PORT TOWNSEND — Hospital leaders, healthcare experts and policymakers gathered at Northwest Maritime to engage in discussions on the topic of reproductive healthcare in rural communities. Jefferson Healthcare hosted the event.
“Like many areas, we face a challenge in supporting and staffing comprehensive reproductive healthcare access across the counties,” said Dr. Allison Berry, the public health officer for Clallam and Jefferson counties.
The economics simply don’t pencil out for rural areas, Berry said, but reproductive health services are critical for women in small communities.
Policy and funding are required to ensure those services, Berry said.
“We recently lost obstetrics services at Forks Community Hospital, which has left women and pregnant people on the West End, having to drive 2½ hours to perinatal care,” Berry said. “That’s not meeting the needs of that community.
“Without things like different bond levies for, we were at risk of losing those services in Port Angeles and Port Townsend too.”
In addition to offering obstetric care, Jefferson Healthcare and Olympic Medical Center offer abortion care.
“One of the challenges I raised in the meeting was encouraging our hospitals to be brave enough to acknowledge publicly that they offer these critical health services, so the patients know that they can access them, and so that we don’t further participate in marginalizing a normal part of healthcare,” Berry said.
Berry, a trained abortion provider, said she has provided many abortions through her career and considers it a meaningful part of her work.
Berry gave a presentation Tuesday on maternal mortality, which has been consistently on the rise. Surprisingly to some, she said, aside from natural causes, causes for mortality are heavily accounted for by drug overdoses, domestic violence and suicide in Washington. Solutions must be robust and multi-faceted, and they may be politically challenging, Berry said.
State Sen. Emily Randall, D-Bremerton, state Rep. Nicole Macri, D-Seattle, and Courtney Normand, director of Washington State Planned Parenthood Alliance Advocates, made up a panel on Tuesday that discussed the policy landscape in reproductive health, moderated by Jefferson County Commissioner Kate Dean.
Randall, a candidate for the 6th Congressional District, which includes the North Olympic Peninsula, grew up in Port Orchard and currently represents Kitsap and Pierce counties in the 26th Legislative District. Randall said she became interested in reproductive healthcare at a young age.
“My sister Olivia was born with really complex disabilities,” she said. “When my mom first became pregnant, she was pregnant with twins. Olivia’s twin died part way through the pregnancy and it was very complicated. I was 7. I have strong memories of my mom coming back from a doctor’s appointment where she was encouraged to have an abortion. For her, it was not the right choice at that time. I grew up in a religious family.”
Randall said it took years for her to sort out her feelings about abortion.
“I realized that my discomfort with abortion care as a young person wasn’t about someone choosing abortion as much as it was about someone trying to pressure my mom into making a decision that wasn’t right for her.”
Randall said she volunteered as an abortion doula in San Francisco. During that time, she provided rides to and from clinics, sometimes providing overnight housing for people who had driven many hours. In 2016, she started working for Planned Parenthood.
“For me it’s always been just an issue of humanity,” Macri said. “Bodily autonomy has just been so central to my experience, and I knew coming into Legislature that I would be a strong champion for reproductive access, but I actually didn’t come to Legislature fully appreciating the role that I would want to have and do have in leading on these issues.”
Normand lives in Arlington, where she grew up.
“It’s a place that did not have great access to sex education or reproductive healthcare,” Normand said. “As a young person, I experienced what it was like to need to get to a place and not have a car and not know what to do. Fortunately, a pharmacist had the ability to provide emergency contraception.”
Challenges to rural access
“One piece is travel,” Randall said. “If you live in a rural community, you either have to drive to get your care or rely on a friend, cause often there isn’t a reliable public transit system. “In Kitsap County, you know our bus service took a big hit in the recession. Around the Peninsula, there’s even less access to public transit.
“That’s a logistical challenge that’s real for people, getting child care to go to an appointment when you have to travel a long way is a real barrier to folks.”
