Supporters of the campaign to overturn one of the nation’s toughest abortion bans would rather not talk to Idaho voters about abortion. Instead, they want voters in their redder-than-red state to think about doctors.
Proposition 1, on the ballot in November, would establish a right to abortion until fetal viability and afterward in medical emergencies. But that’s not how the unlikely Idaho ballot measure is being sold in the conservative state.
Instead, as opponents of abortion focus on the ban’s success in ending the procedure, abortion rights proponents are talking about health care broadly, as Idaho weathers a steep decline in the number of doctors providing obstetrics care amid a population boom.
In the four years since Idaho criminalized doctors who perform the procedure, the number of obstetricians and gynecologists practicing in the state has fallen sharply. A study published last year found that Idaho had lost 94 of the 268 physicians who were practicing obstetrics when the ban took effect, a 35 percent decline in the first two years, even after accounting for doctors who arrived in the state. About half of Idaho’s 44 counties lack a practicing obstetrician-gynecologist.
The result, according to health care professionals: longer waits, higher costs and less access to preventive care for all Idahoans, not just pregnant people.
“Most of what obstetricians do is not obstetrics,” said Dr. Edward McEachern, who led the study. “It’s just taking care of women.”
Conservative lawmakers and activists who pushed the state’s anti-abortion laws focus on the intended result: The number of in-person abortions in Idaho fell to almost none, from around 80 a month before the laws.
“Idaho is a pro-life state, and our laws reflect that,” said Blaine Conzatti, president of the Idaho Family Policy Center.
Idaho is a conservative state and growing more so. Over the past two decades, Republican supermajorities in the State Legislature, fortified by an influx of conservative voters from across the West, have enacted spending cuts and some of the country’s toughest restrictions on transgender health care, public restroom access and scholastic sports.
“We’ve been a lighthouse for the rest of the country,” said Mr. Conzatti, whose organization helped craft much of that legislation. He said he’s not at all worried about Proposition 1 passing.
But organizers believe they stand a chance. Other conservative states, including Kansas and Missouri, have overturned recent abortion bans or upheld abortion rights. More than 57 percent of Floridians voted in 2024 to legalize abortion over the will of the Legislature, but 60 percent was needed under that state’s referendum rules.
A Boise State University survey in January found that 60 percent of Idaho residents supported establishing a right to make private reproductive health care decisions, including abortion until fetal viability and in medical emergencies. More than 110,000 people signed petitions to put Proposition 1 on the ballot.
Beyond abortion, Proposition 1 would enshrine rights to contraception and fertility treatment. Organizers view it as a chance to rebuild Idaho’s health care system, and, more expansively, as a referendum on the state’s hard-right swing of the past decade.
“This is the one way we have to say ‘enough,’” said Melanie Folwell, the proposition’s campaign manager.
Idaho’s abortion restrictions date to before the Supreme Court overturned Roe v. Wade. The state’s 2020 law, designed to take effect after Roe’s repeal, criminalizes nearly all abortions. A separate law prohibits abortion after embryonic cardiac activity can be detected and allows certain family members to sue providers who perform prohibited abortions. Exceptions for rape and incest are limited to the first trimester and require that the crime be reported.
The legal burden falls on providers, not women seeking care.
“It makes the performance of an abortion a crime, a felony,” State Senator Todd Lakey, the sponsor of the ban, said when it came to a final vote in March 2020.
During legislative debates, Democratic lawmakers and health care groups warned that criminalizing abortion could cause doctors to flee. Republicans dismissed the concern; Lori Den Hartog, a legislator from Ada County, challenged “the notion that the taking of a human life is health care.” Idaho’s attorney general briefly threatened to prosecute doctors who referred patients to states where abortion remained legal.
Health care professionals say legislators misunderstood how pregnancy care works. Medical records, for example, can use terms such as “spontaneous abortion” to describe a miscarriage, even though Idaho law does not prohibit care during and after a miscarriage. That reality has created confusion and fear among doctors.
Amy Klinger, a physician assistant in rural Stanley, Idaho, described providers second-guessing their treatment plans for pregnant women in life-threatening situations — or pausing to call their hospital legal team. “If you can go somewhere else and just focus on caring for your patients, why wouldn’t you?” she asked.
Supporters of the ban are eager to focus the proposition fight on abortion, arguing that the referendum could allow them much later in pregnancy than Idaho did before Roe v. Wade was overturned. The proposition’s definition of viability as a “significant likelihood” of sustained survival outside the uterus “without extraordinary medical measures” could permit elective abortions into the seventh or eighth month, they say. Repeal organizers dispute that interpretation, noting that medical authorities generally place viability around 24 weeks.
During a legal fight over ballot language, Idaho’s attorney general and secretary of state, both Republicans, pushed to include references to the lives of “unborn” and “preborn” children. The final ballot features both.
Referendum opponents also argue the statistics on Idaho’s health care system do not stand out nationally. They cite a national study published last year that tracked more than 60,000 obstetricians and gynecologists and found no statistically significant difference in OB-GYN work force trends in the two years after the overturning of abortion rights between states with total abortion bans and states with abortion access protections.
“We have a rural health care problem all across the nation, not just in Idaho,” Mr. Conzatti said. “It’s not abortion laws that are driving physicians away. It’s the hard economics of aging populations in rural areas and consolidation in the health care industry.”
Active OB-GYN licenses in Idaho increased by more than 20 percent between 2022 and 2025, but doctors do not need to live or practice full time in the state to maintain one, and not all OB-GYN practices offer a full-range of women’s health care.
“The bottom line is that licenses do not equal access,” said Susie Keller, chief executive of the Idaho Medical Association, which represents 4,000 people in the field and has not taken a position on the repeal. “The lack of clarity has absolutely convinced some people to leave and reduced health care options in Idaho.”
If voters throw out the state ban, Republican state legislators could restore some version in 2027. Health care professionals say that even if state laws are loosened, it could be years before the state’s medical field returns to the levels it saw when abortion was legal.
“It’s a generational thing,” said Dr. McEachern, the chief medical officer at St. Luke’s Health Plan, an Idaho-based insurer.
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