× Expand Linda Kocher More than 300 trained clinic escorts, including coordinator Olivia Anderson, shown here, shield patients from anti-abortion protesters at the New Orleans Abortion Fund’s partner clinic.

Amy Irvin had her first abortion when she was in college. Young and wanting to be near her support network of friends, she drove from Atlanta, Georgia, where she was working for the summer, back to her college town of Cincinnati, Ohio, for the procedure. Twenty years later, she would have another unplanned pregnancy, and another abortion, while she was living in New Orleans, Louisiana.

The experiences, separated by two decades, as well as more income and stability on Irvin’s part, were starkly different. Though there were protesters in front of the Ohio clinic back then, she was struck by how much more difficult it was seeking an abortion in the South, even in the early 2010s.

In the clinic that day, she remembers the women from Baton Rouge, a drive of about an hour and a half from New Orleans, worrying about their children at home. Because Louisiana has a required twenty-four-hour waiting period following the initial appointment (during which providers must complete an ultrasound, show the patient the picture, and provide counseling to discourage the abortion), the actual procedure would have to be done during a separate trip.

This contrast between Irvin’s two abortions reflects a renewed anti-abortion political agenda that has, over the last decade, passed an onslaught of state restrictions. The effort continues: During the first months of 2019, the United States has seen a burst of extremist anti-abortion bills introduced in state legislatures. The new threats are unprecedented—so-called heartbeat laws that would ban abortion after an embryonic heartbeat can be detected, or roughly six weeks into gestation, just two weeks after a missed period and before many people even know they are pregnant.

Bills sharply restricting abortion access have passed in Ohio, Kentucky, Mississippi, and Georgia, and been introduced in Louisiana, Maryland, Minnesota, Illinois, New York, Florida, South Carolina, Tennessee, Texas, and West Virginia. In mid-May, Alabama passed a near-total ban on abortion, with no exceptions for even rape and incest, followed shortly thereafter by an equally restrictive ban passed in Missouri.

Many people across the nation, including 59 percent of the women living in Alabama, live in counties that do not have an abortion clinic.

Since the 2010 elections shifted control of most state legislatures to Republicans, attacks on abortion rights have become increasingly common. This has resulted in onerous restrictions on people, including waiting periods, mandatory counseling, and time limits, while also placing restrictions on abortion providers and clinics themselves. In the last eight years alone, more than 400 restrictions have been enacted by states, roughly one-third of all restrictions since Roe v. Wade affirmed in 1973 that access to safe and legal abortion is a Constitutional right.

Elizabeth Nash, senior state issues manager at the Guttmacher Institute, a reproductive health research organization, says we’re now seeing the most extreme legislation because “there is little left to do [other] than an all-out abortion ban.” In addition to the heartbeat laws, which would act as de facto bans on abortion after six weeks, some states have also introduced legislation that would ban abortion entirely, defining life at the moment of conception.

The precedent set by Roe, of course, clearly holds these sorts of bans as unconstitutional (similar heartbeat laws passed in recent years in Arkansas, Iowa, and North Dakota were struck down), which is why anti-abortion activists have generally focused on slowly curtailing abortion access at the state level in the first place. Groups like Americans United for Life and the National Right to Life Committee write model legislation for state legislators to easily introduce new bills, including the new policies coming out of state capitols.

But since President Donald Trump has appointed two new conservative Justices to the Supreme Court, anti-abortion policymakers have become emboldened. These six-week abortion bans are meant to be challenged in the courts, slowly making their way to a now more-pliant Supreme Court bench, providing the opportunity to strike down Roe and potentially allow state-level bans.

In the states where these new laws are advancing, abortion access is already greatly limited. In 1992, in Planned Parenthood v. Casey, the Supreme Court reaffirmed Roe but handed down a new standard for determining the legality of abortion restrictions: that a restriction should not place an “undue burden” on a person seeking an abortion. That’s difficult to define, leading to a confusing mosaic of differing abortion laws across the states and ensuring that income, race, gender expression, and geography all have an outsized impact on a person’s ability to obtain an abortion.

