The Supreme Court’s decision last week to review a Mississippi law banning most abortions after 15 weeks was both deeply troubling and completely predictable. After all, it was just a matter of time before the court — given its current makeup — considered a case that could overturn a central component of Roe v. Wade, potentially dismantling the landmark ruling and putting legal abortion further out of reach.
While this news rightly made national headlines, the multiple obstacles confronting those who want an abortion are nothing new. The constitutional right to an abortion established by Roe never ensured true access. The cost, which can run as high as several thousand dollars, and the lack of insurance coverage have always posed barriers. More recently, a landslide of state abortion restrictions has forced clinics to shutter across the South and Midwest, which means people in those states are already traveling long distances for care.
Help is available, but it comes with its own set of challenges. Those who can’t afford to pay for an abortion need to navigate a confusing network of nearly 100 national and local helplines and local abortion funds in hopes of receiving some financial assistance — all while the clock is ticking on the amount of time they have to get the procedure. Very few of those helplines can say yes to every caller or fully fund all of the unmet need.
The reality is that hundreds of thousands of people are already living in a world absent of Roe — a fact that too often goes unrecognized or ignored by foundations and wealthy donors.
For years, philanthropy has largely focused on supporting systemic policy change, funding almost exclusively legal and advocacy efforts to enshrine Roe into law and block state restrictions. Donors have optimistically believed that those investments will result in a world where abortion is available and affordable for all.
Certainly, progress has been made, including moving closer than ever to ending policies that deny insurance coverage for abortions. But after decades of investment, getting an abortion remains a complicated and challenging process, dependent on a network of abortion funds staffed largely by volunteers and on independent clinics, which provide the majority of abortions in the United States. If Roe falls, this tenuous network of care will be stretched even further.
A New Approach Is Required
Philanthropy has a moral obligation to take a different approach. If Roe is overturned, the problems people face trying to get abortions will become far more acute. For instance, the average distance to reach an abortion clinic would increase to nearly 300 miles, according to an analysis by the New York Times. In the 24 states where abortion would quickly become illegal, people would have to find a way to pay for travel to places where the procedure was still allowed, while juggling a host of other obstacles, including securing an appointment, taking time off from work, arranging for child care, and paying for the abortion itself. This isn’t our future, it’s our present, and the need will only grow.
I run the National Network of Abortion Funds, which supports more than 80 local abortion funds across the United States. These funds operate most of the abortion helplines and help people pay for and navigate the complicated path to abortion care. To understand the challenges those seeking an abortion face, recall how difficult it was just a few months ago to schedule an appointment for a Covid-19 vaccine: multiple phone calls to vaccine sites, crashing appointment websites, limited and inconsistent information. That’s just a sliver of the complexity abortion care entails for many.
Abortion funds have grown over the last few years, but their call volumes have doubled on average during the pandemic. The groups we work with are chronically and woefully underfunded, relying on individual fundraising vehicles like crowdsourcing to stay afloat. Crowdsourcing is great for building community involvement, but it should never be a primary health-care funding plan.
Abortion funds, however, have few other options. While private foundations contributed more than $900 million to support reproductive rights from 2015 to 2019, less than 3 percent went to local abortion funds, according to the National Committee for Responsive Philanthropy. Almost no foundations fund abortion directly. Those that do bear an imbalanced load and provide a fraction of the need. Their efforts need to be shared and supplemented by a broader spectrum of foundations.
Creating Barriers
This fractured system of abortion funding is an enormous problem — and the philanthropic approach of almost exclusively funding abortion rights has inadvertently created additional barriers. It’s not unusual for someone seeking an abortion to contact multiple abortion funds in search of enough money to cover all the costs associated with the procedure. The process puts the onus on the person seeking the abortion to understand the landscape and find time to have multiple conversations in the midst of a personal and financial crisis. Still, many come up short and are unable to attain the funds needed for an abortion.
We are currently testing a model that aims to transform this cumbersome system by allowing those seeking an abortion to link to the help they need with one phone call. All services would then be coordinated by a case manager at a local abortion fund who would come up with funding for the procedure, rides to clinics, child care, lodging, legal help, and emotional support such as doula care. In the next year, we are providing five local abortion funds in the Southeast with support to hire four full-time staff and offering them operational assistance.
But expanding our model nationally will require a philanthropic investment to transform the legal right to abortion from theory into reality. That means fully supporting local abortion funds across the country that have the history and expertise to efficiently get money and services to those who need them.
Grant makers need to radically shift their funding strategies. Those who are already supporting reproductive health, rights, and justice — and those who are just now considering joining this work — need to immediately start funding abortion care and logistics. We can’t wait for a government solution.
Policy is, of course, critical to lasting systemic change, and philanthropy needs to continue to play a role in those efforts. In the meantime, no one should be forced to carry an unwanted pregnancy. As we prepare for a world without Roe, the local abortion funds that have worked for decades to connect people to the care they need should become a major focus of philanthropic support.
