The U.S. Supreme Court has overturned the federal right to an abortion, but pro-choice groups in states with restrictive laws say they have long worked under the challenges of a post-Roe landscape.
With the court’s decision to overturn Roe, trigger laws in 13 states have made abortion automatically or soon-to-be illegal, according to the Guttmacher Institute, an abortion rights group. More states are expected to ban the procedure now that it is not federally protected, restricting abortion access in over half the country.
Some states, however, have caught a preview of what a world without Roe could look like much earlier than the rest of the U.S. In late May, Oklahoma became the first state to outlaw nearly all abortions, even when Roe still remained the law of the land. And in 2021, a Texas law—Senate Bill 8— banned all abortions in the state as early as six weeks, before many women discover they are pregnant.
Pro-choice organizations on the ground say that the states where abortion is protected should get ready to expect an influx of desperate clients, a dwindling number of abortion care options, and a total rethink of how they strategize to manage that demand.
“Texas is a glimpse of what post-Roe America will look like, and we’ve been experiencing this now for almost a year,” said Jaylynn Farr Munson, the development and communications manager for Fund Texas Choice, an organization that arranges both in-state and out-of-state travel for residents seeking abortions. “What we’ve been experiencing is now going to become the normal for so many, for half of the country, essentially.”
Higher demand and fewer clinics
Organizations in states that have adopted highly restrictive abortion policies say they have only seen demand rise.
That’s because “restrictions on abortion don’t do anything to prevent unplanned pregnancy or reduce the need for abortion,” Amy Hagstrom Miller, CEO of abortion care provider Whole Woman’s Health Alliance, told Fortune. “All they do is displace people and push people either to have to travel or to take matters into their own hands.”
Hagstrom Miller noticed a kind of domino effect once Texas’s SB 8 went into effect in September of last year. Clients felt a greater sense of urgency to find the soonest abortion clinic appointment, as the available window for the procedure was suddenly condensed.
“We thought at first it would be, ‘Tell me where the closest clinic is,’ and it was like that in September of 2021,” she said. “Then all the closest clinics booked up, and they didn’t have an appointment for four to six weeks, very soon after SB 8 went into effect, in Oklahoma, Louisiana, and New Mexico. And so then, it was about patients saying to us, ‘Where can I be seen? Where’s the next available appointment?’”
In Texas, finding the “next available appointment,” often means traveling hundreds of miles owing to previous clinic closures in the state. In 2013, Texas passed House Bill 2, a major antiabortion law, which shuttered 24 of the state’s 41 abortion clinics. Although House Bill 2 was later overturned and SB 8 did not close any additional clinics, most of the ones that shut down never reopened, so appointments at the few providers left quickly filled up.
Like Hagstrom Miller at Whole Woman’s Health Alliance, Texas-specific abortion funds, organizations that coordinate and cover travel and other logistics associated with the procedure, have also seen a “jump in interest” from clients seeking an out-of-state appointment.
Before September 2021, “70% of our clients were within the state of Texas, staying within the state of Texas, and 30% were going out of state because maybe they were closer to Louisiana or New Mexico,” Farr Munson said. “Now that SB 8 has been in effect, 99% of our patients have to leave the state.”
Fund Texas Choice’s staff of eight used to hear from 40 to 50 monthly callers; for the past nine months, the calls for assistance have skyrocketed to 300 a month.
“We hired additional staff to be able to support that large jump in interest, in need from our callers, but we are still only able to assist about 100 people a month,” Farr Munson added. “We just don’t have the human power.”
Greater demand for abortion funds’ services has led to new choices around how they spend their money. Texas Choice used to fund travel for adults to bring a partner or support person to their appointment. After SB 8 passed, it could typically only make exceptions for minors. For some patients, traveling out of state for an abortion is their first time flying on an airplane, and for many, their first time in a new city, Farr Munson said.
The Kentucky Health Justice Network is an abortion fund that has been increasingly servicing out-of-state travelers owing to “all the restrictive laws that are coming down in other states.”
“We’ve gotten a lot more calls from Indiana. We’re getting more from the Midwest, we’ve gotten some from Texas, we’ve gotten some from Oklahoma, just people trying to figure out where can they go, who can they turn to, as states restrict abortion access,” KHJN’s executive director, Erin Smith, said.
