Abortion access constrained even where it remains legal
In Mendocino County, religious hospitals restrict abortion and federally funded clinics are not allowed to provide it.
August 4, 2022 — Abortion remains legal in California, but there have been barriers to access since well before the Supreme Court overturned Roe vs. Wade.
In Mendocino county, where poverty is high and roads are long, religious hospitals and federally funded clinics dominate the healthcare landscape.
But the pandemic has legitimized telehealth, and the use of abortion pills is on the rise. Organizations whose mission it is to increase access are flush with volunteers.
Gloria Martinez, the Senior Director of Operations at Planned Parenthood Northern California, said her affiliate calls on an organization called Access Reproductive Justice about once a week to give patients a ride or airfare, or even to help cover the cost of abortion. Access Reproductive Justice is not accepting applications for volunteers at this time due to overwhelming interest.
Martinez says Planned Parenthood is upping its availability. “We’re actually doing good on access,” she said. “Which means that most individuals can access an appointment within seven days…the reason we’ve been able to maintain our access as such — and in some cases, depending on the week and the location, they can get in sooner than the seven days — the reason we have been able to maintain that level of access is we’ve been planning for it by increasing hours, making sure we have more evening hours availab.e weekend hours as well, and then alsoy increasing our staffing and the number of staff members who are trained to provide abortion services, not just providers, but also frontline staff.”
But religious hospitals, which manage one out of five hospital beds in the country, and all the hospitals in Mendocino County, routinely deny abortion care. In 2019, when the Mendocino Coast Healthcare District Board was looking for a larger hospital to take over the small hospital in Fort Bragg, the ACLU sent the board a letter reminding it that, as a public entity, the MCHD was required under the California Constitution to provide abortion services. The letter urged the board “to prioritize partnership with an entity that will not restrict care at MCDH based on religious doctrine.”
Dawn Hofberg is a retired Physician Assistant who is part of a reproductive access group that worked to make sure that medication abortions remained available in the former North Coast Family Clinic before it transferred to Adventist control. “It seemed like there was an agreement that whatever services were currently being provided in the community would be continued by Adventist, should they take over,” she recalled. “Of course, the biggest thing on the table was OB-GYN, which was eliminated…we could see that OB-GYN was going to be taken away, but we decided to form this group to make sure that some kind of abortion services on the coast would continue. We would very much like to have both medical abortion and surgical be options for our community, but at this point, all surgical abortions are done in Ukiah or Santa Rosa, through Planned Parenthood or other private clinics.”
The Adventist clinic provides medication abortion about once or twice a month, with referrals from Mendocino Coast Clinics through its Blue Door program. Mendocino Coast Clinics is prohibited from offering abortions because it is a federally funded clinic and the Hyde Amendment to the Medicaid appropriation prevents the use of federal funds for abortion services.
Adventist would not discuss its abortion policies with us, but in 2019, during a proposed merger with another hospital in Delano, Adventist Health told the Attorney General that, while “Medical abortions are performed in Adventist Health facilities…Abortions are not performed on demand, without medical justification.” In non-life threatening situations where a pregnant woman requests an abortion, the hospital convenes an ethics committee to make a recommendation.
Hospitals have long been allowed to deny patients certain kinds of healthcare, even when it was supposed to be a constitutional right. Lori Freedman is a sociologist and Associate Professor at UCSF, and a researcher with the Bixby Center for Global Reproductive Health. “We have a lot of conscience protections in the United States,” she said. “Some scholars have called it conscience creep. Initially, when abortion was legalized in 1973, there was the first conscience clause, the Church Amendment, that said no one would be forced to provide abortions. But importantly, that got broadened to cover institutions. Once it was determined that institutions have conscience rights, that paved the way for all Catholic hospitals to have a doctrine” which overrode the consciences of the people who work within the hospitals.
Freedman said there is a lot of good abortion legislation going forward in California, but she can’t think of a way that any of it would affect the protections that religious hospitals enjoy. On the national level, she would like to see the repeal of the Weldon Amendment, which withholds federal funding from public entities that practice so-calld discrimination against other entities that refuse to provide abortion services.
Freedman reflected that, “The Weldon is insidious, because it prevents us from making policy changes that will impact institutions that are institutionally constraining care.” She does think it’s important for people to know about, so that patients and healthcare providers can make choices about where to seek care. “But these are all individual level solutions, and what we really need is a structural one, so it’s hard,” she conceded.
And the Supreme Court does remain relevant, even in California, where its decision to overturn Roe led to a slate of protective legislative and budget measures.
Freedman cautioned that “One of the key points in this time period is that the Supreme Court is so pro-religious rights that any court case that would attempt to change the status quo could result in really worse law than already exists.