeks, because my body had been through so much pregnancy, it was just really out of whack,” Christensen said. “For me, that was a happy surprise, because I was actively trying to have a child, so I was happy to roll with that. But it’s not that way for everyone.”
Christensen said there is nothing that can ever be done about that path. “We’re talking the human body is complicated, it doesn’t follow legal timelines, people will always need later abortion care because of that first path.”
The second path, Christensen said, is barriers to accessing care as soon as they would have liked.
For many patients, there is a combination of the two paths. “You find out something later you couldn’t have known earlier, and then you are pushed even further because of the barriers that exist.”
Traveling to Colorado changed our whole lives.
– Erica Christensen
“Traveling to Colorado changed our whole lives,” Christensen said. “We were just very unaware of the state of abortion access in this country until I experienced that barrier myself. We were just shocked, living in New York, which you would think is a place that is easy to access (abortion) care, to get on a plane and fly all the way across the country when you are in the middle of a health crisis.”
“I was able to borrow $10,000 from my mom. We were able to put last minute flights and a last minute car rental on our credit cards,” Christensen said. “We speak English. We have IDs that allow us to fly. At the time we didn’t have children at home to figure out what we do with them. Most people who have abortions already have children.”
“The whole time, out there and back, we were just thinking, ‘What would we have done if any of these individual privileges had not been in place? What would we have done?’ And the weight of that just sort of changed our whole lives. It changed the trajectory of everything.”
Christensen and her husband founded Patient Forward, which she describes as a small nonprofit abortion advocacy organization that focuses on abolishing gestational bans, after her abortion in Colorado. They also created Who Not When, a “later abortion” education resource.
“What is going to happen from (the Supreme Court of the United States) is going to be so devastating that it’s going to make SB-8 look like the tip of an iceberg, because we’re about to see a lot more states fall very quickly, and for later abortion access that’s going to be incredibly devastating,” Christensen said. “These procedures are $15,000 to $20,000-plus. People cannot get the $500 together for an early abortion. How are they going to get ($15,000-$20,000) together?”
Texas Senate Bill 8 went into effect on Sept. 1 and bans abortion after the detection of fetal cardiac activity, which is typically around six weeks gestation — before many women know they are pregnant.
“We’re all incredibly scared about this,” Christensen said. “Because we know later abortion seekers tend to be the most under-resourced members of our communities, it’s just going to fall the hardest on them, like everything falls the hardest on them. It’s scary times. This is the time to panic.”
I deeply believe in consent. I believe in consent to pregnancy, I believe in consent to gestation. If we lose that, we lose everything. And that is something we cannot compromise on.
– Erika Christensen
“I deeply believe in consent,” Christensen said. “I believe in consent to pregnancy, I believe in consent to gestation. If we lose that, we lose everything.”
In 2005, it was not difficult for Kimberly Lemme to find a doctor who would perform an abortion in Colorado for her nonviable pregnancy.
“We had fabulous care, all of the doctors were amazing,” Lemme said.
The fetus was diagnosed with Down syndrome, which Lemme said she and her husband could handle. “But then when they went in to do more testing, there were organs in the wrong place and fluid in the wrong places, and so the doctor was pretty clear that even if I did carry until it was delivered, and if it actually survived the whole time, there was very, very little chance of survival beyond minutes or hours,” Lemme said. “On top of that, the risk of preeclampsia, which is why my daughter was born early, was still there.”
Lemme’s oldest child, who was 18 months at the time of Lemme’s abortion, had been born prematurely, and Lemme was still in touch with the newborn intensive care unit doctors and care providers from her, who Lemme said were “super helpful in this process.”
Lemme was insured by Kaiser Permanente at the time, and she doesn’t remember paying anything out of pocket.
Impact on the Rocky Mountain region
The Texas law is making it harder for Coloradans to seek care.
Planned Parenthood of the Rocky Mountains — which has 22 health care centers in Colorado, New Mexico, and southern Nevada — provided abortions, on average, to almost nine patients a week from Texas, according to court documents filed Sept. 14 by Vicki Cowart, the president and CEO of PPRM, who recently announced her retirement. In the one-week period following the ban going into effect, PPRM provided “abortion services” to 20 Texas patients, which the document says is 53% of the typical monthly patient volume with less than a third of the month passed. “We anticipate the number of Texas residents we see to grow, as we have been flooded with calls from Texas residents since S.B. 8 took effect.”
PPRM locations saw an increase in Texas patients seeking abortion services almost immediately after SB-8 went into effect, said Neta Meltzer, the director of strategic communications for PPRM. Meltzer said there was an uptick in Texas patients the week of Sept. 5, and it steadily increased for the next several weeks. It has remained consistent since then.
