Abortion rights at risk after Roe v Wade overturn
California Gov. Gavin Newsom appointed Laphonza Butler, the president of EMILY’s List, to fill the late Democratic Sen. Dianne Feinstein’s Senate seat. While there are many political angles at work with this decision, Butler’s leadership at EMILY’s List, which works to elect Democratic women who support abortion rights is significant.
According to Emily’s List, Butler has dedicated her life to ‘empowering women and supporting them in finding their voice, and using it to make meaningful change.’ When the Supreme Court overturned Roe v. Wade in 2022, Emily’s List said in a statement that the decision would have “sweeping consequences for millions of Americans.”
Americans are seeing the devastating outcome of that decision play out across state lines. Since the Supreme Court’s decision to end the constitutional right to an abortion, Planned Parenthood Mar Monte (PPMM) has seen an increase in the number of abortion patients forced to seek care from out of state.
That number had already been gradually increasing over the past 18 months as more states (like Texas SB 8.) passed abortion restrictions.
Bay Area Planned Parenthood Mar Monte
Planned Parenthood Mar Monte (PPMM) is the largest affiliate in the country and operates 35 health centers in mid-California and northern Nevada. They provide medical and education services to nearly 300,000 patients annually. The affiliate’s name Mar Monte was chosen to reflect a service area that stretches from the sea (mar) through the mountains (monte).
In the Bay Area, they cover Alameda, Santa Clara, and San Mateo counties as well as the coast of Santa Cruz. They offer in-person care and telehealth visits as well.
In the year since Dobbs, PPMM saw a nearly 300% increase in the number of abortion care patients from out of state. One-third of this increase from out of state comes to California from Texas said Andrew Adams, Chief of Staff & Head of Strategic Communications at Planned Parenthood Mar Monte.
A strain on resources
The increasing number of out-of-state abortion patients coming to California strains capacity for all Planned Parenthood health centers in the state, noted Adams, which “requires that other services and patient-flow in our health centers are shifted to accommodate these patients, while still serving the other patients who need us.”
That includes, said Adams, “having our abortion providers be prepared to instantly shift their schedules and perhaps drive more than two hours to help an out-of-state patient who has a very limited time window for abortion care at a certain health center/region.”
There are many patients who ‘literally will fly in that morning and ask for an appointment immediately,’ observed Adams, because they have a ticket to return home that night.
“And we will scramble to make sure that we can provide the care that they need in order to fit the requirements of their life. The majority of our patients are parents already, and so they have to go back home. They have a job that they may or may not have had paid time off. The cost of travel can be astronomical for them sometimes.”
The cost of abortion care at PPMM ranges from zero to several thousand when insurance is paying the costs. Fees are based on a sliding scale and are determined by the patient’s monthly income and number of dependents. This means, that all patients, pay what they can afford and PPMM works with patients to ensure that the ability to pay is not a barrier to care.
What this means is that the cost of subsidizing abortions at PPMM overall in the past year has more than doubled from $2,218,316 to $5,024,843 because of the number of out-of-state patients, whose insurance cannot cover abortions and/or they don’t have the money to cover it themselves.
A toll on physicians
Perhaps the most unforeseen effect of the fall of Roe v Wade on our health centers is how emotionally traumatizing it has been for our care teams, says Adams. “Our dedicated health center staff, who are caring for out-of-state abortion patients that have been traumatized by having to escape their own states to receive essential health care, are profoundly affected by listening to patients’ stories and helping them through the experience.”
Another byproduct of those abortion bans in many states is that doctors training in OB/GYN can no longer get some of that training that was customary or needed in order to be effective doctors in their field.
PPMM has hosted a number of physicians and medical students here in California to get that training, adds Adams because even though abortion is really restricted or outlawed in their states, life continues to happen as well as miscarriages.
One of the unexpected effects of having more out-of-state patients come to our health centers is the legal jeopardy that could potentially face our patients and staff if the patient’s abortion isn’t completed in California or Nevada, explains Adams. “Those who come to us for a medication abortion need to complete both phases of the process in California or potentially risk legal prosecution in their own state. That requires a patient to be able to stay overnight and have transportation home the next day.”
PPMM advises their out-of-state patients to turn off all of their GPS tracking on their phones so that their data cannot be subpoenaed by their cell phone provider.
Other medical services
PPMM provides abortion care but that is just a small part of all the services this affiliate provides. “We provide birth control as well as all sorts of sexual reproductive health care,” reiterates Adams.
PPMM is unique in that it provides a range of services including vasectomies, behavioral health alternatives as well as gender-affirming care.
“We are really, really proud that we provide family medicine and are just a handful of 100 affiliates that provide telemedicine” notes Adams. PPMM saw a need, especially in areas like the Central Valley where the ratio of primary care doctors to patients was egregiously low. “So we see patients – prenatal, to patients in the 90’s with Family Medicine.”
Staying engaged in California
There is a real risk that the protections that we’ve worked really hard to advance and secure in California could be void at the national level, warns Adams.
The Dobbs decision has definitely awakened a sense of urgency in the South Asian community for political action but even Californians have to stay engaged because a small shift in Congress or the Senate can tip the balance nationwide for women’s rights.