California’s status as an abortion sanctuary post-Roe v Wade is uncertain

There was an alternative, the protester said: Obria Medical Clinic, a local arm of a Southern California nonprofit started by a Catholic antiabortion advocate after her own abortion. On its sleek website, Obria says it’s “dedicated to preserving and protecting human life.”

The Fresno clinic, tucked away in a suburban office complex about 10 minutes away from Planned Parenthood, is a modern heir to what state regulators and abortion rights advocates call “crisis pregnancy centers.”

Though California is famously home to more than a quarter of the nation’s abortion clinics — 168 facilities as of 2021, according to UCSF data — they’re outnumbered by an estimated 179 crisis pregnancy centers.

These antiabortion centers with varying religious or medical credentials often advertise reproductive care, but attempt “to intercept women with unintended pregnancies” and persuade them, while under intense time pressure, to parent or opt for adoption, according to a report in the American Medical Association Journal of Ethics.

“They strive to give the impression that they are clinical centers, offering legitimate medical services and advice, yet they are exempt from regulatory, licensure and credentialing oversight that apply to health care facilities,” wrote authors Amy G. Bryant of the University of North Carolina School of Medicine and Jonas J. Swartz of Duke University. “The religious ideology of these centers’ owners and employees takes priority over the health and well-being of the women seeking care.”

In 2015, California attempted to require unlicensed centers advertising reproductive care to more clearly describe their medical qualifications, and for all licensed clinics to offer information about abortion. The Supreme Court sided with lower courts that struck down that policy in 2018.

Today, like Planned Parenthood and other abortion providers, Central Valley antiabortion centers position themselves as an answer to broader public health issues that stem from a lack of information about sexual health, access to contraceptives and deeply unequal health care.

As of 2018, Tulare County had both California’s widest racial gaps in teen pregnancies and the state’s highest overall adolescent pregnancy rate, at 29 births per 1,000 girls age 15 to 19 — five times the teen birth rate in Marin County. In Fresno, the infant mortality rate is almost twice as high for Black babies than any other groups, county data shows.

Antiabortion centers and the limited options they provide are just one barrier.

While California has far more abortion clinics than most states, more than a dozen California abortion facilities closed from 2011 to 2016, a Bloomberg analysis found, due to a range of political and economic factors. Two major concerns, Olivieri Hovis said, are low insurance reimbursement rates and hospital consolidation, where religious or other private ownership groups may acquire a facility that offers abortion and then end the practice.

Those trends make city-level debates about new clinics, like Planned Parenthood’s proposed Visalia outpost, more crucial — and vulnerable to California’s notorious brand of “local control” development politics. It was just a few months earlier, this past winter, when Obria Medical Clinic opened its doors in Fresno with little public fanfare.

The clinic is run by CEO John Gerardi, an attorney and radio host who also leads the Central California Right to Life group that protests Planned Parenthood. The Fresno clinic advertises an OBGYN on site, but like the executives of some clinics that do offer abortion, Gerardi is not licensed to practice medicine in California; a LinkedIn account describes his work at Obria as “establishing a prenatal healthcare clinic serving lower-income women in Fresno.”

Gerardi, who did not respond to multiple requests for comment, joined Obria’s national network during a growth spurt. Its website lists 10 California clinics, including a Bay Area division under the name “Real Options” with locations in Oakland, San Jose and neighboring suburbs.

If all goes as planned, it’s just the beginning. In 2019, Obria’s parent organization won a federal contract worth as much as $5.1 million for family planning services — a feat the left-leaning Campaign for Accountability described as the result of efforts “to camouflage their religious operations in order to receive federal funding.”

It’s a model that other abortion opponents are watching closely.

“Catholic and pro-life leaders have doubled down on plans to make this era the high-water mark of California’s abortion supremacy,” the National Catholic Register reported earlier this month. Obria’s expansion, plus efforts like encouraging more parishioners to foster children, the article added, could “provide a model in other states where abortion interests dominate.”

The cost of access

For Shantay Davies-Balch, working to advance reproductive justice policies where she grew up in the San Joaquin Valley can feel a lot like being stuck on “a hamster wheel.” Every day she hears about grinding poverty, glaring racial disparities and daily indignities like grossly overpriced IUDs or antiabortion doctors who refuse to detail pregnant patients’ options.

Even with 13 new state abortion access bills proposed in Sacramento this year, Davies-Balch is skeptical about local change. In Fresno, she said, it might require enacting term limits for local politicians who control public health budgets, or finding new ways to permeate political echo chambers where self-styled “pro-choice” and “pro-life” factions rarely interact.

“You’re just going around and around and around,” said Davies-Balch, CEO of Fresno maternal health-focused policy advocacy group the BLACK Wellness & Prosperity Center. “You’re saying the same things to the same people who are already in your court.”

A 2019 Kaiser Family Foundation report attributed the Central Valley’s lagging reproductive health outcomes, including high rates of some sexually transmitted infections, to several factors. Among them: a “severe” shortage of medical personnel, a lack of perceived opportunities for young people, high rates of sexual violence and “two-track” health insurance, where patients with Medi-Cal have fewer options for all kinds of care.

