Bridging Gaps in California's Abortion Access

California, a self-dubbed “reproductive freedom state,” scored an A+ on rePROs Fight Back’s forthcoming 50-state report card on reproductive health and rights. However, numerous barriers to abortion– a form of basic healthcare– persist in every state, California included. Jessica Pinckney Gil, Executive Director at ACCESS REPRODUCTIVE JUSTICE, California's statewide abortion fund, sits down to talk with us about the fragmentary landscape of abortion access in the state through a reproductive justice lens and progress made in bridging gaps to care.

Abortion is not accessible for many Californians, particularly low-income individuals and those living in rural areas, and fewer than two-thirds of counties in California have abortion clinics, leaving some residents hundreds of miles away from care. Transportation, childcare, unreliable internet access, and taking time off work can present insurmountable obstacles for many. Still, grassroots efforts and legislative initiatives are making strides toward improving abortion access in the state. The California Future of Abortion Council, a group of reproductive justice activists, researchers, providers, and patients, produced two reports featuring recommendations to improve and safeguard abortion access in the state. These recommendations have led to the introduction of 28 pro-abortion bills in the 2022 and 2023 legislative sessions and secured over $200 million in funding to expand abortion access in California.

Links from this episode

ACCESS RJ
ACCESS RJ on Twitter
ACCESS RJ on Instagram
ACCESS RJ on Facebook
The A Files: A Secret History of Abortion
Medi-Cal Resources
California Future of Abortion Council
Let's Talk About Why Gestational Bans and Exceptions Need to Go

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hey, rePROs. How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, it has been so lovely. It's been like actual spring in dc. I've had my windows open and unfortunately that has meant my kitties have like gone wild. They've been so excited to be able to sit in the windows and like the first day I had them open, I like opened them and they were like sitting in the window and very excited. And then they were like playing and running around my place and Cinder came flying and jumped on my desk and slid across my desk and like almost took out everything on my desk, my laptop, the beverages, like I luckily caught all the things before they spilled everywhere. Just an utter disaster. They've settled down a little bit now that they're a little more used to the windows being open, I'm sure, uh, it's gonna cool off again a little bit because it's not like actual spring yet. But yeah, they have been really happy to sit in the windows and it's been nice to be able to go for a walk outside without a coat and all the nice things. But that has also been, it is time for pollen. Ugh, I'd never had allergies until I moved to DC and I can feel them starting to come on. I'm going to start taking all of my allergy meds so that I can avoid getting really sick, but I can already start to feel like a little bits of it starting to come out. But that's okay. That is the price I'll pay for gorgeous weather. Uh, let's see what else is going on? Oh, let's see. I feel like that's like the big thing happening right now is being able to go outside and enjoy gorgeous weather. I think let's go to this week's episode.

Jennie: So later this week we are releasing our, uh, 50 state report card on sexual and reproductive health and rights. It's the 12th annual report card. Um, the report card actually started under Population Institute and this is the second year, uh, that rePROs Fight Back has done it. I'm very excited. Uh, we've expanded it this year to include some new indicators, uh, including gender affirming care and, uh, Medicaid, maternal health expansion. Uh, so very excited to continue to watch the report card grow and develop. Um, so that'll be out on Thursday. Um, so I'm really excited to have as a guest, Jessica Pinckney Gil with ACCESS REPRODUCTIVE JUSTICE. It's an abortion fund in California, and I, it felt really important to talk about this coinciding with the release of the report card is that state-based grades can sometimes hide what is happening, um, in some states, right? So we talk about states that are doing really well, states that are getting A grades, which California is one of, but there are still problems, uh, accessing abortion care and reproductive healthcare in those states. And so I thought it was really important to have a conversation with Jessica today to show that, to show that even though states are getting an A, there are still things that need to be done to ensure that everybody is able to access reproductive healthcare. So let's turn to my conversation with Jessica.

Jennie: Hi Jessica. Thank you so much for being here.

