November 9, 2022 was a triumphant day for reproductive rights in California. That morning, 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 until 2017, it went up a record 16% from 2020 to 2024; this number points to a rise in demand that California may not be able to meet. The state still struggles to provide reproductive care, including surgical abortions, but also accessible and culturally sensitive information about telehealth options to help manage medication abortions, to many of its rural residents.
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, there are specific challenges 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.
Forty percent 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.