As providers are dealing with increasing numbers of out-of-state patients, rural Oregonians also face a lack of access
The leaked Supreme Court draft revealing the likely reversal of the landmark abortion rights decision Roe v. Wade is reverberating across the nation. In Oregon, as abortion providers prepare for increased need from out-of-state patients, they are also looking to improve access for rural Oregonians, where there are few clinics.
Kenji Nozaki is the Director of Affiliate Operations for Planned Parenthood Columbia Willamette in Oregon. He said Planned Parenthood has been preparing for this moment.
“I think our biggest fears are coming true,” Nozaki said. “Abortion is still legal in this country as of today, it remains your constitutional right. But we are at a crisis moment for abortion access. By this summer, we anticipate that 26 states could move to ban abortion, which would effectively impact 36 million women plus more people who can become pregnant.”
Increasing demand for care
Other than Vermont, Oregon is the only state in the nation without any restrictions on access to abortion. The right to access one is protected in the state’s constitution, meaning the reversal of Roe v. Wade would not affect the ability to get an abortion in Oregon.
The vast majority of abortions in the United States, 92.7%, are performed in the first 13 weeks of gestation, according to data from the CDC Abortion Surveillance System. 6.2% of abortions are performed between 14 and 20 weeks, and less than 1% of abortions are performed after 21 weeks.
That’s not to say abortion providers in Oregon aren’t feeling the pressure of increased national scrutiny on reproductive rights. Amid tightening laws in conservative-run states across the country, including Texas, Oklahoma and Idaho, Oregon clinics are already seeing patients travel from out of state to access abortions. Providers are bracing for an even larger increase in traveling patients if Roe is overturned.
As more states outlaw or restrict abortion access, the distance people seeking an abortion must travel gets longer.
Grayson Dempsey, spokesperson for the Lilith Clinic, an abortion provider in Portland, says they’re already noticing the impact of anti-abortion laws in other states.
“We are already seeing about 25% of our patients are from out of state, about 10% of our patients right now are from Texas every month,” Dempsey said.
Nozaki echoed a similar sentiment, noting restrictive laws in other states are already affecting Oregon clinics.
“They are needing to go further and further outside of where they live, so we're seeing that for sure, and we expect that to increase again come summertime if what the draft opinion suggests (occurs),” Nozaki said.
Access in Eastern Oregon
The constitutionally-protected right in Oregon to obtain an abortion, without restrictions, is of less comfort to those residing in Eastern Oregon.
22% of Oregon women live in a county without an abortion clinic, according to the Institute for Women’s Policy Research. There’s only one clinic offering abortions east of the Cascades, located in Bend.
The Planned Parenthood clinic in Bend offers abortions up to 14 weeks gestational age. The roughly 7% of people who seek abortions after that stage have to seek care in Western Oregon or out of state.
“People in the eastern part of our state have always had to travel for abortion care,” Dempsey said.
Besides the clinic in Bend, which is located more than 260 miles from the eastern border of Oregon, the closest clinics for many living east of the Cascades are located out of state, either in Walla Walla, Washington or in Boise, Idaho, a state which has a “trigger law” that would outlaw all abortions as soon as Roe is overturned.
“If Idaho goes dark, I think that leaves us asking, how do we ensure that they get care?" Nozaki said. "And right now, they will have to travel hundreds of miles either north to Washington, or west to Bend, or to Portland, which is a huge burden."
Areas with a lack of nearby access to abortion services, which Dempsey described as “abortion deserts,” are not unique to Eastern Oregon. Nearly 90% of people seeking an abortion nationwide reported a distance-related barrier to care, according to a study published by the Journal of the American Medical Association.
“Traveling long distances for abortion care has been associated with burdens, including incurring transportation costs, needing time off work, needing to disclose an abortion, and needing to find child care… Delays in care contribute to an ongoing cycle of increased pregnancy durations and more expensive abortions, necessitating more fundraising,” the study concluded.
Adding a distance of just five miles to reach a clinic placed a financial burden on nearly 62% of respondents. More than 19% of Americans live more than 50 miles from a clinic, a distance that financially burdened 75% of people seeking an abortion. The inability to obtain an abortion within one’s community adds a host of other obstacles, forcing the person seeking an abortion to factor in lodging, transportation and potentially child care costs, among other issues.
According to the Malheur Enterprise, Planned Parenthood is now renting a clinic space in Ontario, a town of 11,000 located in the far eastern part of the state, about an hour’s drive from Boise. Nozaki wouldn’t confirm the existence of the clinic, but said Planned Parenthood is “exploring all options to ensure that folks in Eastern Oregon have access to all the care they need.”
The lack of reproductive care options for residents in Eastern Oregon are emblematic of a nationwide problem where abortion clinics are clustered in urban centers, but limited in rural areas.
Broader Concerns about Reproductive Freedom
The potential reversal of Roe v. Wade is the culmination of decades of effort from anti-abortion activists who have pushed to overturn Roe since it was decided in 1973. However, some worry the reversal of Roe is not the end goal for the anti-abortion movement.
“I don't think that this anti-abortion extremist agenda that has worked for 50 years to overturn Roe is going to get what they wanted, and then just say, ‘Great, now we can all go home, abortion is available at the state level,’” Dempsey said. “I think we should all be prepared for them to keep moving forward with things like a national ban, things like attacks on birth control and contraception.”
“It's going to open the floodgates for states across the country to ban abortion. This is not the end goal for the anti-abortion movement, they said it themselves. Their ultimate goal is to pass a nationwide abortion ban.”
— Kenji Nozaki, Director of Affiliate Operations for Planned Parenthood Columbia Willamette
Nozaki echoed similar concerns about the future of reproductive rights in the United States.