Jessica: Hi, thank you so much for having me.

So before we dig into everything, do you wanna take a second and introduce yourself and include your pronouns?

Jessica: Uh, I'm Jessica Pinckney Gil. I use she and her pronouns, and I am the Executive Director at ACCESS REPRODUCTIVE JUSTICE, which is California's statewide abortion fund.

Jennie: So I'm really excited to have you on, we're getting ready, uh, later this week, uh, to release our annual 50 state report card on a sexual and reproductive health and rights. And so just, it's not out yet, but now I'm sure this isn't like much of a spoiler alert, California is getting an A, but I think a lot can be hidden when you talk about like a state level grade especially. So I I'm really excited to talk to you. So we can talk about like all those things that are that kind of you miss and like that California is like really good, but like it's not perfect and we need to like talk about some of that stuff. So what, what is being hidden within this A grade?

Jessica: Yeah, it's a great question and I think it's a really important framing. Um, California has kind of self-identified as a reproductive freedom state, and I think it's really important to dive into what that means because I think it means different things to different people and, uh, from a reproductive justice perspective, um, and from an abortion funding perspective, I wouldn't say that we're entirely a reproductive freedom state. Are we in a better situation than many of our, uh, sibling states across the country? Yes. And we always wanna recognize and acknowledge the privilege that we have. And also, uh, you know, folks in California still have to travel great distances to access the abortion care or other reproductive healthcare that they might want or need. It's until folks can really access abortion care, reproductive healthcare, comprehensive health, healthcare in their homes, in their communities, um, without any barriers to accessing care. Uh, I wouldn't say we're truly a reproductive freedom state. I was actually listening to another podcast the other day where Renee Bracey Sherman from We Testify explicitly named, you know, even in good states, like the abortion clinic can be across the street from your house, but if you don't have the time off work to get there, if you don't have the childcare or family care for other loved ones, if you don't have the money to pay for the abortion or to pay for the reproductive healthcare, then it's really not accessible. Um, so I think it's really important when we think about reproductive freedom states more abortion friendly, reproductive health friendly states to really interrogate, uh, truly what it means to have access to care.

Jennie: Access is like such an important thing to talk about and it sounds so basic, but there is so much within that like, tiny word, right? Like there's physical access, financial access, you talked about so many of those important things and you know, California may have better access than, than a lot of places, but like, that's still not like amazing access for everybody.

Jessica: Right? Exactly. Exactly. Um, I always point out ACCESS REPRODUCTIVE JUSTICE. We celebrated our 30th anniversary last year and, and I always think it's important to lift that up. We've been around for 30 years, we've been around since 1993, and people are like, why and California? What is the need for an abortion? And we were founded by clinic escorts, uh, in the Bay Area who were observing that it wasn't just safely getting into the clinic, that was a barrier to accessing healthcare in California. Folks were needing to have a support person with them to be checked out after an appointment. Folks needed financial resources to get to the clinic to pay for their abortion, to pay for other reproductive healthcare services. You know, there were folks bringing kids with them to the clinic because they didn't have child care, folks couldn't even get to the clinic because they couldn't get the time off work. And so it's really, I always say it's both far more nuanced than we often are talking about it publicly and also it's very simple, right? Like abortion care is not different than any other healthcare you're trying to receive in this state and in this country. And so the same barriers to accessing a regular checkup or quality maternal healthcare or anything else are the same barriers that you experience when accessing abortion care. It's just more stigmatized.

Jennie: Man, the stigma. So much stigma. It's like the conversations have gotten so much better from when I was younger, but like there’s still so far to go to make sure that abortion isn't seen as other and like completely stigmatized.

Speaker 2: (08:57) Right? Right. It's, it's basic healthcare. One in four people are gonna access one in their lifetime. It's not, it's not any different than going to the doctor for any other medical procedure. Um, but yet there are all of these restrictions and barriers and judgments placed on people for doing what they need to do to take care of themselves, to take care of their families, to take care of their communities.

