Abortion remains legal in Alaska, but access for rural residents is challenging and expensive

Bristol Bay in 2017. (Avery Lill/KDLG)

In the wake of the recent reversal of Roe v. Wade, abortion remains legal in Alaska and is protected by the state constitution’s right to privacy.

But that doesn’t mean it’s available across the state. In Bristol Bay, patients seeking abortions have always faced obstacles to care. Like many medical procedures, the long-held understanding is: If you need an abortion, fly to Anchorage. Beyond that, figuring out how to access care is like trying to solve a puzzle. There are multiple health care providers in the region, but none provide abortion services.

Mary Swain, executive director of Camai Community Health Center in Naknek, emphasized that the clinic offers contraception and the morning after pill. But for abortions, they only make referrals.

“We refer everybody to Planned Parenthood in Anchorage,” she said.

Cynthia Rogers, a public information officer for the Bristol Bay Area Health Corporation in Dillingham, echoed Swain’s information in an email. She said that anyone seeking an abortion in Bristol Bay can arrange an appointment with a provider in Anchorage.

Even Safe and Fear-Free Environment, a Dillingham organization that offers support for victims of sexual assault and domestic violence, doesn’t have a clear policy for people who seek abortions. Executive Director Marilyn Casteel said they do provide the morning after pill for anyone, no questions asked. But they would also tell people to travel for an abortion.

“We could say, well, there’s a Planned Parenthood in Anchorage, have you given them a call?” Casteel said.

Limited information about telehealth options

For Bristol Bay residents, many health care services are only available by traveling to Anchorage, so abortion is not unique in that regard.

In areas where in-person health care services are limited, telehealth has the potential to fill the gap. For medication abortions, all that the patient requires is two pills, mifepristone and misoprostol, which can be taken at home.

But it’s unclear how accessible telehealth services are to residents, and the medical experts interviewed for this story declined to provide more information on the availability of self-administered medication abortions.

Each local representative cited different reasons for not providing or assisting with abortions. At the Camai health center, Swain said they don’t have the facilities to address possible complications from an abortion, either medication or surgical. Casteel said SAFE would have to receive grants specifically for abortion in order to support access, and they have never received those grants in the past.

Camai and BBAHC also pointed to restrictions on abortion connected to funding from the federal Health Resources and Services Administration and Indian Health Services. Both funds do include exceptions for victims of rape or incest or in cases when the health of the parent is in danger. But when asked about these exceptions, Rogers repeated that BBAHC does not provide abortions and that patients can make appointments in Anchorage.

When KDLG called the State Medical Board, the representative who answered offered to relay an interview request. Once they learned the conversation would be about abortion, they warned that board members would probably decline to talk because the board is non-partisan. Board members did eventually agree to respond via email, but they were unable to provide information in time for publication.

Other Bristol Bay providers were contacted for this story and declined to comment, including Southcentral Foundation and the Dillingham Public Health Center.

Rose O’Hara-Jolley, the Alaska state director at Planned Parenthood, said via email that in Alaska, it’s legal for patients to be prescribed abortion pills via telehealth appointment and then receive the pills by mail. But in practice, they said, it’s difficult for Alaska providers to offer telehealth abortion services due to factors like outdated telehealth infrastructure and insurance coverage restrictions.

They also said that pills obtained without an appointment can be safe and effective, but they did not comment on the legality of that method. Planned Parenthood does not currently prescribe pills to pregnant people remotely, but O’Hara-Jolley said the organization is working on making that service available from their Alaska clinics.

Traveling for care is costly

For residents of Bristol Bay, the lack of telehealth abortion access leaves them with limited options. The most obvious choice is to travel to a Planned Parenthood clinic, which has locations in Anchorage, Fairbanks, and Juneau. But the price tag can add up quickly.

A roundtrip flight to Anchorage ranges from $443 to $643, while tickets to Fairbanks and Juneau can surpass $1,000. Beyond that, there’s the cost of lodging, food and the abortion itself.

According to Zhenia Peterson, a volunteer with the Northwest Abortion Access Fund, the average cost of an abortion appointment is $550, but it varies depending on the provider. Peterson said the Access Fund aims to provide financial assistance and help patients who can’t meet those costs.

“The services that we provide are pretty extensive,” she said. “The main one is we do fund abortion and we help folks travel to their appointments. You know, we help folks with airfare, any type of lodging. We also do rideshares and we have volunteers that give rides. And then we have emotional support as well.”

The Fund has helped many Alaskans in the past, and their coverage includes Bristol Bay. Once a patient has an appointment, the Fund provides varying levels of support, depending on each person’s income and needs. Alaska’s Medicaid program includes coverage for abortion care, so Peterson encourages patients to apply for Medicaid as well.

In Anchorage, Planned Parenthood has trained staff to discuss all of a patient’s choices. This includes abortion, adoption, and parenting. The clinic provides abortion pills 11 weeks after the patient’s last menstrual period and surgical abortions up to 17 weeks and 6 days.

Beyond that timeframe, patients are referred to providers outside the state.

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