Texas patients are primarily traveling to Planned Parenthood locations in New Mexico and Colorado, Meltzer said. While PPRM only oversees Planned Parenthood locations in the Rocky Mountain region, Meltzer said she has heard that other Planned Parenthood health centers, such as locations in New York, have also seen Texas patients.
The increase in Texas patients at PPRM locations has made wait times for appointments longer.
“Ideally for us, wait time would be at most a few days to get the care that you need, but in some instances, some locations of ours are seeing a couple week wait times,” Meltzer said. “That’s not ideal, for local patients or patients coming from out-of-state either.”
Meltzer said she believes there were about 56,000 abortions performed in Texas on Texas patients in 2019. In Colorado, the number was close to 10,000 and in New Mexico, it was about 2,700. “That’s an order of magnitude difference … that’s a tall order to absorb all of that patient volume. We’re all working everyday to try to meet that need, but it certainly is impacting wait time and availability.”
In an Oct. 4 virtual discussion, Cowart, Colorado Attorney General Phil Weiser, and Planned Parenthood president and CEO Alexis McGill Johnson discussed the impact the Texas bill is having on Texas women, and on states near Texas, including Colorado, New Mexico and Nevada.
“What Dick Lamm recognized, and Justice (Ruth Bader) Ginsburg talked about this unabashedly in her confirmation hearings, is that if women are not able to have choice over their bodies, over whether they will carry the child, they are not in an equal position,” Weiser said in the discussion. “Bodily autonomy and the ability to be in control of your own personal destiny is connected to sound mental health, to sound opportunity, and to basic fairness.”
“Making abortions illegal in Texas for so many people in such a draconian and wrongful manner is not going to end abortions,” Weiser said. “It will end legal and safe abortions, particularly for poor women, for women of color. Many people today haven’t ever lived during a time of back alley abortions. We need to keep fighting so that we don’t once again witness such an era.”
“I want to be clear, Planned Parenthood of the Rocky Mountains will do everything we can to serve the patients who turn to our region for care,” Cowart said in the discussion regarding the number of abortions that took place in Texas in 2019 and how that might impact PPRM health centers given the new abortion restriction. “We are working overtime to do this. But with numbers like these, that won’t be enough. There will be patients who simply cannot access care, and that is the core of the injustice created by Senate Bill 8.”
“Here in Colorado, when people come here, we will protect their constitutional rights, both to travel and to have reproductive healthcare. We’ll fight for constitutional rights whenever they are at issue,” Weiser said.
Because appointment availability and wait times are being impacted by the Texas law, local patients who are seeking their annual exam or their birth control may have to wait longer or have to travel to a further health care center to get an appointment, Meltzer said.
Abortion in Colorado
Abortion is legal in Colorado.
Despite being a sanctuary for some women to get abortions, Colorado is home to several groups that advocate for abortion restrictions, including Focus on the Family, a Fundamentalist Christian nonprofit organization with headquarters in Colorado Springs, and Colorado Right to Life, an anti-abortion group that protests outside of Denver’s Planned Parenthood center.
In 2015, a man killed three people and injured nine in a shooting at the Colorado Springs Planned Parenthood. At a hearing to charge the shooter, he interrupted the hearing to say he is guilty and said he was a “warrior for the babies.” A Colorado Public Radio reporter who was at the hearing said defendant Robert Dear said “Kill the babies, that’s what Planned Parenthood does.”
Prior to this year, the Colorado state Constitution required that Medicaid cover abortions only if the person seeking an abortion was the victim of sexual assault, incest, or if their life was endangered, and the abortion must be performed at specific facilities. There was only one center, in Denver, where recipients could get an abortion covered by Medicaid.
Earlier this year, Colorado Sens. Brittany Petterson and Kerry Donovan and Reps. Yadira Caraveo and Julie McCluskie introduced Senate Bill 21-142, which removes the requirement that Medicaid recipients go to a specific clinic to get an abortion. The Health Care Access in Cases of Rape or Incest also removes the requirement that specific physicians perform the abortion. Now, medically necessary services are allowed to be performed by a provider who is “licensed by the state and acting within the scope of the provider’s license and in accordance with applicable federal regulations.” Gov. Jared Polis signed the bill on May 21.
In September, Attorney General Phil Weiser joined a coalition of 24 attorneys general in filing a brief in the U.S. District Court for the Western District of Texas in support of the Department of Justice’s challenge to the abortion restriction in Texas.
Weiser joined a coalition of attorneys general last month in urging the Supreme Court to stop the Court of Appeals’s hold on blocking the ban from going into effect, according to an Oct. 18 press release issued by Weiser.
Colorado has had a series of anti-abortion measures on the ballot over the past several election cycles. Last year, Proposition 115, which would have subjected doctors who performed abortions after 22 weeks to possible criminal penalties, failed, with almost 60% of voters opposed.
