Those making the drive from Utah into Colorado along Interstate 70 are greeted with a new billboard trumpeting the state as a refuge for those seeking abortion care: “Welcome to Colorado, where you can get a safe, legal abortion.”

Billboard advertising has long been a tool of the anti-choice movement, but pro-choice advocates have recently hit back with billboards of their own. The Colorado billboard, paid for by pro-choice group ProgressNow Colorado, sheds light on how the state acts as a safe haven for people seeking abortion care from neighboring states, where Republican-majority legislatures are hostile to reproductive rights.

While Colorado has few restrictions on abortion, Republican lawmakers in surrounding states including Utah, Kansas, Wyoming, Nebraska, Texas, and Oklahoma have made it difficult to access the procedure. Laws targeting abortion providers in Texas, for example, have led to widespread clinic closures.

Over 8 percent of abortions performed at their Colorado health centers in 2018 were for out-of-state patients, but that percentage is much higher for health centers located near the state’s borders, according to Planned Parenthood of the Rocky Mountains (PPRM). In Fort Collins, more than a quarter of abortion services provided were for out-of-state patients, and at their Durango health center, it was more than 40 percent.

“We’re anticipating the numbers who are going to have to travel to get to a provider will increase,” said PPRM President Vicki Cowart. “We’re positioning ourselves to be part of the solution to deal with what we’re anticipating is going to be a public health crisis.”

A GOP-backed Texas law passed in 2013 required abortion providers to make costly upgrades to their facilities and only employ doctors with admitting privileges at local hospitals. The law made it impossible for many of the state’s abortion clinics to operate, and as a result, more than half of them shut down.

A year after passage of the Texas Republican bill, Planned Parenthood of the Rocky Mountains, which encompasses Colorado, New Mexico, Wyoming, and Southern Nevada, saw a spike in out-of-state patients at its health centers. That was especially true in New Mexico, where more than eight in ten out-of-state patients come from Texas, according to PPRM.

The Supreme Court overturned that law in the 2016 Whole Woman’s Health v. Hellerstedt case, but the majority of the shuttered clinics, many of which were located in the western half of Texas, have not reopened.

Denver-based OB/GYN Aaron Lazorwitz told Rewire.News that he left his home state of Texas to get adequate training in Colorado, which he called a “bastion of access” for reproductive health care.

“There was a huge lack of training in Texas,” Lazorwitz said. “In order to get the training I needed to provide comprehensive reproductive health care including abortion and contraception, I knew I needed to leave.”

People from Texas rely on Colorado to get abortion care later in pregnancy after fetal anomalies are detected, Lazorwitz said. “We see a lot of later anomalies end up here because most of the outpatient clinics [in Texas] don’t go beyond 17 weeks, and bad anomalies are picked up around 20 weeks.”

Potential health outcomes can be devastating when a fetal anomaly is detected later in pregnancy, leading many people with otherwise wanted pregnancies to make the choice to terminate.

Lazorwitz said having to travel out of state for abortion care in this scenario draws out the process to the detriment of abortion patient’s health, considering the risks associated with the procedure, along with the costs, increase over time. “It’s really disheartening to see women having to travel hours to get basic health care,” Lazorwitz said. “We’re lucky in Colorado.”

Abortion providers are sparse in other neighboring states as well. Wyoming, for example, has just one advertising abortion provider, located in Jackson. Utah has two, but both are located in Salt Lake City. Nebraska, Kansas, and Oklahoma all have multiple providers in their more populated areas to the east, but the rural western parts of those states are abortion care deserts.

For those who are able to make the journey to an abortion provider in these states, the challenges don’t stop there. Colorado’s neighboring states ban many health insurance plans from covering abortion care, forcing people to pay out of pocket for the procedure. These states tend to have laws requiring people to sit through counseling designed to discourage them from having an abortion, and then wait anywhere from 24 to 72 hours before getting the care they need.

These waiting periods necessitate multiple trips to the clinic, making the process significantly lengthier and placing a major financial burden on women who might have to take time off work, pay for childcare, or arrange lodging.

“These are laws that have no basis in medicine or science. They have nothing to do with medical care, and they have everything to do with politics,” Planned Parenthood Federation of America President Dr. Leana Wen told Rewire.News. “It goes against the tenets of trusting our patients and trusting women.”

Wen warned of legal challenges to abortion rights winding their way to the U.S. Supreme Court, which now has five conservative judges who have consistently sided against reproductive rights.

“We have at least 15 cases that are one step away from the Supreme Court, and if any of these are heard, even in the next year, we could face a situation where Roe is further eroded or overturned,” Wen said. “If that were to happen, then 25 million women, which is 1 in 3 women of reproductive age in this country, could be living in states where abortion is illegal.”

With an administration stocked with avowed enemies of abortion care, state governments are the last line of defense for reproductive rights.

“States are a critical backstop at this time in our history,” Wen said. “There is proactive legislation we’ve introduced in over 20 states, and we expect even more as this year goes on because states play such a critical role.”

In the November midterms, Colorado elected a Democratic majority to both legislative chambers and a Democratic governor, so the state could become even more of an abortion oasis if lawmakers enact pro-choice legislation.

That could mean repealing the state’s main restriction on abortion, a law requiring parents of minors be notified before the procedure is provided. Democrats could revive a bill that would require insurers to cover the full range of reproductive care, including abortion, at no cost to patients.

“There’s a strong momentum among those who were elected in this midterm cycle,” Cowart said. “It’s our job, those of us who care about making sure women have the full range of reproductive health care, to keep it available for everybody.”