Abortion access in San Diego is in danger; here’s why
Despite boasting more liberal abortion laws, California is facing a crisis of care
In a county of more than 3.3 million people, San Diego provides one surgical abortion clinic: the Planned Parenthood Michelle Wagner Center on First Avenue.
Planned Parenthood has become a bastion of reproductive health care in a state with a troubled history surrounding abortion rights. But despite its history, California is now one of the few states still committed to reproductive rights.
A tidal wave of laws restricting abortion access around the country are having profound impacts even in jurisdictions that do provide legal abortions. And these restrictions are expected to soon turn into outright bans after a leaked draft of a Supreme Court opinion showed the court is preparing to overrule Roe v. Wade, the landmark 1973 decision which prevented the government from excessively restricting abortion access.
California Gov. Gavin Newsom said he wants the state to act as a sanctuary for out-of-state abortion seekers. The California Future of Abortion Council found hundreds of thousands of women who have the means to travel will soon be coming to California in pursuit of safe abortions.
In March, a bill was signed into law that eliminates out-of-pocket costs for abortion services in the state. The goal is to make it as easy as possible to terminate a pregnancy even for low-income women.
But San Diego County does not yet have the infrastructure to take on this influx of people. Despite the state’s commitment to make abortion access easier, there is still a lack of clinics and lack of health care professionals to actually carry out the procedure. Chrissy Cmorik, director of education for Planned Parenthood of the Pacific Southwest, said she believes access will soon become even more difficult.
“What we are preparing for and we know is going to happen is that we are going to be taking more support from other states,” Cmorik said. “It may take longer for appointments for both people out of state, and people in California. It may mean being more short-staffed because we’re providing more work.”
When more people come, the problem of access will be exacerbated in San Diego given its lack of clinics that provide surgical abortions.
But to understand why the options are limited, it’s important to know what different methods of abortion are available.
Medication vs. surgical abortions
There are 11 Planned Parenthood clinics in the county that offer some form of abortion. Only one of them provides abortions that aren’t considered “medication abortions.”
According to a new Guttmacher Institute study, medication abortions now account for more than half of abortions in the United States, in large part due to their accessibility.
A medication abortion is usually started in a health center, then is completed at home. It involves taking two pills at different times to prompt an emptying of the uterus.
Cmorik said the procedure is very similar to a miscarriage. But even though most of the process happens at home, it is still treated with the care and attention of any other procedure.
“All of our services still will include some options counseling to ensure that the person is there on their own free will,” Cmorik said. “That they’re not being pressured to do this, that this is really their decision.”
Cmorik said an ultrasound is administered before the procedure to ensure the pregnancy is not past the 10-week benchmark. One of the limitations of a medication abortion is that it is typically only effective up until the 10th week of pregnancy. According to Cmorik, many women do not know they are pregnant by then.
“Sometimes people in the very beginning of a pregnancy still continue to spot or bleed and have what could appear to be a period, but may not be,” Cmorik said. “So there’s a lot of reasons why people don’t find out until a little bit later.”
Given this, surgical abortions may become the only option for some women past 10 weeks. But even if a woman reaches this point, she may not be aware of all her options.
Persistent problems surrounding education
There has always been a stigma around abortion, despite its ease of access or lack therof, according to Cmorik.
“We put so many rules and regulations around it, because of its stigma — not because of anything else,” Cmorik said. “It could be stigma associated with abortion providers … possibly just the stigma of running the operation and the threat there could be for the staff and the patients that are coming in.”
This stigma has been present throughout history, and has stuck even since Roe v. Wade. United Methodist Rev. Emma Moore-Kochlacs remembers being in college when that decision came down.
“It didn’t change overnight,” Moore-Kochlas said. “It took time for this to work itself in.”
Moore-Kochlacs has been providing pastoral care in the United Methodist Church for decades. She has worked with dozens of women and families who struggle with unplanned pregnancies.
“What I think mattered most in my almost 40 years of ministry was the care I could give to people in difficult situations,” she said.
Unlike many other religious leaders, Moore-Kochlas has always been strongly pro-choice.
“If they decided they did want to have an abortion, I would immediately refer them to Planned Parenthood,” she said. “They were the best resource and they could work with the woman or couple in terms of what to do going forward.”
Moore-Kochlacs has always had a positive view of Planned Parenthood and its commitment to honesty around reproductive health. She said she has been irritated over the years with third-party health clinics that claim to present women with all options regarding their pregnancy, but ultimately would never allow them to seek an abortion.
