(Daily Montanan) There are few issues in American politics that generate more passionate disagreement than abortion. States have become the battleground for many national policy fights, such as the one over abortion access.

With full control of state government for the first time in decades, Montana’s Republican legislators have joined a nationwide wave of states that introduced bills aimed at reducing access to abortion.

Every legislative session in Montana sees its share of this kind of legislation, but opponents say this year is different. By the time the 2021 legislative session ended, the GOP majority had introduced seven bills increasing abortion restrictions. They succeeded in passing five of those bills, all of which have been signed into law by Gov. Greg Gianforte.

Montana is large and rural, and the five medical or health clinics that do both in-clinic procedures and offer medication abortions are spread out across the state in some of the largest population centers. Those clinic locations are not easily reached by Montanans living elsewhere.

A person seeking an abortion in Montana may have to travel hours to obtain one. If someone doesn’t have a car, a supportive family, or extra money for medical expenses, accessing any healthcare in rural Montana can be difficult.

According to Dawn Dockstader, who oversees abortion and telehealth services for Planned Parenthood of Montana, neighboring states also struggle with limited accessibility.

“We see patients in Helena from Idaho. We see a lot of patients in Billings from North Dakota, South Dakota and Wyoming. People are coming to Montana because they are desperate for services,” she said.

In Montana, a person must be a medical doctor or a physician assistant to provide abortion services. Many of Planned Parenthood’s clinics are staffed by nurse practitioners, and state law does not allow them to perform surgical abortions or dispense medications for terminating a pregnancy. These restrictions mean that Montana’s clinics do not have the personnel to offer abortion care, either surgical or medicated, on a daily basis.

“It’s just shocking, that this type of health care – because it is health care – is not more accessible. There’s just so many barriers,” Dockstader said.

She notes, though, that technology has allowed the clinic to expand all-encompassing general health care, not just reproductive care, to remote clients.

“Telehealth has made such an incredible impact for women because we offer it four out of seven days of the week,” she said.

In 1981, Tom Roberts, a doctor, and his wife Lindsay, an obstetrician-gynecologist, moved to Missoula. The two are retired now, but during Lindsay’s years in practice she delivered thousands of babies and also provided abortions.

Roberts previously served as president of Western Montana Clinic for 15 years, sat on public health boards, and co-founded Montana Health Co-op, an insurance company. He is currently the board chairman of Blue Mountain Clinic and practiced internal medicine for 35 years.

During his years as a physician, Roberts says some practitioners working in healthcare provided abortion services through their own practices scattered across the state. These distributed options have decreased over time, though, with abortion care being concentrated among centralized providers. Patients are now more likely to seek abortions at primary care clinics like Planned Parenthood and Missoula’s Blue Mountain Clinic Family Practice, which offer reproductive healthcare and abortion as part of family medicine.

Montana’s state legislature meets every two years, and consistently, legislators introduce bills that would limit access to abortion.

During the past 16 years, when these bills passed the Republican-controlled House and Senate, they were vetoed by the state’s Democratic governors. Montana’s newly elected Republican governor, Greg Gianforte, however, said he would sign any bill that puts additional limits on abortion.

And he did.

“I think the difference between this, and prior sessions is somewhat a degree of how dominant the Republicans and especially conservative Republicans are in the Legislature,” Roberts said.

The first of the five bills passed into law, House Bill 136, sponsored by Rep. Lola Sheldon-Galloway R-Great Falls, bans abortions in most cases after 20 weeks. The second, House Bill 140, sponsored by Rep. Amy Regier, R-Kalispell, requires medical providers to offer an ultrasound to a patient seeking an abortion, which Roberts said is not standard of medical care.

House Bill 167, sponsored by Rep. Matt Regier, R-Kalispell, creates a ballot referendum in 2022 asking Montanans to vote on punishing medical providers for failing to provide life-saving care to a newborn if an abortion procedure is unsuccessful.

Rep. Sharon Greef, R-Florence,, sponsored House Bill 171, which now requires people seeking medicated abortions to pick up the prescription in person instead of over telehealth, requiring multiple trips to a provider that might be hours away. The bill also requires patient data to be reported to the Department of Public Health and Human Services.

Roberts believes that HB 171 contains inaccurate medical information and intentionally puts burdensome requirements on doctors.

“Women will have to go through multiple steps and sign forms and be seen in the office and give informed consent. It’s not designed to keep people safe; it’s designed to make it very hard for women to come in and follow up on their choice,” Roberts said.

House Bill 229 from Rep. Jane Gillette, R-Bozeman, was also signed into law. It prohibits plans offered through the health insurance exchange in Montana from covering abortion services.

