Wading without Roe
— where do you go?
California becomes a last-resort haven
for patients seeking to end pregnancies
By Audrey Tomlin • Bay City News
In September 2023, Marcela Bermudez bought a one-way ticket, stepped on a plane in Houston, Texas, and flew more than 1,000 miles to Los Angeles, California. She was 25 years old. She was 14 weeks pregnant. She did not want to be. Roe v. Wade, the U.S. Supreme Court decision recognizing the federal constitutional right to an abortion, had been overturned 15 months earlier. In Texas, abortion was banned.
Bermudez was one of nearly 7,000 patients who traveled to California from out of state for an abortion that year. She, alongside other patients who crossed state lines for abortion care, shared memories of long, costly travels, overwhelming stigma, and the need for much effort and a little bit of luck — the right friend or a supportive partner — to receive their abortions.
They voiced pain: trying to replicate the comfort of home through a phone call to a friend, moving a lifetime’s worth of belongings under the physical stress of pregnancy, fearing what might happen should something go wrong. But also, they voiced real gratitude: to the people who personally helped them access their procedures, to the people who, more broadly, are still fighting for abortion access.
Together, their stories and the insights of physicians, researchers, advocates, and legal experts sketch a broader picture of the ongoing effort in California — whether through surgical abortions or financial and logistical support or mailing abortion medication under shield laws — to aid patients from abortion-banned states in terminating their pregnancies.
Crossing the double lines
Bermudez had discovered she was pregnant two months earlier. She was expecting her period before a girl’s trip to New Orleans. It had not come. All day at work, she had felt “something was just off, like, completely off.” When she got home, she took a pregnancy test, “casually, just for shits and giggles.” She checked. One line; negative. She took a nap. She woke up. She felt a siren calling her to recheck the test. She picked it out of the trash, placed it on her bathroom counter. Two lines; positive. She bought eight more pregnancy tests at the grocery store down the street. They all came back positive.
“I literally was just devastated,” she said. “No excitement, no joy, nothing. It felt like a doomsday.”
Still, at first, Bermudez wasn’t sure she wanted to terminate her pregnancy. She never pictured herself needing an abortion. She felt alone. She spent a month considering. One day, lying in bed watching “Blueface & Chrisean: Crazy in Love” on her iPad, she came across a scene of Chrisean telling her family she did not want to move forward with her pregnancy. She stood up.
“And something in me just clicked,” she said. “I don’t know if it was an angel. I don’t know what it was, but it just dawned on me. I was like I can’t move forward with this pregnancy. I can’t imagine myself in this situation … I never wanted this for my life.”
Along came Dobbs
When the Supreme Court overturned Roe v. Wade in late June of 2022, finding in Dobbs v. Jackson Women’s Health Organization that the Constitution does not confer the right to an abortion, abortions performed in the U.S. dipped, but only slightly. In July 2022, around 80,000 abortions took place in the U.S. versus more than 86,000 the month before, according to the Society of Family Planning’s #WeCount report, which aims to catalogue the number of abortions in the U.S. by month and state.
Abortions performed in states without total abortion bans, however, rose 11% in 2023 from 2020, the last year of available data, according to the Monthly Abortion Provision Study by the Guttmacher Institute, a research and policy organization committed to advancing sexual and reproductive health and rights.
In California, where abortion is legal until viability, or the point when a doctor determines that a fetus could survive outside the uterus without medical intervention, abortion is also on the rise, according to the study. Total abortions provided in California increased 17% between 2020 and 2023 and abortions provided to out-of-state patients traveling to California increased more than 200% during the same time frame, the study found.
Thus California, alongside other states with strong legal protections for abortion, has become an important location for patients seeking abortion care as reproductive rights and access in the U.S. continue to shift.
“We have travelers from Louisiana going all the way to California,” said Isabel DoCampo, a Senior Research Associate at the Guttmacher Institute. “What these data show is that the abortion care infrastructure in the U.S. is highly connected, and that a policy that goes into effect in one place absolutely affects the ecosystem in other parts of the country.”
