By Jess McCabe | 14 October 2006, 03:23

Even in the solidly pro-choice state of California, women struggle to access abortions because of a dearth of providers and the cost of the procedure, according to a report in the San Francisco Bay Guardian.

Although NARAL Pro-Choice America gives California an A+ rating on access to abortion, the Guardian reveals how the number of clinics are dwindling, and 41% of counties have no provider at all.

Spike Kahn, an ACCESS [a service which helps women co-ordinate their abortions] housing volunteer, estimated that of the clients she’s hosted, “Half already have kids, and the other half were kids themselves.”

Kahn said that working with ACCESS has “opened my eyes to how difficult it is to have an abortion in a progressive state. It seems to me that it’s like it was in the 1950s.” The situation angers and scares her, she said. “It’s not like the alternative is they’re going to be happy, healthy kids. If [the women] can’t afford to get to San Francisco to have an abortion, how can they afford to raise a child?”

Indeed, many ACCESS clients have tenuous finances and living situations. (Several women who said they wanted to share their stories had moved before we were able to interview them thoroughly.)

But financially secure women also face obstacles. Those who don’t speak English or have a preexisting health condition can have a hard time getting an abortion in today’s California. Their circumstances and stories can vary as much as their day-to-day lives do.

Some of the cases ACCESS deals with will probably occur regardless of the economic situation of those involved and healthcare arrangements. For example, the girl who was forced to flee her parents twice in order have an abortion.

But many of the cases the Guardian describes could be fixed with universal, free healthcare and universal provision.

California is one of only 17 states in the country that provides public funding for poor women seeking abortion (Congress outlawed federal funding for the procedures in 1977). In theory, any low-income woman who qualifies for state-subsidized health care can get “emergency” Medi-Cal to pay for an abortion here. But few places perform later abortions and accept all Medi-Cal patients.

Many clinics, such as the Pregnancy Consultation Center in Sacramento, used to offer that service but have stopped because the actual costs of the procedures are much higher than the reimbursement that the state provides.

California reimburses community clinics $188.08 for performing a first-trimester abortion on a Medi-Cal recipient and $265.88 for a second-trimester surgery. Other states pay significantly more.

Department of Health Services spokesperson Michelle Mussuto said in an e-mail, \x93Medi-Cal has no information indicating that clinics have stopped providing abortions for Medi-Cal beneficiaries…. The California Department of Health Services continues to review beneficiary access to care.\x94 She later added that \x93state law makes it illegal for a Medi-Cal provider to discriminate against a Medi-Cal beneficiary because of payer source. There is no requirement that a provider be a Medi-Cal provider, but once they are, they can\x92t discriminate.\x94

Nonetheless, Dockray recalls that when she became involved with ACCESS in 1996, there were 10 to 12 places in Northern and Central California where low-income women on Medi-Cal could seek an abortion up to 23 weeks. Today there are only two, and one of them sees only a negligible number of Medi-Cal patients.

Meanwhile, Nicaragua is considering introducing a law that would ban all abortion, even when the woman’s life is in danger, reports the Feminist Majority Foundation. Not many details, but this sounds like a worrying step backwards.