In 2008, the Colorado Definition of Person Initiative sought to include “any human being from the moment of fertilization” in the definition of a person. The initiative failed, with 73% of voters opposed.
In 2010, the Colorado Fetal Personhood Initiative attempted to ban abortion in Colorado by defining personhood as “every human being from the beginning of the biological development of that human being.” In 2014, the Colorado Definition of “Personhood” Initiative was on the ballot, which attempted to expand the definition of a person to include fetuses, according to Ballotpedia. Both initiatives failed.
In addition to essentially banning abortion, the Texas law attempts to circumvent legal precedent by allowing private citizens to sue people who they believe assisted someone in Texas getting an abortion.
No freedom is more precious than life itself.
Starting today, every unborn child with a heartbeat will be protected from the ravages of abortion.
— Greg Abbott (@GregAbbott_TX) September 1, 2021
The bill does not allow individuals to sue the woman who gets an abortion.
Some abortion providers and clinics, including Planned Parenthood, requested the Supreme Court temporarily block the abortion ban prior to it going into effect on Sept. 1, but the Supreme Court voted not to prevent the ban from going into effect.
There are no exceptions for rape or incest in the Texas law, with one deviation: the person who “impregnated the abortion patient through an act of” rape, sexual assault, or incest cannot file a civil action against someone who assisted that person with getting an abortion. It is not clear whether this exception applies only if the person accused of rape or incest has been formally charged.
The Supreme Court voted on Oct. 22 to allow the Texas bill to remain in effect until the Court considers the legality of the bill. The Supreme Court began hearing challenges to the Texas bill on Monday. As of Nov. 4, the Supreme Court had not announced a decision.
Impact on Texas
In court documents, Vicki Cowart, president and CEO of Planned Parenthood of the Rocky Mountains, mentioned some of the hardships that Texas patients have faced as a result of the Texas abortion bill. One patient was attempting to leave Texas to seek an abortion without her abusive husband finding out, but had to sell personal items to be able to pay the additional expenses for an out-of-state trip, and was worried her husband would find out given the planning she had to do, according to the document.
Another patient from Texas did not realize they were pregnant until it was too late to have an abortion under SB-8, but could not afford to travel out of Texas. A different patient was seven weeks pregnant and did not have her own credit card, which many rental car companies require, to rent a car. This patient was employed full-time, according to the document, but it was difficult for her to save the funds to pay for the rental car, gas, and the abortion.
The document said that the patient said she was able to rent a car by using a friend’s credit card, and then drove over 1,000 miles round trip alone because she could not afford the time off of work and didn’t have paid time off.
Several members of the Colorado Senate Democratic Women’s Caucus expressed their outrage over the Court’s refusal to temporarily block the Texas bill, which the Department of Justice had requested, in an Oct. 22 press release: “As we stand with Texans fighting to protect the right to reproductive freedom, we remain committed to ensuring that Colorado continues to be a safe place for any American seeking access to their right to reproductive care.”
Justice Sonia Sotomayor wrote the dissenting opinion in the vote on whether to allow the Texas bill to remain in effect until the Supreme Court considers the case.
“There are women in Texas who became pregnant on or around the day that S.B. 8 took effect,” Sotomayor wrote. “As I write these words, some of those women do not know they are pregnant. When they find out, should they wish to exercise their constitutional right to seek abortion care, they will be unable to do so anywhere in their home State.”
“There is no dispute that under this Court’s precedents, women have a constitutional right to seek abortion care prior to viability,” Sotomayor wrote.
Not the first time
This is not the first time Colorado and other PPRM health care centers have seen an increase in patients from Texas.
When Gov. Greg Abbott of Texas banned abortion care at the beginning of the COVID-19 pandemic, PPRM saw an increase in people from Texas seeking abortions at PPRM centers.
Between March 22 and April 25, 2020, PPRM saw 198 patients from Texas, when it would have expected 44 patients, based on prior monthly averages, according to court documents.
“This was a 350% increase over expected patient volume from Texas, and is a relevant case study for what we can anticipate since Texas’ ban on abortions after 6 weeks went into effect … The strain on our system from Texas patients will have a significant impact on our ability to serve patients from New Mexico and Colorado specifically, which we experienced during the COVID-19 ban,” Cowart said in a court document. “Absorbing thousands of Texas residents will have a domino effect on access and wait times, and will interfere with our ability to provide timely reproductive and sexual health care to the communities we currently serve.”
She continued: “Thus, patients living in New Mexico, Colorado, and Nevada must delay preventative care or go without, which may result in undetected cervical or breast cancer, the continued transmission of STIs, or more unintended pregnancies as the result of lapses in access to birth control.”
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