Paying for Abortions Is About to Become A Lot Harder

After Joe Biden won the presidency, Diana Parker-Kafka lost a $5,000 grant. Parker-Kafka is the executive director of the Midwest Access Coalition (MAC), a practical abortion fund in Illinois that covers transportation costs for people traveling to and from the Midwest. A local funder had invited MAC to reapply for 2021 funding before changing its mind; now that Biden was heading to the White House, Parker-Kafka recalls the group saying, it wasn’t going to directly support abortion. She understood the implication: They thought, with a Democrat in the White House, abortion was no longer threatened so they could focus on other causes.

“I get the sense that a lot of funders don’t actually know what’s happening on the ground,” Parker-Kafka said. “We lost the federal courts under Trump. We lost the Supreme Court and the fact that SCOTUS took on the Mississippi case is just a clear sign that this is going backwards. We need to be ready.”

MAC’s client load has doubled every year since launching in 2015, and these days, it’s not uncommon for them to fly someone from South Dakota to Colorado for an abortion—a procedure that is technically legal, but inaccessible, in their state. Even though Roe v. Wade is still the law of the land, abortion is already legal in name only in much of the country. The procedure costs hundreds or even thousands of dollars, which patients often pay for out of pocket, and as clinics continue to close, getting abortion care can also mean booking a flight, hotel room, or babysitter. Abortion funds are the safety net to fund the logistics of getting an abortion—a net that is badly fraying.

Abortion funds directly support people seeking procedures, but get a fraction of the donations that the larger reproductive rights movement sees. A January 2021 report from the National Committee for Responsive Philanthropy (NCPR) determined that, between 2015 and 2019, foundations gave $912 million to reproductive rights issues, but only 20 percent was earmarked for abortion rights; a mere 3 percent for abortion funds. That helps explain why abortion funds can’t meet the existing need: In Fiscal Year 2020, the 83 members of the National Network of Abortion Funds (NNAF) served just 45,000 people out of the 230,000 who called.

This funding gap is set to get worse in June 2022 when the Supreme Court is expected to issue its decision on Mississippi’s 15-week abortion ban. It’s generally assumed that the Court’s 6-3 conservative supermajority will uphold the ban, further restricting access in hostile states, if not overturning Roe entirely. The problem won’t be limited to Mississippi. Other states will immediately try to enforce their bans at various gestational stages, whether that’s at 15, 12, eight, or even as early as six weeks into the pregnancy (as Texas already has)—before many women even know they’re pregnant. Such laws already exist or are expected to pass in most of the South and large swaths of the Midwest, meaning legal abortion could be restricted out of existence. People will still need abortions, of course—they’ll just have to travel even farther to get them. And they’ll need support in getting there. Yamani Hernandez, NNAF’s executive director, said the status quo is untenable: “We’re talking about depending on a network that still needs a lot in order to be the backbone of care as this system falls apart.”

Hanging by a Thread

Under Texas’ six-week ban, which took effect on Sept. 1, Texans must drive more than 14 times further for abortion care. For 70 percent of women in Texas, their nearest abortion provider is in Louisiana.

Longer trips means skyrocketing costs that abortion funds are unable to absorb. Many have told Hernandez they’d need to triple their budgets to get people care in a post-Roe world. More people are already calling, and they are requesting more money than before as state restrictions, COVID protocols, and lost income mean they’re getting care later in pregnancy and increasingly having to travel out of state.

The pandemic impacted budgets in other ways, too. NNAF’s biggest grassroots fundraising campaign, Fund-A-Thon, raised a little over $2 million in 2019. In 2020, that figure shrunk to just $563,000. Donations partially rebounded in 2021 to $1.53 million, but call volume at many funds is higher than before the pandemic, Hernandez said, so they need more money, not less.

According to the Washington Post, the country’s largest abortion fund, the Justice Fund at The National Abortion Federation (NAF), which helped more than 100,000 people pay for abortions in 2020, lost contributions in 2020 from anonymous foundations that experienced financial troubles or wanted to fund groups addressing racial inequities. NAF president Rev. Dr. Katherine Hancock Ragsdale said the organization secured new donors to help offset some of the decline, but it still expected the fund’s budget to be down at least 25 percent and has had a surge of callers from Texas since its ban went into effect. NAF created a dedicated hotline and fundraiser for Texas callers and, since Sept. 1, it has provided more than $16,500 in assistance for Texans traveling out of state, compared to $855 for all other patients traveling in the U.S. NAF projects it could spend around $50,000 a month just on Texans’ travel expenses alone if the law stays in effect.

And when NAF has less to give, people request higher amounts from already cash-strapped local funds. Kamyon Connor, executive director of the Texas Equal Access (TEA) Fund, one of 10 funds in the state, said its annual helpline budget is $400,000 and yet it can only partially assist about half of the people who call—and that was before the six-week ban took effect. “The burden’s falling on us,” Connor said.

