FLAGSTAFF – Beth Otterstein, a nurse practitioner at Planned Parenthood Arizona’s clinic here, says patients sometimes break down and cry when they hear the news: If they want abortions, they now have to travel to Phoenix for a 15-minute consultation with a doctor and then stay overnight to have the procedure. It’s an expense that some can’t afford, and no other facility in the area provides abortions.
“It’s devastating because they don’t have anywhere else to go,” she said.
Planned Parenthood halted abortion services at clinics in Flagstaff, Prescott Valley and Yuma because of provisions in state laws that took effect this month. Legislation passed this year requires that only licensed physicians to provide abortion services, while a 2009 law that Planned Parenthood decided to stop fighting in court requires women seeking abortions to meet in person with doctors 24 hours before the procedure.
The clinic here and those in Prescott Valley and Yuma have only nurse practitioners on staff.
Otterstein said some patients tell her they can’t take time away from work or find someone to take care of their children, while others worry about what to tell family members and friends about a trip out of town.
“There’s been a great amount of anger and disbelief,” she said.
Planned Parenthood’s nurse practitioners had been prescribing mifepristone, often referred to as abortion by pill, since it was approved by the Federal Drug Administration in 2000. The medication requires a woman to take one pill in the medical office and an another at home. The pills provided an easier access to abortions for women in rural communities who couldn’t reach physicians in metropolitan areas.
Candace Ryan-Schmid, center manager for the Planned Parenthood clinic in Flagstaff, said her organization has always required that physicians do surgical abortions.
Rep. Tom Chabin, D-Flagstaff, who voted against these measures, said he’s concerned that women facing having to travel will seek out black-market abortions. The only way to know a woman has done this often is when she winds up in the emergency room, he said.
“If a woman can’t get access to services needed in rural areas they’ll have no choice,” Chabin said.
Karla Hackstaff, director of the Women’s and Gender Studies program at Northern Arizona University and a feminist scholar, said that in addition to black-market abortions she’s concerned there will be an increase in unwanted children in Flagstaff. This could create more dysfunctional and impoverished families, she said.
“It’s almost like the choice (to have an abortion) is removed from some people’s hands,” Hackstaff said.
Sen. Nancy Barto, R-Phoenix, a key supporter of this year’s measure, said she was responding to concerns that physician assistants aren’t qualified to prescribe drugs used for abortions and that women misdiagnosed as pregnant are at greater risk of infection if they take the pills, though she acknowledged that there aren’t records proving that nurse practitioners have harmed patients in prescribing the pills.
“Why do we need to wait for a crisis before we make sure it’s safe?” she said.
She also noted that the 2009 law allows health professionals to refuse to provide abortions on moral grounds, something that she said could lead to more physician assistants performing abortions by medication.
“It’s important to maintain proper medical standard of care for all medical procedures including abortion,” she said.
Bryan Howard, CEO of Planned Parenthood Arizona, said all of the organization’s health professionals have provided safe treatment. “Which just points out that the impetus for this legislation was about limiting the number of providers, not improving the quality of health care,” he said.
He said nine out of 10 women seeking abortions visit clinics in metropolitan areas, though he monitors the number of patients to assess where physicians would be most efficiently placed. But adding physicians to rural clinics could be problematic, he said, not only because of a doctor shortage in Arizona but because a provision of this year’s law prohibits using any public money, tuition or student fees to teach how to perform abortions.
“It’s going to take some time because it’s not like new graduates from the University of Arizona medical school are going to receive this training because the legislation says they can’t,” Howard said.
Otterstein, the nurse practitioner in Planned Parenthood’s Flagstaff clinic, said her 30 years of experience suggests that women won’t stop having abortions but may opt for unsafe procedures, including late-term abortions caused by saving for travel expenses.
“I’m very sure we’re going to see illegal abortions crop up, which can be very serious because they can lead to deaths,” she said.