Additional constraints may be on the horizon. Republicans who support abortion restrictions are more than Democrats in the state legislature, and while North Carolina’s governor, a Democrat, has so far vetoed bills to further restrict access, a Republican governor, or future trials to redraw district boundaries may give Republicans the advantage of reaching one veto-proof majority.
In some ways, California is the opposite of North Carolina. The state’s only restriction is on abortions for viability (when the fetus could survive outside the womb), except when the patient’s life or health is in danger. The California government has promised financial resources and legal protection for people who need reproductive care. And unlike North Carolina, most of California’s neighboring states will retain access. Yet California is a critical destination for out-of-state patients in need of abortions because of the state’s financial support and reputation for access. Los Angeles in particular receives about 100 patients from abroad a month, according to Dunlap. She expects that number to double next year and continue to rise for the next five years.
“We have long known that we play an important role in the national dynamics of sexual and reproductive health care,” Dunlap said. In addition to its community resources, Los Angeles clinics are designed to accommodate traveling patients. “We have built an infrastructure, especially for abortion, that is flexible and capable of expanding, that is consciously aware of hospital partners, aware of travel centers, aware of the politics and the communities in which we are located,” she says.
The California legislature is taking a relatively bold push to protect reproductive rights. Right now, lawmakers are considering one 13-bill package based on recommendations in a report from the California Future of Abortion Council. A bill bans the investigation, prosecution or imprisonment of anyone in California for terminating or losing a pregnancy. Another proposes a California Reproductive Health Service Corps to provide health care, including abortion, in underserved communities. Two bills protect doctors from lawsuits or having their licenses revoked to perform abortions.
Part of this proposal would be to create a government website to help anyone look for providers, health centers, available services, the nearest airport and resources for funding. “This could be extremely helpful, not just for California, but for people outside of California’s borders,” Nash says. (Washington state and New York have similar sites.)
Access to abortion outside the state will be much more difficult for people in lower-income communities. While online information moves more fluently than people do, the digital divide means that not everyone has access to computers, smartphones or Internet services. Other people may simply not be aware of the resources at their disposal. Many people do not know about abortion pills or that they can be obtained by mail. Some may not be aware of telehealth options – or independent sites like Plan C, Aid Access, Hey Jane and Choix, where customers can order pills, including regular contraception and emergency contraception.
They may also not know about the financial assistance from states and non-profit organizations for travel and medical expenses, or how widely it can be used. Dunlap says Planned Parenthood LA provided over $ 4 million in uncompensated care last year. It includes coverage of flights, bus tickets and Uber trips. “Everything you can imagine,” she says. “And we budgeted significantly more than that for next year.” A big challenge will be getting that message out, she says.