Two other bills were introduced in this session. Senate Bill 315, carried by Sen. David Howard, R-Park City, is identical to HB 167. And House Bill 337, a constitutional amendment to define personhood as starting at the moment of conception, would have banned abortions in Montana outright. It was sponsored by Rep. Caleb Hinkle, R-Belgrade, and failed to pass the Legislature.

Montana’s constitution guarantees the right to privacy, and opponents of these laws believe courts will likely block their implementation. Similar laws have been struck down in the past, and abortion limits have rarely succeeded in Montana courts.

Alison James is the board chairwoman for Montanans for Choice, an organization working to get pro-choice candidates elected. Lawyers tell her that legal precedent suggests these bills are unconstitutional.

“These cases will go through the courts and cost everybody a lot of money and a lot of time and energy. And, you know, hopefully, in the end, the courts uphold the Montana constitution, but there’s no guarantee of that,” James said.

Montana is generally considered a conservative state, but according to James, polling shows that more than 50% of Montanans are pro-choice.

“We really are a place where people want other people to stay out of their business, and not have politicians interfering with their private medical decisions. And that’s kind of the way it’s been since Roe,” said James, referencing the 1973 Supreme Court decision in the case, Roe v. Wade, which established the constitutionality of abortion.

Montanans For Choice is concerned about access to abortion, but they are also concerned about reproductive health care in general. These bills represented a threat to both, and James sees the new laws in the Montana Legislature as part of a national trend. She says the bills’ language was not specific to Montana law and looks like bills written by special-interest groups.

Nationally, anti-abortion groups have adopted a strategy of reducing access to abortion by making it more difficult to access, rather than relying on outright bans. They have succeeded in passing laws requiring long waiting periods, forced ultrasounds, parental consent, and increased regulation of clinics.

Like with most political topics, James sees a strong partisan split on abortion. She believes it is not fundamentally a partisan issue, but one that has become deeply polarized. She sees this divide reflected in the trajectories of different states with different political cultures and the recent wave of more restrictive laws.

“I would say that it’s a trend in parts of the country, and it’s going the opposite direction in so-called liberal parts of the country,” James said.

Sharon Nason, president of Pro-Life Helena might not agree with James on much surrounding this issue, but she does agree that abortion does not need to be as political and divisive as it is.

The mission of her organization is to educate and help women who are in an “unplanned or crisis” pregnancy to understand and consider options other than abortion.

Nason, a licensed counselor, acknowledges that abortion is not usually a very easy subject to talk about, but she feels more discussions on the topic are needed. She doesn’t believe the extreme politicization of the topic has helped.

“I think the rhetoric colors things and makes it jargon,” Nason said. In her opinion neither sides’ advocates have done a good job representing their perspectives, which has only served to deepen the political divide.

Pro-Life Helena supported all of the abortion-restricting bills that were in front of the Montana Legislature, because each one could “potentially save a life.” But Nason doesn’t see legislation as being a true solution to the issue. She believes there has to be a cultural shift towards “valuing life” and away from the idea that it is okay to “end a life.” Until that point, she thinks abortions will continue and believes that “honestly, there will probably never be an end to abortion.”

Nason draws a historical comparison to the passage of the 18th Amendment to the U.S. Constitution. That amendment enacted the legal prohibition of alcohol, but it didn’t work. An underground and illegal bootlegging industry developed, and there was widespread violation of the law until the prohibition was later repealed. Since then, efforts to reduce the use of alcohol and mitigate its risks are undertaken primarily through education.

“If we tried to outlaw abortion, I think the same thing would probably happen,” Nason said. “However, I think legislation can be a part of the education process. As people learn more about abortion, I think that is one way to move our culture towards the day when abortion will be unthinkable.”

Pro-Life Helena provides training on how to speak to women contemplating pregnancy options. Nason recognizes that not everybody approaching a clinic like Planned Parenthood or Blue Mountain Clinic is seeking an abortion. She says Pro-Life Helena’s goal is to share information and feels that for those who want an abortion in Montana, “it seems like it’s pretty accessible.”

As Montana’s abortion restriction bills advanced through the State Legislature and were signed into law, whatever existing accessibility there was became less certain. Roberts, Blue Mountain Clinic’s board chair, doesn’t think this is the end of abortion services in Montana, but he believes it will create barriers.

“It’s a cultural battle. It’s a human rights issue. It’s a woman’s issue in terms of women’s rights,” Roberts said. “But I think we’re going to be able to meet the need.”

Erica Zurek is a freelance journalist and photographer based in Missoula.