Dan Gorenstein: A quick note before we start: this episode includes some strong language.

The fall of Roe v. Wade has galvanized the country.

Some people are celebrating…

News clip: For the older generation of pro-lifers to see this today, I’m so grateful for them… 

DG: Others are protesting.

News clip: My body my choice.

DG: And many are opening their wallets.

News clip: In the 24 hours after the decision, they saw a 40-fold increase in donations. 

DG: More than 100 abortion funds dot the country.

These nonprofits helped at least 45,000 people pay for abortions in 2020.

They’ve raised millions of dollars since Roe was overturned.

And now, more and more people seeking abortions are turning to these funds especially in states where the procedure is outlawed.

Kim Floren: They call you in a state of panic, like, ‘What am I going to do? Where am I going to get this money?’ And when you’re able to offer practical solutions, it helps.

DG: Today, how abortion funds work, who they help, and what role they can play in a post-Roe world.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

*****

DG: To help us understand how abortion funds work, let’s turn back the clock for a look at Brittany Mostiller’s story.

In the summer of 2007 one question dominated her life.

Brittany Mostiller: What am I willing to do to not be pregnant?

DG: Brittany was 23, sharing a 2-bedroom apartment on the South Side of Chicago with her three kids, her sister and her niece.

Four kids under 6.

BM: That was the only affordable option or barely affordable option was to live together and try to split whichever bills we could pay at that moment.

DG: Brittany had just given birth to her third child in February.

She’d wanted an abortion but couldn’t afford it.

Carrying that pregnancy to term had pushed her into a depression.

And when she learned she was pregnant again in July, Brittany was angry with herself. And she was scared.

BM: Everything was just a mess. I was just like, something’s fucking wrong with me because here I am pregnant again. Everything just felt like it was caving in, but there I was still like clawing and fighting, like, I’m going to figure some shit out. Like, if it’s one thing I can do is figure some shit out.

DG: The first step: get an abortion this time.

But money was still a problem.

Abortions can cost anywhere from a few hundred to a few thousand dollars depending on where you live and how far along the pregnancy is.

34 state Medicaid programs and Washington D.C. don’t cover abortions, so especially for low-income people, the procedure is often all out-of-pocket.

Brittany worked part-time at a grocery store bringing in less than $1,000 a month.

She was struggling to pay rent and buy food.

A $400 abortion almost seemed like a joke.

BM: I felt stuck. I wanted something more. I wanted to offer my children something more. And so what grew out of that was like this sense of really strong self-determination to give them more and to be more for them.

DG: Brittany was determined enough to end her pregnancy that she considered some dark options.

BM: Maybe my five year old can, like, pounce on me right now. 

Maybe I can throw myself down the stairs. I was only on the first floor, but I thought if I do it enough, I would miscarry or something.

I was going to do this by any means necessary.

DG: A less scary plan: the county hospital offered early abortions for $50.

A stretch for Brittany but doable.

So on a Tuesday, Brittany dragged herself to the train at 5 a.m. to make her 6:15 appointment.

DG: At the hospital, they gave her an ultrasound to see how far along she was.

BM: 12 and a half weeks.

DG: That was a problem.

The hospital only offered $50 abortions for pregnancies up to 12 weeks.

Brittany got back on the train sobbing. 

The hospital had given her a list of pricey abortion clinics and the number for the Chicago Abortion Fund.

The organization has been around since 1985 helping people like Brittany pay for abortions.

Brittany had never heard of them and was suspicious.

BM: I’m like, ain’t no way in hell somebody out here paying for people’s abortions, right? I don’t know if I need to pay it back, do anything, I don’t know. Like I didn’t know what to expect.

DG: But Brittany was also desperate, so she dialed the number.

CAF Message: Thank you for calling the Chicago Abortion Fund…

BM: The hotline wasn’t open at that moment, but they did have a recorded message letting you know everything you need to do prior to calling them back for funding.

DG: Brittany didn’t know it at the time, but this was normal.

Volunteers staff most abortion funds and calling hours can be limited. 

The message Brittany heard said the hotline would open at 3:00 and callers had to have an abortion appointment scheduled.

So she booked a $900 appointment.

The recording also said funding sometimes ran out within an hour, so at 2:58  Brittany started dialing.

BM: At 3 o’clock I got through.

I remember being like super excited that they answered and I remember like crying through the whole intake process.

DG: The woman on the other end told Brittany the fund could pay for about a third of her procedure.

She made it clear that this was a contribution, not some kind of loan.

She walked Brittany through how it would work.

BM: They let me know that they would send a voucher over to the clinic and that would then be deducted from whatever portion I needed to bring in.

DG: Brittany hung up knowing she’d need extra shifts at work, could maybe borrow money from her great-grandma, and probably leave a few bills unpaid to cover the rest of the $900.

A few weeks later: Brittany had her abortion.

BM: After the procedure I felt relieved. I can breathe and start to figure out what the next chapter of my life could look like or even just be able to imagine.

DG: The financial help from the Chicago Abortion Fund was critical.

But Brittany says those few minutes on the phone gave her a lot more than money.

BM: That was like the first time I had experienced something that compassionate and that understanding. I felt really held on that call and seen and in a way that I had never, ever felt.

DG: Every abortion fund we spoke with said this has always been part of the job — helping people seeking abortions for whatever reason feel safe.

Brittany found a community through this process.

She started volunteering with the Chicago Abortion Fund, meeting other Black women who had gone through the same things she had.

Eight years after her abortion, Brittany was the running the fund. And she now works for the National Network of Abortion Funds.

Brittany says more than a career, in this world she’s found a calling, and she knows how important funds are going to be in a post-Roe world.

