BOISE, Idaho — Physicians are expected to take the stand in Idaho’s capital on Tuesday to argue that the state’s near-total prohibition of abortion care is jeopardizing women’s health, forcing them to carry fetuses with deadly anomalies, and preventing doctors from intervening in potentially fatal medical emergencies.

Their testimony is scheduled to lead off the second week of a closely watched trial concerning one of the nation’s strictest abortion bans. The case, brought by four women, two physicians, and a group of medical professionals, seeks to limit the extent of the state’s ban, which prohibits abortion in almost all circumstances except to prevent a pregnant woman’s death, to stave off “substantial and irreversible impairment of a major bodily function,” or if the pregnancy was a result of a woman or girl being raped.

Over three days in district court last week, the women who brought the case shared emotional testimony about serious pregnancy complications that forced them out of state for medical care. That testimony drew objections from James Craig, an attorney with Idaho’s Office of the Attorney General, who interrupted the women frequently arguing that the details of their stories were not relevant.

Craig pushed back on assertions that Idaho’s criminal abortion laws are endangering women’s health care, while also casting abortion procedures in a negative light. Craig called abortion “barbaric and gruesome” in an opening statement.

“Abortion laws prevent unborn children from being exposed to pain,” he said.

At one point in the trial, Craig suggested that women could use any medical condition to sidestep the law, describing a scenario in which a pregnant woman who stepped on a rusty nail could claim she was at risk of infection and thus entitled to an abortion.

If the court finds in favor of the women, Craig said, “women [would] have a right to kill their unborn baby anytime it’s disabled, anytime they have an infection.”

During the plaintiffs’ testimony, as the women described what happened to their bodies during their pregnancies, Craig’s repeated objections drew reprimands from the 4th Judicial District Court judge overseeing the case, Jason Scott.

The patient plaintiffs’ testimony drew a warmer response from Scott, who said the women’s “circumstances are very worthy of sympathy.”

The case has drawn national attention to Idaho’s ban, one of the first enacted after the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization. As it proceeds, abortion rights advocates are watching to see whether court challenges — including in other Republican-led states, such as Tennessee, where a similar case is ongoing — will be successful.

The plaintiffs in the case are not seeking to overturn the Idaho ban but rather to enact medical exceptions to the law. Their prospects are unclear, though a similar challenge in Texas did not fare well.

As the trial played out in a Boise courtroom, Jillaine St. Michel sat with her husband as they tended to their 10-month-old son. St. Michel had faced a pregnancy in which her fetus developed in devastating ways — a lack of leg and arm bones, a missing bladder, fused kidneys. She was barred from ending her pregnancy.

“We were told in the state of Idaho an abortion was not legal, and my case was no exception,” she said. 

Instead, the family drove to Seattle for an abortion, she said, to spare the fetus she carried from further torment.

“The state talks about how barbaric it is, they keep using that term,” St. Michel said. “The idea of allowing your child to experience suffering beyond what is necessary, to me that feels barbaric. To put myself through that when that is not something I desired, that feels barbaric. To have that ripple down into my ability to parent my existing child, that feels barbaric.”

Earlier this year, the Texas Supreme Court ruled against 20 women and two OB-GYNs, upholding that state’s criminal law that allows abortion only to prevent a pregnant patient’s death. The court added one clarification ruling that abortions would be considered a crime when the amniotic sac breaks before 37 weeks of pregnancy, known as preterm premature rupture of membranes, because the condition can cause rapid and irreversible infection. That exception is not currently allowed in Idaho, and physicians who testified in the first week of the trial said they’d been forced to put their pregnant patients into cars and planes to receive abortions out of state.

In Idaho, a previous legal challenge to the state’s near-total abortion ban was rejected by the Idaho Supreme Court. In the case brought by Planned Parenthood, the justices wrote in a January 2023 ruling that the Idaho Constitution contains no right to an abortion, and that Idaho’s laws criminalizing abortion are constitutional.

This latest challenge, Adkins v. State of Idaho, comes on the heels of Donald Trump’s presidential victory. His Supreme Court appointments made way for the anti-abortion movement’s most vaunted goal of eliminating a woman’s constitutional right to abortion. 

Advocates for abortion rights say that a loss in the case would close off options for challenging bans.

“If this isn’t successful, it’s not really clear if there are really additional places to go for help,” said Gail Deady, a senior staff attorney at the Center for Reproductive Rights, a legal advocacy organization representing the plaintiffs.

Kayla Smith, one of the plaintiffs, sobbed during her testimony as she recalled suffering from preeclampsia during her pregnancy with her first child. When medication could not control the condition, physicians were concerned that the blood pressure disorder could cause Smith to have a stroke or seizure, so they induced birth early, and Smith delivered a daughter, who is now 4 years old.

She told the court her second pregnancy seemed normal until a routine anatomy scan showed her son had multiple lethal heart defects. She and her husband had named him Brooks.

Idaho’s abortion ban had taken effect two days earlier and no longer allowed a physician to allow women such as Smith to end a pregnancy involving lethal fetal anomalies.

Her husband recalled the moment when their doctor, Kylie Cooper, delivered the diagnosis. “I remember finally asking just her if Brooks was going to be able to survive, and Dr. Cooper, she broke down. And the three of us just cried. And I understood that we were helpless in Idaho at that point,” James Smith said.

Despite a frantic search, the Smiths could not find a fetal surgeon who would operate on Brooks. His heart could not be fixed.

“My son wasn’t going to survive,” Kayla said in an interview. “We wouldn’t bring a baby home. And we also didn’t want him to suffer, so we just decided to do the most compassionate thing for him and also for me.”

Idaho’s criminal abortion laws required either that Kayla stay pregnant until her condition deteriorated and an abortion would be needed to prevent her death, or that she give birth to Brooks, who would not survive.

“I was not willing to watch my son suffer and gasp for air,” she said about the couple’s decision to end the pregnancy.

The Smiths drove with their toddler to Seattle, where physicians induced labor at about 20 weeks into her pregnancy, and Kayla and James were able to hold Brooks, who did not survive.

Attorneys for the state of Idaho are expected to call one witness this week, Ingrid Skop, an OB-GYN anti-abortion advocate.