A state court in Idaho has begun hearing testimony in a pivotal case challenging the medical exceptions to the state’s restrictive abortion laws. The lawsuit, filed by the Center for Reproductive Rights, seeks to expand the scope of exceptions in Idaho’s two abortion bans to allow physicians to provide necessary care to preserve the health and safety of pregnant people, particularly in cases involving fatal fetal conditions.

The case, Adkins v. State of Idaho, was filed on Sept. 11, 2023, and involves a group of plaintiffs, including women who were denied medically necessary abortions and physicians who claim that the current law impedes their ability to provide standard, life-saving medical care.

The plaintiffs argue that the existing medical exceptions under Idaho’s abortion laws are so narrow that they effectively deny critical health care for pregnant people, especially when the pregnancy involves fatal fetal anomalies or life-threatening complications. The trial, which began on Nov. 12, is expected to last several days, with a decision potentially shaping the future of abortion access in the state.

“No woman should have to question in their worst moments whether they can get the urgent medical care they need,” said Jillaine St. Michel, one of the women who testified, during a press conference. “No woman should ever have to question whether the provider in front of her is willing to put their career at risk to help save her life. And no one should have to feel this inconsequential or devalued by their own state. Not ever.”

The women who testified include St. Michel, who was forced to travel out of state to seek an abortion for a nonviable pregnancy; Jennifer Adkins, who was denied an abortion despite facing life-threatening complications if she continued her pregnancy; Kayla Smith, who faced significant financial and logistical barriers when seeking abortion care outside the state for medical reasons; and Rebecca Vincen-Brown, who was denied an abortion even after doctors discovered the fetus had multiple fatal conditions and was unlikely to survive.

“Mrs. Adkins had no choice but to make that drive,” said attorney Gail Deady during opening statements. “She received abortion care outside her community, without her family and her support system, and without the Idaho physicians that she knew and trusted. She will tell you today that she made that trip to get the medical care she needed, not only for her own health and safety but to also make sure that she could be there to parent her 18-month-old son.”

The trial, which began Nov. 12 in Ada County District Court, is scheduled to run through Nov. 21. During the first two days of proceedings, key plaintiffs—four women directly impacted by the abortion bans—testified alongside healthcare professionals who have been forced to navigate the state’s confusing and restrictive abortion laws.

“People across the country are dying because of these bans, and without clarity on these laws, only more people will die,” Deady said during a press conference following the first day of trial. “We cannot let this stand, so we are asking the court to put a stop to the agony. The court must protect pregnant Idahoans and give doctors clarity on what circumstances qualify as exceptions.”

The court will also hear from medical professionals, including Dr. Emily Corrigan, an OB-GYN based in Boise, and Dr. Julie Lyons, a family physician serving rural communities. Dr. Lyons is scheduled to testify on Nov. 19. Both doctors will address the challenges they face in providing care under Idaho’s restrictive laws and the chilling effect these laws have on medical decision-making.

Representatives from the Idaho Academy of Family Physicians (IAFP), an association representing more than 600 medical professionals across the state, will also provide testimony on how the state’s abortion bans are affecting their ability to deliver necessary care.

“Idaho’s current abortion bans are unclear. They rely on non-medical language that confuses doctors and limits our ability to make the best treatment decisions in consultation with our patients,” said Dr. Crystal Pyrak, the current president of the IAFP, during the press conference.

The case highlights the real-world consequences of Idaho’s abortion laws, which are among the most restrictive in the nation. Since the U.S. Supreme Court overturned Roe v. Wade in 2022, Idaho implemented a near-total abortion ban, allowing the procedure only in limited circumstances, such as when the life of the pregnant person is at risk. However, the state’s definition of a “medical emergency” is vague, leaving doctors unsure about when they can legally perform abortions without risking prosecution.

“Instead of grieving the loss of our baby with family and friends, we were forced to scramble and travel to find care that I needed to protect my health and abortion in a neighboring state,” Adkins said in the press conference. “So we grieved the loss of our daughter alone and had to leave the medical team that we had grown to love and trust through our previous pregnancy.”

The trigger ban, which went into effect after the Supreme Court’s decision, criminalizes the provision of an abortion without exceptions—except in cases where a pregnant person’s life is at immediate risk. This exception allows physicians to defend their actions in court if they can prove the abortion was necessary to prevent death. However, critics argue this leaves doctors with little clarity, especially in situations where delaying abortion care could result in serious health complications, but the patient is not yet at immediate risk of death.

The six-week ban, which came into effect in 2021, includes a slightly broader medical exception that permits abortion only to prevent the pregnant person’s death or to avoid a “serious risk of substantial and irreversible impairment” of a major bodily function. However, this exception does not account for the health of the fetus, such as in cases of fatal fetal conditions, where the fetus is unlikely to survive birth or has already died in utero.

“As a family physician myself who delivers babies, I can tell you that my priority is always the health and well-being of my patient,” Pyrak said during the news conference. “Laws written by politicians that interfere with the physician-patient relationship should never stand in the way of a doctor providing the standard of care of each patient for each patient’s needs. For their unique circumstance with this lawsuit, I am hopeful that we can all work together to ensure that Idaho mothers and babies have access to the best, the safest, and the timely care they all deserve.”

The Center for Reproductive Rights argues that these narrow exceptions put both patients and physicians in an untenable position, forcing physicians to wait until a pregnant person is at imminent risk of death or injury before providing care. In cases where the fetus has a fatal condition, the current law effectively denies patients the ability to make informed decisions about their pregnancy, even if continuing the pregnancy could jeopardize their health.

The lawsuit filed by the Center for Reproductive Rights seeks to have the court clarify and expand these exceptions to ensure that doctors and patients are not forced to wait until it is too late to address life-threatening pregnancy complications. The plaintiffs argue that the state’s current laws are causing unnecessary harm by forcing women to either travel out of state for care or wait until their condition worsens to the point of crisis.

“These insidious laws made our heartbreaking situation so much worse when my husband and I found out that our expected son had several fatal fetal conditions two days after Idaho’s trigger ban went into effect, no one could help us in this state. These laws are not allowing our doctors to treat us with compassion or to offer us the standard of medical care for the dire situations we find ourselves in,” Smith said during the press conference.

Since the abortion ban was enacted, Idaho has seen a significant exodus of healthcare professionals, particularly OB-GYNs, who fear criminal prosecution for providing abortion care. According to recent reports, more than 1 in 5 OB-GYNs have left Idaho since the ban was enacted, exacerbating the state’s already strained healthcare system.

With the trial now underway, it is expected that the court will issue a ruling in the coming weeks, potentially expanding the medical exceptions to Idaho’s abortion bans and ensuring that physicians can provide care without fear of legal repercussions.

“I think I speak for all of the patients that putting our most intimate and devastating experience that we’ve been through as a family out for public display is incredibly challenging, but as the others have stated, we’re doing it because we want to make a difference and we want positive change out of this,” Adkins said. “We don’t want other families to have to experience the heartbreak and the trauma that we experienced, so being up on that stage is putting us again through that trauma, reliving that trauma that we’ve been through.”