Abortion in Wyoming: the inexact numbers

CASPER - The Wyoming Department of Health's 2022 report didn't capture all abortions in the state. The number of women who received abortions in Wyoming doubled last year to 200, according to the Department of Health's official 2022 Induced Termination of Pregnancy Report - but even that total appears to fall well short of the actual count.

Just The Pill, a telemedicine abortion provider that serves women in Wyoming, as well as Colorado, Minnesota, and Montana, recorded more than 400 patients in the state in 2022, Julie Amaon, the organization's medical director, told the Star-Tribune in a statement. But Just The Pill filed its reports late, so its tally is likely not at all reflected in the state's report.

However, both Just the Pill's statistics and the Department of Health's report - as well as data from Colorado - suggest that even as Wyoming lawmakers have moved to restrict abortion, more women have been able to access the procedure as abortion providers and rights groups have pushed to ease the obstacles facing women in Wyoming and surrounding states.

"If you have a health issue, you should be able to go to your primary care doctor and get that taken care of," Amaon said in an interview. "You shouldn't have to drive four and five hours across state lines to get primary health care."

She added, "These are personal issues that every pregnant person needs to make between them and their doctor. It really doesn't have anything to do with lawmakers or politicians."

A surge amid restrictions

Over the last two years, Wyoming has appeared destined to outlaw abortion.

In 2022, the state's trigger ban swept through both the House and the Senate before garnering the signature of Gov. Mark Gordon.

The U.S. Supreme Court's reversal of Roe v. Wade a few months later set the stage for Wyoming's ban to go into effect, but it was suspended by Teton County Judge Melissa Owens after a group of Wyoming abortion providers, women and an abortion fund challenged the ban for violating the state's constitution.

Cody Republican Rep. Rachel Rodriguez-Williams, who sponsored the trigger ban, introduced the Life is a Human Right Act earlier this year in response.

Rodriguez-Williams and anti-abortion advocates portrayed the second sweeping ban as a path to end abortion sooner, arguing it addressed the constitutional questions that had tied up the state's trigger ban.

At the same time, lawmakers approved a third ban targeting abortion pills.

Both were again shelved after the same group of Wyoming abortion providers and advocates sued the state and Owens temporarily blocked them. Even as lawmakers have tried to criminalize abortion, the data suggests women have increasingly been able to access the procedure in Wyoming.

According to the Department of Health's annual report, the number of Wyoming women who obtained an abortion grew by roughly 79% in 2022, while the number of women from other states more than doubled.

Since 2020, the number of abortions in the state has swelled from 91 to 200, increasing every year.

Based on the state's data, it's difficult to say what, if anything, has changed.

Lawmakers only began requiring the Department of Health to publish abortion statistics publicly in 2019, making it nearly impossible to discern if the steady increase over the last four years represents a growing trend or if it is simply a product of providers and the Department of Health adapting to new reporting requirements.

But Just the Pill's figures show significant demand for abortion from women inside and outside Wyoming.

Amaon and Just the Pill began providing telehealth abortions in Wyoming in December 2021.

In the first month alone, the organization helped 21 women obtain an abortion, roughly half of them Wyoming residents, Amaon said in a statement. It was a sign of things to come.

In 2022, Just the Pill saw 449 patients, exceeding even the largest tallies the Department of Health has recorded over the last four years.

"We know from other studies that have been done in other places with restrictions and bans that people are carrying pregnancies they would rather not to term," Amaon said in an interview. "We knew that the need was there."

Of the more than 400 abortions Just the Pill performed in Wyoming, 319 were residents. The rest largely came from surrounding states where abortion is either banned or in limbo.

Since the fall of Roe v. Wade and the constitutional right to abortion last June, the number of women seeking Just the Pill's services has increased fourfold across the states it serves, Amaon said.

Data from Colorado backs the idea that more women are obtaining abortions in Wyoming as the state's bans stall.

In 2021, 414 women from Wyoming traveled to Colorado for abortions, more than any other state, according to the Colorado Department of Public Health and Environment. Last year abortion soared in Colorado, including a more than doubling of out-of-state patients and a 500% increase in patients from Texas, where abortion is banned, the Colorado Sun reported.

Wyoming, though, was one of only a handful of states where fewer women traveled to the state for the procedure and one of just three states with an abortion ban or impending ban where the number of women traveling to Colorado declined.

In all, fewer than 300 Wyoming women sought abortions in Colorado in 2022, the largest drop of any state, according to Colorado state data.

"We know that the majority of the people in the United States feel like this should be accessible to patients," Amaon told the Star-Tribune. "I feel like our lawmakers need to listen to that - Wyoming residents need this care."

Expanding access

It's hard to draw a causal link between Wyoming's attempted abortion bans and demand for the procedure in the state. But anecdotal reports suggest the two are at least loosely related.

Chelsea's Fund is Wyoming's sole nonprofit abortion fund and part of the group suing the state for its abortion bans. Each time lawmakers have passed a ban, Chelsea's Fund, which helps connect women with abortion providers and offers financial assistance, has seen a swell in clients.

The number of women who reached out to Chelsea's Fund quadrupled in July 2022 as Wyoming's trigger ban took effect for just hours, Christine Lichtenfels, the executive director of Chelsea's Fund, told the Star-Tribune in a text.

Its client list again doubled immediately after the Life is a Human Right Act banned abortion for several days in March.

"It appears that by passing abortion bans and attempting to strip Wyoming women of their right to make their own health care decisions and exercise bodily control, the legislators are inspiring Wyoming women to exercise their rights and independence," Lichtenfels said.

