This article is published in collaboration with California Health Report. 

Rosalinda Hernandez-Guzman grew up in the same Central Valley town where she is now raising her daughter. Visalia is rich in agriculture—fields of grapes, olives, and citrus ring the city—but it falls behind many other parts of California in access to reproductive health services.

Despite California’s progressive bent—there is a Democratic supermajority in both houses of the state legislature—pockets of the state are staunchly conservative, including some in the Central Valley. Even though abortion is legal under federal and state law, women here often have a tough time actually finding abortion providers.

“California has great public policy regarding abortion access, but great public policy does not always translate to women being able to have greater access to care,” said Amy Everitt, state director of NARAL Pro-Choice California.

This was the case for Hernandez-Guzman, now 21. Last summer, when her daughter was 2, Hernandez-Guzman became pregnant but knew immediately that she and her husband couldn’t support another child at the moment. They didn’t have enough money for a car or, at times, cell phone service, and Hernandez-Guzman had plans to go back to college to earn her bachelor’s degree.

“When it comes to diapers and clothes and formula and bottles, it’s overwhelming,” she said. “When you have prior bills and another child in diapers … the financial aspect was a huge part of the decision.”

Her decision made, Hernandez-Guzman needed to find a clinic. “There are zero” abortion services in Visalia’s Tulare County, population 460,000, said Sarah Hutchinson, senior policy coordinator for the nonprofit ACT for Women and Girls in the town. “Even for medication abortion, which is up to about 10 weeks [of pregnancy], women have to go to Fresno to get the pills.” That’s a 47-mile drive each way.

The situations for Hernandez-Guzman and others in similar towns show what could happen state- and nationwide if the Republican-controlled Congress and President Donald Trump limit abortion access and funding. When running for president, then-Republican nominee Donald Trump said that he would nominate anti-choice judges and that if Roe v. Wade were overturned, states would have jurisdiction over abortion access.

That would likely mean fewer resources for all communities, but compounded barriers for already underserved areas. If abortion does go back to the states, economic security and access to health care could even more heavily “depend on your ZIP code,” said Everitt.

Transportation Challenges

If Hernandez-Guzman had not talked with a friend who worked for ACT, she wouldn’t have known where to turn. Like many in the Central Valley, she was raised in a conservative Catholic Latino family and didn’t think she could ask her community for help. In her family, “we don’t talk about abortion,” she said. So Hernandez-Guzman approached her friend, who shared her story of an abortion at age 17, and helped Hernandez-Guzman make an appointment at one of two Fresno abortion-providing clinics.

“But then it was, ‘How am I going to get there?’” Hernandez-Guzman recalled. “It was just a frustrating feeling that I couldn’t just hop on a bus and just go.”

Buses do run between Visalia and Fresno, Hutchinson said. But the trip typically takes about two hours one way, and some routes can take up to four hours. Also, many people live in rural areas of Tulare County with no bus service. A California nonprofit, ACCESS Women’s Health Justice, has a hotline that people in need of transportation to an abortion appointment can call, but few in the Central Valley know about it, Hutchinson said.

Growing distraught, Hernandez-Guzman finally found transportation to the clinic. “It was hard, but luckily I had a good friend that just took me, no questions asked,” she said.

For women who live in more remote areas of the Central Valley, or for those who need later abortions, access is anything but guaranteed.

In 2014, 43 percent of California counties had no abortion-providing clinics, and 5 percent of California women ages 15 to 44 (considered reproductive age) lived in those counties, according to the Guttmacher Institute.

The Planned Parenthood clinic in Fresno performs abortions up to 17 weeks of pregnancy. But many Californians must generally go to Los Angeles or San Francisco to access a later abortion, Hutchinson said.

Furthermore, options tend to narrow for the 13- to 18-year-olds who are ACT’s clients. Hutchinson told a story of a 17-year-old girl whose mother found out that she had had a birth control implant in her arm and forced her to get it removed at a local clinic. When the girl became pregnant soon after, the physician assistant at the same clinic shamed her and tried to convince her not to have an abortion, Hutchinson said.

“These are a majority farmworker people breaking their backs with no health insurance, and the things that [health-care workers] say resonate with them and those folks believe them,” she said. “That’s what’s really upsetting to me.”

The girl, who was in an abusive relationship, eventually found help through ACT. “She said, ‘I need to not have a kid now—I need to get a college degree because I’m undocumented,’” said Hutchinson.

Hutchinson now is also working on state legislation, Senate Bill 320, which would require public college campuses with student health centers to offer medication abortion. Though the bill, introduced by Sen. Connie M. Leyva (D-Chino), won’t help young teens who need access to reproductive health care or women who aren’t enrolled in college, it would still greatly expand access across California, and particularly in the Central Valley—home to at least nine colleges that would fall under the umbrella of the legislation, Hutchinson said.

The bill passed with a 6-2 vote through the Senate Health Committee in mid-April and now moves to the Education Committee.

Nearly a year after her abortion, Hernandez-Guzman is preparing to enroll in college and working a secretarial job. She’s thankful she was eventually able to access the care. “I feel like, because of the position I was in,” she said, “I was making a mature decision in my life.”