Jennie: Um, so one of the things I really think about, um, I'm from a rural area, is like California has a lot of rural areas that I'm sure have a real problem with physical access, um, to them. And I think, again, when you think of like rating a state is really well, like things like that really can be obscured.

Jessica: Absolutely. Absolutely. In California, the data is a little out of date. Um, but Guttmacher reported, it was 2020 or 2021, I wanna say that 40% of California counties had no abortion providers. Um, and while about 5-10% of California's population is represented in those counties, it's still pretty significant, right? Almost half of California, California's 50 plus counties have no abortion providers, no abortion clinics. Um, and so this is part of the challenge and accessing abortion care and other reproductive healthcare services in California on our health line, we're often supporting folks who are in the more rural parts of the state and folks are like—

Jennie: Oh, there are rural part parts of California.

Jessica: --Yes, everyone is not centralized in the Bay Area and Los Angeles and San Diego. There's the entire Central valley, the entire central California, everything between the Bay Area and Los Angeles that folks often forget. Um, and then also everything above the Bay area, like Bay Area is defined as Northern California, but when you actually look at it on a map, it's pretty central. And so there's a lot, um, of California represented north of the Bay Area, and we're often supporting folks, uh, who are coming from those more rural parts of the state. There are some really serious challenges, uh, even to providing abortion care in the more rural parts of the state. For the few who do those tend to be the more conservative parts of the state. And so there's a lot more abortion stigma. There's a lot, uh, more anti-abortion sentiment protestors, et cetera, that threaten patient safety, that threaten clinic safety. Um, and I also, uh, always point to women's health specialists, which is a clinic in northern, uh, northern California, uh, in more, some of the more rural parts of northern Northern California because they point to some real reproductive justice issues in the challenges that they face in operating their clinic or their clinics. Uh, and one of those I think is access to reliable technology, uh, wifi, right? Like, like phone lines, um, things that are necessary to run a clinic and be able to connect people in the community to the resources they need. Not reliable in parts of California. Um, also women's health specialists was really impacted a few years back by some of the wildfires that we've had in California. So literal climate change is a reproductive justice issue. Um, if you're in the redwoods, if you're in more densely like populated, naturally populated parts of the state, you're impacted by a lack of water, by fires, by, you know, any number of natural disasters. And there, there are just not as many resources as there are in the more urban and suburban populated parts of the state in terms of like fire departments or pipelines for water, like so on, so forth, right? And so I think those are some unique challenges that folks in more rural parts of the state do face on top of, you know, the challenges that many are facing in terms of like, okay, if you, if you don't actually happen to be close to a clinic in the Central Valley in northern California, you may have to travel three or four hours to the closest clinic in your home state, right? And so I really question whether that's reproductive freedom, whether that's access quality healthcare, if you can't access it within 10 or 15 minutes from your home. Not to mention, you know, we're talking about parts of the state that don't necessarily have an airport or a lot of, uh, transportation options. So folks have to take planes, trains, cars to get from point A to point B oftentimes. And so the coordination of that care can look really, really complex. And yeah, I, the that's just the tip of the iceberg in terms of what the barriers can look like, right? Again, there's still the child care, the food, the getting the time off work. Do you have insurance? Can you pay for the procedure or the pills? Like so many other things. But I think those are some of the things that are particularly unique when you're not in a clinic populated part of the state.

Jennie: Yeah. And honestly, you don't need to be like that rural, like no, extremely rural. Like my mom doesn't live that incredibly far from a decent sized city, not like huge, but like, she doesn't have internet and like the phone got real temperamental. So like she doesn't have a hardline phone, a landline phone anymore. She only has her cell phone and like while she has good reception there, I don't have good reception when I'm there. So like, there are all these things like creep up really quick that can impact your ability to like, well call to get the care, but like doing the research online if you don't have like great internet like… man, frustration.

