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The California Report

For Many Rural and Lower-Income Californians, Abortion Access Remains Limited

Katie Orr
California has some of the nation's most progressive abortion laws, but gaining access to the procedure is still difficult in rural areas of the state, and for many lower-income residents.
Four women stand together outside wearing black pants, brown, blue, purple and neon jackets.
Women's Health Specialists employees (from left) Maria Barreto, Cindy Xiong, Laura Morehouse and Katrina Maczen-Cantrell, in front of the group's clinic in Chico, on Nov. 18, 2021. The clinic is one of the few abortion providers in the region. (Beth LaBerge/KQED)

Update June 24, 2022: The decision in Dobbs v. Jackson Women’s Health Organization was announced June 24, overturning Roe v. Wade and eliminating the constitutional right to an abortion.

California guarantees the right to abortion in statute and the state constitution. Our state’s abortion laws are the strongest in the United States. Both officials and abortion providers have made it very clear that abortion access in California will not change because of the U.S. Supreme Court’s decision. Read more about the overturning of Roe v. Wade.

Original story continues:

The U.S. Supreme Court will hear oral arguments today in a case challenging Roe v. Wade, the landmark 1973 decision guaranteeing the right to an abortion.

The case before the court considers whether a Mississippi state ban on abortions after 15 weeks of pregnancy is constitutional. The decision could undercut current law, which allows for abortion procedures up until a fetus is deemed viable — usually around 24 weeks.

The court’s ultimate decision could have vast implications for millions of pregnant people living in an estimated 26 conservative states across the country, where officials have long worked to restrict abortion access.

Two people with face masks sit in an office.
Cindy Xiong, left, the director of health services at Women’s Health Specialists, and Katrina Maczen-Cantrell, the executive director, meet at the group’s Chico clinic on Nov. 18, 2021. (Beth LaBerge/KQED)

But whichever direction the conservative-leaning court goes, its decision likely will have little bearing on access to the procedure in California, where the fundamental right to obtain an abortion before viability is guaranteed, and will remain so.

That assurance, however, doesn’t mean it’s always easy to terminate a pregnancy in California, especially in many rural parts of the state.

Laura Morehouse knows firsthand just how difficult it can be. When she sought an abortion about 10 years ago, she struggled to find a clinic that would do surgical abortions, and that could provide the service at a rate she could afford.

“My abortion was going to cost me around $1,000,” Morehouse said. “I made minimum wage at the time. I worked part time as a cashier. So that was terrifying, absolutely terrifying.”

Morehouse now works as an assistant at Women’s Health Specialists in Chico. The clinic, with three locations in California, provides abortions, and Morehouse says she deeply relates to patients who face even greater challenges than she once did.

A 2-story wood-paneled building.
Outside the Women’s Health Specialists clinic in Chico. (Beth LaBerge/KQED)

“These are single parents. These are young people. These are people who have minimum-wage jobs,” Morehouse said. “They can’t afford to take time off. They can’t afford additional child care. They can’t afford the gas. These are people who have to travel two, three hours one way.”

In a 2017 study, the Guttmacher Institute, an abortion-rights advocacy and policy organization, found that some 40% of mostly rural counties in California — home to hundreds of thousands of women in the state — had no clinics that provided abortions. That means even in a state with some of the nation’s most progressive abortion laws, many must travel over 100 miles to find a provider.

Like it was for Morehouse, the cost of an abortion, which rises sharply as a pregnancy progresses, also continues to be a major barrier for many lower-income pregnant people, including those with insurance. A medical abortion in California, in which pills are used to terminate a pregnancy, costs an average of $306 out of pocket, according to an analysis by the California Health Benefits Review Program, but can’t be done after 10 weeks. The only option after that, a surgical abortion, costs an average of over $1,000 out of pocket, when factoring all associated expenses.

A woman wearing glasses and a masks sits behind a desk seen through glass.
A staff member at the Women’s Health Specialists clinic in Chico checks in patients on Nov. 18, 2021. (Beth LaBerge/KQED)

In some more conservative-leaning areas of the state, where anti-abortion sentiment is strong, safety also can be a concern — both to those seeking procedures and those running the clinics that provide them.

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Katrina Maczen-Cantrell, the executive director of Women’s Health Specialists, who oversees the clinic in Chico as well as the group’s locations in Redding and Grass Valley, says community disapproval of abortion in some rural areas can drive providers away.

“We have not, in our 45 years, really managed to have local providers,” Maczen-Cantrell said. “No local physician wants to remain in the community. It was just for so long, literally, physically hostile.”

The threats aren’t just theoretical. In the early 1990s, Maczen-Cantrell’s clinics in Redding, Chico and a now-closed location in Sacramento were the targets of arson and acid attacks.

And, she said, many of those tensions remain.

“We continue to have protesters who harass, intimidate and threaten at our sites on abortion clinic days,” she said.

Yellow pieces of paper that read "survival guide" and a white sign that reads "free condoms" with a purple wrappers sits on a table.
Literature and condoms sit on a table in the waiting room at the Women’s Health Specialists clinic in Chico on Nov. 18, 2021. (Beth LaBerge/KQED)

Maczen-Cantrell’s clinic does not divulge the exact number of abortions they perform, but staff members suggested demand for the procedure remained high, despite the myriad obstacles often involved.

With the fate of Roe v. Wade uncertain, and the possibility that California could see a major influx of people from out of state seeking abortions, Maczen-Cantrell and her staff say they’re ready to help anyone who may need to travel here to get one.

But, she points out, many patients don’t have the resources to travel for several days in search of a provider. What they really need, she says, is safe, reliable care close to where they live.

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