Health clinics such as Birth Choice of San Marcos advertise their free family planning services. While their website acknowledges a woman’s legal right to decide the outcome of her pregnancy, they list a plethora of considerations discouraging the procedure.
Moore-Kochlacs said she believes clinics like these are incredibly harmful to women who do not know if terminating their pregnancy is a legitimate option.
Birth Choice of San Marcos declined an interview request.
Speaking to the importance of transparency, Vernita Gutierrez, the Vice President of External Affairs for Planned Parenthood of the Pacific Southwest, said in a statement:
“We’re proud to provide access to a full range of sexual and reproductive health care services, including abortion, as well as comprehensive, medically-accurate, and inclusive sex education. All people should be able to decide if and when to start a family, and have access to the information and health care they need to lead full, healthy lives.”
In the past few years, however, Planned Parenthood has taken significant hits to its ability to provide unfiltered education around reproductive rights. Perhaps the biggest factor in that is the abatement of Title X.
Funding issues after the Title X gag rule
Title X was implemented in 1970 to provide affordable reproductive health care to low-income people. In effect, it provided Planned Parenthood with a lot of funding. By 2016, more than 4 million people relied on Title X for access to reproductive health care.
It did not provide federal funds for abortion — something the Hyde Amendment explicitly prevents. It instead funded clinics and allowed them to focus resources on education and awareness, in addition to services such as wellness exams and providing birth control.
In 2019, the Trump administration implemented a gag rule on Title X. The rule prohibited clinics from telling patients how they could safely and legally seek abortion.
“If somebody asks us where they can get an abortion, we can’t tell them where we can provide it as an option of pregnancy,” Cmorik said. “Which really goes against best medical practices of informed consent, because informed consent is about knowing all of your options.”
Because of this, Planned Parenthood clinics in San Diego County had to make a choice: continue to receive funding but be unable to be completely honest with patients regarding all of their reproductive options, or refuse Title X funding.
Planned Parenthood chose to refuse the funding.
“We as Planned Parenthood made the decision that we were not willing to do that,” Cmorik said. “So we decided to step back from the program to continue to provide these services, because so many people in our service region and across the country for Planned Parenthood rely on us for their care.”
The gag rule on Title X is a big reason access to reproductive health care is limited in San Diego County. Withdrawing from the program’s funding cut the ability of clinics to provide family planning in half.
One of the biggest consequences of this was the scaling back of education programs that were crucial to informing women around the community about the options available to them.
“It made it difficult that we weren’t able to provide more education to young people,” Cmorik said. “It stopped our prevention efforts more than anything else.”
Last year, the Biden-Harris administration repealed the gag rule on Title X. But the amount of changes health clinics had to go through to adapt to the turbulence makes it unlikely they will ever operate at the same capacity.
The politics dissuading improvement
For many health clinics, the solution to all of this is not as simply as receiving Title X funding again.
For one, the program’s funding was significantly reduced after the gag rule. Rejoining would not be as beneficial as it was before.
But on top of this, there is a fear that the next presidential administration might implement another gag rule or revoke funding altogether.
“It does make it more difficult for organizations or clinics that had to step away from the program to get involved (again), because they’re concerned about that,” Cmorik said.
Because clinics have finally started getting used to operating without the Title X funding, they are more hesitant to jump back online. It may help them in the short-term, but they do not want to become reliant on the funding and find themselves reeling when it is taken away in the future.
“I think we’re facing another really dark time,” Cmorik said. “And I think before it gets better, we’re going to see it get worse — and getting worse is what could happen with the Supreme Court.”
Politics at the local level have to be supportive of health clinics as well.
Last year, the County Board of Supervisors voted to declare San Diego County a “champion and defender of health equity and reproductive freedom for all.” It was in direct response to restrictions placed on reproductive rights in other states. The resolution also acknowledged the county will welcome women who come to California seeking safe and legal abortion.
And in a statement, San Diego City Council President Sean Elo-Rivera said:
“San Diegans need and deserve comprehensive healthcare, and that includes access to in-clinic abortions. It is critical that reproductive health clinics like Planned Parenthood continue to receive the necessary funding and support to provide safe abortions and other vital services for all those in need.”
But until clinics like Planned Parenthood are able to operate with full funding, full education services and even expand their abortion services, San Diego County will not be ready to handle the expected influx of women and families seeking reproductive health care from states that have denied them access.
“They’re not an abortion mill,” Moore-Kochlas said of Planned Parenthood. “They’re a thoughtful decision-making resource, and I really trust them for that.”