Jessica: Yeah. Yeah. It's so true. It's so true. And yeah, it doesn't impact folks who are in, like, I think when we talk about rural parts of the state, people are thinking about like someone living off the grid in a cabin in some kind of deserted area. But no, we're talking like 20, 30 minutes outside of San Francisco and Oakland or Los Angeles. We're not talking about super far out, like off the grid locations. We're talking about folks who like go to regular jobs every day who are raising families in regular homes and regular circumstances. It's, uh, but yeah, don't have access to basic internet, phone lines, et cetera. And that's not something that folks really comprehend if you haven't experienced it. And also don't comprehend is a reproductive justice issue. Like why, like if you have to go to the local library or like get on a hotspot or go to your local McDonald's or Starbucks or something, right? Like there are so many things that people—

Jennie: --and all things I have done at my parents' house, like having to like work on the report card or something, I was like, can we go to like McDonald's so I can like download this before I go and edit it back at home? Like I…

Jessica: --Yeah. Ugh. I have family who are in the south and are older and have never had internet in their home. And so, you know, when I would go and visit as a kid, like I'd have to go to the local McDonald's to do my homework, and it was very foreign to me coming from southern California where I always had access to internet. And you know, it's not something you comprehend as a barrier to getting healthcare or a barrier to getting education, but it, it really is and can certainly impact people's, you know, ability to, as you named, research the healthcare that they might need also to call a clinic for a clinic. You know, many clinics are operating on electronic health records and things like that at this point. They need to have reliable internet access to, to be able to, to record things and, and process payment and all of this inside their clinic. So it's really, um, far more complex than, than many realize, but also doesn't need, right?

Jennie: It feels like it should be so easy.

Jessica: Yeah.

Jennie: So like that's a, that's abortion. I'm sure there are other reproductive health and reproductive justice issues that are worth talking about in California.

Jessica: Absolutely. I mean, I, so, you know, ACCESS REPRODUCTIVE JUSTICE, we’re a practical support organization, the majority of the folks who call us are seeking support with accessing abortion care. Um, but we, we are certainly supporting folks with other needs as well. Um, oftentimes folks are just looking for resources on how to access an appointment to get testing or access to contraception. Uh, something folks always point out is California, uh, is a state that has expanded Medicaid so that Medicaid covers, uh, reproductive healthcare including abortion here in the state. Uh, but not a lot of providers don’t always take MediCal, um, because the reimbursement rates are not great. That's like a very wonky, um, not like fun political issue to talk about. But it impacts access, right? If providers can't afford to provide the care that people need. Um, because clinics and abortion providers, reproductive healthcare providers are businesses, right? Like, if they can't provide the support that people need because the financial barriers, then that adds to the barriers for folks who are trying to access that care. Um, so I always like to shout out MediCal because so many are eligible for MediCal here in California and do have increased access to abortion care and reproductive health through their MediCal benefits. And also we still have work to do to expand MediCal. We also, you know, I think high copays and deductibles on private insurance plans have been a barrier that many have communicated experiencing here in the state, and we've done some work to help reduce that, but I, we still have work to do. Um, there are a lot of insurance plans that are not on the exchange, that don't, that are kind of like a, you know, get around, um, get around eliminating copays and deductibles, cost sharing. So that's another barrier. Uh, we're definitely seeing an increase in, uh, support requests around, um, transgender care, um, supporting folks who are transitioning, um, and who, who need the full range of reproductive healthcare, which does include trans and gender non-binary folks. Uh, also California has, I, again, I'm not the expert on this, I think there's three or four anti-trans bills, um, in the state this, this legislative session. And so, you know, again, folks think California is this really progressive blue bastion over here on the left coast, but it's in pocket, right? It's in pockets of the more restrictive parts of the state and the, those legislators are really pushing, uh, to take us back. And so we have a lot of work to do to make sure that we're supporting our trans and gender non-binary folks, uh, throughout the state and beyond, and accessing the care and support that they need.

