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As originally published in The Mercury News on Sunday, January 1, 2023.

Women are making ‘traumatizing’ trips across state lines for care.

One woman had never flown on a plane before and was petrified to make the journey from Texas to California. Another drove all night from El Paso to make her appointment because she couldn’t miss work. A third was so worried about getting in trouble that she asked the staff at Planned Parenthood if they could wipe her phone and destroy all evidence of her abortion.

Six months after the U.S. Supreme Court overturned Roe v. Wade, prompting about half of the states in the country to move to ban or limit abortion access, these are the kinds of stories California clinics say they are encountering on a regular basis as they continue to serve an influx of patients from Texas, Arizona and beyond.

“When patients arrive, they’re in a much more panicked situation,” said Stacy Cross, president and CEO of Planned Parenthood Mar Monte, which serves half of the counties in California, including most of the Bay Area. “These are patients frequently that have never left their small home town. And now they’re having to drive or fly thousands of miles to get essential health care.”

California abortion providers have long been gearing up for an expected surge of patients from states with new abortion bans after the court reversed half a century of abortion rights in June. But while demand for care from out-of-state women is definitely up — at Mar Monte’s clinics it’s quadruple what it was before the Supreme Court ruling — it’s not as high as some experts predicted.

That’s likely because while 26 states were poised to ban or limit abortions with the fall of Roe, not all of them have been able to do so, because of legal challenges and legislative delays. And for most women who need an abortion but can’t get one in their state, California is a trek — going to North Carolina, Colorado or Illinois would be far easier.

“California has become extremely well prepared and done everything possible to be inviting,” said Carole Joffe, a professor at the UCSF Bixby Center for Global Reproductive Health. “But simple facts of geography mean that at this moment more people are going to places where it’s still legal in the South and Midwest.”

Even so, the increase in out-of-state patients has had ramifications for California clinics, such as increased wait times in some places.

Planned Parenthood Mar Monte — the Bay Area’s main affiliate — prepared to serve between 250 and 500 extra patients per week. Instead, it is seeing about 100 extra patients per month. Even so, that represents an overall four-fold increase from last year.

What’s even more stark is the spike in women who can’t afford to pay for the procedure. Last fiscal year, Planned Parenthood Mar Monte subsidized all or part of the cost of 2,800 abortions. This fiscal year, that number has jumped to more than 3,500 — showcasing the impact abortion bans have on low-income women.

Increased demand for abortion services takes resources away from other services, such as family planning, and has increased wait times across the board, Cross said. Her clinics are seeing some patients coming up from Southern California, where demand from out-of-state patients is so high, they can’t get in for an appointment at a clinic near where they live, she said.

But the biggest impact has been on Planned Parenthood’s staff, who now in addition to providing abortion services have to make sure patients who have traveled hundreds of miles for their appointment have someone to watch their children during the procedure, a change of clothes and food for their hotel stay, and someone to hold their hand and help them navigate the harrowing experience.

“Taking care of out-of-state patients has been really traumatizing for our staff,” Cross said, “because people are essentially escaping their states where they used to receive essential health care and they’re coming to our health center.”

The number of out-of-state patients seeking abortions at Planned Parenthood of Orange and San Bernardino Counties increased three-fold between June — when Roe v. Wade was overturned — and August, said Nichole Ramirez, senior vice president of communication and donor relations. That’s on top of a 900% increase between September 2021 — when a Texas law banning most abortions took effect — and June.

“Our numbers have been large but manageable, I would say, and I think that’s because we were ready for it,” Ramirez said.

The Southern California Planned Parenthood affiliate has hired more than 80 new staff members since July, and, at one clinic, added nine new rooms where abortions can be performed. As a result, Ramirez said that the surge hasn’t impacted wait times, and clinics generally have next-day appointments available.

Most out-of-state patients come from Texas — where anyone can sue someone who “aids or abets” an abortion after six weeks of pregnancy — and Arizona — where two conflicting abortion laws and resulting lawsuits have caused widespread confusion over whether the procedure will be legal from one day to the next.

As of October, at least 66 clinics in 15 states have stopped offering abortion services, according to the Guttmacher Institute, a reproductive health research group that supports abortion rights.

Many additional states are poised to ban the procedure, including Utah, where a court order is temporarily preventing a ban from taking effect. And that may drive more patients to California, where Gov. Gavin Newsom and legislators have taken steps to protect women seeking abortions and abortion providers from civil and criminal liability, and set aside funds to help out-of-state patients access care.

“I think what California has done,” Joffe said, “and to me, this is very impressive, is created a template for what a good public health approach to abortion looks like.”



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