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Early providers of abortion care in Montana saw women through 'devastating' experiences • Daily Montanan [1]
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Date: 2025-06-25
When Jim Armstrong was an intern at Queens General Hospital in New York City decades ago, he saw women die every day from self-induced or illegal abortions, recalled Susan Cahill, a retired physician assistant and founder of the original All Families Healthcare in the Flathead Valley.
That was before the U.S. Supreme Court’s opinion protecting abortion based on privacy in Roe vs. Wade in 1973.
“He told me the story of staying at the bedside of a woman all night watching her die as the police hounded her to get her to tell them the name of the doctor that performed her abortion,” Cahill said in written remarks. “She refused. Jim vowed after that that if abortion ever became legal, he would learn how to do it as part of his family practice training. He kept his promise.”
The late Dr. James Armstrong is the same person in the often cited Armstrong vs. State of Montana case from 1999, in which the Montana Supreme Court found abortion to be protected as part of the privacy provision in the state Constitution.
Abortion remains generally legal in Montana, but Tuesday marked the third anniversary of the Dobbs vs. Jackson Women’s Health Organization decision that overturned federal privacy protections for abortion, and this week, medical providers and advocates for reproductive freedom are assessing milestone changes in medical care since Roe.
Cahill, who worked with Armstrong in Montana for years, shared a talk she gave in spring 2024 about providing abortion care in her career and her work with Armstrong, and other advocates shared reports with other anecdotes.
In her talk, Cahill said when she came to Montana to work with Dr. Armstrong in 1976, “he was so busy performing abortions that he could not take care of his regular family practice patients.
“I helped fill that need.”
Earlier, when she was in training in inner city New York, Cahill said she cared for terrified teenagers.
“I took care of 11- and 12-year-old girls in labor from rape by their fathers or brothers, or another family member, in pain and frightened, screaming for their mothers, not understanding what was happening to them,” Cahill said.
In 2002, she said, she was asked to set up a reproductive health clinic at the University of Rochester in upstate New York, a couple of years after medication abortion had become legal.
Rochester had a significant Somali refugee population, and Cahill wrote about helping one woman in particular through a medication abortion.
“Complete female circumcision is practiced in Somalia,” Cahill wrote. “It’s called infibulation. A woman’s complete labia is removed from the urethra to the anus, and the lacerated tissue is joined together with what becomes scar tissue.
“Only two very small holes are allowed to remain, one for urine and one for menstrual blood. When a Somali woman marries, a physician cuts through that scar tissue in order for her to have intercourse with her husband, and confirmation that she is a virgin.”
She said the Somali woman she saw couldn’t speak English well, but she said “he” had “put water on her” while she was sleeping, and she hadn’t had her menstrual cycle since.
Cahill said she examined the woman and was shocked to see the infibulation, and after an abdominal ultrasound, she learned the woman was six weeks pregnant.
If the woman had to continue the pregnancy, she likely would have been thrown out of her refugee community, and probably would have killed herself, Cahill said. She said surgical abortion was out of the question because of her “female circumcision,” but providers gave her a medication abortion.
“When she returned for her two-week checkup, having bled so she knew we had gotten her period going again, all she could do was hold my hands and kiss them continually. Her smile would have blinded you,” Cahill said.
This week, Montanans for Choice Take Action released several reports with more recent experiences women have had related to abortion care and restrictions. One report discusses six deaths in Texas and Georgia.
Another, called “The Rise of Pregnancy Criminalization,” said Montana hasn’t seen many cases of criminalization, but it said the state is primed “for lawmakers to promote and enforce laws to control people’s pregnancies.”
It shared a December 2024 story from Texas, citing coverage from the Los Angeles Times. It said a Texas woman spent five months in prison after having a miscarriage in a restaurant bathroom stall.
“After restaurant employees contacted authorities, the woman and fetal remains were taken to a hospital,” the report said. “The woman was detained, charged with abuse of a corpse, and remained in prison for five months before charges were dismissed. She was held in jail despite the medical examiner’s determination she had a miscarriage and the fetus was nonviable.”
It said Montana is one of 11 states with a broad “personhood provision” in legal code. The Montana Abortion Control Act of 1999 “reaffirms the tradition of the state of Montana to protect every human life, whether unborn or aged, healthy or sick,” but it also said Montana courts have generally found the law’s provisions to be unconstitutional.
Armstrong’s obituary said the clinic he and Cahill shared was destroyed by arson in the winter of 1994.
In 2014, an arsonist destroyed Cahill’s original All Families Healthcare, and four years later, Helen Weems, a nurse practitioner, opened up a new All Families Healthcare to carry on the legacy, according to the Flathead Beacon.
Published on the Buffalo Hill Funeral Home & Crematory site, Armstrong’s obituary said he worked 35 years before he retired. After Roe, it said, he incorporated “safe, legal abortion work” into his family practice in Kalispell.
“In addition, he found great satisfaction from delivering the babies of women he had himself delivered years earlier,” the obituary said.
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