As Arizona prepares for a near-total ban on abortion to go into effect in the coming months, providers in California are getting ready to welcome a surge of out-of-state clients and live up to the state’s reputation as an “abortion sanctuary”.
California clinics have been treating patients confused by the legal framework in neighboring Arizona ever since the supreme court overturned Roe v Wade, the landmark 1973 law enshrining a federal right to abortion, in June 2022.
Arizona has had a near-total abortion ban on its books since 1864, but that law hadn’t been enforced since the Roe decision in 1973. After the supreme court’s ruling to overturn Roe, the Arizona supreme court allowed enforcement of the 1864 ban to go back into effect. At the same time, however, Republican lawmakers in the statehouse passed a newer law banning abortions after 15 weeks.
After Roe was overturned, “there was a lot of confusion both on the part of patients and providers in terms of what they could and could not do to be adhering to the law,” said Pratima Gupta, an OB-GYN who provides abortion care in San Diego and a fellow with Physicians for Reproductive Health. She remembers clinics closing their doors, just to be told that the 1864 total ban wouldn’t be enforced after all.
The need was urgent, Gupta recalled. She particularly remembered one patient who had driven hours by herself from Arizona for an abortion. After the procedure, “she literally jumped off the table, started to get dressed and asked: ‘Can I go home now?’ Because she had arranged childcare for a certain amount of time.” Gupta and her colleagues begged her to stay just 10 minutes so they could observe her before she drove the four hours home.
“That is the level of motivation that we are seeing,” she said.
California law guaranteed abortion rights before Roe and voters further enshrined those rights in the state constitution in November 2022. When Roe was overturned, the California governor, Gavin Newsom, signed a package of 12 laws protecting and expanding abortion access in the state and directed $200m in state funding to supporting out-of-state patients, including $20m to help those patients pay for travel, lodging and other logistical expenses. Clinics across California saw a surge in out-of-state patients.
Planned Parenthood of the Pacific Southwest (PPPSW), for example, which operates 20 clinics across the California border in San Diego, Los Angeles and Imperial county, said roughly 10% of all abortion patients at its clinics today come from states outside California.
Today, California providers are preparing for another surge in Arizona patients. On 9 April, the Arizona supreme court ruled that the 1864 total abortion ban – which had wound its way through the local courts – could take effect. The ban will become enforceable this June – meaning abortion is still legal in Arizona before 15 weeks until then. Kris Mayes, Arizona’s attorney general, has said her office will not prosecute patients or physicians who provide abortions, and Democratic lawmakers in the state have vowed to try to repeal the ban (including by introducing an amendment that voters will get to consider this November guaranteeing the right to abortion care in the state constitution). Still, providers expect the legal limbo will move many people seeking abortions to seek care elsewhere.
“This ruling places patients in Arizona in an even more precarious position,” said Darrah DiGiorgio Johnson, president and CEO of PPPSW. The organization announced that it has appointments available for Arizona patients “in days not weeks”.
Organizations such Access Reproductive Justice, a California-based abortion fund, are offering to connect people seeking abortions and other reproductive healthcare with providers in the state, and provide logistical and financial support.
Still, there are challenges. Many patients needing care struggle to make the journey out of state, said Gupta, especially youth, members of the LGBTQ+ community and undocumented patients.
Currently, the majority of southern California’s abortion clinics are located in the San Diego and Los Angeles metro areas. Those are crucial, and convenient for patients to fly in to from out of state.
But there are far fewer providers in rural areas, including near the California-Arizona border, and a growing number of hospitals in those regions have made significant cuts in maternal and reproductive healthcare.
Planned Parenthood does operate one clinic in El Centro, just an hour’s drive from the Arizona border. That clinic burned down in August 2023. The organization opened a temporary facility to continue seeing patients there and is scheduled to open a new permanent health center this summer, said Sandra Duran, communications director of PPPSW. Before it caught fire, up to half of the patients seeking care at the El Centro clinic came from out of state or Mexico.
Although she’s hopeful that advanced practice clinicians will be able to expand access to abortion care in rural California, Gupta notes that the continued closure of obstetrics units in rural hospitals across the state is worrisome. It means that backup can be increasingly far away for those providers.
The 2022 bills have provided some relief, she said, in particular a law that allowed nurse practitioners and nurse midwives to perform first-trimester aspiration abortions without a doctor present. “That’s been tremendously helpful, especially in expanding care to our more rural communities in California,” said Gupta. She adds that although California “is welcoming trainees from other states”, it’s difficult to convince new providers to move to California because it’s one of the most expensive states to live in.
Researchers are also examining whether allowing California pharmacists to prescribe abortion pills to out-of-state patients would be another way to expand care. Pharmacists in California and in many other states can prescribe contraception, but prescribing abortion medication is out of their scope, explained Cathren Cohen, a staff attorney at the UCLA Law Center on Reproductive Health, Law and Policy and the author of a recent paper on the topic. She and her colleagues found that 69% of California pharmacists would be willing to prescribe abortion pills if they were allowed to.
Researchers are still studying how effective a legislative change making that happen would be – and whether such laws could be implemented will depend on a supreme court ruling expected this summer that could limit access to medication abortion.
