by Utah Republican Gov. Spencer Cox signed legislation Wednesday that would effectively ban clinics from providing abortions, prompting a rush of confusion among clinics, hospitals and prospective patients in the deeply Republican state.
Hospital and clinic administrators have not made public their plans to adapt to the new law, adding a layer of uncertainty on top of fears that if the clinics are closed, patients may not be able to access the hospitals due to staffing diversity and cost concerns .
With the law set to take effect on May 3, both the Utah Planned Parenthood Association and the Utah Hospital Association declined to elaborate on how the increasingly fraught legal landscape for abortion providers in Utah will affect how the facilities provide abortion.
The upheaval mirrors developments in Republican strongholds across the United States since the U.S. Supreme Court overturned Roe v. Wade, changing the legal landscape and sparking a spate of lawsuits in at least 21 states.
Utah lawmakers behind the legislation said removing the clinics from state law would help protect lives and serve as a necessary update given the new restrictions allowed to take effect in Utah after the constitutional right was overturned in abortion.
While lobbying against the legislation, Planned Parenthood, which owns three of the four clinics in Utah, said it would dramatically hamper the organization’s ability to provide abortions once it takes effect. Jason Stevenson, the association’s lobbyist, said Wednesday that the organization will now further examine the wording, implications and whether other provisions of the bill allowed clinics to apply for a new type of hospital-equivalent license.
Based on Planned Parenthood’s interpretation, he said in an interview, the clinics would no longer be able to provide abortions with their current licenses. They plan to continue to provide the majority of their services, however, such as STD tests, pregnancy tests, cancer screenings and vasectomies. Stevenson said they were “carefully considering” other “hospital equivalent” licensing options set out in the legislation, but did not say whether the clinics would apply at that point.
Jill Vicory, spokeswoman for the Utah Hospital Association, said in an email that it is “too early to comment” on whether hospitals could soon be the only abortion providers in Utah, noting that each “will have to decide on the how will he choose to move.”
If the clinics stop providing abortions, experts say they worry that the comparatively higher cost of care and hospital staffing shortages will make it harder to obtain legal abortions in Utah, even though the law does not specifically limit those seeking them in the state, where they remain legal until and 18 weeks.
Dr. Carole Joffe, a professor at the University of California, San Francisco who has written about the social impact of reproductive health, said removing licenses from clinics would upend the way abortions have been provided for more than 50 years. Historically, patients with low-complication pregnancies have received abortions at outpatient clinics, which on average are able to provide them at a lower cost.
“Everything in a hospital is more expensive than in a clinic. Doing an abortion in a hospital, you need more staff,” he said, noting that hospitals, with teams of anesthesiologists, doctors and surgeons, have historically provided them in emergency scenarios.
Another challenge facing already overburdened hospitals is staffing, Joffe said, both in recruiting and staffing abortion providers. Especially in states where anti-abortion sentiment is strong, many doctors or hospital nurses may be reluctant to provide them, he added.
“You have to draw from a reservoir that may or may not be sympathetic to abortion, as opposed to a clinic where you don’t go to work unless you have a commitment that abortion is part of health care,” Joffe said.
Abortion advocates say the confusion stems from vague language about the licensing process included in the legislation. It bars clinics from obtaining new licenses starting May 2 and enacts a full ban on Jan. 1, 2024. But advocates are concerned about a separate provision in the 1,446-line bill that specifies under state law that abortions can only be performed in hospitals, making the licensing dates irrelevant.
The clinic-focused legislation has also raised questions about which segments of the population will be most affected and which types of facilities are best equipped to provide specialized care to patients regardless of their income or location.
If clinics stop providing abortions — as early as May or until the end of next year — it could reroute thousands of prospective patients to hospitals and force administrators to devise new policies to provide elective abortions for low-complication pregnancies. To do so would require expanding their services beyond the emergency procedures they previously provided, raising questions about the shift’s impact on capacity, staffing, waiting lists and costs for patients. About 2,800 women in Utah had abortions last year.
The Utah Hospital Association said no hospitals provided elective abortions in the state last year. He declined to answer questions about whether there were plans to accommodate additional patients who might seek care if the clinics close.
The new restrictions are most likely to affect those seeking to end low-complication pregnancies through medication, which accounts for the majority of abortions in Utah and the United States. Abortion medication is approved up to 10 weeks of pregnancy, is mostly prescribed in clinics, and after the FDA rule changed in the era of the pandemic, is increasingly provided via telemedicine.
In Utah, clinicians at three locations run by Planned Parenthood and a fourth by the independent Wasatch Women’s Center in South Salt Lake City provide the majority of abortions. The new law takes on added significance amid a legal vacuum surrounding other abortion laws signed into law in Utah.
Last year’s Supreme Court decision led to two previously approved pieces of legislation – a ban on abortion in 2019 after 18 weeks and a ban on abortion in 2020 regardless of trimester, with several exceptions such as cases of risk to maternal health as well as rape or incest reported to the police. Planned Parenthood of Utah sued over the 2020 ban, and in July, a state court delayed its implementation until legal challenges were resolved. The 18-week ban has since been de facto law.
Abortion access advocates decried this year’s clinic ban as a back door used by anti-abortion lawmakers to limit access while the courts deliberate. If abortions were restricted regardless of trimester to exceptional circumstances, the closure would have a less wide-ranging impact on patients seeking elective abortions between zero and 18 weeks of pregnancy.
The law also clarifies the definition of abortion to address legal liability concerns providers have raised about how the exemptions are worded in state law — a provision the governor and Republican lawmakers called a compromise.