BM: We have been preparing for this. It’s just real now. It’s so much more than just funding people’s procedures. For callers, for folks to feel seen and held, that shit means something. It gave me hope. Like shit was rough, and they were like this light.

DG: When we come back, how abortion funds are responding to their new reality.

MIDROLL

DG: Welcome back.

With the fall of Roe, abortion funds are taking on a much larger role than in the past.

Gretchen Ely: They’re going to be really vital for people to access legal abortion out of state.

DG: Gretchen Ely is one of the few researchers in the United States who studies abortion funds.

She’s a social work professor at the University of Tennessee and has published six papers on the topic since 2016.

Her research started with a phone call from a colleague who worked at a national abortion fund.

GE: She reached out to me and said, ‘I have all this data from working in this role for many, many years. Would you like to partner and take a look at some of the characteristics of these cases?'”

DG: Gretchen had studied abortion access for more than a decade. This was her first exposure to abortion funds.

She learned a few things right away:

Each fund was independent.

Some served specific states or regions. Others served particular populations like indigenous women. 

Many funds were tiny, just one or two volunteers answering a cell phone.

Others were run by clinics or part of a larger organization like Planned Parenthood.

One of Gretchen’s first research questions: Who did these funds help?

GE: On average, they mostly serve younger parents in their twenties who already have children.

DG: That’s in line with the people who tend to seek out abortions nationwide.

Gretchen also found that about half of abortion fund clients were Black, compared to around one-third of overall abortion seekers.

And that people turning to abortion funds often lacked full-time work, stable housing and safe relationships.

In other words:

GE: They serve people who have the greatest needs.

DG: Another lesson for Gretchen: These funds have limits.

Most only offer about $215 on average, leaving patients with hundreds or even more to find on their own.

Funds operate like this in hopes of stretching their limited dollars to help as many people as possible, but they can only stretch so far.

Survey data from the National Network of Abortion Funds show that about half of abortion fund callers don’t receive any financial support.

GE: They help so many people, but they can’t help everyone.

DG: Now, with abortion bans and restrictions spreading week-by-week, abortion funds are playing a bigger role than they ever have. And money is pouring in.

In the first three weeks after the court struck down Roe, the National Network of Abortion Funds raised nearly $11 million for local funds. That’s more than all funds in the network nationwide gave out in 2020. 

Some of that money has gone to Kim Floren in South Dakota, one of seven states where abortion is now illegal.

KF: We’re seeing increased demand for procedure costs, like when people call, they don’t just need like $200 or $300. They need $500 or $600. 

DG: Kim co-founded and runs the Justice Through Empowerment Network.

Before Roe fell, she said her fund sent about 70% of its clients out of state.

Now, that’s 100%, and travel costs — known as “practical support” — are mounting.

KF: By the time you count in somebody who has to drive 600 miles and then stay two or three nights in a hotel. And then they have to eat that whole time while they’re there. And food isn’t cheap and gas isn’t cheap and a lot of times the practical support costs just as much as the actual funding for the abortion.

DG: Kim guesses she’s given out at least $5,000 for these expenses just since the Supreme Court decision leaked in May.

She’s also raised more in the last few weeks than she gave out last year — about $40,000.

Enough to keep pace with the increased demand so far.

Kim says the biggest change she’s seen is just how freaked out people are when they call.

She says many of them are going online and looking for anyone who might be able to help, even if they’re literally a thousand miles away.

KF: We’ve gotten calls from people in Missouri and Kansas, North Dakota, Minnesota. In the last week I probably had like six Texas numbers pop up.

DG: The heightened fear and uncertainty around abortion is palpable, and abortion funds are trying to step into that breach the best they can.

Erin Smith knows all about it. 

ES: I’ve had people come up to me and say, I’m afraid to call you all because I don’t want my line getting tapped. I don’t want to go to jail. I don’t want to be arrested.

DG: Erin runs the Kentucky Health Justice Network in Louisville.

Kentucky’s abortion ban was set aside by a judge leaving abortion legal in the state for the time being.

While their fund serves all Kentuckians, the organization focuses especially on transgender and nonbinary people.

ES: I had a friend of mine come up to me, and they were like, ‘Hey, I have a friend who’s a trans man who is seeking an abortion. They’re afraid to call because they don’t want to be ostracized.’ Those are stories that people don’t hear and don’t see.

DG: Erin says their work with trans and nonbinary patients has required the organization to do more than give money.

They’ve gotten good at providing information, a real service in this moment of fear and confusion.

ES: Making sure that not only are we calling our callers and reassuring our callers, that we’re reassuring the community, that we’re letting the community know what we can and can’t do or what they can and can’t do. We are here to be a light for people who feel like they have no way out of their situation.

DG: Virtually overnight, abortion funds’ role has grown in the fight to protect reproductive rights.

But there are also serious legal questions.

Texas funds have temporarily stopped paying for abortions, unsure if they can legally operate under the state’s restrictive abortion laws.

At least one other fund in Alabama has done the same.

The National Network of Abortion Funds is offering grants, helping funds hire lawyers.

Kim Floren in South Dakota, says she’s ready for a fight.

KF: I know that our state government is going to come after us in the next special session because we saw what happened in Texas, and they’ve made some pretty clear threats that they want to target people who help people go out of state for abortions.

DG: Kim and other fund operators are adapting to their new, bigger roles.

When they can, writing bigger checks, helping more people, keeping folks informed.

But just like before, there’s only so much they can do.

I’m Dan Gorenstein, this is Tradeoffs.

Tradeoffs’ coverage of health care costs is supported, in part, by Arnold Ventures and West Health.