November 8, 2022, was a triumphant day for reproductive rights in California. That day, voters approved a ballot measure known as Proposition 1 that sought to enshrine the right to abortion and contraception in the state constitution, mere months after the Supreme Court overturned Roe v. Wade. “We have governors that won their reelections tonight in other states that are banning books, that are banning speech, that are banning abortion, and here we are in California moving in a completely different direction,” California governor Gavin Newsom rejoiced at the time.
California is one of the most progressive states in the country when it comes to abortion legislation. Abortion rights are now officially enshrined in its state constitution. State Medicaid funds and private health-insurance plans must cover abortion. But the actual experience of trying to procure an abortion can be another matter entirely. And California has not been exempt from the nationwide fallout of Roe’s overturning.
While the abortion rate in California had been steadily falling for decades until 2017, it went up by 16% from 2020 to 2024, its highest level in a decade; this number points to a rise in demand that California may not be able to meet. The state still struggles to provide to many rural residents not only reproductive care, including surgical abortions, but also accessible and culturally sensitive information about telehealth options to help manage medication abortions.
One particular challenge of expanding abortion care and access throughout California is its sheer size. It boasts the most residents of any state in the country, and according to Elisabeth Smith, the director of state policy and advocacy at the Center for Reproductive Rights, specific challenges are involved with providing abortion care in such a populous state. “There are obviously many more clinics in California than in lots of other states, but they are still really grouped around the major cities in the state, which means that there are various places in the state where you’re miles and miles from a clinic or your ability to travel to a clinic can be really difficult,” says Smith.
Some 40% of California’s counties do not currently contain an abortion provider, forcing rural Californians—especially those in the Central Valley—to travel long distances and arrange time off from work, childcare, and other responsibilities in order to obtain abortion care. When Planned Parenthood attempted to open a clinic in the Central Valley city of Visalia in 2022, conservative groups and individuals quickly mobilized to attempt to shut the plan down. Such actions are not confined to more right-leaning regions either; recently the Beverly Hills City Council withheld permits for a clinic that would offer abortions beyond 24 weeks.
It’s easy to romanticize California as an oasis for those seeking abortion care around the country, and indeed the Guttmacher Institute estimates that in 2023 about 3% of abortions in the state were performed on non-California residents seeking care they were unable to obtain in their home states. But Smith feels that number doesn’t necessarily tell the full story of California’s relative scarcity of abortion resources for its own residents. Smith points to a 2023 report from Access Reproductive Justice that identified 345 callers from out of state last year seeking assistance and more than a thousand callers looking for help from inside California. “That’s a data point that is really rich in terms of what access looks like inside California and for Californians,” Smith says.
While rural Californians face an uphill battle, information about abortion care can remain opaque and difficult to access even for some urban residents. “Abortion bans and access issues fall hardest on communities who have faced historic discrimination and systemic barriers to access,” says Smith.
One study shows that Black and Latinx people seeking abortion care in the state disproportionately have to travel more than 100 miles to find an abortion provider that accepts public health insurance. “Due to ob-gyn department closures across California, there is a lack of reproductive health services and expertise in medically underserved communities,” says Kimberly Robinson, community liaison for the California-based group Black Women for Wellness, adding: “ERs are often the only point of contact for care for many marginalized communities. With limited options, folks are often referred to—or seek care from—emergency medical professionals who are not properly trained or equipped to meet contraception, miscarriage, pregnancy-loss, and abortion-related reproductive-health needs.”
California is frequently touted as one of the most diverse places in the country to live, but even in a state whose Latinx population is estimated at 40%, access to abortion care for Latinx and Spanish-speaking people seeking abortions—especially those who are undocumented migrants—remains fraught. Six years ago, a Latinx Californian woman named Adora Perez was charged with murder and sentenced to 11 years in prison for delivering a stillborn baby who had methamphetamine in its system at birth. (Perez was the first woman in California to be sent to prison for the death of her unborn child.) While the charges were dropped and Perez was freed in 2022, her case still sends a troubling message about how reproductive agency could be criminalized—and, specifically, who that criminalization will inevitably target—in California.
Against the backdrop of the draconian laws passed in states like Texas in recent years, it’s tempting to overlook the real challenges faced by those in liberal states, especially when that landscape is still failing some of its most vulnerable and marginalized populations. Hopefully, the anniversary of the Dobbs v. Jackson Women’s Health Organization ruling this week will inspire us all to fight for a California—and a country and world at large—where abortion access is legal and readily available for all who need it.
