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As originally published in the Mercury News on Saturday, June 24, 2023.

Susana Gutiérrez lived in two worlds when the ruling of Dobbs v. Jackson came out a year ago and reversed nearly five decades of federal abortion rights.

The first was her world at Stanford Law School in pro-abortion California, where she was surrounded by students who were focused on the structure of the pivotal Supreme Court opinion in what she describes as an intellectual exercise. The second was the world of her home state of Texas, where abortion restrictions prevented her sister-in-law who works as an ob-gyn from helping a patient terminate her complicated pregnancy weeks after the ruling.

The contrast of those two worlds has come to define a nation divided over one of the country’s most passionate and personal issues.

“It’s been felt very physically on the bodies of many, many people,” said Gutiérrez, whose sister-in-law’s patient spent weeks in intensive care because she developed an advanced-stage infection. “It’s really hard to talk about these things as though they exist only within the confines of legal strategizing and Supreme Court opinions when it’s reflecting very viscerally on the bodies of young people all across the country.”

Saturday marked one year since the Supreme Court’s 6-3 decision to overturn Roe v. Wade, allowing states across the country to enact legislation restricting access to abortion or outlawing it altogether. “Roe was egregiously wrong from the start,” Justice Samuel A. Alito Jr. wrote in the decision.

A year later, the public would appear to disagree. An NBC News poll conducted this past week showed 61% of voters oppose the court’s decision, compared to 36% who approve. Among female voters ages 18-49, 77% say they disapprove of the ruling.

While states such as Alabama, Missouri and Arkansas wasted little time enacting outright abortion bans, government leaders in California took swift action to protect patients and health care providers and declare the Golden State a safe haven for those seeking an abortion.

Hundreds of pregnant women have come to California seeking help. Since the Dobbs ruling, Planned Parenthood Mar Monte has seen a 300% increase in out-of-state patients at its clinics, with the largest increase in San Jose, Oakland, Sacramento and Fresno.

Planned Parenthood clinics in Orange and San Bernardino counties have seen more than 450 out-of-state patients, said Krista Hollinger, the agency’s chief operating officer for those counties. About 40% of those patients are from Texas while 30% come from Arizona. Although abortion is fully banned in 14 states, the patients have come from 32 different states.

“We’re really seeing a domino effect,” Hollinger said, “where even women that are in states where abortion is still legal, they may not be able to get into their local providers because there’s such a demand from neighboring states where it has been banned.”

For Hollinger, the stories of people seeking treatment in California have been heartbreaking. This past week, one of her medical assistants told her about a couple who were so intimidated by their home state’s new abortion laws that they didn’t even feel safe to buy a pregnancy test until they left the state.

“I think about how resilient and brave our patients are,” she said, “and then how scared and how horrible it is that they have these hurdles.”

For reproductive rights leaders in California, the work to strengthen the state’s reproductive health care laws started before the Dobbs ruling.

Flor Hunt, executive director of TEACH (Training in Early Abortion for Comprehensive Healthcare), said that it became clear to her and others that they needed to start doing more to protect abortion access in California once the Supreme Court in December 2021 upheld a Texas law that banned abortions after six weeks of pregnancy and then agreed to hear the Dobbs case.

The California Future of Abortion Council (CA FAB Council), TEACH and other organizations came together to create a set of policy recommendations to help California prepare for the worst-case scenario: the end of Roe v. Wade.

Their work paid off, according to Hunt, who witnessed the recommendations turn into legislation such as California’s Proposition 1, passed by voters in November, which enshrined the right to abortion access in the state’s constitution. Two-thirds of California voters backed the measure in the November 2022 election.

“I think we’re fortunate enough to have leadership that really believes in reproductive freedom,” Hunt said. “I think the question would be, ‘What happens when that is no longer the case?’ I think what we learned with the overturning of Roe … is that you can’t take for granted your leadership.”

Despite California’s strong laws to protect access, some anti-abortion groups are working to push for other reproductive health pathways. Kathleen Domingo, executive director of the California Catholic Conference, says the organization is working to support alternatives to abortion, including legislation for “adequate paid family leave” and finding ways to prioritize housing for pregnant women. Even with the passage of Prop 1, Domingo and other anti-abortion advocates still believe more can be done to convince Californians that other options are available.

Terrisa Bukovinac, founder of Pro-Life San Francisco and Progressive Anti-Abortion Uprising, believes that changing the culture is key to pushing for a stronger pro-life presence in California. “These referendums aren’t written in stone. If the people will it to change, then it can change,” Bukovinac said.

That’s why California-based abortion advocates say their work is far from over. Hunt is supporting more legislation that would lead to investments in a diverse abortion provider workforce, additional safeguards for health care providers looking to support out-of-state abortion seekers and ensuring that medical malpractice insurance includes coverage for reproductive health care.

Reproductive health care leaders are also keeping a close eye on the status of abortion rights across the nation. Should a federal abortion ban go into effect, there won’t be much recourse even in California. Still, Laura Dalton of Planned Parenthood Mar Monte feels a sense of hope. Hours after the Dobbs ruling went into effect, the chief medical operating officer and her team made one thing clear:

“Our doors are open, and we’re going to keep fighting,” she said. “This is life-saving essential health care, and we’re gonna keep doing it.”


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