Pre-“Roe v. Wade,” Chicago’s Jane collective organized to provide abortions for more than 10,000 women who couldn’t access them legally. Courtesy of Women Make Movies, www.wmm.com

What would life be like without Roe v. Wade, the landmark 1973 ruling that gave women in the U.S. the right to a legal abortion? This has become a common question ever since President Donald Trump nominated federal judge Brett Kavanaugh last month to replace the just-retired justice Anthony Kennedy on the Supreme Court, with anti-abortion activists gearing up for a post-Roe world and defenders of abortion rights warning that if confirmed by the Senate next month, Kavanaugh could be the deciding vote to re-criminalize abortion.

If that were to happen, the United States would revert to a patchwork of local laws; only eight states — Maine, Connecticut, Delaware, Maryland, California, Nevada, Washington, and Hawaii — have laws that guarantee the right to abortion, while others have legislation in place that would immediately ban it. In New York, the state’s 1970 abortion legalization law remains in place but makes no allowances for procedures after 24 weeks of pregnancy, even if the fetus can’t survive or if the pregnancy is causing non-life-threatening risks to the woman’s health. The likelihood of an eventual overturn of Roe has raised specters of a return in most of the U.S. to the days when women routinely had to cobble together money to either pay underground practitioners or travel to places where abortion was legal, or were forced to carry undesired pregnancies to term.

In practice, though, that’s already the reality in which many Americans live. A report published last year in the medical journal the Lancet found that in 2014 the median distance a woman would have had to travel to get to an abortion clinic was between 10 and 79 miles, and 20 percent of women would have had to travel 42 miles or more. Another study issued last year by the Guttmacher Institute found that the number of clinics decreased by 22 percent in the Midwest and 13 percent in the South between 2011 and 2014.

As Rebecca, a resident of Buffalo, New York, who spoke to the Voice on the condition that she not provide her last name, says, getting an abortion in 2018 can already prove a monumentally difficult task. “I was terrified,” she recalls of the moment earlier this year when she determined she needed an abortion promptly to meet legal time limits, and of her discovery of all the obstacles she would face in obtaining one. “It was surprising realizing what isn’t available where I live and how many barriers there are.”

Mary Badame, a board member at the New York Abortion Access Fund, which ended up aiding Rebecca, warns that if Roe is fully overturned, insurance coverage of abortions will likely be very limited — making it that much harder for women to afford services even in states where they still exist. Without stronger state laws and more funding from both local governments and donors to abortion access funds, she warns, “hundreds if not thousands of individuals may go without the care that they need and end up being forced to carry a pregnancy to term that they wanted to terminate.”

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Last January, as Rebecca recalls, she felt a fluttering in her stomach and had a sinking feeling; two pregnancy tests later, she found out she was pregnant. Though she has a well-paying job in the insurance field, is married to her high school sweetheart, and has an eight-year-old daughter who she describes as her dream girl, Rebecca says she knew she shouldn’t have another child right now — she was taking medications for depression and anxiety, and didn’t know how they would affect the fetus.

“The alternative to having an abortion felt unsafe, so I made the best decision I could for my family,” she says. She scheduled an appointment at one of Buffalo’s three remaining abortion providers for the following day.

The next day at the clinic, however, Rebecca learned that she was 24 weeks pregnant. As none of Buffalo’s providers perform abortions after 19 weeks of pregnancy, “New York City was the closest and only option for me,” she tells the Voice. What’s more, since she was already near New York State’s cutoff for a legal abortion, she had to make an appointment at a New York City clinic for five days later, take emergency time off of work, and ask her parents to help out her husband with their daughter while she made the eight-hour drive downstate, unsure if the clinic there would turn her away because her pregnancy was so close to the legal limit.

When she arrived in New York City, she found out that her insurance didn’t completely cover the procedure, and that she would have to pay for a portion of it herself up front.

“At this point, I start to freak out,” she says. She sent her friend who’d accompanied her to New York City to the nearest ATM with her bank card, to withdraw what funds were left in her checking account. Her friend returned with the money and a suggestion: She knew of an organization called the New York Abortion Access Fund, which helps women who need financial assistance to obtain abortions.

Rebecca says she called NYAAF and spoke with a volunteer: “I let her know that my situation was time-sensitive, and if I didn’t have step one of the procedure done today, I likely wouldn’t be able to have it done at all.” After a few more phone calls and several more trips to the ATM, NYAAF was able to provide the $800 Rebecca still needed.

“She told me that she would call reception and let them know,” she recalls. “I paid the balance minus $800 and reception told me they’d heard from NYAAF already. They said I would be called to go in for the procedure.”

