Abortion in Montana remains legal, but landscape changed following Dobbs

Although abortion remains generally legal in Montana, people on the frontlines in the Treasure State said work on the ground has changed since the U.S. Supreme Court decision in Dobbs vs. Jackson Women’s Health Organization.

In the 2022 Dobbs opinion, the nation’s highest court overturned Roe vs. Wade, which protected the right to abortion based on medical privacy.

Since then, laws criminalizing abortion took effect in Idaho, South Dakota, Texas and elsewhere, and staff at clinics in Montana are fielding more phone calls from people out of state with questions about medical care.

“What has changed is the intense heightening of fear and confusion,” said Helen Weems, owner of All Families Healthcare in Whitefish.

The Guttmacher Institute estimated 155,000 people traveled out of state for abortion care in 2024, or 15% of all abortion patients obtaining care in states without total bans. It said the number is a decline from 2023, but still represents an increase from the pre-Dobbs baseline of 81,000 in 2020.

And providers at Blue Mountain Clinic in Missoula have seen women from other states they feared were at risk of death, even as a report released this week identified women who died preventable deaths outside Montana due to complications after abortion bans took effect.

More people in Montana also need financial support, such as gas money to get to a clinic, according to the Montana Abortion Access Program.

In recent interviews, in advance of the third anniversary of the Dobbs decision, providers and advocates in Montana reflected on the changes they have seen in the field during the course of three years.

They also argued Montanans who support reproductive freedom should remain vigilant despite protections that remain in place in the Treasure State.

“The values of Montanans, everyday Montanans, continue to be that we strongly value our privacy, and we don’t want the government interfering in any way with our ability to make medical decisions,” said Nicole Smith, with Montanans for Choice Take Action.

Three years ago, millions of people in this country lost their right to access safe and timely abortion care, said Mary Sullivan, with Planned Parenthood Advocates of Montana.

“Your access to care shouldn’t depend on where you live, and that’s what we have to continue fighting for is everyone having access to essential care,” Sullivan said.

In 1999, the Montana Supreme Court opinion in Armstrong vs. State of Montana found the state Constitution protected abortion based on privacy, similar to the rationale in Roe.

Since then, the state Supreme Court has found numerous laws attempting to restrict abortion unconstitutional based on the privacy protections in the Armstrong case.

Despite those protections, after the U.S. Supreme Court overturned Roe, advocates for reproductive freedom in Montana collected signatures to place Constitutional Initiative 128 on the ballot last November, and voters approved the measure to specifically enshrine abortion protections in the state Constitution.

Earlier this month, the Montana Family Foundation announced it had sued the state of Montana over CI-128, alleging the state should have printed the entire amendment language on the ballot, and asking the amendment to be declared null and void.

The case is pending, even as the landscape for health care providers who offer abortion quietly, but significantly, shifts.

In 2024, the Montana Abortion Access Program served more clients and pledged more funding to help pay for abortions and travel than it did in its first 10 years combined, said executive director Erin Case.

The uptick started during the COVID-19 pandemic, grew after the Dobbs decision, and the need has continued to grow, she said, especially as people experience financial struggles.

“That increase has not stopped,” Case said.

Case said even though Montana is generally well served, with six clinics in the state that provide abortion care, including four operated by Planned Parenthood of Montana, access for patients in more rural areas can still be difficult.

Montana Abortion Access Program started in 2009, and it covers as little as $30 in travel support for a patient who needs to get to a clinic, she said. But in August 2024 and April 2025, the organization had record breaking demand, with 63 clients served each month.

In April, it pledged $24,549 toward the costs of abortion care and travel, the largest amount ever pledged in one month, Case said.

“The urgency for us is still there,” Case said. “There are still a lot of people accessing abortion care who need help.”

Since the Dobbs decision, women have died in the country from complications after abortion bans took effect, according to one of several reports released this week by Montanans for Choice Take Action. The report identified six documented cases whose families publicly shared stories.

It identified women in Texas and Georgia, citing reporting from The New Yorker and ProPublica. ProPublica said data is hard to come by, including because reviews are slow or even stalled.

In one case, a medical team failed to provide timely treatment for a miscarriage, and ​​the woman died of an infection in a case experts described as “horrific,” said the report from Montanans for Choice Take Action. It said one woman passing blood clots during a miscarriage bled to death in a fatality more than 12 experts found to be preventable.