Another dynamic that isolates the Central Valley from the rest of the state is how Kings County, just south of Fresno, recently became the first California jurisdiction in decades to charge women with murder after they experienced a pregnancy loss. Adora Perez and Chelsea Becker were jailed in 2018 and 2019 after delivering stillborns that tested positive for methamphetamine at the same Adventist hospital in the county seat of Hanford.

Their convictions were later overturned after appeals by attorneys and civil rights groups outside the Central Valley. Earlier this month, the district attorney who prosecuted the women, Kings County Republican Keith Fagundes, appeared to be defeated in an upset primary election focused on harassment allegations against him.

Attorneys for the women are heartened by their clients’ releases, plus a state bill, AB2223, that would clarify California law and ban future pregnancy-related prosecutions. But the measure is staunchly opposed by antiabortion groups, and recovery is painful for the two California women already punished for their loss. Some advocates worry that other “rogue” prosecutors could still test the law to court voters in conservative areas.

“I don’t think you ever get over that,” said Perez’s San Francisco lawyer Mary McNamara. “This is just the start of cases like this, in California to some extent, but in half the country.”

A group of Bay Area lawyers, including McNamara, are offering free legal services to other people running into issues related to pregnancy or abortion. In the meantime, state politicians are debating a laundry list of proposed laws.

One bill, AB2134, would provide more grant funding for birth control and abortions for low-income patients, which advocates say would quickly open up providers to more patients in underserved areas. Another measure, SB1142, would create a “practical support fund” to help cover transportation, child care and other necessities for people seeking abortions.

Laura Jiménez is encouraged by AB2586, which would create a California Reproductive Justice and Freedom Fund to support community groups already working on access issues — a key step, she said, in reorienting services for “the most marginalized” women and LGBTQ people.

“It has to be more of a trickle-up,” said Jiménez, executive director of statewide advocacy group California Latinas for Reproductive Justice. “Things don’t really trickle down.”

As the policy debates continue, some abortion rights advocates are juggling more dire concerns — namely, whether long-standing backlash could boil over into vigilantism or violence. Twice since a draft Supreme Court decision in the case that could overturn Roe v. Wade was leaked, Davies-Balch said her Fresno organization has called the police after discovering video surveillance of unfamiliar men surveying the space late at night.

Direct threats have surfaced in cities including San Francisco, where a man was charged this spring with stalking and other offenses after “attempting to barge into operating rooms” at a women’s clinic. Across the country in Maryland, a 26-year-old California man was recently arrested outside the home of Supreme Court Justice Brett Kavanaugh with a gun and zip ties, in part, he reportedly told officials, because of anger about the Roe reversal and gun violence.

At Planned Parenthood, California staffers used to contending with protesters are encountering violent extremist groups like the Proud Boys, said Lauren Babb, vice president of public affairs for the Planned Parenthood Mar Monte division that covers the Central Valley. With other states poised to close clinics, one concern is national antiabortion celebrities and activists refocusing their attention on more visible California providers.

“How do we proactively keep people safe?” Babb said. “That keeps me up at night.”

‘Pregnancy pacts’

Growing up in Tulare County’s sprawling patchwork of agricultural communities roughly the size of Connecticut, Rivera remembers school sex-ed was brief, heavy on “don’t do it” messaging and involved shimmying at least one condom onto a banana.

Rivera was mostly raised by a single mom, who immigrated from northern Mexico, in the Central Valley town of Dinuba — population 25,000 and a major exporter of frozen Mexican food. In the early 2000s, hallway talk about “pregnancy pacts,” where girls at school planned to have babies at the same time, was more common than conversation about abortion.

That world started to expand a decade ago, when Rivera moved to a Visalia apartment complex for what the government calls “transitional-age youth” after older siblings at home struggled with drugs and gangs. A neighbor mentioned the nonprofit now known as ACT For Women and Girls, where Rivera started to embrace their queer identity and volunteered to hand out contraceptives at local proms (catchphrase: “Don’t let a hot date turn into a due date”).

They finally got a full sex-ed class in their early 20s. Some lessons came too late.

“Me and my friends went through some very dangerous situations because we didn’t know about consent,” Rivera recalled. “We just thought, like, ‘Oh, that was weird,’ or, ‘That didn’t feel right.’”

They ended up with a full-time job at ACT For Women and Girls, teaching sex-ed in communities where students still often got abstinence-focused lessons that omitted discussion of LGBTQ identities. But that wasn’t always the plan. Around 2014, Rivera left the Central Valley to become an English teacher at San Jose State University; they were forced to come home when their mom panicked about deportation amid Trump-era immigration raids.

It was just after the pandemic hit, in fall 2020, that everything came full circle: Rivera found out they were pregnant.

There was a clinic in Fresno, they’d heard, where the gynecologist was respectful of different gender identities. So they took time off work, brought their private insurance card and prepared to go in alone due to COVID-19 restrictions — an endeavor that, even for an early-stage medication abortion, required three appointments and cost about $1,000 out of pocket.

The relief was immediate, despite the stress from draining their savings.

Today, as a new version of an old culture war rages around them, Rivera is bracing for whatever comes next. On a recent morning in a beige Central Valley office building, they sorted big bags of condoms, menstrual pads and emergency contraceptive pills: discreet survival kits to be mailed directly to young people nearby.

“We’re going to be OK,” Rivera said. “For now.”