In mid-July, Alison Dreith said she felt like she was going to have “a breakdown.” It’d been a few weeks since the Supreme Court struck down Roe v. Wade, and the Midwest Access Coalition, where Dreith is director of strategic partnerships, was drowning in phone calls from people who needed help accessing abortion. Before June 24, Dreith, a crew of four staffers, and volunteers at the abortion fund assisted about 30 clients a week. As of July 15, they were serving over 200 calls.

“We are at capacity every single day,” Dreith said. “We really pride ourselves in helping people access abortion and in knowing what the laws are, but everything is changing so rapidly we can’t really keep up. Right after the [Supreme Court] decision, we had to shut down our hotline number for the first time because we had hundreds of overnight messages to respond to.”

The calls come in from far and wide, including Louisiana, where an ongoing legal battle has forced clinics to shut down and reopen several times to the great confusion of patients. Dreith relayed a story about a recent client from the southern tip of Arkansas, right at the Louisiana border. In the before times, she would have been able to access abortion care in nearby Shreveport, Louisiana. Not anymore. 

“This was around the time that they were going back to court in Louisiana, and I wasn’t willing to risk it with this client, who would have to endure a 24-hour waiting period only to maybe wake up the day-of her appointment in a state that just shut down abortion again. We had to send her to Kansas, which was about 10 hours away,” Dreith explained. 

Even before the Supreme Court’s decision in Dobbs v. Jackson, people routinely had to travel for care, and abortion funds moved mountains to support patients in hostile states with anti-abortion laws. In post-Roe America, these groups have been inundated with funds and volunteer requests, but they are still experiencing demands and obstacles like never before. Some have even been forced to stop operations. 

People “need time to grieve”

Texas’ abortion ban has been devastating for people in the state—especially undocumented immigrants in the Rio Grande Valley. Members of the community are confined to their sliver of the region because of Border Patrol checkpoints, so traveling for health care of any kind is often out of the question. Making matters worse for those in search of other forms of sexual and reproductive health care, the independent abortion provider Whole Woman’s Health (WWH) recently announced it was relocating to New Mexico. WWH’s McAllen, Texas, location was the only clinic that serviced the Rio Grande Valley. (The provider launched its Wayfinder Program to help people access abortion care no matter where they are, though the program does not appear to provide help for those in need of other sexual and reproductive health care services.) 

The situation facing Texas’ abortion funds is also dire. The Texas Equal Access Fund, the West Fund, the Lilith Fund, Jane’s Due Process, the Frontera Fund, Fund Texas Choice, the Clinic Access Support Network, and the Bridge Collective have all quietly paused abortion-related operations as they figure out the parameters of the work they can do in a state where abortion is now illegal.

Rosann Mariappuram, the executive director of Jane’s Due Process, said the last few weeks have been “crushing.” For more than 20 years, the organization has helped young people navigate parental consent laws and confidentially access abortion in the state of Texas. Continuing this work may subject employees and volunteers to criminal and civil liability, so the organization was forced to pause abortion-related services. 

I want people to know that we’re not going anywhere.

Rosann Mariappuram

Mariappuram told Prism that the work of many abortion funds will have to shift. Jane’s Due Process is currently thinking through its options, like whether the organization can pivot to helping young people access abortion out of state. Perhaps it will focus on supporting teens forced into parenthood by anti-abortion laws? Figuring out a path forward will take time, and the people who have been doing this work for years also “need time to grieve,” Mariappuram said. Still, the executive director said she worries that people who are new to the fight for abortion rights will be discouraged by funds’ need to temporarily suspend their work. 

“But my hope is that people will trust the methods of abortion funds like ours who have been doing this work for decades,” Mariappuram said. “There is no easy fix here. The chaos we’re experiencing is intentional—the Supreme Court knew that the abortion laws in the lower courts and in the states were a mess, and they didn’t care. I get that people are angry and they feel this sense of urgency, but we need patience. We’re going to win in the long run, but we have to move intentionally, and that means figuring out how our work will evolve. In the meantime, I want people to know that we’re not going anywhere.” 

“Letting the Midwest go”

Texas’ laws criminalizing abortion and people who provide abortion support have also created a ripple effect in the Midwest, where members of the Midwest Access Coalition are now slammed trying to aid their region and support people arriving from hundreds of miles away. 

