The fight to fund abortions in post-Roe America

In recent weeks, supporters of abortion rights have been reeling from the Supreme Court's decision to revoke constitutional protection for reproductive choice. Some are mounting a political movement for Congress to codify a federal right for abortion. Meanwhile, those on the ground, providing and funding abortion services, now have to navigate a murky legal landscape, which makes their work much more difficult in a vast swath of America.

With 13 states in the process of outlawing or limiting abortion through laws automatically triggered by the court's decision, and 13 more states likely to pass restrictions in coming weeks and months, defenders of reproductive rights now face the fight of their lives. And for abortion providers and funders, the next round of this fight is about more than politics and law. It's become increasingly about money and logistics: providing women in states that restrict abortions the option — and the resources — to travel to states where abortion is legal and accessible.

A long list of major corporations — including Amazon, Tesla, Nike, Google, Starbucks, Disney, and Dick's Sporting Goods — have announced that they will cover travel expenses for employees seeking abortions. Some commentators, like NPR's own Gene Demby, are asking about the fine print of these policy announcements. Who, he asks, are considered "employees"? Doordash, for example, has said it will cover abortion travel expenses for its employees, but most of the people who work for the food delivery service are actually independent contractors who will not be getting this medical benefit.

The reality is the population most hurt by the overturning of Roe v. Wade is impoverished women in red states, not well-paid employees of Fortune 500 companies. They are more likely to be people of color and live in rural areas (other groups of women and people who don't identify as women will, of course, also be affected). And many lack the means or ability to travel to a faraway place and obtain a relatively expensive procedure. According to Planned Parenthood, an abortion can cost "up to $750 in the first trimester, and up to $1,500 later in the pregnancy" — and that doesn't include additional costs like gas or a plane ticket or lodging or the need to take time off from work or providing childcare.

Even before the Supreme Court overturned Roe in the recent case Dobbs v. Jackson Women's Health Organization, many across the country struggled to pay for and access abortion care. Some lacked healthcare coverage. Others had healthcare coverage but their insurance didn't cover the procedure. Still others lived in "abortion deserts," which required making a costly journey to end a pregnancy.

Research finds that women who seek abortions but are unable to get them tend to suffer from a host of social, psychological, medical, and economic problems. One study, by scholars at UC San Francisco, finds that "Women denied a wanted abortion who have to carry an unwanted pregnancy to term have four times greater odds of living below the Federal Poverty Level."

To improve abortion access, a bunch of local and national organizations known as "abortion funds" have formed over the years to help people pay for the procedure. In post-Roe America, money is now even more determinative of who can get an abortion and who can't, and abortion funds are emerging as an even more crucial mechanism to provide poor women in red states the opportunity to access care if they want or need it.

Abortion Funds

Founded in 1991, the Women's Reproductive Rights Assistance Project (WRRAP) is "the largest national, independent, nonprofit abortion fund." It provides financial assistance to people seeking abortions or emergency contraception through a network of 700 clinics and doctors spanning the country.

In 2021, WRRAP spent $538,301 to assist 2,565 patients in getting abortions or emergency contraception. Nearly 60 percent were unemployed. 20 percent were students. And 24 percent had to travel out of state to get an abortion.

Sylvia Ghazarian, the executive director of WRRAP, says that even before the Dobbs decision, her organization was seeing a surge in the number of patients forced to travel out of state to get abortion care. Clinics that provide abortions have been shutting down, due to restrictive laws and economic difficulties. The clinics that remain have found themselves swamped with growing backlogs. These delays have medical and financial consequences. Every week a patient has to postpone the procedure, Ghazarian says, "the cost of an abortion goes up."

WRRAP, like many other abortion funds, only funds abortion services and emergency contraceptives, not travel costs. Recognizing that travel costs present a growing barrier to accessing abortion care, a number of "practical support" organizations have popped up in recent years, including The Brigid Alliance.

The Brigid Alliance was launched in 2018, and it serves clients who must travel an average of 1000 miles to get an abortion. They cover costs like gas, plane tickets, childcare, and food. They also provide virtual support to clients to help them along their journey.

Since their founding, The Brigid Alliance has seen an explosion in demand for their services. Last year, Texas passed Senate Bill 8, which severely restricted abortion access. As a result of the law, Texans have been flooding clinics in neighboring states, contributing to much longer wait times and skyrocketing travel costs for those who want abortions. The Brigid Alliance saw a 900% increase in demand for financial assistance, says Odile Schalit, the organization's executive director.

Now, with the overturning of Roe v. Wade, "We are expecting an even more significant surge," Schalit says. The Brigid Alliance, like other organizations, has benefited from a groundswell of charitable donations since the Dobbs decision was leaked and then published. But, she says, "Does the organization have enough money to be able to deal with that need? Quite frankly, no, we don't. And that is one of the most painful parts of doing this work right now." She adds that inflation, particularly surging gas prices, is making the cost of travel an even bigger barrier to abortion access.