Berry said for someone in Neah Bay to get an abortion, they have to travel to Jefferson County, about three hours or beyond.
Rural areas, already dealing with shortages, are seeing a lot of closures, Randall said, due in part to a payer-mix in rural communities, which is unevenly weighted toward Medicaid, which pays less than private insurers.
“We need to increase our Medicaid rates for that reason,” she said.
Normand said some public hospital districts have not been meeting legal requirements to provide abortions. That affects rural people more than their urban counterparts, as it may be a further distance to next hospital offering services.
“I think it was in 2013, (state) Attorney General (Bob) Ferguson issued an opinion pointing out that the Reproductive Privacy Act, that the voters passed in 1991, states that if a government is spending money on maternity care, it must provide substantially equivalent access to abortion care,”said Normand. “Again, it’s coming down to that your financial situation should not be the thing that determines what your pregnancy decisions are.”
The office later investigated and found that 27 hospital districts were out of compliance with his opinion, Normand said. The office sent letters to the hospitals informing them that they needed to inform the office of plans to fix the issue.
The panelists also discussed the necessity to continue working on telehealth as an option for rural patients.
No federal funding
Panelists discussed challenges and strategies for funding reproductive healthcare.
“We have made the decision in this Washington that medicaid patients — low-income patients — deserve comprehensive reproductive healthcare, including abortion care,” Randall said. “The state has put those funds into place to ensure that all patients get that healthcare. The Hyde amendment has been a real challenge for states, providers and individuals.”
The Hyde amendment, which prohibits use of federal funding for abortions, with limited exceptions, was ratified in 1977.
Title X, 1970, is a funding program for family planning services. Title X monies are not to be used on abortions but have been usable by clinics which provide abortions, so long as those specific dollars are shown to be separate from funding the abortions.
In 2019, former President Donald Trump implemented the Title X Gag Rule, which prohibits facilities receiving the funding from providing patients with information on how to access abortions. The gag rule also requires physical separation between a facility receiving the funding and where a termination procedure can occur.
“Under the Trump administration, when Title X came under attack, we (Washington state) were one of just a handful of states to jump in and sue against that and push back,” Normand said. “There were multiple attempts to defund Planned Parenthood from the family planning safety net across the country.”
Macri said Washington has a track record of protecting abortion rights, and that history helped to prepare the state for the loss of federal funding during Trump’s presidency.
“But a protective right doesn’t really mean much if you don’t have access,” Macri said. “So we really focused in on that, both through policy, and more specifically, through budget protections, by making investments in family planning, by expanding access to care. Washington State Medicaid (Apple Health) covers abortion care. We passed a bill in, I think it was 2019, to ensure reproductive health access for folks who otherwise would not be covered, making sure that all immigrants could have access to family planning.”
With the Dobbs Decision, the Supreme Court overturned Roe v. Wade (1973) in 2022, thus overturning the constitutional right to abortion.
“Sixty percent of Americans support the protections of Roe v. Wade,” Randall said. “Even religious Americans, by and large, support individual decision making. We’ve seen some countries in South America or in Central America, including Mexico, pass abortion protections, countries that are much more religious than Washington state or the United States.”
Workforce shortages
The state is working on investing in education programs to encourage more students to engage in the healthcare professions, Macri said, as well as focusing on offering loan forgiveness programs at rural hospitals, with the intent of attracting providers from across the state.
Planned Parenthood went to the state Legislature to request funding for expanded needs following the Dobbs decision. The Abortion Action Project provided half of its request.
Normand said the funding went toward increased security — because violence has increased following the decision — toward increased workforce needs and toward paying for out-of-state patients, traveling for care.
After the Dobbs decision, abortions increased at Washington Planned Parenthood centers by 23 percent, and out-of-state patients increased by 46 percent, Normand said. The number could be higher, because some patients are afraid of reporting where they are coming from, she said.
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Reporter Elijah Sussman can be reached by email at elijah.sussman@sequimgazette.com.
