California Prepares for Potentially Massive Surge in Out-of-State Abortion Patients

The U.S. Supreme Court is set to hear oral arguments this week in a case that directly challenges Roe v. Wade, the 1973 ruling affirming the constitutional right to an abortion.

Roe guarantees the right to an abortion before a fetus is deemed viable, usually around 24 weeks. The case before the court considers whether a Mississippi state ban on abortions after 15 weeks of pregnancy is constitutional.

In the event the court does overturn Roe — giving states the option to ban abortions, as many states would likely do — abortion providers and advocates in California, an abortion rights stronghold, say they expect a surge in out-of-state patients seeking the procedure.

Shannon Olivieri Hovis, director of NARAL Pro-Choice California, said there will be national implications if the conservative-leaning court sides with Mississippi.

“We estimate that 26 states will outlaw abortion entirely or almost entirely," she said. "And if 26 states outlaw abortion, millions upon millions of women and pregnant people across this country will not have access to care.”

A recent study from the abortion-rights Guttmacher Institute estimates that the number of people traveling to California each year for an abortion would likely skyrocket — from about 46,000 currently to some 1.4 million, a nearly 3,000% increase — if the court overturns the decision and allows conservative states to completely ban the procedure.

Olivieri Hovis said California is largely prepared but faces some real challenges, including a lack of providers. According to her group, nine California counties do not have a single OB-GYN, and some 19 counties have fewer than five. And while the state does allow for a wider range of health professionals to provide abortion care, Olivieri Hovis said there are hurdles there as well.

"In order to actually be able to make that practicable, they have to get adequate training and they have to have adequate clinical experience. They also have to work in a facility that allows them to provide that care. And that's not always the case," she said.

Providers who work at federally qualified health centers that do not provide abortions may lack access to training, she says. The same may be true for those who work at religiously affiliated hospitals that prohibit the procedure.

In response, Gov. Gavin Newsom recently convened the California Future of Abortion Council, an advisory group tasked with identifying barriers to care and recommending solutions. The council is working to finalize a set of policy proposals that it will present to lawmakers in early December.

"California is really making strides to kind of shore up our abortion access here in the state and make sure that the folks in California and those who would be coming to California can access the abortion care they need," said Jessica Pinckney, executive director of ACCESS Reproductive Justice, a nonprofit group included in the new state council.

Abortion-rights advocates note that California — and the Bay Area specifically — has long served as a refuge for pregnant people seeking abortions, even before the procedure was allowed in the state.

Much of that is due to the work of early abortion-rights activists — once considered radical — who led the fight for expanded access to the procedure in California and elsewhere.

Chief among those trailblazers was Pat Maginnis, who in 1962 started the Society for Humane Abortion in San Francisco, the nation’s first abortion-rights organization.

Carole Joffe, a professor at UCSF’s Bixby Center for Global Reproductive Health, said one of Maginnis’s main contributions was helping pregnant people get safe abortions in Mexico.

"She gathered lists of reliable doctors in Mexico. She gave advice to women going to Mexico," Joffe said. "When they came back she asked them, was the doctor kind? Was he competent? Was the facility clean? And so she really was a one-woman referral service."

Joffe also highlighted a group of doctors known as "The San Francisco Nine," who in the 1960s began performing abortions on pregnant people infected with rubella after it was discovered the disease could cause severe birth defects. The doctors risked losing their medical licenses, but Joffe said the medical community rallied around them when word of their work was circulated.

"This San Francisco case had national implications," she said. "It was really instrumental in making the medical profession as a whole realize this is untenable. You know, what's legal? What's not legal? We need clarity."

Joffe said the case was also one of the reasons that then-Gov. Ronald Reagan signed a 1967 law making abortion more widely available in California, a move the Republican later said he regretted.

Joffe is reassured that the drugs that pregnant people might use today to initiate their own abortions at home are much safer than methods they used to resort to, like coat hangers. But she says they now face other challenges.

"What I do worry about is the legality of the surveillance that will occur. Already, we have seen cases of women arrested for attempting their own abortions. And my assumption is this will only increase," she said.