The last few weeks have been “brutal,” Dreith said, noting that she’s recently gone on anxiety medication and limited her news intake. This is largely why she was unaware of how a 10-year-old rape victim from Ohio became a “flashpoint” for abortion rights after it was reported the child had to travel to Indiana to access care. Republicans and factions of the media called the girl’s story fake. Dreith said she didn’t even need to hear the details of the circus to know that conservatives “would pretend to be clueless” about the far-reaching ramifications of their efforts to ban abortion.

“This is not something out of the ordinary. We support young people all the time,” said Dreith, noting that the Midwest Access Coalition helped two 11-year-olds access abortion care the week we spoke. “These politicans say they care about children, but if they really did, they wouldn’t place restrictions on abortion that exacerbate gender-based violence.”

After more than 540,000 voted to defend existing abortion rights in Kansas, organizers are now being celebrated for providing a “blueprint” to other states where abortion will be on the ballot.  But when we spoke back in July, Dreith lamented how little support abortion access experts in the Midwest have received over the years as they battled severe restrictions on par with those in the South. 

“The South has its own unique history and challenges, and I don’t want to diminish that, but in many ways the Midwest has been in the same boat when it comes to restrictions, the rolling back of our rights, and attacks on democracy rooted in white supremacy,” Dreith said. “Missouri is a leader in anti-abortion legislation. They were the first state to pass a restriction on private insurance covering abortion, they were [one of] the first states to pass a restriction for telehealth for abortion, and they were really the first state to ban abortion. Planned Parenthood doesn’t want to talk about it, but they haven’t provided meaningful abortion care there since 2019.”

Abortion is now banned in Missouri. In a statement to Prism, Bonyen Lee-Gilmore, vice president of strategy and communications for Planned Parenthood of the St. Louis Region and Southwest Missouri, said that Missouri politicians “have a long history of ignoring doctors, science, and patients when it comes to sexual and reproductive health care.” 

“As a result, politicians imposed medically unnecessary restrictions year after year, and we complied at every turn in an effort to preserve what little was left of abortion access. We provided abortion care at the last clinic in Missouri until abortion was banned on June 24, 2022,” Lee-Gilmore said. 

In other Midwest news, abortion may soon be on the ballot in Michigan, where state legislators want to criminalize this form of health care, and in Indiana a near-total abortion ban will go into effect Sept. 15. The state recently became the first in the nation to successfully approve a ban after Roe was overturned. 

“It’s been really frustrating to watch this erosion of our rights over the last several years. It hasn’t received the attention it should, and it felt like people were OK just letting the Midwest go. Now the battle is so much bigger, ” Dreith said. 

“What do you do if you don’t feel safe at home anymore?”

In Kentucky, where voters will soon consider a measure declaring that there is no right to abortion in the state Constitution, Erin Smith says they are “tired and working through grief while holding onto hope.”

Smith is the executive director of the Kentucky Health Justice Network (KHJN), an organization that focuses on advocacy, education, and direct services that include funding abortion and helping trans Kentuckians access health care. At least one other abortion fund serving Appalachia halted operations after Roe was overturned, but Smith made the choice to keep operating in Kentucky. It was a risky decision, and it hasn’t been easy.

“Right now I feel like we are in strategic survival mode,” Smith said. “There is so much we have to figure out, and there’s a lot we have to learn, especially with our trigger law. Kentucky’s a very complicated place right now.” 

Things have only gotten more complicated since Smith spoke to Prism in July. Earlier this month, a Kentucky judge reinstituted the state’s near-total abortion ban, reversing a lower court’s order from July that temporarily allowed people to access care. Abortion is currently illegal in Kentucky, unless a pregnant person is at risk of death or serious permanent injury. There are no exceptions for rape or incest. 

Abortion experts who spoke to Prism said the court battles in individual states have been frustrating and confusing to people in need of care. Smith said patients in Kentucky “don’t know if they’re coming or going”—literally. 

As members of the National Network of Abortion Funds, KHJN has received support from other funds in protected states willing to help Kentuckians travel for abortion care, but the logistics are getting harder. 

We get the middle finger every time we try to defend human rights.

Erin Smith

“Before you might have had to travel a couple of hours, now it’s four, five, six hours out of state—and we’re still in a pandemic,” Smith said. “There’s no mask mandate, and people are afraid of getting sick, but on the other hand gas prices keep rising. All of this has drastically changed accessibility.” 

The executive director told Prism that Kentucky doesn’t have a state-wide sex educuation curriculum or state services specializing in sexual and reproductive health beyond HIV preventation and abstinence-focused programs. This greatly affects Kentuckians’ ability to make informed decisions about their health, they said, which means Kentucky is not a place that can afford to be without abortion care. 