Making it stop
Alexandria Cardenas sought her abortion in January 2023, roughly six months post Dobbs v. Jackson. She lived in Houston, Texas, where abortion was banned. She recalled visiting a Planned Parenthood in the area. There, they provided little guidance beyond recommending that she could give the baby up for adoption.
“I think in the beginning it was really, really challenging. Nobody really (knew) what to say,” she said. “They were just like, ‘yes, you are pregnant.’ But they weren’t like, ‘oh, here’s your option.’ They weren’t like, ‘‘if you want an abortion, you should do this.’ They were just like, ‘you could adopt.’”
Still, she knew she did not want to carry her pregnancy to term. She was 23. She had graduated college that summer. She had yet to secure a job with her degree. She had broken up with her college sweetheart. She had just started seeing a new partner. She was still struggling to find stability, to figure life out. The night before she found out she was pregnant, she had been doing cocaine.
“The first thing that came to mind was, ‘I can’t have this baby. Like, there’s no way,’” she said. “I was just like, ‘what the hell am I gonna do?’”
She took a week off work. She spent it at her partner’s house distracting herself with episodes of “Ginny & Georgia.” She cold-called abortion clinics. They told her, mostly, that they were booked or that they were not taking patients from Texas. She told almost no one: just her supervisor and three friends. At one point, she called a suicide hotline. Eventually, she found a clinic in Santa Ana, California, willing to take her the next week. Her partner paid for the trip and the procedure. In total, she estimates it cost $2,000.
In California, Cardenas took the first of two medications — mifepristone to stop the pregnancy from growing — in the clinic, an older, cash-only establishment at a shopping center. The couple then drove to an Airbnb in San Diego. It was evening. It was raining outside. Cardenas remembers calling a friend in Houston, crying over the phone, wishing she was home.
“The first thing that came to mind was, ‘I can’t have this baby. Like, there’s no way.’ I was just like, ‘what the hell am I gonna do?’”
“I was just like, ‘this is … this sucks,’” she said. “Because I’d much rather have been at my house, or somewhere where I had access to a support system. It was just … It was difficult because you were doing something so personal, and you were doing it in a place that was unfamiliar.”
She took the second medication — misoprostol to empty the uterus — in the Airbnb. Almost immediately, she started cramping. And then she was in excruciating pain, curled in a fetal position, throwing up. Three hours later, she was able to fall asleep. She flew back to Houston, still bleeding, on Sunday.
A blur of adrenaline
For Bermudez, California was already the future. She was “done mentally and physically being in Houston.” She had never meant for it to be a permanent home, just a phase in her 20s, a chance to leave her hometown and try something new.
She contacted a Planned Parenthood in West Hollywood, near the aunt she planned to move in with. They offered to cover $600 of the procedure. Still, she would have to pay the remaining $493. She was living paycheck to paycheck. A friend working in sexual and reproductive healthcare advised her to contact Access Reproductive Justice, an abortion fund in California. They paid the $493 for her.
Her final days in Texas were a blur of adrenaline. She felt as though she blacked out. She was living day to day, telling herself, “I just have to get through this week, this month.” She was fixated on the singularity of her upcoming abortion. She moved at 14 weeks pregnant, physically exhausted, trying to hide her baby bump.
The morning of her abortion, Bermudez woke up early. Her appointment was around 7 a.m. The clinic felt almost like a hospital. Outside, security buzzed her in. Inside, a nurse’s station sat in the middle, surrounded by various medical rooms. She sat with 12 other patients, waiting, filling out paperwork. The others read books, chatted casually, watched the movie playing on the television. Internally, Bermudez was freaking out.
“And I’m here panicking,” she said. “I’m here like, I’m about to do this. Like, I don’t know what’s gonna happen at the end. Am I gonna be okay? Like, my family doesn’t know what’s going on. Like, what if something happens to me?”
A nurse beckoned her back. Her blood pressure was too high because she was nervous. She had to calm herself down. They gave her misoprostol. She started cramping, badly, breaking into a sweat, asking for another blanket to comfort the pain. The television was playing “Taken.” To this day, she still cannot watch “Taken.” In the background, she could hear the sound of vacuuming, of another patient receiving their abortion. A nurse walked by with a biohazard disposal. She wondered if it contained fetuses.
