EL CENTRO, Calif. — On a recent Monday afternoon, all the abortion appointments at Planned Parenthood-Imperial Valley Health Center were already booked up for the week.
Vivian Perez, an office manager at the center, had already clocked in a 12-hour day, but she remained in the office tinkering with the schedule. She’d received a desperate call from the San Diego call center, which helps with scheduling.
“Could you please add one more” patient? the scheduler asked.
Knowing that the patient was probably traveling from far away, Perez managed to squeeze her in.
It didn’t used to be this way.
The El Centro clinic was always busy. Now it’s overwhelmed as it finds itself on the front lines of the drastic changes wrought by the U.S. Supreme Court’s recent Dobbs decision, which by overturning Roe v. Wade eliminated 50 years of federal protections for abortion care.
Almost instantly, many abortion clinics throughout the country stopped providing services, positioning states such as California, where the procedure is still legal, as something of a refuge for people seeking abortions.
A recent report from the UCLA School of Law’s Center on Reproductive Health, Law, and Policy estimates that between 8,000 and 16,100 more people will journey to California each year for abortion care, and that at least half of those will travel from Arizona because of the long border it shares with California.
Since the Dobbs decision, out-of-state patients have increased at all 19 clinics in San Diego, Riverside and Imperial counties affiliated with Planned Parenthood of the Pacific Southwest.
As of last week, out-of-state patients made up 21% of abortion visits at the clinics in those three counties, a 513% increase compared with two weeks before the Dobbs decision. Patients from Arizona make up the highest demographic of out-of-state patient visits for abortion care — an 847% increase from two weeks before the Dobbs decision, Sandra Duran, spokeswoman for Planned Parenthood of the Pacific Southwest, said.
In the Imperial Valley, the Planned Parenthood center in El Centro is one of the most affected because it’s the closest to Arizona, where legal abortion care vanished overnight. The fall of Roe v. Wade created confusion because Arizona’s laws are unclear on whether abortions are outlawed.
The Grand Canyon State had a ban dating to 1901 that had been blocked by the courts since the 1973 Roe decision. Some legal scholars argued that the courts would have to lift the block for it to go into effect.
In March, the Arizona Legislature passed a ban on all abortions after 15 weeks of pregnancy with no exceptions for rape or incest. But the law didn’t make it clear when it would be implemented. As a result, abortion providers, including Planned Parenthood, have stopped all abortions in the state out of an abundance of caution.
In El Centro, Perez, 60, who lives in nearby Holtville, had long prepared for a rise in patient visits.
In late May, she was in the midst of looking for more employees, including an additional registered nurse and medical assistant, to bolster the clinic’s 20-person staff. She said she wanted to make sure to have enough capacity for abortion care while still providing preventive health care, birth control, pregnancy tests and other women’s health services.
At the time, the clinic offered surgical abortions once a week, and medical abortions were performed about twice a week. Perez planned to offer one more day of surgical abortions.
Last week, Perez was so inundated with abortion care appointments that she had to ask the Planned Parenthood medical team for additional abortion providers.
“We were preparing, anticipating that it would be busy,” Perez said after the Dobbs decision. “But this is more than I expected. Definitely.”
Last week, Perez booked more than 100 surgical and medical abortions for Tuesday and Thursday and the rest of the week was booked up with more than 50 medical abortions. The clinic normally would have one abortion provider during the week. Now it has two to three.
One day a couple of weeks ago, El Centro’s clinic saw 17 patients for medical abortions. All but one was from Arizona.
Out-of-state patients — especially Arizonans — aren’t something new for the El Centro center. Ever since it opened seven years ago, it was clear that Planned Parenthood-Imperial Valley Health Center wouldn’t just serve El Centro.
An easy 20-minute drive from the Mexican border and an hour from Yuma, Arizona, the center has long served as a refuge, particularly for Mexicans and Arizonans seeking abortion care.
“In Arizona, you have to go through a process,” Perez said a few weeks before the Dobbs decision. “There is a waiting period. There are barriers. It’s a lot easier for them to come over here. It’s not far from Yuma, Phoenix, Tucson.”