“We don’t have a statewide sex education curriculum. We, as a country, have one of the highest maternal mortality rates in the world. As a state, we’re number one in child abuse and neglect. There are parts of the state where people can’t even access basic health care in hospitals and clinics. We don’t properly fund child protective services, public schools, teachers, or state social workers. These are the conditions we’re forcing people to give birth in, and once the child is born, there is little-to-no help for them, and there are few resources for their parents,” Smith said. 

One of the abortion funds now seeing a large number of traveling Kentuckians is the Carolina Abortion Fund (CAF), which provides support in North and South Carolina. 

Even before Roe was overturned, North Carolina was a haven for people in the south in need of abortion care. In 2019, 18% of North Caorlina’s abortion patients came from neighboring states. According to Carolina Public Press, in the first two weeks of July, more than a third of Planned Parenthood South Atlantic’s appointments for abortion care in North Carolina were for out-of-state patients. 

CAF board member Lauren O., who is not using their full name for safety reasons, told Prism the fund is trying to “adjust to a rapidly changing landscape in real time.” Indeed, many surrounding states are now operating in a gray area with various levels of access (or none at all) because of trigger laws. North Carolina didn’t have a trigger ban in place or old laws on the books, and no new restrictions on abortion have been imposed in the state. When combined, all of this means that abortion remains far more accessible in North Carolina than other regions of the South, and the number of people seeking abortion care in the state will only continue to skyrocket. 

O. said that CAF has been inundated with a “massive influx” of donations and volunteer requests. These are “good problems to have,” she said, but too much of a good thing is still too much of a good thing.

“The funds we can put to immediate use to help people access care, so I’ll never complain about that. But it takes time to suss out who is serious about volunteering and then convert that interest into on-the-ground action because that requires vetting and training and all kinds of things that require a lot of labor and investment. We have been around for 10 years, and we usually have the infrastructure to do that, but we are so slammed handling requests for support that we can’t currently juggle it all,” O. explained.  

I don’t want to leave the place I call home, and I don’t want to leave the place of my ancestors, but what do you do if you don’t feel safe at home anymore?

Erin Smith

Most abortion funds are largely staffed by volunteers operating on a strict budget, which is certainly the case for KHJN. When you add the stress of living in a state where the legislature is “hostile to abortion and human rights,” it can feel like “you never catch your breath,” Smith said.  

Reproductive justice advocates in the state are currently fighting for abortion rights at the same time their communities are being ravaged by floods in eastern Kentucky, where low-income families are being warned that accepting donations will prevent them from receiving benefits from the Federal Emergency Management Agency (FEMA).

“We get the middle finger every time we try to defend human rights,” Smith sighed. 

The executive director told Prism that there is a part of them that wants to put on a brave face and tell the world that everything is going to be OK, but they also don’t want to be dishonest. 

“I want to be real and say this shit is really scary,” Smith said. “I am a born and raised Kentuckian. I got my degree from Northern Kentucky University. I got my master’s from the University of Louisville. I will fight like hell for this place, but this is a defining moment. I am a Black nonbinary person, and I am having conversations with my partner I never wanted to have. I do not know if Kentucky is still a place we can have the future we want to have, if this is a place we can safely build a family. I don’t want to leave the place I call home, and I don’t want to leave the place of my ancestors, but what do you do if you don’t feel safe at home anymore? So many marginalized Kentuckians are struggling with these same questions,” Smith said.

“The more patients who have to travel, the more risk”

After Roe was overturned, there was a lack of clarity regarding Arizona’s abortion law, which pushed most providers to err on the side of caution and halt procedures in the state. Last month, after an Arizona law granting “personhood” to fetuses was blocked in court, the state’s independent providers began offering medication abortion again. Currently, there is only one clinic in Arizona that still offers surgical procedures up to 23 weeks and six days gestation. 

Eloisa Lopez, the executive director of the Abortion Fund of Arizona, told Prism that independent providers’ decision to resume services has helped Arizona residents access care sooner and closer to home. 

“Abortion is still legal in Arizona. The fear that has been circulating around abortion criminalization in our state has caused much harm to providers and abortion seekers,” Lopez said.

Over the last several weeks, the Abortion Fund of Arizona’s primary focus has been helping people get the care they need wherever it’s accessible to them. Supporting people to travel is pretty routine work for abortion funds, but overnight Lopez said that some funds had to pivot to help every person leave the state for abortion care. 

