This article was co-published with Oregon Public Broadcasting as part of The 19th News Network’s Abortion on the Ballot series.

States around the country have seen an onrush of abortion restrictions since the U.S. Supreme Court ended federal abortion protections in June 2022.

But in Oregon, the laws have only gotten stronger. 

Consider how Dr. Sara Kennedy, head of Oregon’s largest Planned Parenthood affiliate,  explained the availability of the procedure to a curious conservative Republican lawmaker at a legislative hearing earlier this year. 

“We have same-day appointments everywhere,” Kennedy said. “They can get in whenever they need to, when they are sure about their decision.” 

Oregon’s broad abortion protections can feel so entrenched that even the state’s most staunch anti-abortion groups concede outlawing the practice is impossible. 

But for people like Kennedy, working on the frontlines during uncertain political times, the matter is far less settled than it seems. When she took the helm near the beginning of this year, Kennedy shook up the way her group interacts with state politics. Part of her “north star” mission, she said, is ensuring Planned Parenthood clinics can still “take care of everyone.” 

“I think my job is really to make sure that our organization is as fortified as we can be to withstand the threats that could be coming,” she said. 

Oregon has positioned itself to serve as a reproductive health care sanctuary for those in states with strict abortion bans. Thirteen states have near-total abortion bans, several have gestational limits and 13 states have a mandatory waiting period before someone can access care. 

Since Roe v. Wade fell, ending federal abortion protections, Oregon Planned Parenthood clinics have seen an increase in patients from Idaho, Texas and California seeking abortion-related healthcare. People from at least 37 states have used Planned Parenthood clinics in the state for abortion-related care in that time period. 

But the debate over whether and when people should be allowed to end their pregnancies continues, heightened by the upcoming presidential election. Despite having almost no restrictions on abortion access in Oregon, those on the frontlines said they’ve learned complacency can be dangerous; no state is immune from what happens at the federal level. 

In the past couple of weeks leading up to the election, Oregon’s Planned Parenthood clinics have had to beef up security as anti-abortion protesters grow increasingly aggressive. Clinic employees have been in constant contact with local law enforcement. 

U.S. Rep. Val Hoyle, D-Ore., put it bluntly: “For anyone in any blue state to think they won’t be affected (by a Republican in the White House), they are sadly mistaken.”

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In Oregon, there are no legal restrictions on abortion; there are no gestational limits, no waiting periods and no limits on abortion pills by mail. 

The state has seen patients from even liberal California, where abortion is restricted once a fetus would be able to survive on its own outside the womb — also known as fetal viability, which is hotly contested.  Some Planned Parenthood health care clinics in Oregon have seen a 50% increase in demand for their services since the Supreme Court decision. 

Sometimes the talk of access to abortion being restricted in Oregon can feel like Democratic political hyperbole. 

Oregon’s Right to Life, the strongest anti-abortion group in the state, has moderated what they push for in the state Legislature because Democrats have controlled the state for so long. Their main mission legislatively is to end abortions later in pregnancy — those that occur at or after 21 weeks. Most Oregonians, 72% according to a post-Roe poll, said they believe abortion should be legal in all or most cases. 

“We haven’t compromised our individual belief that all abortions are human rights violations,” said Lois Anderson, Oregon Right to Life’s executive director. “But we live in a democracy and we have to think about what is possible and most broadly acceptable to Oregonians.” 

There remain myriad ways access can be chipped away in Oregon or other blue states: through a national abortion ban; through judicial action; by restricting the pills used in medication abortions or simply by making Planned Parenthood ineligible for federal Medicaid dollars — threatening its ability to operate as a provider of birth control, STD testing and other health care, as well as abortions. 

Oregon had already started stockpiling mifepristone, a pill used in medication abortions, and the state is co-leading a multi-state lawsuit to have the Food and Drug Administration’s restrictions on the pill removed.

There is one law in particular, known as the Comstock Act, that has resurfaced and has many abortion rights advocates worried. The 1873 federal law prohibits mailing or transporting items across state lines that could be used in producing an abortion. Some have interpreted that could mean anything used in an abortion, from the equipment to the painkillers. 

