West Coast Advocates Strategize to Support Abortion Access as Roe Fallout Continues

by Megan Burbank

As states move to ban or limit abortion in the wake of Roe v. Wade's reversal, western states including Washington are upholding abortion access for the rest of the country. That's the motivation behind an ambitious package of abortion access policies California's state legislature passed in August, including expedited licensure for abortion providers, a California Reproductive Health Service Corps aimed at nurturing a diverse pool of reproductive health care workers, and expanded privacy protections for medical records. It's just one set of policies that represents major efforts among advocates and policymakers in western states to preserve and expand protections once guaranteed under Roe. Three months after Roe was overturned, reproductive health policy advocates from California, Colorado, Oregon, and Washington gathered virtually to discuss the road ahead.

"[T]he legal landscape at the national level is truly devastating," said Lisa Matsubara, general counsel and vice president of policy at Planned Parenthood Affiliates of California. "So, while we always knew that the protections under Roe were the floor, we are now seeing how far anti-abortion legislators in other states would go."

By Matsubara's count, 13 states have enacted total or "near-complete" abortion bans, and 13 others with abortion-hostile policies are "gearing up for a new legislative session, with even more extreme proposals in place." These proposed policies, she said, penalize abortion providers, people who facilitate abortions, and — in a newly extreme deviation even for anti-abortion laws — patients themselves. "They also try to prohibit people from accessing basic information about not just abortion care but basic sexual, reproductive health care in their home state," said Matsubara. (We're already seeing this dynamic play out in Idaho, which has no such policy yet, but where the University of Idaho is no longer providing students birth control, citing a cautious approach to the state's new abortion ban and existing abortion policies.)

Western states are absorbing the impact of these policies, and it's now showing up in data. In Colorado, Planned Parenthood reports to the state where out-of-state patients come from, said Jack Teter, regional director of government affairs for Planned Parenthood of the Rocky Mountains. "We know that we see a large number of patients traveling to Colorado from Texas, from Wyoming, from the Midwest broadly, and we also are able to look at trends," he said. "And so we know that in 2021, about 1,500 out-of-state patients traveled to Colorado to access abortion care. And right now, in our affiliate we are seeing about 500 out-of-state patients scheduling appointments every two weeks to give you a sense of the scale of travel."

All kinds of factors contribute to these numbers, and proximity is just one of them. "Sometimes it's where the nearest Frontier Airlines hub is, so we see patients from all 50 states every year, and we did before the bans came into effect as well. But the volume has certainly increased dramatically," he said. "We are seeing patients who have driven 1,000 miles one-way through the night from eastern Texas. The majority of people who have abortions are already parents, and so we are seeing patients come with their sleepy kids in the back seat after driving all night."

And these are just the folks with the resources to travel, he noted: "We also have to think about what it means for those people who can't travel and who will just be denied access."

But even in states with robust protections for abortion rights, access can be complicated by the growing influence of religiously affiliated hospitals, many of which have policies banning abortion, despite its use as a common treatment for ectopic pregnancy and miscarriage, which can be emergencies if left unresolved. Kia Guarino, executive director at Pro-Choice Washington, pointed to the Keep Our Care Act, a bill that stalled out in last year's legislative session and would have set new requirements to ensure continuity of care when health care institutions merge.

Oregon has passed similar legislation successfully, said Christel Allen, executive director at Pro-Choice Oregon, prompted by a proposed — and unsuccessful — merger between religiously affiliated Providence Health & Services and Care Oregon, one of the state's largest Medicaid providers. "That was obviously incredibly concerning," said Allen. "We know that religiously affiliated health care systems can be incredibly restrictive when it comes to the reproductive, gender-affirming, or end-of-life health care options that their patients are seeking, and so thankfully we were able to fend off that merger."

Oregon and California, which both have more stringent conditions for hospital mergers, serve as an example for how Washington's system might be changed.

Guarino said collaboration across the Pacific Northwest could help "inform the most innovative policies we can possibly introduce."

"While abortion policies are local," Guarino said, "access is regional, and we recognize this is a critical path forward."

While western states have responded to anti-abortion policies since Roe was overturned, working to expand access may require more proactive imagining. Looking to the future, Onyemma Obiekea, policy analyst at Los Angeles' Black Women for Wellness/Action Project, emphasized "the importance of visioning in the [reproductive justice] world." At Black Women for Wellness/Action Project, said Obiekea, "We talk a lot about the importance of visioning for the future — the importance of being expansive in our visioning at our organization."

Visioning work has "produced a legislative package that works and moves us towards a liberated future — a future whereby we see reproductive freedom in California," said Obiekea, referring to California's new policies expanding reproductive health care access. "Another lesson is that it's possible. The visioning exercise has shown us that achieving our vision is, in fact, possible."

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