OAKLAND, Calif. (CN) — With California positioned as a sanctuary for abortion access in the wake of the Supreme Court’s overturning of Roe v. Wade, providers and advocates anxiously await an increased demand for services from out of state — even as many Golden State residents lack easy access to care.
Abortion remains legal in California and the state could see a nearly 3,000% increase in demand for services, according to Guttmacher Institute. About 26 states have or plan to ban or heavily restrict access to abortion following the court's ruling and people might travel hundreds of miles from states like Texas, which already effectively outlawed abortion, for abortion care.
UC San Francisco reported data from the Abortion Facilities Database that distribution of abortion-providing facilities varied dramatically and California has 168 — 1 in 5 of the nation's facilities. It is the closest abortion provider for about 1.4 million people, and between 8,000 and 16,100 people come to the Golden State each year for abortion care.
But California is a huge state and not entirely the blue bastion many believe it to be. A report from UC Berkeley School of Public Health said traveling any distance more than 50 miles can be “an insurmountable barrier to abortion access.” And according to NARAL Pro Choice California director Shannon Olivieri Hovis said UCSF’s study found many Californians have to drive at least 180 miles to the nearest clinic.
This creates abortion “deserts,” according to Dr. Tania Basu Serna, associate clinical professor in UCSF’s Bixby Center. And Tricia Gray, volunteer engagement coordinator at Access Reproductive Justice, a California-based nonprofit abortion fund, noted only half of California's 58 counties have abortion care providers. She said the “resource deserts” are concentrated in Imperial County, Riverside County, the Central Valley and counties north of the San Francisco Bay Area.
“These are the areas where people have to travel the farthest to an abortion clinic, and even in these instances their closest clinic may not provide all types of abortion care,” Gray said.
And in those areas — the red parts of California — the local opposition to abortion is growing. Olivieri Hovis said crisis pregnancy centers outnumber abortion clinics even in California, particularly in the Central Valley and parts of Northern California. She said people north of Sacramento choose Redding or Chico or even farther for a provider who provides abortion services.
“Part of the problem is a political one, unfortunately,” she said. “Some governments will fight having a clinic open in their region. Unfortunately, their residents are just harmed by that. Sometimes we have very anti-choice vocal people on the ground representing a really small minority, and they’re preventing clinics from opening.”
There are shortages of doctors, nurses and midwives legally allowed to provide first trimester care, and some counties have very few or no ob/gyn at all, Olivieri Hovis said. Consolidating health care systems, combined with “restrictive hospital systems” like Providence, St Joseph’s and Adventist creates “a perfect storm of a lack of clinics that can provide care, and a lack of healthcare systems that will provide it.”
“Those are systems that do not provide comprehensive health care and have quite severe restrictions on reproductive and gender inclusive care,” she said. “That means for many people who are living near the Oregon border, they might go into Oregon frankly, rather than trying to access care in California. That's a failure of our system.”
Olivieri Hovis said these obstacles to abortion access will most affect “those who are already suffering from being marginalized by our health care system — immigrants, young people, low incomes, LGBTQ people, people with disabilities.”
Susy Chávez Herrera, spokesperson for California Latinas for Reproductive Justice, said Latinos — making up 53% of the population in counties like Fresno — have few resources in the Central Valley. Access to adequate health care, let alone comprehensive reproductive health care, is already an issue for these populations, particularly immigrants.
FPA Women’s Health in Fresno released a statement that 25 California offices are expanding capacity.
“We have streamlined access in our 11 surgical clinics to accommodate patients who choose to fly into California for care and fly home immediately.” FPA is also relying on the abortion-by-mail program for California patients, “to preserve surgical access for patients seeking care from hostile states.”
These problems are also present in urban areas, as even regions which have more abortion providers also have 20% more anti-abortion “crisis centers,” Chávez Herrera said. She said people of color, people with disabilities and LGBTQ people are more likely to live in areas where these crisis centers are and more likely to be targeted or threatened. She said patients may also be misled about what services a clinic offers and forced to receive ultrasounds rather than given information about abortion services.
Serna agreed that she often talks to patients who unknowingly went to an anti-abortion “crisis center” and were surprised to later find her clinic and receive evidence-based counseling. She said being transparent about exactly what services are provided at clinics, increasing telemedicine and medication abortions, will be vital to make sure people receive evidence-based care anywhere in the state.
When people do come from other states to access abortion care, however, reproductive rights advocates vow to be ready. NORVAL is mobilizing thousands of volunteers to provide people with aid such as rides to clinics and hotel stays, Olivieri Hovis said. They also worked with state lawmakers who crafted 16 new health care bills before the Legislature, including an Abortion Practical Support Fund — but current gaps in the health care system have to be addressed now, advocates say.
But cost could remain a major obstacle. UCSF reported medical abortions, first-trimester and second-trimester procedures — the latter widely varying in cost — are all most expensive in the West, at an average of $650, $750 and $926, respectively. California abortion clinics usually accept a form of insurance, but rarely insurance from other states.
Chávez Herrera said people from other states may not have insurance coverage at all and may not be able to afford the peripheral costs.
“There are going to be folks who get left out regardless of how much we fund abortion," she said. "There are folks who can’t take time off from work. Most folks who have abortions already have children and might not have child care.”
As Chávez Herrera noted, even a progressive state like California may need to up its game when it comes to ensuring reproductive health care to all who seek it.
“Pre-appeal of Roe, there were gaps that we haven’t been able to address. I hope in the next few years we’re able to address those more fully, because people’s lives are at stake.”
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