For Rural Californians, Abortion Is Legal. But It's Not Always Accessible

The town of Bishop lies at the intersection of two highways, Route 395 and Route 6, that in their own ways serve as a reminder of how isolated this community is. Route 395 runs north to south, mirroring the mountainous skyline that separates the town from the rest of the state. Route 6 begins here in Bishop; a sign on the outskirts of town reads “Provincetown, Massachusetts: 3,198 miles.”

This is where Megan (whose real name KQED is withholding to protect her medical privacy) has made her home for the last decade, after moving from the Bay Area.

“It’s such an exhilarating experience to drive over the mountains and discover what’s on the other side,” she said. In addition to the town’s rugged beauty, she also fell in love with the “effortlessness of community.”

The town of Bishop has a population of under 4,000, but with a number of outlying neighborhoods (officially “census-designated places”), the community is home to around 10,000 people, more than half the population of Inyo County.

In April, Megan learned she was unexpectedly pregnant. She knew that if she had to continue her pregnancy, she could. But, she thought, she didn't have to: She was in California. So, completely confident in her decision to focus on her small business now and revisit having children in a few years, she called her local women’s clinic to schedule an abortion.

To her surprise, the staff told her they didn’t do abortions. She called several other clinics but they all had the same answer. “And that’s how I found out that you can’t even get an abortion in Bishop or in the entire Eastern Sierra,” she said.

Rights vs. access

Before she needed an abortion herself, Megan had assumed that the procedure was available all across the state. Reproductive rights are openly supported by Gov. Gavin Newsom, who has promised to make the state a sanctuary for abortion seekers from all over the country.

Ever since the Supreme Court overturned Roe v. Wade, California legislators have been passing bills aimed at providing abortion access for out-of-state patients. And last month, Californians overwhelmingly voted to enshrine the right to an abortion in the state’s constitution. But Megan’s experience exemplifies how, in many rural communities, having the right to an abortion doesn’t necessarily mean having access to it.

Dr. Marty Kim, a local OB/GYN, says Bishop health clinics don't offer elective abortion services — as opposed to, for example, abortion procedures when a patient's life is in danger, or during a complicated miscarriage — because of what she calls “rural American politics.”

Inyo County is fairly conservative; in the November election, nearly 55% of voters here voted for Republican Brian Dahle for the governor’s seat. Recently, city council and school board members have faced criticism from residents and church leaders around discussions of LGBTQ+ pride events and guidelines surrounding COVID-19.

Kim believes that those reactions are part of a larger trend, one that indicates the town would respond harshly toward abortion providers. She isn’t ready to put the target on her own back by offering elective abortion procedures, despite her ardent personal support of abortion rights.

“What I think is very different and so important about being a doctor in a small town is that you get to be a town leader, whether you want to be one or not,” she said.

Kim said this conservatism is felt in the clinic where she works, too, and has contributed to her clinic’s decision not to offer abortion services.

The Rural Health Women’s Clinic is part of the Northern Inyo Healthcare District, home to the largest hospital in both Inyo County and neighboring Mono County. If the clinic started offering elective abortions, Kim said, “You'll have nurses who will refuse to participate in it or won't do it.” And, she added, “we don’t have extra nurses.”

Kim isn’t the only provider in town who is frustrated by the lack of abortion services. Dayna Stimson is a nurse practitioner at Bishop Community Health Center, a federally qualified health center (PDF) that receives funding to help underserved populations. This federal funding is what’s keeping Stimson from being able to perform abortions, not the potential for community objections.

“If funding were not an issue, I'd be willing to at least try and see what the backlash would be like,” Stimson said. “It's health care and we're not going to know what the community response is going to be until somebody decides to step up.”

The Hyde Amendment (PDF) prohibits federal funding from supporting elective abortion services, which means that for clinics like Stimson’s to provide abortions, they need to create a separate billing structure. They’re in the process of assessing the feasibility of doing so, but it’s a big lift for such a small clinic.

Logistics, planning and expenses

No matter the reason, the fact that the closest abortion clinic to Bishop is over 200 miles away makes access difficult for people like Megan. First, she tried a clinic in Reno but, faced with a four-week wait, she drove further, to Pomona.

“It was just a matter of having a long drive, getting a really miserable motel experience, and waking up at 5:30 a.m. to get it done, and then driving back that day,” said Megan. “So it can be done. It's just a lot more logistics, planning and expenses.”

Megan said she’s grateful that she had the resources to finally access her abortion, but she knows that not everyone does. One obstacle for Inyo County residents like Megan is the lack of available information. The state of California has recently created a website for abortion information, but its abortion-finder tool uses as-the-crow-flies directions, which aren’t necessarily helpful for residents of a valley surrounded by mountains.

For example, for Bishop’s ZIP code, the tool shows that the closest clinic is in Fresno, which it says is 89 miles away. But Fresno is on the other side of the Sierra Nevada, and to access it by car (there is no public transportation there), it’s a 250-mile drive in the summer or a 350-mile drive in the winter, when the pass through Yosemite National Park closes for snow. In fact, the closest clinics are in Reno, Bakersfield and Lancaster, but appointment availability sometimes means patients like Megan must travel even further.

For Megan, the financial burden was manageable, despite spending a few hundred dollars on a motel room near the clinic and gas for the 500-mile round-trip journey. And while she didn’t look for financial assistance to cover those costs, resources are available for Californians in need: Access Reproductive Justice, for example, is an Oakland-based organization that provides information and funding to people who need help accessing abortion care.

Thankfully, one cost Megan didn’t need to incur was for the procedure itself. She has Medi-Cal, the state’s Medicaid program, which covers all abortion services performed by a physician regardless of medical necessity.

Despite the anxiety she experienced walking through a wall of protestors to access the Pomona clinic, and the pain of the procedure itself, once her abortion was over, Megan said she felt immediate relief. “I felt back to myself,” she said. This is why Megan wants to make sure progress is made in continuing to remove barriers to abortion access. “Your work is not done, California,” she said.