The reality is that we can have all the money in the world to pay for travel expenses and abortions, but at the end of the day there is no amount of money that’s going to make it safe for some people to travel because of the realities of their life.

Eloisa Lopez

“Before the Supreme Court’s decision, it was primarily people […] who needed to travel to California, Nevada, Colorado, or New Mexico for care work [due to gestational age or limited clinic availability]. We established those clinic relationships a long time ago, so getting people to those states is not a challenge for us. Now that almost everyone needs to travel, the challenge is what happens on the patient side,” Lopez said. 

Meaning, can a person take two, three, or even four days off to travel for care? Will they be able to financially survive if that time off is unpaid? Most people who access abortion care already have children. Do they have someone in their life who can watch their children while they travel out of state for abortion care? Do they have an I.D. to travel by plane, or do they have reliable transportation to travel by car? Does their immigration status hinder them from traveling by car because of Border Patrol checkpoints? 

“While these are the questions we’ve always had to ask, the more patients who have to travel, the more barriers in accessing abortion care,” Lopez explained. “The reality is that we can have all the money in the world to pay for travel expenses and abortions, but at the end of the day there is no amount of money that’s going to make it safe for some people to travel because of the realities of their life. These are the people who are not going to be able to get care.”

Complicating matters further, Lopez said that after Roe was overturned, the National Abortion Federation stopped funding abortion care in Arizona. This means that the Abortion Fund of Arizona is now paying for the full cost of patients’ care. The costs have increased massively. In July, the Arizona Abortion Fund paid out over $22,000 for patients’ care. As of Aug. 17, the fund has spent over $30,000 for the month of August. 

Outside of a small abortion support collective in Tucson, Arizona, the Arizona Abortion Fund is the primary funding source for people in need of financial support in the state—and the pressure is mounting to get people the care they need. On Friday, a hearing is scheduled to decide if an abortion ban first implemented before Arizona was a state will go into effect. 

“When you see a national funder drop out of a state, the financial burden falls onto us,” Lopez said. “Fortunately at the moment we have the resources to provide the support, but that’s not sustainable for our organization. It’s going to require a lot more fundraising to make sure people get their care.” 

Hope for the future

It’s not just local abortion funds that have recently had their worlds turned upside down. Organizations that work nationally also paused operations to take stock of the legal landscape, explained Mariely Neris Rodriguez, the director of client services at the Brigid Alliance. The organization’s referral-based service provides logistical support like travel, food, lodging, and child care for people seeking abortions.

Prism spoke to Neris Rodriguez in late June, and like many other abortion experts who knew the end of Roe was coming, she was still struggling with “intense shock and sadness.” 

The Brigid Alliance is currently up and running because the organization paused operations for a few days after the Supreme Court decision. The public should expect to see more of these recalibration periods from abortion support groups in the future depending on state legislation changes and the time that’s needed to understand potential liability, Neris Rodriguez said. 

Our movement is full of people who are deeply committed to getting people the care that they need, and on the hard days, that pushes me to keep going. I wouldn’t do this work if I didn’t have hope for the future.

Mariely Neris Rodriguez

“In a way, we have no idea what’s coming next. Some laws appear to follow the same kind of template, while other state laws will have different parameters and nuances that we have to take time to assess and understand and develop a plan for. With all of these changes, we have to shore up our infrastructure and build new partnerships. This is just what the future is going to be for groups like ours,” the director of client services said. 

The leaked draft of the Supreme Court opinion in the Dobbs v. Jackson Women’s Health Organization that would overturn Roe gave abortion support groups several weeks to plan for the worst case scenario, but Neris Rodriguez said that many in the movement still retained hope that “things would not be as awful” as they turned out to be.

For many groups, working closely with attorneys to assess whether they can legally provide abortion support in their state has been eye-opening. Some funds may never come back from their pause, while others may have to reshift their focus or develop creative workarounds for the work they want to do. 

More than a few abortion support workers who spoke to Prism on background said they have personally sought counsel to better understand the legal risks they are taking if they continue helping people access care in states where the procedure is now illegal. One noted the “exciting work” that is happening behind the scenes with activists in Mexico who are helping Americans living under bans get the abortion medication they need. 

“Is this a horrible time? Absolutely, but this is also a time in our movement when we are exploring new ideas and using our imaginations to envision a way forward,” Neris Rodriguez said. “Our movement is full of people who are deeply committed to getting people the care that they need, and on the hard days, that pushes me to keep going. I wouldn’t do this work if I didn’t have hope for the future.”