In what Smith called the “toughest decision that we’ve had to make,” KHJN started placing weekly and monthly budget caps on the phone calls they receive, which are still consistently met every time, to cope with the influx of out-of-state residents seeking assistance.
Kentucky’s trigger law means that abortion is illegal “effective immediately” upon the Supreme Court’s reversal of Roe v. Wade. And the end of Roe means that there will be even fewer out-of-state clinics to send clients to, even in states where abortion remains legal.
“What strain is that going to place on providers and clinics back in states where they still have access to abortion, and they have to absorb all of our clients?” Farr Munson asked.
Whole Woman’s Health Alliance manages nine abortion clinics in five states including Texas. Those clinics span states where abortion will be banned and “haven states” like Minnesota that promised to guarantee the right to an abortion prior to the overturn of Roe. The strategy at WWHA moving forward is to close down operations in Texas and help its physicians in states with bans get licenses to work in those haven states.
“We’ve kind of been operating in what I call two different Americas for quite some time. We’re preparing to wind down in the banned states, and we’re trying to prepare for a potential surge in the other states,” Hagstrom Miller said.
Skyrocketing costs for abortion care
The longer journeys clients must make to access abortion health care have substantially increased the cost of an abortion for patients and for the groups assisting them in states like Texas where abortion has been significantly restricted. Those costs extend far beyond the price of the procedure, and include childcare expenses, flights, hotels, lost wages from missing work, and more.
“The more people have to go to the same state to access care, the further out appointments at those clinics in these less restrictive states are going to be,” Farr Munson said. “Someone who may have been seeking an abortion at eight weeks or nine weeks may now be waiting until 12 weeks or 15 weeks or 20 weeks into the pregnancy to be able to get an appointment, and so then the cost of the actual procedure is going to go up as well.”
After SB 8 passed in Texas, Whole Woman’s Health Alliance piloted a new Wayfinder program to help Texans locate an abortion appointment. Hagstrom Miller calculated that on average, funding came out to $1,000 per patient—an amount that was “not really sustainable” for the organization.
Since the Wayfinder program began nine months ago, the health care provider has adjusted, putting in place new financial strategies that Hagstrom Miller likened to those of a travel agency.
“We’ve figured out relationships with a couple of hotels so we can get a room block with a decent rate,” Hagstrom Miller said. “We figured out which airline cancels flights less often, and which times of day are better to travel—like where things don’t get canceled or delayed as much.”
A portion of those additional costs may be offset by donations in response to the overturn of Roe.
On a typical day, Farr Munson said Fund Texas Choice receives “a handful of donations.” But the fund saw “hundreds” of donors on May 2, the day Supreme Court Justice Alito’s draft opinion overturning Roe was leaked to Politico.
Fund Texas Choice and the Kentucky Health Justice Network are part of the National Network of Abortion Funds, a membership of 97 local groups across the country. Within a week of the draft opinion leak, the national network raised over $1 million through its annual Fund-A-Thon, according to Debasri Ghosh, managing director of NNAF. The following week, it received 16,000 donations through an ActBlue page, that totaled $1.6 million across the network.
Smith said the Kentucky Health Justice Network sees building partnerships with other funds as “the new lifeline”—a potential area to cut costs in the long term.
“Right now we are operating with like, ‘Okay, we have transport volunteers who use what they have to get someone to where they need to go.’ I think it could change to maybe like, ‘Hey, let us try renting a bus and doing a twice a month transport or once a month transport if we can to this location in another state,’” Smith said. “Something where multiple organizations are kind of coordinating these logistical things.”
“It’s going to be about tweaking systems that we already have and adjusting to the change, but the mission’s always going to stay the same,” Smith added.
Even with the years of preparation, though, abortion funds and clinics say they face many unknowns while navigating how to continue providing support to patients amid new civil and criminal penalties for those seeking abortions, or those helping them with the process.
“We don’t know what the repercussions may be. We don’t know if just providers and funds will be the target of these repercussions or if pregnant people themselves will be at risk,” Farr Munson said.
“That’s sort of where we have to lean on the lawyers to go through those laws and figure out exactly what that’s going to look like and how we can still exist and operate and get the assistance that they need.”