“It's going to open the floodgates for states across the country to ban abortion,” Nozaki said. “This is not the end goal for the anti-abortion movement, they said it themselves. Their ultimate goal is to pass a nationwide abortion ban.”
Concerns about further restrictions on reproductive freedom, such as limitations on the morning-after pill and birth control, are intensifying. In the coming days, Oklahoma Gov. Kevin Stitt is expected to sign the most restrictive abortion law in the nation, banning abortion “from the moment of fertilization.”
Oregon’s neighbor state of Idaho is among those already mulling further restrictions to reproductive healthcare after the reversal of Roe, including limiting access to emergency contraception and birth control, according to the Idaho Statesman. This deepens concerns about access to reproductive healthcare for not only Idaho residents, but people living in Eastern Oregon who rely on cities like Boise and Meridian to seek care.
“We're talking about an extremist agenda that really wants to control the lives of women and of pregnant people,” Dempsey said. “And it's very scary. All of this stuff, that even five years ago, people would say, ‘It was so Doomsday,’ but this has been a very concentrated effort over many decades … (The Supreme Court) showing us that they feel like they have the power to continue to push these kinds of laws through.”
“Crisis Pregnancy Center” Confusion
Even in the Willamette Valley, people seeking an abortion must navigate a host of potential barriers in their pursuit of care.
Adding to the difficulties a pregnant person is facing during a stressful time are so-called “crisis pregnancy centers.” These centers, which are often religiously or politically affiliated, are not medical facilities, but advertise themselves as medical facilities providing services to pregnant people. They have names like “Options360 Women’s Clinic” or “Pregnancy Resource Center.” Despite often showing up as the top search results when a Google search for “abortion” is performed, they do not provide abortions and are instead known to dissuade people from seeking abortions using a variety of methods.
“We see patients and talk to patients all the time, who have been tricked into thinking these so-called crisis pregnancy centers are in fact medical facilities and the experience of having gone to a clinic like that is often really frustrating, enraging, traumatizing for patients,” Dempsey said. “Patients come to us knowing their own mind and have often unknowingly sought out care from a crisis pregnancy center, thinking that they were going to a place that was going to give them honest and accurate information and sometimes we have to work to undo the misinformation that they have received in those places.”
The majority of abortion clinics in Oregon are clustered around the Interstate 5 corridor in the Willamette Valley, but “crisis pregnancy centers” are located throughout the state. They vastly outnumber abortion clinics in rural areas.
“Pregnant? Need help? We’ve got this!” boasts the website of The Rachel Pregnancy Center in Baker City, which is located more than 100 miles from the nearest abortion clinic. The Rachel Pregnancy Center’s website claims to offer “free, confidential support and services in a safe, caring environment.”
The Center says it offers “facts” on abortion, but clicking on a tab labeled “Pregnant?” will lead users to a tab with a seven-minute long video about abortion, which features a dramatized animation of an abortion showing a cartoon fetus being ripped to pieces. The website also advertises “abortion pill reversal,” an unproven, potentially harmful hormonal regimen that is dubiously claimed to reverse pharmaceutical abortion. There’s no evidence to suggest this so-called treatment can reverse a pharmaceutical abortion, according to the American College of Obstetricians and Gynecologists.
Only in small font at the very bottom of the center’s webpage does it disclose the center does not provide or facilitate abortions.
An unpopular decision
The Supreme Court’s draft opinion is not yet finalized, meaning Roe v. Wade is still the law of the land. However, most states already place limits on abortion access. A total of 26 states are set to completely ban abortion should Roe v. Wade be overturned, according to the Guttmacher Institute, a reproductive health nonprofit.
The decision to overturn federal protections for abortion access is an unpopular one with the general public — 61% of Americans support access to abortion, according to a recent survey of 10,500 adults by nonpartisan think tank Pew Research Center, while 37% believe it should be illegal in all or most cases.
Abortion access and availability currently vary between states. Nationally, only 38% of women aged 13-44 live in a state supportive of abortion rights, according to the Guttmacher Institute. The figure does not account for gender non-conforming or transgender individuals seeking abortions. Of all pregnancies in the United States between 2015-2019, 46% were unintended, and 34% of unintended pregnancies ended in an abortion.
Despite the uncertain future of abortion rights in the United States, the demand for care will not cease, nor will the controversy around abortion.
After the leaked draft decision, groups like the National Abortion Rights Action League are working to galvanize pro-choice activists.
“We need to brace for a future where more and more people are punished and criminalized for seeking and providing abortion care. Now more than ever, we must support those working to provide abortion care and elect champions who will relentlessly fight for reproductive freedom and take bold action to safeguard abortion rights,” NARAL campaigner Mini Timmaraju said in a statement.
Even in Portland, anti-abortion activists have a long history of protesting abortion providers, sometimes violently, such as when anti-abortion activists set fire to the now-closed Lovejoy Clinic in 1992. The presence of anti-abortion protesters persists in Portland, and Dempsey warns against a false sense of security in a region that’s seen as solidly pro-choice. There are often anti-abortion protesters in front of the Lilith Clinic, who Dempsey says harass the clinic’s staff.
Despite opposition from some anti-abortion members in the community and a changing national climate regarding reproductive freedom, Dempsey says the Lilith Clinic is undeterred in its mission to provide care to all patients who visit.
“While the statement from the leaked opinion was devastating, it wasn't something that came as a complete surprise,” Dempsey said. “I really think I can speak on behalf of everybody in our clinic and say, the people who work in our clinic are there because they are so passionate about making sure that people can get the abortion care that they need, that nothing is ever going to shake that resolve.”
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