The screws will also tighten in states where abortion will remain legal. After the Supreme Court rules next year, people from all over the South are expected to travel to Florida to get abortion care, which is currently protected through 24 weeks by the state constitution’s right to privacy. (Though that could also change; Florida’s state senate president has promised to introduce a Texas-like measure next session, which starts in January.) “We are fully expecting other states to lose their rights, and that we will have to pick up the slack,” said Kelly Nelson, co-founder of the Tampa Bay Abortion Fund. The fund’s incoming board president Kris Lawler said, this year, they were originally set to run out of money in October, but they recently secured an unexpected grant to get them through the end of the year. Still, Lawler said, “it’s possible that we’ll be back in the same boat searching for new funding by the end of 2021.”

Illinois is another state set to become an abortion haven, but the Midwest Access Coalition doesn’t have enough money to transport people from all over the U.S. to and from the Midwest for care, said Parker-Kafka, MAC’s only paid staff member. “We know how to do it, it’s just a matter of, where’s the money going to come from?” she said. “We probably need to hire full-time coordinators to handle all of this.” If funds can’t make up the gap, patients may delay care until they can gather more money. But abortions also cost more later in pregnancy, so the money problem snowballs.

Odile Schalit knows how this vicious circle works. She’s the executive director of The Brigid Alliance, an organization that pays the travel costs of people forced to cross state lines for abortions after the first trimester. If a patient can’t ultimately make it to their appointment in the faraway state, the fund runs out of the money it spent on airfare and a hotel in that person’s name, Schalit said.

In raw numbers, reduced abortion access will mean more people giving birth, and more births means a greater number of severe or life-threatening pregnancy complications. The U.S. already has a maternal mortality crisis with uneven effects: Black and Indigenous women are two to three times more likely to die from pregnancy than white women. The impacts of more unintended births could be particularly horrific in places like Texas, which has one of the highest maternal death rates in the U.S.

Criminalization is also a risk. Unlike the back alley wire hanger era, highly effective abortion medications now exist. But 19 states restrict the use of telemedicine abortion to prescribe them, and people who can’t make it to a clinic are increasingly ordering pills online outside the medical system, which can result in legal risks. While only five states explicitly ban self-managed abortion, people in more than 20 have faced investigations over their pregnancy outcomes. Infamously, an Indiana woman who ended her pregnancy with pills bought online spent nearly 18 months in prison before her conviction was overturned in 2016. Advocates are taking steps like an abortion bail fund that launched this summer to support people facing prosecution.

Calling for Change

The repro movement relies heavily on a few non-profits including the David and Lucile Packard Foundation and the Susan Thompson Buffett Foundation, but for abortion to remain accessible, reinforcements need to join the fight. “We need more foundations to step up and take a little pressure off the small and dedicated handful that support us now,” Ragsdale said.

Funds are also asking supporters to give without restrictions. A foundation might offer a restricted grant, for example, saying its money can only be used for staff salaries or advocacy, not abortions. Connor said these rules have made it difficult to increase TEA Fund’s helpline budget, and she wishes the philanthropy sector would trust funds’ expertise. “We’ve been navigating this for years. We’re the experts on what we need to spend our dollars on,” she said.

As for individual donors, funds appreciate the bumps they receive after big legislation or Supreme Court news, but it’s monthly donations—however small—that help them plan for the future. “We need to know that we can rely on you the way our callers are relying on us,” said Connor, who gave $3 a month as a TEA Fund donor before going to work there. And they need this money now so they can staff up, do outreach, and respond to any states that copy the Texas law.

Many people doing funding work are unpaid, which isn’t sustainable for them—or their clients. NNAF surveys show that funds with full-time staff are able support two to four times as many callers as volunteer-led funds. To that end, NNAF is expanding its staff at five key funds in the Mid-Atlantic region, with the aim of giving 100 percent funding to every single caller in summer 2022 once they are fully staffed. The staffing increase is a pilot program and NNAF plans to use its findings to staff up funds nationwide, but that will take time and more money, and the clock is ticking. “There’s enough wealth in this country to fund every abortion, and we just need people to recognize that and give it,” Hernandez said.

The longer-term goal is state and federal funding. Cities like New York, Austin, and Portland, Oregon, have budgeted money for abortion access. While the House passed a bill in July lifting the Medicaid ban on abortion coverage, that measure won’t pass the Senate anytime soon. If it does, people will still face private insurance restrictions and travel costs. And they’ll still need abortion funds. Hernandez said she’s heard state lawmakers argue that public funding for abortion isn’t necessary because abortion funds will take care of it. “That’s not how it’s supposed to work!” she said. “Abortion funds are doing this because nobody else will.”

Find your local abortion fund and support them directly at abortionfunds.org/funds.

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