Unexpectedly seeing two lines on a positive pregnancy test is a drastically different experience for people living in the South Bay compared to residents in red states, especially in the southeast corner of the country as 2021 draws to a close.

In October, Texas passed a bill allowing people to file lawsuits against anyone involved in any abortion that takes place after six weeks of pregnancy—often called a “heartbeat” law, since this is when electrical activity in cardiac cells is detectable.

The nine justices who make up the Supreme Court of the United States are now hearing oral arguments from the state of Mississippi’s lawyer, positing that the abortion rights should be decided by states, since the U.S. Constitution doesn’t mention the issue.

If a majority of the bench agrees, Mississippi and a dozen other states are poised to ban abortion after 15 weeks of pregnancy or less. Analysts say this will overturn or weaken Roe v. Wade, and Planned Parenthood v. Casey: landmark cases from 1973 and 1994, respectively, that carved out constitutional protections for safe and legal abortions before 24 weeks—the timeline generally accepted as to when a fetus can survive outside the womb.

While Silicon Valley is seen as a haven for abortion services by medical professionals and legal experts, gaps still exist online and on billboards across the South Bay.

Googling “abortion services” can lead people to crisis pregnancy centers, which are typically anti-abortion organizations that do not staff medically trained or licensed professionals and are known to use advertising in their efforts to continue pregnancies that has been declared “unethical” by the American Medical Association Journal of Ethics.

There are several pregnancy centers dotted across the South Bay—often near or next door to abortion providers such as Planned Parenthood—including RealOptions Obria Medical Clinics, GHS Women’s Center, Birthright San Jose, Informed Choices, St. Juan Diego Women’s Center and Support Circle Pregnancy Clinics.

In 2016, Valley Crisis Pregnancy Center in Pleasanton encouraged delaying abortion by highlighting that nearly a quarter of pregnancies end in miscarriage, while a Birthright of San Jose volunteer told reporters in 2018 that “our first response is not to answer yes or no [about abortions] but to talk to them a little bit and understand the situation.” Birthright International has previously reported that its work is guided by the idea that “it is the right of every pregnant woman to give birth … and the right of every child to be born,” even though the organization claims to have a “non-evangelism” philosophy.

While Dr. Sophia Yen, a clinical associate professor of pediatrics at Stanford’s Lucile Packard Children’s Hospital and CEO of online birth control delivery company Pandia Health, sees Silicon Valley as a haven for access to abortion services, she says the people without medical credentials wearing white coats in crisis pregnancy centers are a major concern.

“I'm all for these crisis pregnancy centers if you want to offer free diapers and all those kinds of resources, sure,” Yen says. “But they're not giving you all your options or unbiased options, and that I feel is key to medicine. We've taken the oath ‘do no harm,’ and we believe in informed consent.”

Yen says her fears about weakened protections for abortion check off every cliché in the book—the tip of the iceberg, a can of worms, Pandora’s box—since carrying a pregnancy to term is more dangerous than a first trimester abortion, especially amongst lower socio-economic groups. As a physician, she says listening to people ignore the health risks of illegal abortion sounds like the medical version of Holocaust deniers.

“Before my time, there were wards of women with pus pouring out of their uterus, and all we could do was hold their hands and pray, and that I do not want to go back to,” Yen says. “As a doctor, I don't want to see more people die than necessary, and I think if you make abortion illegal or difficult to access, there will be two deaths: the mother and fetus. It's purely numbers.”

Yen says she’s heard stories of young women in the Bay Area, where abortion is readily available, who still take matters into their own hands, from throwing themselves down flights of stairs, to attempting to put bleach into their uteruses, to asking partners to hit their stomachs with a baseball bat.

One way of averting such catastrophes is to make abortion medications readily available. Yen points to PlanCPills.org, a nonprofit providing information about how to access abortion medications—such as Misoprostol—by mail. Even though Pandia Health does not offer abortion pills, she still sees prescription delivery as a vital tool to combat the negative impacts of abortion bans. Pandia Health can currently deliver medications in all 50 states and write prescriptions in 13.

However, 19 states and Washington, D.C, have access to telemedicine abortion access. In California, companies such as Hey Jane and Choix offer care and mailed prescriptions to people as young as 16.

“We will always need abortion, but the numbers could be far less if everyone had access to comprehensive sex ed, free birth control, condoms, IUD implants, everything all the time,” Yen says. “But for the pregnant person who doesn't want to be pregnant, it's hard if you were simply born in the wrong state.”

Michelle Oberman, a law professor at Santa Clara University, has seen this all before, having spent decades studying the ramifications of forced pregnancy in El Salvador, Chile and Nicaragua. And while she’s seen this coming from an intellectual perspective, Oberman says she’s still emotionally stunned, shocked and surprised by the reality of pregnant people being denied the right to determine their future and make their own medical decisions.

“This will be an unenforceable law, and it's unenforceable even in countries like Salvador that are completely committed to enforcing it,” Oberman says. “This is a moment I didn't think I would see; I'm horrified to have to see it, and everything I've learned and everything I've done and everything I've worked for my entire life is now actually in play. It matters urgently that we respond in this moment.”

Beyond legal professionals involved in lawsuits, Oberman says questions loom over protecting access to accurate information online, whether regarding validity and instructions of medications like Plan C or providing chat rooms where teens can get information on birth control and reproductive health issues.

“That frontline for the war is going to be really complicated, because it's not just Google searches,” she says, pointing to groups like the Digital Defense Fund, which protects the technology behind abortion services. “People get their information from places like their friends’ Instagram feeds.”

Oberman says as some conservative states are likely to continue shrinking access to abortions, more liberal states are conversely likely to expand their rights. Newsom released a statement in September affirming California’s commitment to expanding reproductive choices for pregnant people, even convening a “California Future of Abortion Council.” That is one reason a study from the pro-choice Guttmacher Institute estimates 1.4 million people may travel to California for abortion services—a 3000% increase.

But even if abortion services abound in the South Bay, financial and social factors still present major hurdles.

Abortion services may be available at no cost through Medi-Cal, but the procedure during the first trimester costs an average of about $500 and typically isn’t covered by insurance. Those costs can be hundreds more in the second trimester, reaching up to $2,500.

According to Oberman, half of all abortions in the Unites States are performed on people below the poverty line—representing 13% of the population—and 75% of abortions involve people within 200% of the poverty line.

That’s why Oberman urges local pro-choice advocates to recognize that even in California there are communities that, whether due to economic circumstances or cultural traditions, will be affected more strongly by efforts to take away abortion rights, even if the most extreme impacts remain concentrated in places other than California.

“The elephant in the room that we don't talk about is how expensive it is to raise children in a country that actually is not interested in having you have children,” Oberman says. “We have to start having a very different conversation about abortion access and what it means in the 21st Century, and we have to center poverty and class in every conversation about abortion going forward, because that's what's on the line here.”