She waited two hours. A nurse beckoned her back again. The physician asked if she needed guidance on what to do should a medical complication from the abortion arise when she was back in Texas. She said she was not going back to Texas. She remembers music playing, and then she was asleep. When she woke up, a nurse led her to the recovery room. Next to her, a girl was bawling her eyes out. Bermudez was just happy to be alive. A friend — the same one who had recommended she contact an abortion fund — drove her to eat at IHOP, then dropped her off home with a care package.
“I’m here like, I’m about to do this. Like, I don’t know what’s gonna happen at the end. Am I gonna be okay? Like, my family doesn’t know what’s going on. Like, what if something happens to me?”
Without this friend, Bermudez thinks, she may never have found the emotional and practical support necessary to obtain an abortion. They’re not friends anymore, but she’s still grateful.
“Without her, I think I would have been a single mom in Texas,” she said. “I honestly think I would have been a single mom in Texas. Because again, people don’t really talk about these things … For me, it feels like an underground tunnel. Like you have to know someone to know what it is.”
Restructuring to meet demand
Since Dobbs v. Jackson, a network of support — of friends, partners, and family members, of politicians, abortion funds, advocacy groups, and clinicians — has fought for safe and affordable abortion access.
A physician who works at multiple abortion clinics across California described the increase in demand for abortions as “a big burden on staffing” and “a big burden on being able to pay for it” for clinics in the state. He shared stories of abortion clinics renovating, expanding, adding additional days of the week, and hiring additional staff as well as helping patients with logistics, travel, childcare, and social support to try to meet the need for abortions. He requested anonymity “for safety and privacy.”
He remembered the day Roe v. Wade was overturned. He was working at a clinic in Little Rock, Arkansas. They had foreseen the change because the decision had been leaked earlier, in May. Still, he described it as “devastating.” He remembered his colleagues at the clinic “frantically trying to reschedule patients to help get them the care that they needed.” He remembered seeing a patient he couldn’t provide abortion care for in Little Rock the next week, at a clinic in Illinois.
“It was really somber. It was incredibly sad for the patients that were there. It was devastating for all the people that worked at the clinic for so many years,” he said. “It meant that, you know, the fight wasn’t ending, it was just changing.”
Mail from afar
Yet in 2024, out-of-state travel for abortion care in the U.S. dipped, according to the Guttmacher Institute study. In California, out-of-state patients seeking abortions dropped 44% from 2023 to 2024, the study found.
Instead, strengthening shield laws — laws that protect abortion providers within a state from out-of-state legal consequences stemming from reproductive health care that is legal in that state — have allowed physicians to mail abortion medication to patients in abortion banned states.
Last year, 10,000 abortions on average were provided under shield laws in the U.S. each month, the #WeCount report found. Abortion medication delivered by mail increased from 5% in April 2022, when the organization first began tracking the number, to 25% by the end of last year. Nearly half of all abortion medication delivered nationally by mail last year was provided under shield laws, according to the report.
DoCampo emphasized the importance of shield laws and providing abortion medication by mail in expanding abortion access for women in states where the procedure is banned.
“In the last couple of years, increasing numbers of providers are able to mail pills out-of-state to individuals who reside in states with total abortion bans,” she said. “So for a certain category of patient that’s living in a state with a total ban … getting pills in the mail from an out-of-state provider might feel like a more convenient option than traveling out of state.”
Taking flight
Still, so many patients choose to, or need to, travel out of state to obtain abortion care. For some, they are beyond the gestational limit for a medicated abortion. For others, the overwhelming stigma and fear of criminalization in their home states drives them to seek abortion care elsewhere, according to Sarah Moeller, Senior Director of External Relations at The Brigid Alliance.
The Brigid Alliance works to help patients, especially those later in pregnancy, access abortions through practical support: booking flights; helping navigate airport accessibility accommodations; arranging Ubers; sending cash for pain medications; planning and funding meals, overnight accommodations, and childcare. Currently, the organization arranges for, supports, and funds 150 abortions each month. Their clients range from ages 11 to 53.
Moeller recalled clients with family members or partners actively trying to prevent them from obtaining abortion care. She remembered clients who had never traveled out of their county before, let alone across the country.
