An abortion provider in Idaho describes living a double life to protect his safety and career

• An abortion provider in Idaho said he and others lead double lives to protect their careers and safety.
• Their abortion services are legal, but public and professional hostility pushes them to secrecy.

On any given day in his family medicine clinic, Dr. James can be found giving a kid a back-to-school checkup, diagnosing and treating a 30-something's UTI, or counseling an older patient on their diabetes management.

But two days a month, James, who asked to use a pseudonym to protect his safety and career, takes personal time to perform abortions at Planned Parenthood. He doesn't let the two worlds publicly collide. He's not alone.

Even before Roe v. Wade was overturned last month, Idaho was a hostile state for abortion providers, James and other doctors in the state told Insider. There, abortion has been banned at fetal viability, and it will soon be considered a felony — with exceptions only for rape, incest, and to save the life of the mother.

The population leans anti-abortion, too, with 49% of residents saying it should be legal in all or most cases, compared to 45% who say the opposite, the Guttmacher Institute reported in 2014.

As such, abortion providers are few and far between in the state, and those who do exist often take on a split identity in order to protect their full-time jobs and feel safe, despite the fact that they don't and won't operate outside the scope of the law, James said.

Keeping the roles and where they're performed separate protects primary-care clinics from potential funding cuts and legal action, James said. It also protects the doctors' careers: Physician colleagues with different views could withhold patient referrals, for instance, if they knew James and others provided abortion care, he said.

But the secrecy can take a toll on them personally, and isn't what's best for patients, James said.

What it's like to live a double life

James considers himself one of the more open abortion providers in his state. Still, his neighbors don't know about that part of his identity.

"They know that I'm a family doctor, but they don't know exactly what I do," he said. "When they ask about my job, I don't advertise" abortion care.

Other clinicians he knows have had to be more secretive.

"I knew of a provider who couldn't even tell their front office staff that they provided that service because they knew that if it got into the community, they would get blackballed from getting referrals for OB care, and they wanted to be able to continue to provide that," James said. "Nobody would come to them if they knew that they provided abortions."

Another provider ducked into their bathroom to take an abortion-related call "because they had family over that didn't know that they provided abortions," James said. " So it's very secretive here."

The secrecy is warranted. Tess Howell, a 35-year-old woman in Idaho, previously told Insider her OB-GYN stopped prescribing the abortion pill because protesters were showing up at her house.

"She was like, 'I've got young kids, I can just refer patients to Planned Parenthood in Spokane' and 'This isn't worth my quality of life,'" Howell said.

Another doctor trained to provide abortions in Idaho, who also requested anonymity, told Insider that a colleague had received negative feedback on an evaluation because they were "too outspoken in their views in support of abortion rights."

Abortion is a procedure "that could be safely done in almost any primary care office setting by a provider that is trained in the procedure," he said.

"However," he continued, "due of the fear of legal action, community perception, concern of loss of business — from something like boycotting — and personal safety, we have to provide this very simple procedure in a completely different setting and not tell anyone about it so that we don't put ourselves, our family, or our clinical practice in jeopardy."