WRRAP and The Brigid Alliance are both members of the National Network of Abortion Funds (NNAF), an umbrella group for over 90 abortion funds that seeks "to remove financial and logistical barriers to abortion access." Lindsay Rodriguez, NNAF's communications director, says that between July 2020 and July 2021, the funds across their network answered 80,000 calls and dispersed more than $11 million. While they are helping more and more people every year, she says, abortion funds are also underfunded. They are typically only able to fund "a quarter to a third" of the people who request their financial assistance.

While NNAF has raised millions since the leak of the Dobbs decision, Rodriguez anticipates that ongoing demand for financial assistance will continue to surge, dwarfing their available funds. "Basically every time you see an abortion restriction in a state, that's an added price tag for each abortion," she says. This added price tag now includes much more travel from red states to blue states.

Beyond money, there is a growing capacity problem. Blue states are declaring themselves abortion "sanctuary states," but there are increasing worries that clinics that provide abortions in these places will be overwhelmed with a swell of demand from residents traveling from red states.

"Abortion providers in blue states are doing whatever they can to hire more abortion providers, to expand their clinics, and start new clinics," Schalit says. "But we will need more abortion providers."

In this post-Roe world, funding interstate abortion travel and building up an abortion infrastructure in blue states to facilitate it is "going to be one of the critical ways that we support abortion access," Schalit says. "Now without the protections of Roe and the number of bans that have been triggered by the Supreme Court decision, interstate travel is more necessary than ever."

A Minefield For Abortion Funds

It won't be easy for abortion funds to muster the significant resources that are needed to ensure access to abortion care for low-income folks in red states. And even if they do raise the money to bankroll interstate abortion travel and care for those who can't afford it, lawmakers might still torpedo their efforts.

"States that are hostile to abortion rights have clearly signaled that they are not going to be satisfied by simply outlawing abortion within their own borders," says Elisabeth Smith, the director of state policy and advocacy for the Center For Reproductive Rights. "They want to see a national abortion ban."

It's worth noting that Supreme Court Justice Brett Kavanaugh issued a separate, concurring opinion in Dobbs that is relevant here. While he agreed with the majority in holding that there is no constitutional right to an abortion, he wrote he does see "the constitutional right to interstate travel." Kavanaugh explicitly wrote that he believes a state cannot bar residents from traveling to another state in order to obtain an abortion.

U.S. Attorney General Merrick Garland recently issued a statement making the same point. "We recognize that traveling to obtain reproductive care may not be feasible in many circumstances," Garland wrote. "But under bedrock constitutional principles, women who reside in states that have banned access to comprehensive reproductive care must remain free to seek that care in states where it is legal."

Even if companies or abortion funds provide the money to enable people to cross state lines for abortion access, however, legal questions remain open. "States may not be able to stop people from traveling, but what happens when someone comes home?" Smith says. What happens to out-of-state clinics that provide care to residents from states where abortion is outlawed? What happens to a company or abortion fund that helps a resident of a red state get an abortion in a blue state?

In a recent op-ed in The Washington Post, Stephen L. Carter, a professor at Yale Law School, writes that he agrees with Kavanaugh that states cannot legally bar their residents from obtaining abortions in other states. However, he adds, "if the travel is paid for by an in-state actor" — like a local employer or abortion fund — "the case might come out differently."

State leaders are already signaling that they want to clamp down on funding that helps their residents obtain out-of-state abortions. In May, after Citigroup announced it would fund interstate abortion travel, a Texas legislator threatened to introduce legislation financially penalizing Citigroup and any other company that has such a policy. And the threats aren't just financial. With the constitutional right to an abortion gone, some leaders in states that restrict abortions might try to make it a crime to help state residents obtain abortions within or outside their state.

"We have not yet seen new criminal laws that would purport to prohibit travel to a state where abortion is available," Smith says. "But we know that states are gonna wanna chill that activity, and they're going to try and do that through a variety of means."

Will federal courts allow states to prohibit companies or abortion funds from aiding interstate abortion travel? We don't really know. Smith says the First Amendment clearly protects speech, so abortion providers and funds should be able provide information to residents of states where abortion is banned. But, she says, "making someone an appointment, funding that appointment and driving them there, that clearly goes beyond just providing information." Because we haven't seen prosecutions yet, Smith says, "it's really hard to fully pinpoint what the risk is."

All of the abortion funds we spoke to expressed concerns about the legal minefield that has been opened up by Dobbs. "There's no question that we and our clients are operating and traveling in a heightened state of fear and concern," Schalit says. [Copyright 2022 NPR]