And because the two states have different gestational limits for abortion, for some Washington state residents Portland may be their only option. In Washington, abortion is allowed by law only up to the point of viability, an imprecise threshold generally interpreted to be 24 to 26 weeks. Oregon, on the other hand, is one of only a few states in the country with no gestational restrictions on abortion at all.
“We specialize in procedures all the way up through the 26th week of pregnancy,” said Grayson Dempsey, director of public affairs at the Lilith Clinic, an independent abortion clinic in Portland. “We can even go a little bit farther than that. So for people who are experiencing any sort of medical complications, fetal anomalies, testing that shows that there is a need for an abortion that maybe they weren’t anticipating — those people are largely traveling into Portland to get that care.”
The same thing happens at clinics close to Oregon’s borders with California and Idaho, said Dempsey, where there are “swathes of miles and miles and miles where there’s not going to be an abortion provider.” Abortion access is much like other kinds of health care that are less accessible in rural communities, even in states with robust medical institutions like OHSU and the University of Washington.
Complicating abortion access in rural Washington even further is the proliferation of mergers between secular and religiously affiliated hospital systems, which often result in cuts to elective abortion and reproductive health care services more broadly.
The availability of medication abortion — which terminates a pregnancy with a combination of two medications, misoprostol and mifepristone, and sometimes can be taken at home, rather than just as an in-clinic procedure — has bridged the gap in access for some, but not for patients who need in-clinic procedures. While most abortions take place before the 15th week of pregnancy, medication abortion is typically offered only through the 11th.
In Washington, 17 clinics provide procedural abortions after 11 weeks of pregnancy, the vast majority of these in the Puget Sound region. At Vancouver’s Planned Parenthood affiliate, patients can receive medication abortions, according to Montana Pindell, a patient navigator with Planned Parenthood Columbia Willamette. But patients past the 11-week threshold may need to go elsewhere for a procedural abortion, and delays due to increased out-of-state demand could make the difference between being seen by the cutoff date or needing an in-clinic procedure once it’s passed. At that point, Portland would be the closest option.
It’s also the closest option for people seeking abortions beyond Washington’s viability limit.
Abortions beyond 15 weeks are rare, and those after 21 weeks make up just 1% of all abortions. Patients seeking abortions after 21 weeks often report major structural or financial barriers to getting care earlier, or they are seeking an abortion because of fetal anomalies detected later in pregnancy.
“We see the most horrific cases you’d ever heard of, and we see some that are just really sad,” said Pindell, the patient navigator. “And so the spectrum is huge.” Often, she said, patients seeking abortion care later in pregnancy have been “really failed by the medical system and social support systems, or they’re folks that are facing something really unexpected with a wanted pregnancy.”
Getting care for the kinds of fetal anomalies Pindell alluded to has always been complicated, and abortion bans can also cause delays in care, resulting in more expensive and complex procedures — and sicker patients. One high-profile example is the case of Kate Cox, who could not get an abortion in Texas after a fatal fetal diagnosis because of her state’s ban.
Working with patients from Washington wasn’t new for any of the Oregon providers or advocates interviewed for this story, nor did they explicitly link it to Dobbs, though Dempsey and Colwill said it was possible mounting out-of-state demand for care in states like Washington could mean more reliance on Oregon providers.
Colwill said OHSU had anticipated a surge in abortion referrals after Dobbs, and doubled their abortion volume accordingly over the last two years. Washingtonians also use OHSU’s abortion telemedicine services, she said.
Even with its gestational limits, Washington remains one of a handful of states with more permissive timing requirements for abortions; the others include Colorado, Maryland, and the District of Columbia. And that’s made the Pacific Northwest a destination for patients seeking abortions. “What we are seeing in those states is that we are becoming inundated with patients who are really at their last stop for care,” said the Lilith Clinic’s Dempsey. Demand in urban centers like Portland and Seattle can mean more delays for local patients seeking uncomplicated abortion procedures.
For years, said Dempsey, she had wanted to normalize abortion, to avoid focusing strictly on the most harrowing cases, like that of Kate Cox. But with the imposition of abortion bans, getting an abortion has become a more traumatic experience even for patients who aren’t facing life-or-death decisions due to concerns about risks related to surveillance and prosecution, she said. Patients and providers in states with more robust access are feeling ripple effects from those with active abortion bans.
“Abortion has become an emergency in places where it wasn’t before,” she said.
