Oregon is one of the most protective states in the country for women seeking an abortion, stronger than even California. There is no gestational limit, Medicaid funds must cover the cost of the procedure and state law shields abortion providers from investigations in other states.

But just because the right to choose is enshrined in Oregon law doesn’t mean it’s easy for women to access that reproductive freedom, especially in the rural areas of Central and Eastern Oregon.

When the Supreme Court overturned Roe v. Wade in 2022 with what has colloquially been termed “the Dobbs decision,” abortion rights activists faced challenges they had not seen before, said Rachel Lachenauer, senior director of the National Abortion Federation Hotline.

“But make no mistake, accessing abortion care — especially from rural areas or less dense areas — has never been easy,” Lachenauer said.

East of the Cascades, there are only two clinics that provide abortion services: Planned Parenthood Bend and Planned Parenthood Ontario. Planned Parenthood Ontario only has the ability to perform abortions up to 12 weeks, while Planned Parenthood Bend can perform the surgical procedure up to 14 weeks.

Any patient with a gestational age past that date must travel to Portland or another coastal clinic for the procedure.

Planned Parenthood Columbia Willamette, which runs both clinics east of the Cascades, combats the issue of rural accessibility by using patient navigators, who help patients navigate barriers to care and the complicated healthcare system.

Responsibilities of a patient navigator

Planned Parenthood Columbia Willamette first started developing its patient navigator program shortly before the Dobbs decision. Its first patient navigator was hired shortly after, and the program has been incredibly successful so far.

“If you were to simplify my job description, it would be to help people. I do it every day in little and sometimes bigger ways,” said Nova Newman, one of three abortion navigators in Oregon.

Every patient she works with has a different story and their own unique barriers to care. Sometimes, Newman’s job is as easy as being a sympathetic ear. Other times, it’s as complicated as booking travel and finding financial assistance to pay for the procedure, which could $500 during the early stages of pregnancy.

Almost none of Newman’s patients end up paying for the procedure, in part due to resources available to Planned Parenthood Columbia Willamette.

There was one patient who stuck out to Newman who demonstrated the difference a patient navigator can make in turning a stressful abortion experience into a one of understanding and support. Newman spoke to her in person.

“She was able to share that she was really stressed out about the cost of travel, which she hadn’t shared before,” Newman said. “But she also hadn’t spoken to someone in Spanish. She’d been speaking through an interpreter, so I think just being able to connect one-on-one made the difference for her to feel comfortable opening up.”

In Oregon, the Spanish-speaking population has dramatically increased from fewer than 100,000 people in the 1980s to more than 600,000 in 2024, which is why Newman feels her skills as a bi-lingual navigator are so important. These populations are also largely concentrated in rural, agricultural centers.

Barriers to care

In her day-to-day working with Central and Eastern Oregonians, the two biggest obstacles Newman encounters are the financial strain of paying for the procedure and organizing travel to the closest clinic.

Other barriers she sees might include anything from finding childcare to determining who in a patient’s life might provide the best emotional support after the procedure. There’s a lot to cover, she said.

“Let’s say they don’t have health insurance and aren’t able to pay out of pocket. We then screen them for abortion funding, and see what they qualify for depending on how far away they live from the clinic,” Newman said. “Then, after we discuss the travel plan, we see if they need any other resources and connect them to those as needed.”

Most people in rural parts of Oregon will have to travel more than 100 miles to access abortion care, though some people in Deschutes County may only need to travel 30 miles. Those distances increase if a patient’s gestational age is past 14 weeks. Past that point, there is no clinic east of the Cascades that can perform the procedure, forcing patients to travel more than 200 miles to Portland, in some cases.

Lachenauer said this presents a unique challenge as more women have to travel across state lines to obtain abortion care.

“Across the board, the farther along you are in pregnancy corresponds with an increase in the cost of abortion,” Lachenauer said. “So even if you are able to find a provider who is able to provide you with the procedure later in pregnancy, the price just goes up astronomically. Things get more complex … and the price corresponds with that.”

Then there is the cost of traveling such a long distance — which requires a car in good working order, gas, hotel stays and taking time away from work. All of this compounds the financial burden put on women from rural areas, who are more likely than their urban counterparts to fall below the poverty line.

Then, there is the issue of navigating insurance coverage. Even though Oregon requires Medicaid and private insurance providers to cover the cost of abortion procedures, many residents living in rural parts of Oregon are still uninsured. That number only increases if they are below the poverty line.

Perseverance amidst continuing stigmas

Even with the challenges so many women in rural areas face, the abortion navigator program has been incredibly successful, Newman said.

“I think that we do have hopes of expanding. I’m the third patient navigator, and we also have a (fourth) navigator for gender affirming care services. The hope is, as the need is still there and seems to be increasing, that we will also be able to grow,” Newman said.

But there are still issues that the navigators can’t fix, said Joanna Dennis-Cook, the Planned Parenthood Bend health center manager, like continuing stigmas and an overall lack of education in the rural areas of Oregon. They only have the opportunity to help when people reach out to them and not the other way around, she said.

“One of the things that I continue to worry about is that people just don’t know that there are resources if they’re wanting an abortion … I think the more people that know to just reach out and ask for help (the better). We’re happy to help as much as we can, and we want people to get the care that they need and want,” she said.

Dennis-Cook attributed the root cause of that ignorance simply to the lack of education and continuing stigmas in rural Oregon, where political views are more likely to lean conservative. Even in Bend, an urban area of Central Oregon with a more liberal demographic, protestors still come to Planned Parenthood Bend every Thursday from 10 a.m. to noon.

Speaking from a national perspective though, Lachenauer highlighted what she sees as a glimmer of hope.

“There’s this misconception that if you just make abortion access hard enough, people are going to give up and that is not what we see. Now, to be clear, this comes at incredible cost to the individual who’s trying to coordinate all of this, but the patients who we speak with are unbelievably resilient. They know that this care is the best thing for them. They know that they need it, and they will stay in touch and advocate for themselves to make sure that it happens,” said Lachenauer.