Jessica: So that's another issue that's really concerning. And I think this is abortion related, but also broader reproductive healthcare related. You know, something that's also happening in more rural, uh, parts of the state is there are new abortion providers and clinics that are trying to open and expand access to care throughout the state to meet a, a growing need, right? Folks are coming to California from other states. California is a highly populated state, so there's always a need here. Um, and folks are facing resistance. And I'll say this is happening in more rural parts of the state, like Fresno, the Central Valley. This is also happening in the heart of Los Angeles, in the heart of LA County, where an all-trimester care clinic was trying to open, uh, last fall and was basically thwarted by the Beverly Hills City Council, which colluded with the mayor to ensure that this clinic could not open. Um, and so, you know, local politics, state politics matter. Again, there are progressive parts of this state. There are pro-abortion parts of this state. There are quote unquote reproductive freedom parts of this state. And then there are parts including places that we think of as very abortion friendly and reproductive healthcare friendly, that are doing everything possible to keep attention away from themselves, to continue to stigmatize abortion, to not want to get into the politics of providing abortion care and reproductive healthcare in their county and their city. And really what that does is just further stigmatizes care that people want, need and deserve.

Jennie: I'm so glad we were able to look at some of those real barriers that are in states where that are getting As, because I think so often people just assume everything is great in some of the states that, like you said, are seen as reproductive freedom states are, um, see themselves as reproductive freedom states that there's still a lot of lack of access underneath that. Um, so what, what needs to be done in California to like, make it an actual reproductive freedom state?

Jessica: I think we're trying to do a lot of it, right? So, um, there was a group of advocates, activists, researchers, providers, patients that came together after the SB8 decision in, um, in Texas back in 2020. Uh, and we came together and really thoroughly assessed the abortion access landscape in California and how we were impacted by other states, right? Because I think that's something that folks don't think about, like what happens in Texas, what happens in Oklahoma? What happens in New Hampshire impacts what happens here in California? Um, and so we put together a comprehensive set of recommendations. It was about 45 recommendations that we made to the governor and the California legislature. And it was everything from how to improve clinical provision of care, to how to expand practical support, uh, clinic safety, patient safety, support, safety, expanding the provider pipeline here in California, and ensuring that it's a diverse pipeline that can represent the diversity of individuals experiencing a need for reproductive healthcare in the state. Um, it was really an expansive report and, uh, based on those recommendations, uh, the legislature at this point, after two legislative sessions has passed about 30 bills based on those recommendations some more. It's really amazing. And, you know, it's technical. Some of it's very technical, but it's important. It's important. And, uh, the, you know, the devil is in a lot of the tiny little details. So, uh, I think that nuance is really important. And along with those, um, bills, the, the governor has invested about a million in expanding abortion access in the state. And that's everything from uncompensated care to providers who are providing no or low-cost abortion care to folks in the state, a practical support fund to help cover the cost of airfare, lodging, childcare, food, and other needs that folks may have to access care here in California. It includes funds and incentives for providers who are trained in providing abortion and other reproductive healthcare services. It includes some of that infrastructure work around clinic safety and technology, et cetera. So I think we're on the right path. I think I would really like to see an expansion of all trimester care in the state. Um, there are very few, uh, providers here in California who, um, can provide, uh, abortion later in pregnancy. And I think that's a, a real barrier for folks, right? Because as we know, people get pushed later into, um, their pregnancies for a number of reasons, whether it be economic, trying to get their resources together, finding a provider, getting the time off work, getting all their affairs in order, right? Or issues later gestationally and, and require them to have abortions later in pregnancy. Um, and there are just very few providers who can provide that care here in the state. And of course a lot of stigmatization, again, that comes along with, uh, later abortion. Um, so I think we really need an expansion in the range of abortion care that we can provide in the states. We really, uh, I think as I was just naming, need to improve, um, transgender, gender affirming care for folks in the state, um, and really do more to, to really integrate it with reproductive healthcare. The biggest thing I think, and this, you know, is, uh, the thing that feels like it should be so obvious, um, but also seems to be the hardest, is just saying abortion, making abortion common, making it reasonable and understandable, right? Like, this is something that folks access every day in their lives. It's not any different than going for your regular checkup to a dentist appointment, et cetera. And so much of the, the barriers that we've talked about today are impacted by the politicization of abortion care, the stigmatization of abortion care.

