The Hawaii Abortion Collective on Wednesday released the state’s first comprehensive resource providing information on abortion rights and services for patients and providers in the islands.

The guide follows the U.S. Supreme Court’s June decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and ruled that abortion is not a constitutional right.

While abortion remains legal under Hawaii law, the Supreme Court’s decision has created confusion and concern among both patients and abortion providers, Khara Jabola-Carolus, executive director of the Hawaii State Commission on the Status of Women, said Wednesday during a press conference.

Abortion access also is highly unequal across the state, said state Rep. Jeanne Kapela, who represents District 5 on Hawaii island. In rural districts such as her own, women lack the knowledge and resources needed to make informed decisions about their reproductive health, she added.

“This guide, I think, fills this gap that’s so needed, especially when we’re talking about rural neighbor islands,” Kapela said. “The biggest gap is just having a space where people can go to look up different services or potential services and to know that it’s safe, it’s equitable, and it’s accessible.”

The collective, which includes over 50 stakeholders in the medical, legal and religious fields, was formed after the Supreme Court decision. Alani Bagcal, coordinator of the new abortion guide and an organizer with AF3IRM Hawaii, said the resource will be distributed over social media and urged people at the press conference to share the resource throughout their communities.

Dr. Divya Dethier, a complex family planning fellow at the Women’s Option Center, said she regularly sees patients from the neighbor islands who are unable to access abortion care in their own communities.

The Women’s Option Center can provide telehealth services and mail abortion medication to patients who are up to 11 weeks pregnant. However, if patients are further along in their pregnancies or do not qualify for a medication abortion, they must fly to Oahu if they cannot find a surgical abortion provider on their island, Dethier added.

According to the guide, Oahu, Hawaii island and Maui all have providers that offer both medication and in-clinic abortions. However, Colleen Bass, a certified nurse midwife and women’s health nurse practitioner at Hua Moon Women’s Health on Kauai, said patients are not always aware of local abortion services, resulting in unnecessary and costly trips to Oahu.

“Despite being a state that allows abortion, Hawaii is limited,” said Bass, adding that Hua Moon only offers medication abortions at this time. “Oftentimes, if providers don’t know about my practice or they don’t refer their patients to me, the patients end up flying to Oahu … which is a huge waste of resources.”

Dr. Reni Soon, who provides clinical and abortion care at the Women’s Option Center and Planned Parenthood, added that a lack of on-island abortion services can create significant financial hardships for patients.

Soon also said the overturn of Roe v. Wade has added to the shame and confusion abortion patients may face. As recently as this past week, Soon said she has seen patients who believe abortions are illegal in Hawaii – but are continuing to seek her services anyway.

“You can imagine the turmoil and the trauma that someone goes through in, ‘Okay, I’m gonna call an office and get an appointment for something that is illegal,’” Soon said.

Currently, at least 12 states have placed full bans on abortions. Dethier said she has not seen a significant change in the number of out-of-state patients coming to the Women’s Option Center to seek abortion services.

However, Hawaii must continue to increase its abortion provider workforce to ensure that patients receive necessary care in a timely manner, said Dr. Tracy Chen, another complex family planning fellow at the Women’s Option Center. She added that both patients and providers are still trying to understand laws that could potentially punish women for traveling beyond state lines to receive abortions.

Elizabeth Jubin Fujiwara, a civil rights attorney and board director for Hawaii Women Lawyers, raised concerns that Hawaii providers could be arrested or sued for providing abortions to patients from Texas and other states with strict abortion bans.

Soon said the Women’s Option Center remains committed to providing abortions to all individuals seeking services. She added that she does not know of any abortion providers in Hawaii who have been prosecuted for serving out-of-state patients.

“We will provide abortions for anyone who comes to see us requesting an abortion,” Soon said. “We take care of patients who need help.”

Fujiwara said she would like to see Gov. David Ige follow the lead of other governors across the nation by signing executive orders that could protect Hawaii abortion providers from criminal or civil charges coming from states like Texas.

In an August interview with the Honolulu Civil Beat Editorial Board, Ige said he was working with the attorney general to understand how other states’ abortion laws could impact physicians and health care providers in Hawaii. Gary Yamashiroya, special assistant to the attorney general, said the office remains committed to protecting reproductive rights but declined to provide additional details in an emailed statement.

House Majority Leader Della Au Belatti said legislators are also considering what laws the state could implement to further protect its abortion providers.

“We’re in this period where we’re just watching, analyzing, assessing and preparing for any eventualities,” Belatti said. “Everything is on the table.”

For now, Bagcal said she hopes the Hawaii Abortion Collective’s work will empower individuals to find the care and support they need during uncertain times.

“We as a society have a lot more work to do to destigmatize abortion and chip away at the many barriers that limit people from receiving care and knowing the necessary information about abortion,” Bagcal told reporters.

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.