“Abortion has not been in the headlines as much in the last, you know, six to eight months,” she said. “And yet it doesn’t go away. People need this care everyday … When you need an abortion, it is extremely urgent. It’s not something that can wait for the next administration.”
Procedures rise despite bans
Last year, despite total abortion bans in more than 10 states, more abortions were performed in the U.S. than in 2022, the year the Supreme Court decided Dobbs v. Jackson. In 2024, an average of 95,000 abortions took place in the U.S. each month, as compared to 80,000 in 2022, the #WeCount report found.
This is not to say that abortion bans have not had a profoundly negative impact on abortion access, DoCampo said.
“I do think there are people who couldn’t access abortion who may have wanted one as a result of these bans,” she said. “So I think this reflects a lot of different policy changes and Herculean efforts … to get people this care.”
She underscored the politicians and abortion funds and clinicians and advocacy groups and individuals fighting for reproductive rights. There are still so many people dedicated to helping patients obtain abortion care, she said. A practical support organization. A new partner. A friend in another state.
Currently, however, shield laws across the country are being tested. In Texas, the Attorney General sued a New York doctor for allegedly prescribing abortion pills to a patient in Texas. In Louisiana, a state grand jury indicted the same doctor for allegedly providing abortion pills to a Louisiana resident. Also in Texas, a man is suing a California doctor, asserting the doctor provided abortion medication his girlfriend took.
At least one of the cases will likely land in a federal court as a battle of interstate laws, according to Alyssa Morrison, Senior Staff Attorney for Reproductive Justice at Lawyers for Good Government, a nonprofit that mobilizes lawyers to uphold civil and human rights. The result, she thinks, will largely depend on which federal courts the cases end up in. Ultimately, the cases will likely end up in the U.S. Supreme Court.
Morrison highlighted the providers she works with who have all the education and training and knowledge to provide reproductive care but could not help their patients through a miscarriage or a devastating fetal diagnosis because of the law.
“The amount of moral injury and personal distress that creates in providers is immense,” she said. “For every one of those cases that breaks through to the media, I can tell you from talking to our clinician partners, there are many cases that don’t. That just fly under the radar.”
Anger, sadness and shame
Cardenas is still healing. She’s healing from having to travel so far from home for her abortion and from the Catholic shame that followed the procedure. For some time, she questioned why she existed in this life. She kept thinking, “I killed my baby, so I shouldn’t be alive,” and “I just want to go be with them.” She went to intensive outpatient psychological treatment. She credits the treatment with saving her life. She told her parents about her abortion. Her dad still avoids the subject. Her mom, she thinks, understands.
Mostly, though, Cardenas is angry. Angry that others still must go through what she did: cold-calling clinics in another state, flying more than 1,000 miles for an abortion, crying to a friend over the phone, wishing for the familiarity of home. Angry that two of Houston’s Planned Parenthood clinics are set to close in the fall.
“I feel really angry about it all. Angry just more of the fact that people have to go through this. And they shouldn’t have to,” she said. “Sad, just because it was sad for me. To have to travel, and to think that people are still traveling.”
Not alone
Bermudez, too, only began to fully process her emotions following her abortion. Growing up, abortion felt taboo, she says. The environment she was raised in was very much, “well, if you decide to make a kid, you’re gonna keep this kid.”
She still has not told her family. Today, she works at Access Reproductive Justice, the abortion fund that helped finance her abortion two years ago. She still thinks back on her abortion, mostly during big moments.
“There’s a community for this. You’re not the first person. You won’t be the last person that’s going to go through this.”
“When I graduated (Long Beach City College) in June, I thought, ‘Oh wow, if I never would have got my procedure done, I wouldn’t be standing here, walking on this stage.’ … When I moved into my new apartment, I said, ‘if I would have never got my procedure done, there’s no way I would have been living back in LA,” she said.
“I didn’t feel comfortable enough to share this story, I think, until I started working for an abortion fund and realizing there’s a community for this. You’re not the first person. You won’t be the last person that’s going to go through this.”
AI illustrations by Local News Matters editor Glenn Gehlke via Adobe Firefly, with additional resources via Freepik.