Jennie: A right is not is just a word. If you can't actually access the care.

Jessica: Yeah. It's, it's rough out here, you know, and I think there's so much shame that people carry around doing something that is very common. And I think that's something that we hear a lot on our health line and they're always trying to support people through support, asserting their bodily autonomy, making the decisions that are right for themselves, for their bodies, for their families. And yeah, I think when we can, I always joke, like I say abortion more than I say my partner's name, right? Because it's a common conversation in my life at my dinner table, in all the work I do personally, professionally, spiritually, et cetera, right? And so I think the more we can do to destigmatize abortion that helps, it's a, it's a snowball effect and helping to reduce the barriers because so many of the barriers are political barriers.

Jennie: Yeah. And I often just think of like, you know, hearing from abortion storytellers and hearing about like the stigma they internalized, like they didn't have it, but they felt it put on them. Like having these more open conversations helps look.

Jessica: Absolutely. Absolutely. Yeah. So much of it is internalized, right? Like we're living in a capitalistic, paternalistic society that places shame on folks. You know, folks don't even realize people would've gladly driven them to the clinic, right? But there's so much like veiled secrecy right around, um, basic healthcare. And so, uh, yeah, folks sit in a lot of, of shame that they don't necessarily need to. Um, and so hopefully we're doing everything we can to, to lift the, lift the veil and talk about what is simply part of asserting your bodily autonomy.

Jennie: Okay, before I let you go, we always like to ask what can our audience do? So how can our audience get involved in this?

Jessica: I mean, say abortion, say it loud, say it proud, say it more than you say your partner's name. Um, I think that's really important. I think that it's really important to support your local abortion funds. There are funds throughout the country in every state, sometimes more than one in your state. Um, and they're doing the really important work of getting financial resources directly into the hands of people who, uh, need or want to have abortions. Um, and so I think that's really important and I think it's also really important to pay attention to what's happening at the local and state level. I personally am tired, right? Like I'm tired of our government. The systems are not working for folks. Um, these systems were never meant to work for us, and I fully recognize that, um, particularly at the federal level, but you know, going to your local city council meetings, going to your local school board meetings influencing, uh, your local legislators is also hard and disheartening. Um, but I have seen there be some movement at the, the local level and an ability for us to hold local officials, um, more accountable than we can sometimes hold our federal officials. So it's a both/and, right? Like in some ways I see, uh, that work as harm reduction. It, it's not going to save us. It's to get to reproductive freedom. We really need to abolish a lot of the systems that are in place and, and dream anew in liberation. And we're operating in the systems we have now, and I think there's still influence that we can have, and that's important to recognize.

Jennie: Jessica, thank you so much for being here. It was so much fun. Get to get to talk to you again. Yeah,

Jessica: It was so fun to get to talk to you too. It's been a while, but I love everything rePROs Fight Back does. So grateful for you lifting the veil around everything, abortion and reproductive healthcare.

Jennie: Okay, y'all, I hope you enjoyed, uh, my wonderful conversation with Jessica. It was so wonderful to get to talk to her. It's been a while since she's been on the podcast. Um, and so it was what a wonderful to get to catch up and learn that, you know, even though states are getting an A, that doesn't mean there aren't problems lurking underneath. And it was really important to have that conversation because that can be hidden when you talk about state level grades. So it was really important to me that we have that deeper conversation. Uh, so I hope you all check out the report card when it comes out on Tuesday. It'll be on our website at reprosfightback.org/reportcard, so check it out. Also, if you've signed up for our email list, you'll make, you'll get it in the email. Um, and with that I will see you all next week.

If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!