How battle over Roe v. Wade threatens San Francisco’s abortion access

Experts say San Francisco must prepare for a surge of out-of-state patients

Abortion rights are on trial in the nation’s highest court, and even California, whose state constitution guarantees the right to abortion, isn’t impervious to the potential fallout.

Should the Supreme Court vote to uphold a Mississippi state law that prohibits abortion after 15 weeks of pregnancy, California could see a nearly 3,000% surge in the number of annual out-of-state patients, according to estimates from the Guttmatcher Institute, a pro-choice research organization based in New York.

That means all patients, including those who reside in the state, could experience longer wait times for appointments and harder-to-access resource for all kinds of health care, not just abortions.

“We need to start doing some things now to address existing problems,” said Gilda Gonzales, the CEO of Planned Parenthood Northern California. “But we also must start as early as next summer to bulk up infrastructure.”

The Mississippi case directly challenges Roe v. Wade, the 1973 landmark Supreme Court case that constitutionally protected access to abortion before pregnancy reaches 23 weeks. The Supreme Court heard oral arguments on Dec. 1, but a ruling isn’t expected until next summer.

If Roe is overruled, San Francisco is likely to see a particularly large increase in the number of out-of-state patients seeking reproductive health care.

That’s in part because The City is a transportation hub for many locations in the broader region. But it’s also because San Francisco offers extensive “practical support,” said Ushma Upadhyay, a professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

“We have people who are willing to pick up patients at the airport, drive them to an appointment, or house them,” she said. “Many people are willing to leave their states for the first time (for an abortion) and need a couch because they can’t afford a hotel. San Francisco can offer that.”

Many Northern California clinics also provide specialized care for later-stage pregnancies and fetal anomalies, according to Upadhyay. Out-of-state patients might come to the area with more complicated pregnancies and with less time to seek abortions, which means any delays with securing an appointment or receiving treatment could have possibly dire consequences.

“There are some people who learn about major fetal anomalies or have significant health needs who really need an abortion later in their pregnancy in order to preserve their health and their life,” she said.

If Roe v. Wade is overturned, the Guttmacher Institute estimates as many as 26 states will severely restrict abortion access or prohibit it entirely. The most vulnerable to losing their right to abortion will be low-income individuals and people of color who already face deeply entrenched barriers to access, such as transportation, time from work and child care, among others.

Governor Gavin Newsom convened the California Future of Abortion Council in September, anticipating the potential role that California will play should abortion rights be struck down by the Supreme Court.

More than 40 sexual and reproductive health care providers gathered to discuss how California can be a “sanctuary” for people seeking equitable, affordable reproductive health care nationwide. It released a report Dec. 8 detailing 45 recommendations for how to achieve that goal.

Numerous recommendations call on state and local governments to put more money into the kind of practical support that Upadhyay mentioned — gas, lodging, food and lost wages, for example — as well as expanding the sheer capacity of the reproductive health care system.

San Francisco recently made great strides in bulking its resources in an effort to serve more patients, more quickly. Planned Parenthood opened a new flagship location on Bush Street and Van Ness Avenue in March, which Gonzales says doubles the number of visits the organization can offer as well as diversifies its services to include mental health care and expanded reproductive health offerings.

Whereas patients might have had to previously wait up to a week for an appointment, now Planned Parenthood has shrunk that wait time to one to three days, progress Gonazales hopes can be maintained even as more people are likely to seek such health care in San Francisco.

The report also recommends the state improve its reimbursement practices.

Medi-Cal covers nearly half of all abortions statewide, but those without coverage or coming from outside the state do not enjoy such reimbursement. These patients often pay thousands of dollars in medical bills, the threat of which might deter them from getting an abortion entirely.

Upadhyay noted one estimate that legal abortions would decline by 14% if Roe v. Wade was overturned, with low-income or people of color being the most likely to forego the procedure.

“That’s a lot of people not obtaining care,” she said. “And what we know is that denying abortion care can cause physical and economic hardship for years to come.”

California is one of only a handful of states to offer telehealth abortion to eligible patients, a service the report recommend could be expanded through partnerships with other states.

Consultations take place either over a video chat or over a secure messaging platform, practitioners take an extensive medical history from the patient and then a prescription is sent via mail order to a pharmacy along with heat pads, nausea medications and other useful items to support a person through the process. Afterward, there’s a follow-up consultation.

“I do think it will mitigate, but not solve the problems of the surge,” Upadhyay said.

All told, the report’s 45 recommendations lay out an ambitious path forward for how California, including major cities such as San Francisco, can prepare for the dramatic impact that would follow the overturning of Roe v. Wade.

Most abortion rights experts, though, will drive home this final point: the fight for legal, uninhibited access to reproductive care will never end.

“If you care about access to equitable, reproductive health care and abortion services, then you must be civically engaged,” Gonzales said. “It matters who our representation is at every level of government because when we elect people who are hostile to equitable reproductive health care and abortion, these types of restrictions and deterioration begin to happen.”

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