For some Idaho sexual assault survivors, there is no Plan B

For survivors of domestic violence, having a wide array of resources and choices — including those related to reproductive health — is essential, said Em Stone, public policy director at the Washington State Coalition Against Domestic Violence, which works with advocacy and practical support organizations for survivors of sexual assault and domestic violence throughout the state: “People really need to have options and access.”

Advocates who work with survivors are concerned these options are running out in Idaho, placing an additional burden on service providers in Washington. Meanwhile, people in situations of abuse are reaching out to some of the only free and confidential resources still available to them, calling Washington organizations from a state where abortions are essentially no longer legal, exemptions for sexual assault survivors are rare and logistically complex, and women’s health care providers in general have left in large numbers.

Emergency contraception in high demand

In particular, WSCADV’s partner programs along the border have reported heightened demand for emergency contraception from survivors in Idaho, even from patients who’ve tried to seek care from sexual assault nurse examiners (SANE) in the state, where emergency contraception is still legal. “If they do go to a hospital or see a SANE nurse in Idaho after a sexual assault,” said Stone, “SANE nurses and hospitals are not providing Plan B for survivors who’ve been raped, even when they explicitly ask for it, so the survivor has to go all the way to Washington just to get that Plan B.”

In Washington, offering emergency contraception — which prevents pregnancy after unprotected sex by delaying ovulation, and is available under a number of generic names as well as Plan B — is a routine component of a sexual assault forensic exam, according to Laurel Redden, director of communications and policy at King Country Sexual Assault Resource Center. State law requires hospitals with emergency departments to provide emergency contraception to survivors of sexual assault.

And even in Idaho, emergency contraception is legal — and in high demand. That’s a rare deviation from the dynamic in most states with restrictive abortion bans, where emergency contraception use has largely fallen since Dobbs. In Idaho, by contrast, emergency contraception use has increased by 148%, according to recent data from researchers at the University of Southern California.

Plan B supplies less and less available

Normally, said Stone, domestic violence shelters near the border keep emergency contraception on hand for clients. But now, supplies are used up quickly. “What we hear time and time again is the community cupboard is empty every single week, so as soon as they stock it, there’s a huge need, and you just can’t keep up,” she said.

This increased demand isn’t necessarily reflected at reproductive health clinics in the state. Mack Smith, communications manager with Planned Parenthood Great Northwest Hawai‘i, Alaska, Indiana, Kentucky, said Planned Parenthood was aware of past reports of pharmacists not being comfortable providing emergency contraception, but said the organization couldn’t confirm heightened demand on its own providers for it.

Still, it’s an ongoing problem for programs supporting victims of sexual assault and domestic violence, Stone said. In addition to calls for emergency contraception, she said programs WSCADV works with have received more crisis calls from Idaho in general; one group estimated a 20% increase.

Idaho’s ‘most restrictive’ abortion ban

In 2022, when Dobbs went into effect, Idaho imposed one of the nation’s most restrictive abortion bans, alongside a law based on Texas’ Senate Bill 8, which allowed people in Idaho to sue health care providers for up to $20,000 for facilitating abortion. In April of 2022, 220 abortions were performed in Idaho. In October of that same year, that number dropped to just 10, according to data from the Society for Family Planning.

Even before Dobbs, Idahoans routinely traveled to Washington and other states for abortion care. Now, they’re even more dependent on out-of-state providers, which can have particularly harmful outcomes in situations involving abuse and assault.

Technically, Idaho has an exception written into its abortion ban allowing people who have been sexually assaulted to seek care legally. But this exemption is only available in the first trimester of pregnancy in Idaho, and requires that the assault be reported to local law enforcement. Even in situations where an assault is reported, most state policies don’t provide clear guidance about what documentation would be required to make the abortion legal, a KFF policy review of abortion ban exceptions found.

Hidden dangers to lack of abortion access

For people in abusive relationships, this can be dangerous. In the United States, homicide is a leading cause of death for women who are pregnant or recently postpartum, researchers at Harvard T.H. Chan School of Public Health found. More pregnant women are killed by homicide than pregnancy-related medical conditions like hemorrhage or sepsis.

In an article published in the medical journal the BMJ, Harvard researchers reported that this homicide risk is linked to both intimate partner violence and access to firearms. Policies limiting access to abortion and other kinds of reproductive health care exacerbated it, said Harvard postdoctoral research fellow Rebecca Lawn of the findings.

Stone said the same thing: “Once someone becomes pregnant, violence frequently escalates, putting them at greater risk of domestic homicide.”

Domestic violence organizations provide support to pregnant people in these situations, and in Washington, they’re legally protected when they do. The state’s Shield Law, passed in a suite of abortion access policies last year, protects abortion providers and patients from out-of-state lawsuits. It also protects advocates for victims of domestic violence and sexual assault when they do. “We made sure that [they] were also included in that immunity,” said Stone, “so that they can continue to help survivors who are fleeing violence and seeking help.”