California lacks even basic tallies of abortions
With federal abortion protections eliminated in a watershed U.S. Supreme Court decision, California is preparing for a flood of out-of-state women seeking abortions as it positions itself as a stronghold for reproductive rights. Most lawmakers are even willing to foot the multimillion-dollar bill.
But amid all the politicking one crucial question remains unanswered: How does California plan for a significant increase when it doesn't know how many abortions are currently performed in the state?
Although almost every other state tracks abortion information — including how many people arrive from out of state — California is one of three that does not. The California Department of Public Health has not kept track of any abortion data since 1997. The agency did not answer why it stopped keeping data.
“Having a lack of information and data is sometimes an issue,” said Jessica Pinckney, executive director of ACCESS Reproductive Justice, which provides funding for those who can't afford abortions.
UCLA's Center on Law, Reproductive Health, and Policy estimates that post-Roe, 26 states would ban all or nearly all abortions — prompting 8,000 to 16,100 more people to travel to California seeking abortions each year.
Yet as of today, there's no centralized system collecting information on how many Californians are obtaining abortions here. Individual clinics and hospitals in California know how many procedures they perform, but it's hard to get the full picture on abortions and how much they cost, Pinckney said. The new Health Care Payments Database, which tracks insurance claims, should capture abortion procedures and medication, but the information likely won't be available until the end of next year.
In the meantime, estimating demand for abortion services remains difficult — but that hasn't stopped legislators from pushing forward with bigticket budget proposals.
Gov. Gavin Newsom and legislators pledged more than $200 million to improve reproductive health care in the state, including $40 million to directly subsidize the cost of providing abortions for low-income or uninsured patients.
Next year, most insurance plans in the state will be required to eliminate out-of-pocket fees for abortion services, meaning the money will go primarily to uninsured Californians and out-of-state residents.
The budget deal also commits $20 million over three years to establish the California Abortion Support Fund to help offset travel, child care and other costs that might prohibit a woman from getting to a clinic.
However, the number of Californians who need additional support is at best a guesstimate.
Although the state doesn't track abortions, that doesn't mean that there's no information out there, advocates say. The Guttmacher Institute, a national reproductive health think tank, is widely cited for its survey of abortion providers. The organization sends a survey to all known abortion providers in the country every three years to calculate its estimates.
“It's not like we're running blind,” said Fabiola Carrión, director of reproductive and sexual health at the National Health Law Program. “Guttmacher has numbers on abortions in California.”
Guttmacher's latest abortion survey with 2020 estimates shows the first significant increase in abortions nationwide since 1980. It estimates roughly 154,000 abortions were performed in California in 2020, a 16% increase from 2017.
Some of those abortions were likely for nonresidents, but the number isn't specified.
The U.S. Centers for Disease Control and Prevention, which conducts an annual abortion survey, does ask what state women reside in as well as where the procedure was performed. But California does not participate in the CDC survey.
The best guess on abortion numbers comes from another Guttmacher data point. Its projections indicate the number of women of reproductive age whose nearest abortion clinic would be in California would increase 30-fold as other states ban abortions.
That means 1.3 million more women, primarily from Arizona, would find themselves closest to a California clinic.
Using women of reproductive age is an imprecise metric, especially considering how abortion rates have declined nationally over the past three decades.
Those estimates are also based on driving distance and don't take into account the fact that California's transportation hubs make flying a convenient option, said Lisa Matsubara, general counsel for Planned Parenthood Affiliates of California. Evidence from ACCESS already shows women from states farther away than Arizona are seeking abortions in California, with 18 states represented among its clients.
Some questions are fairly basic: How many abortions are performed each year in California? How many women seek out medication abortions versus procedural ones?
Others are important to assess the impact of current health policy: Are there ethnic or age groups that are disproportionately impacted?
Still others seek to identify how accessible abortion care is and what the unmet needs are: How many people come from out of state for abortions? How far do people in the state have to travel to reach a clinic?
The CDC's survey includes answers to many of these questions, but California stopped reporting data in 1997.
In a separate email sent without attribution, a statement reads “the California Department of Public Health does not have information about the history of abortion-data reporting in California.”
The only window into abortions is through MediCal, the state's health insurance program for lowincome people, which covers roughly a third of all Californians. Medi-Cal data suggest that the abortion rate has been dropping among enrollees since 2014. There are no numbers on procedures among those with private insurance, those who may have paid out of pocket or those from out of state.