Tess Fields, executive director of the Blue Mountain Clinic in Missoula, said four months ago, a young woman from Idaho called the clinic for help because of the abortion ban in Idaho.

The woman was eight weeks pregnant and scheduled an appointment a couple of weeks out to arrange for time off work and the drive of seven hours, Fields said.

Then, she called the clinic again and reported cramping, bleeding and intense pain.

The woman refused the urging of Blue Mountain staff to go to the hospital, Fields said: “This person was absolutely terrified and said, ‘I can’t do that. I can’t tell them that I am scheduled to have an abortion in Montana. What if they arrest me?’”

The woman drove seven hours straight, in pain, bleeding and alone, to the Blue Mountain Clinic, and within 15 minutes of her arrival, providers learned she was experiencing an ectopic pregnancy, Fields said.

The condition is potentially fatal, she said, and Blue Mountain transported her to a local hospital, where she received emergency surgery.

“It’s about saving lives,” Fields said. “This person was so scared … of accessing health care in her own state, that that was the situation that she was put in. And she could have died on the way here, driving alone.”

The Dobbs decision means Blue Mountain Clinic is hearing from more pregnant people who need help, and Fields said it is poised to raise $1 million this year in order to add staff, including a provider.

Fields said she’s proud of the history of the clinic, which opened nearly 50 years ago as the first in Montana and one of the first in the nation to provide abortion care. It provides the full range of family practice medicine — wellness exams, vaccines, chronic pain management, more.

“In our view, that (full range) includes abortion care,” Fields said.

She’s also proud that one of its founders, the late Judy Smith, was instrumental in the case that became Roe vs. Wade at the U.S. Supreme Court; that supporters rebuilt a reinforced clinic after an arsonist firebombed it in 1993; that some of the art on display in the new building is made of relics of the fire, such as an old phone, repurposed by clinic patients.

Sullivan, of Planned Parenthood Advocates of Montana, said after Dobbs, opponents of abortion made “incredibly hostile attempts” to restrict it, but that isn’t the most enduring outcome she’s witnessed.

“What has changed the most is how fired up people are about their reproductive rights and just how much people do not want the government interfering in these decisions for them and their families,” Sullivan said.

She said CI-128 was one example: “The signatures turned in were a state record for any ballot issue in the state.”

She said the 2025 Montana Legislature was also the first time since the 1990s that an anti-abortion bill was defeated on the Senate floor.

Although abortion remains legal in Montana, Smith, with Montanans for Choice Take Action, said people still don’t have full reproductive freedom here.

Montanans passed CI-128, to enshrine abortion rights into the state Constitution, and it may be disputed at the Montana Supreme Court, but Smith said it only reaffirmed Roe vs. Wade.

“We all know that Roe v. Wade was never enough,” Smith said.

Montana allows for care up to fetal viability, typically 23 to 25 weeks, but she said so many people need care after viability, and those people have to leave the state.

Weems, with All Families Healthcare, said medication abortion needs to be protected as well. She said more than half of all abortions in the country take place by mail, and the number in Montana, a rural state, is the same or higher.

She said since Roe was overturned, maternal and fetal deaths have increased. She sees patients from Idaho too, and she said their fear is palpable.

“They are terrified to be pregnant because being pregnant in Idaho is dangerous,” Weems said.

The Dobbs decision also has had a chilling effect on obstetrics in general, she said. Fewer people are going into obstetrics training, she said, and fewer people will be trained in abortion in the future because they are being trained in states where abortion is banned.

“It will mean fewer providers (of abortion care),” Weems said.

Despite the bulwark the 1999 Armstrong case has provided to women seeking medical care, and the resounding 58% approval of CI-128, Smith and others said people who want to ensure reproductive freedom isn’t further eroded need to remain vigilant.

In particular, Smith said, legislation to grant “fetal personhood” criminalizes women for having a miscarriage or stillbirth, has been attempted in Montana, and it could be again, despite being out of alignment with the values of Montanans, she said.

Since the Dobbs decision, she said, the atrocities women have experienced in other states could happen in Montana without fighting to protect their rights.

“We will not tolerate it,” Smith said. “We will not stand for it. Abortion bans are torture, and we have a long way to go to achieve true reproductive freedom in this state and in this country, and we believe pregnant people deserve care and support, not criminalization.”