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NYAAF is one of several dozen abortion funds that have been quietly operating in the U.S. for decades, and the largest in New York City. (New York is also home to the Haven Coalition, which works with clinics to provide housing for women who have to travel to the city to seek abortions, and the Brigid Alliance, which helps with transportation, housing, meals, and childcare.) Founded in 2001, it remains an all-volunteer-run organization — Rebecca notes that its board needed to vote before approving her $800 — that offers financial support for women living in or traveling to New York who aren’t able to pay for abortion care.

Badame explains that NYAAF volunteers operate three helplines — one for people living in New York City, one for those outside of New York City, and one for Spanish speakers — as well as respond to requests for assistance via email. As in Rebecca’s case, hotline operators work to determine whether Medicaid can cover any costs, negotiate discounts with clinics, and seek out other funding sources, then decide what to pledge from NYAAF’s own fundraising as well.

Along with such national organizations as the National Abortion Federation and the National Network of Abortion Funds’ Tiller Fund, abortion funds provide a loose network that fills the gaps in abortion access that have existed since not long after Roe. The biggest reason women today seek aid, says Badame, remains the Hyde Amendment, which, starting in 1976, banned the use of federal funds like Medicaid to pay for abortions, leaving it up to individual states to determine whether to cover the procedure. “We see a lot of people from states where Medicaid won’t cover the cost of the procedure.” She says NYAAF also often receives requests from young people trying to avoid mandatory waiting periods and parental consent laws.

Bans on abortion after 20 weeks, in place in 17 states, are another factor that forces women to travel to other states to receive care, says Badame. To that end, she says that at NYAAF, “there has been a consistent increase in the distance clients must travel to access abortion after 17 weeks’ gestation.”

Recently, she says, NYAAF has noticed that clients traveling from out of state are particularly prone to be seeking care in their second trimester or later. In 2016, according to Badame, 36 percent of NYAAF’s clients had traveled from other states to New York to get care, with 15 percent of those coming from the South, where clinics are now few and far between: More than 90 percent of Mississippi women aged 15 to 44 live in a county with no abortion provider, and Kentucky’s last remaining clinic is currently fighting for its life in court.

“We’re already seeing these states imposing more and more restrictions that make abortion care harder to access, states where there are many less clinics, maybe a parental consent law, or a mandatory waiting period and people just can’t access the care that they need in their home state,” says Badame.

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Not all women forced to travel for abortions are headed away from blue states. New Yorker Erika Christensen has previously written about her experience in May 2016, when she discovered that her pregnancy wasn’t viable: The fetus was going to be unable to breathe, and would choke to death when it was born. She and her partner decided that an abortion was the best option — but at 30 weeks of pregnancy, she was past New York’s 24-week cutoff, and ended up having to travel to Colorado for a procedure to stop her fetus’s heartbeat. “This was very shocking to us because we had no idea that there were restrictions in New York at all,” says Christensen.

Even though she ended up having to borrow $10,000 from her mother’s retirement fund to pay for the procedure in Colorado, she considers herself privileged in a way. “How about the people who can’t read a bunch of really complicated paperwork, who don’t speak English, who aren’t adults in a loving relationship?” Christensen asks. The problem, they eventually realized, was New York’s law making abortions after 24 weeks illegal: “Every time we saw a problem, we would look for what caused it, and it all kept coming back to this law in New York.”

Christensen has advocated for the Reproductive Health Act, a bill currently up for consideration in the New York State legislature that would allow abortions after 24 weeks for nonviable fetuses or to protect the woman’s health. But though the RHA may finally have a chance at passage — the Independent Democratic Conference that has helped prevent the bill from getting a vote has finally dissolved, and feeling pressure from Cynthia Nixon’s campaign, Governor Andrew Cuomo called for passage of the legislation last month — it wouldn’t do anything for women who live in states with anti-abortion legislatures, or where abortions are impossible to come by or pay for.

In 1971, Jan Peterson became pregnant at age 16 in Illinois, where abortion was still illegal, and borrowed money from friends to travel to New York, which had legalized the procedure the previous year. She says she was ecstatic when Roe legalized abortion nationwide two years later. But when asked about its precarious future, she explains that she worries women “are going to go places where they shouldn’t be going to have a procedure done that is the wrong procedure.”

“I never realized that there were that many obstacles,” says Rebecca of her experience, and the growing realization that she would have to grapple with everything from hours-long travel to finding a way to pay for a procedure that her insurance would not. “As many barriers that I faced, there could have been a lot more. We think that we have the right to choose, but there is a threshold for when that stops being true given the political climate that we’re in right now.”