“To me, it is much more effective and immediate and scary than a national abortion ban, which would be litigated and litigated heavily,” Kennedy said. “All the Trump administration would have to do is say ‘we’re enforcing a law’ and it’s on the books … a hostile (Department of Justice) could file lawsuits … It’s a terrifying thought.” 

Since Roe was overturned, the fight to keep abortion access has become an issue that is increasingly intertwined between both the health care side and the political one. And for Planned Parenthood that dynamic has caused tension — and not only in Oregon.

The former CEO of the nationwide Planned Parenthood, who, like Kennedy, was also a physician, was essentially ousted when she tried to pivot the organization away from the political battles over abortion to prioritize health care more generally. 

On her way out from Planned Parenthood, Leana Wen wrote, “The best way to protect abortion is to be clear that it is not a political issue but a health care one.” Wen’s ouster happened in 2019, before Roe fell. 

Shortly after getting the job in Oregon earlier this year, Kennedy made a controversial move to dissolve Oregon’s political advocacy arm. The decision blindsided some advocates. High-ranking elected officials warned Kennedy of seriously “miscalculating,” noting that the advocacy group was the last one remaining in Oregon. Many were worried that the move lacked political understanding or strategy. 

The political offshoot for Planned Parenthood has been given credit for many of the strong laws the state currently has on the books protecting care. Not only is the right to have an abortion codified in state law, but state-regulated insurance plans must cover reproductive health care such as abortions with no out-of-pocket costs.  

Despite the blowback, Kennedy said the decision was the right one. And she clarified: She’s not backing away from advocacy. She wants to create a newer, stronger advocacy chapter with a more robust staff and stronger messaging. About three people lost their jobs when the advocacy group was dissolved, and Kennedy envisions tripling the number of employees. 

“You can’t offer good health care if you don’t have policy and rules and regulations to protect the health care you’re offering,” said Kennedy, who also has a master’s in public health. 

Kennedy said the new beefed-up advocacy organization will be the backstop from a potentially hostile administration and be more integrated into what the health care clinics are doing. 

“We are building a fierce, fierce (advocacy group) that is going to help us stand strong and survive in front of a Trump presidency,” Kennedy said.

Part of Kennedy’s vision is increasing Medicaid rates and how much providers get paid. 

“We have to recognize we are the people on the frontlines taking care of the folks who are the most vulnerable and if we don’t find a way to support the providers, the problems are only going to get worse,” she said. 

Grayson Dempsey, who is the public affairs director for the independent abortion clinic known as the Lilith Clinic, in Portland, said Kennedy made the right move. Dempsey was also instrumental in forming a coalition in recent months with all of Oregon’s abortion providers, including Planned Parenthood and the state’s public hospital Oregon Health & Science University. 

“We are seeing patients arriving in Oregon seeking abortions that have overcome more barriers. They are sicker. There is trauma there. They are stressed,” Dempsey said. 

Both Dempsey and Kennedy said all abortion providers in the state are working together. There is no competition for clients. At this point, it’s crucial they are all working together. 

“We are now seeing very clearly the effects in states that have banned or restricted abortions. You cannot practice safe obstetric care without abortions,” Kennedy said. “We have seen people die. We have seen mothers die. This is happening in states that have banned and restricted abortions. If you imagine that across the country, we are talking about so many preventable horrible deaths because of politics.” 

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For Kennedy, protecting Planned Parenthood and the health care clinics she oversees is a deeply personal mission. 

Soon she will have her Oregon medical license and in addition to serving as Planned Parenthood’s CEO, Kennedy will again act as a physician. 

The memory of a young mom who was pregnant with her third child but found herself in Kennedy’s office years ago remains seared into the CEO’s mind. The young woman wanted her pregnancy, but was recently diagnosed with an aggressive brain cancer. She couldn’t be treated while pregnant and delaying treatment for months would reduce her survival rate; she also had two other little ones at home to think about. Kennedy performed the abortion. 

“There’s a lot of … circumstances out there that you can’t even imagine and you can’t judge,” Kennedy here. “And we are just here to support people with whatever decision they make.”