Women inside and, just as significantly, outside Wyoming have begun tapping into the state's expanding abortion landscape. The last few years have yielded the two most significant developments for abortion access in Wyoming in decades.

The first was Just the Pill's expansion to the state in 2021. Just the Pill, which is based in Minnesota and aims to expand abortion access to rural and underserved communities, became Wyoming's first and only dedicated telemedicine abortion provider, a significant step since all of Wyoming's abortions in 2022 were medication abortions.

Then in April, Wellspring Health Access in Casper opened its doors.

The second abortion clinic in Wyoming and centrally located, Wellspring is also the only surgical abortion provider in the state.

So far, the majority of Wellspring's patients have come to the clinic for procedural, or surgical abortions, said Julie Burkhart, the founder and president of Wellspring Health Access.

"If you did not have access to a procedural abortion in the state of Wyoming, you would have to travel out of state, no question about it," Burkhart told the Star-Tribune. "We've really helped people within the borders of Wyoming to be able to access abortion care closer to their backyard."

Both Burkhart and Amaon reported their patients have expressed appreciation for Wyoming's burgeoning abortion access.

"It's always gratitude like, 'Thank you, I didn't have anywhere else to go in my state. I'm not anywhere near Casper,'" Amaon said. "... The majority of people I see are not near Casper and they're just very thankful that they have this option and they're able to do this in the comfort of their own home."

Wyoming's changing abortion landscape has also been a boon for women from neighboring states.

The Department of Health's annual reports hint that women outside of Wyoming are increasingly turning to the state's providers, a trend that is again supported by data from Just the Pill and observations from abortion providers.

Roughly a quarter of Just the Pill's patients traveled to Wyoming from Utah, South Dakota, Idaho and Nebraska in 2022. All four states have some kind of abortion ban in place.

Wellspring has similarly seen patients come from surrounding states like North Dakota, Montana and Utah, but the clinic has seen more women from South Dakota - which has among the strictest bans - than anywhere else, Burkhart said.

While Wyoming's new abortion providers can offer out-of-state patients a closer option than Colorado, women still face barriers, Burkhart said.

"Because abortion is illegal in these states, it is forcing people to drive to other states where abortion care is legal to access the health care that they want, that they need," she said. "What that does is it really puts the hardship on the patient."

Anti-abortion advocates undeterred Marti Halverson, president of Wyoming Right to Life, wasn't surprised by the Department of Health's 2022 abortion report.

Halverson and the anti-abortion group have long suspected the Department of Health's annual reports didn't show the full picture of abortion in Wyoming. She said Wyoming Right to Life knew some abortion providers that refused to report to the state, a legal requirement, though she did not provide any evidence.

She said the group knew the state's 2021 abortion figures were low "just from having our ears to this ground for so many years."

"What we think is that this report is probably more realistic than what has been reported in the past," Halverson said. "We are still not certain that every abortion in Wyoming is being reported."

In 2019, lawmakers passed new reporting requirements for abortion providers and the Department of Health, adding gestational age to the data doctors and the state needed to collect.

The state's 2019 update also imposed a new time limit, requiring physicians to report abortions within 110 days or face investigation by the Wyoming Board of Medicine, which "may take disciplinary action."

It's unclear what, if any, punishment Just the Pill will face for its late reporting in 2022, in part because the state's deadline gives abortion providers some leeway.

Wyoming's abortion reporting system is also antiquated, requiring doctors to fill out and mail in a form for each patient, a significant - and potentially costly - task given Just the Pill's 449 patients.

In a statement, Amaon said reporting was "a time-consuming process" and Just the Pill has been inundated trying to meet demand for abortions following the fall of Roe v. Wade. She added Just the Pill is now up to date on its reporting.

Kim Deti, a spokesperson for the Department of Health, said in an email the agency would follow state law and report any late data to the Board of Medicine.

"The most recent ITOP [abortion] report includes all data that was received by the time the report was finalized, distributed and published," she said. "We are aware some data may have recently been filed late with our department, but do not yet have details about that data available as the information is still being reviewed."

When asked if Just the Pill's data made it into the Department of Health's 2022 abortion report, Deti declined comment.

She said she expected any late data submitted to the state would be included in future reports.

Though Wyoming's final 2022 abortion count is uncertain, it's safe to say the figure will be well above previous years. Despite statistics that suggest access to abortion is growing in the state, Halverson said Wyoming Right to Life is undeterred.

The group hopes to use the updated numbers to convince more lawmakers to take stronger action against abortion.

"Several years ago when we started pushing for as much of a ban as we could get, the comeback against our efforts was, 'Well, there's only 93 abortions,'" she said. "Now that we know there are more - double at least - we are hoping that legislators who have been on the fence on these bills wake up and smell the coffee and realize there are a lot more abortions going on in this state than they imagined."

"Wyoming is a pro-life state. Voters are pro-life voters. And the numbers prove that this issue is not being addressed," she added.

While Halverson pledged Wyoming Right to Life would continue its campaign against abortion, Wyoming's abortion rights groups and providers have also said they will keep up their battle against the state's restrictions.

For Lichtenfels, the director of Chelsea's Fund, the state's abortion fight and the end of a constitutional right to abortion have come with a silver lining. Both have raised awareness about the nonprofit's work and abortion access in Wyoming, she said.

"All we ever care about," she said, "is that anyone who wants that opportunity is able to access that opportunity."

This story was published on August 3, 2023.