Patients have come from all over the country, Perez said.
A few months ago, an Oklahoma woman, her husband and small children crammed into a small recreational vehicle and traveled more than 1,200 mile to get her abortion care in this conservative agricultural border town.
Exhausted from the journey, the family looked relieved when it arrived at the health center, Perez said.
The mother was finally able to get an abortion — something Oklahoman leaders had made nearly impossible to obtain in her state.
Oklahoma banned abortion in May with a law enforced through private citizen lawsuits. State officials also criminalized abortion the day that Roe v. Wade was overturned, except to save a mother’s life.
Tucked into a strip mall next to a Thai restaurant, the center looks unassuming — a beige and brown building with a blue sign that reads “Planned Parenthood.” It’s just steps from the Imperial Valley Life Center, a pregnancy center, one of many that have sprung up in the last few years and are meant to persuade people to reconsider abortion and provide support to those who continue with their pregnancies. A gate on rollers usually separates the two in El Centro.
Inside the health center, a modern lobby akin to that of a three-star hotel welcomes patients. The building has a nouveau mid-century flair with neutral tones and a turquoise wall accent.
It used to be a health clinic that served the Spanish-speaking population before Planned Parenthood took over and renovated it. It hosts six exam rooms. A security room near the back is full of screens with images from cameras stationed throughout the facility.
The clinic attracts maybe one protester a day.
Anticipating that Arizona might be one of those states to do away with abortion if Roe fell, Planned Parenthood officials in California and Arizona created a system to provide coordinated abortion care and help funnel Arizonans to providers in California. Planned Parenthood staffers in Arizona confirm each case of pregnancy and then refer the patients to clinics in California.
If a patient decides to get an abortion, the care coordinators in California assist them. That could mean helping pay for gas, a plane ticket or rental car, securing child care, providing a hotel voucher or cutting the cost of the abortion procedure, said Tessa Hemmi, care coordination program manager at Planned Parenthood of the Pacific Southwest.
On June 24, the day the U.S. Supreme Court justices overturned Roe, Hemmi and three others on her team already had five patients waiting on the phone when they started their day at 9 a.m.
They fielded 50 calls just that day. It’s been consistently busy and all hands on deck. The need was so great that first week that the team had to work over the weekend, navigating patients to California.
Some callers cry. Others thank her. Most are panicked.
Their stories are overwhelming, Hemmi said.
“I have my two kids. What do I do with my two kids? I don’t have child care,” one caller said.
“Do you have a Sunday available so I don’t have to take off work?” another questioned.
“Is it legal for me to come to California?” others asked.
“Abortion is safe and legal in the state of California,” Hemmi and her team members responded.
One of the biggest worries for those calling from out of state are California’s gas prices.
“People gasp when we tell them it’s more than $6 a gallon,” Hemmi said.
One woman called to say her car had broken down. In between sobs, she said she had to spend all the money she had for the abortion procedure on a rental car.
Hemmi sent the woman gift cards for gas and helped reduce the abortion cost.
The call center’s team can help with just about everything but one complicated question.
“Can I get in trouble for getting an abortion here when I go back home?” some ask.
Hemmi and her team tell callers that they can’t really answer that question because they don’t want to provide wrong information.
“We’re not legal professionals, and the laws are constantly shifting,” Hemmi said.
Perez said she’s happy to see that many of the out-of-state patients arriving at the El Centro center have received some sort of support to get them there. Some have gas cards. Others hotel vouchers. Many of those arriving for abortion care are women who already have children.
The center didn’t used to perform medical and surgical abortions on the same day, but some travelers are too far along to qualify for a medical procedure. When that happens, Perez can sometimes easily squeeze them in for a surgical appointment the same day.
Some days, Perez feels the pressure. But, she said, she then thinks that it’s nothing like the pressure the traveling patients must feel.
“We can do this,” she tells herself. “This is what we need to do, and this is what we’re going to do.”
