The stunning leak of Justice Alito’s draft ruling overturning Roe v. Wade has, in dramatic fashion, pushed California and its Western neighbors to the fore of the movement to protect access to abortion. Over the past week, Governor Newsom has vowed to both codify the right to an abortion in the state’s Constitution and make the state, which has had legal abortions since 1967, something of a sanctuary for those from other parts of the country seeking abortions.
For abortion rights advocates, this is positive news. But there’s an underlying problem—Newsom’s sprawling ambitions could well run up against the reality that the state just doesn’t have enough providers.
According to a recent Guttmacher Institute report, when data was compiled on abortion providers around the country in 2017, California was found to have 419 facilities providing abortions, but 40 percent of the counties in the state, all of them rural and sparsely populated, had no such facilities. In conservative parts of the state, abortion clinics have been targeted for attack in much the same way as they have in other parts of the country. In these rural regions, despite California’s reputation as a liberal haven, abortion access isn’t really that much easier than it is in more conservative states with far fewer abortion-providing facilities.
The Guttmacher Institute estimated that just over 15 percent of all abortions in the United States each year are carried out in California. Since California’s population is 12 percent of the US total, that means the state is already overrepresented when it comes to providing abortions. Should more than half the US states stampede to ban abortion, California, New York, and other states that have pledged to welcome those seeking the procedure will have to massively ramp up their reproductive health care infrastructures, especially in areas that are already underserved, in order to meet escalating demand.
That means training and hiring more specialist doctors; it means building more medical facilities; it means massively ramping up an infrastructure to deal with an influx, potentially, of hundreds of thousands of patients each year seeking abortions they can no longer access in their home states.
Last week, I wrote about the CARE Courts proposal that Newsom has pushed to mandate that counties provide mental health services to homeless, seriously mentally ill individuals, and to compel those individuals to accept treatment. Several progressive groups reached out to me to argue that Newsom’s plan is doomed to failure because there simply aren’t enough care providers to provide wraparound services to the tens of thousands of people who need them. In other words, they argued, it’s a plan that seems good on paper but could well fall flat simply because there aren’t enough counties with the specialists to make it workable.
It’s certainly possible that similar shortages will bedevil efforts to make California a sanctuary state for anyone seeking an abortion. Sure, some abortion providers will likely leave states where their practice is now illegal, and relocate to California, New York, and other more tolerant states, and that will alleviate some of the staffing shortages. But many won’t. Many medics for whom providing abortion services is but one part of a larger practice will stay put and simply cease working in the area of abortions. As a result, at least in the short term, California might well struggle to meet surging needs for abortion services.
Similar staffing issues are impacting abortion clinics in Oregon, which has strong protections for abortion, but which has also seen a surge of patients from nearby anti-abortion states such as Idaho in recent years. Washington, Nevada and Hawaii are the other Western states that also have enacted strong protections for abortion in the past decade.
In all of these states, at least in the short term, access to abortion won’t be restricted because of the Supreme Court’s decision. But if patients flood in from out of state, clinics might well end up with longer wait-times for procedures, and, despite the promises of Governor Newsom and other West Coast leaders, already overstretched providers might well struggle to keep up with demand.