Because anti-abortion activists have focused their energy on the states, it makes sense that abortion advocates would do the same via local and grassroots efforts, with an eye to how people are most impacted.

After her firsthand experience with Louisiana’s restrictions, Irvin was motivated to co-found the New Orleans Abortion Fund. Abortion funds directly provide resources to people who want abortions, because the procedures are expensive and generally cannot be covered by insurance.

“We want to support people in whatever decision they make, whether that’s to have an abortion, carry a pregnancy to term, or even adopt,” says Irvin. “We do this work unapologetically.”

Though abortion policies are made on the state level, their consequences play out locally. Geography plays a role in determining how difficult an abortion is to access—and few know this better than abortion advocates in the South, where the introductions of heartbeat bills are spreading like wildfire.

“We make reproductive rights a reality,” says Kamyon Conner, executive director of the Texas Equal Access Fund, which serves all of North Texas. The mutual aid work of funds mitigates the strict regulations handed down from state legislatures, enabled by the federal government. What better way to address a person’s inability to pay for an abortion than by simply paying for it? Nearly half of all Americans wouldn’t be able to immediately scrape together enough savings to cover the cost of an abortion—roughly $500, depending on how far along the pregnancy is and the method of abortion used.

That’s why “access is really flipped,” says Nash from the Guttmacher Institute. People with means are much more able to pay for the cost of abortion care, as well as accompanying costs like travel or unpaid leave, but the majority of people who have abortions are low-income.

Abortion is not covered by federal funds due to the Hyde Amendment of 1976, meaning that people with public insurance—like Medicaid—cannot use this coverage for abortions unless their state uses its own funds. (While exceptions to Hyde exist in cases of rape or incest, federal law is not always honored.) For low-income people seeking abortions, just over a dozen states cover the procedure with their own state Medicaid funds. But even in those states, most who are eligible for Medicaid can’t access it.

And because of the ties between race and socioeconomic class, abortion access is much more difficult for black women.

The majority of the clients who call the Yellowhammer Fund in Alabama are African American, says Amanda Reyes, president of the fund. Alabama is largely rural, and there are just three abortion clinics in the state. Reyes says that many of the fund’s callers live in rural areas, as they have “the most barriers to overcome with regard to abortion access.”

Many people across the nation, including 59 percent of the women living in Alabama, live in counties that do not have an abortion clinic. The state’s southernmost clinic is in Montgomery, in the center of the state. Those in the southern areas must travel either to Montgomery or to another state.

Like Louisiana, Alabama imposes a waiting period, but at a more onerous forty-eight hours between initial appointment and the procedure, forcing people to rack up expenses for hotels, meals, and time spent away from work. In response, the Yellowhammer Fund sometimes offers practical support, like transportation or money for lodging.

“Legality is meaningless without access,” notes Reyes. “If people don’t have the money or if they don’t have transportation to clinics, then [legality] doesn’t matter.”

Conversations around abortion generally frame it as a “women’s issue,” ignoring that not all of those who can get pregnant are women. Cazembe Jackson, an activist and trans man, tells his abortion story to destigmatize abortion especially for queer and trans people, who have had abortions but have not seen themselves included as part of the abortion rights movement.

“We definitely celebrate abortion, because abortion saves people’s lives.”

In his home state of Texas, Jackson was raped by four men and became pregnant. He knew immediately that he wanted an abortion. At the time, he didn’t know about abortion funds—and so he had to take out a payday loan to finance it.

Finding the right clinic was also difficult, because Jackson was transmasculine. Medical care is often rife with homophobia and transphobia. One-third of respondents to a 2015 survey from the National Center for Transgender Equality reported at least one instance of mistreatment, due to being transgender, by a health-care provider.

Jackson got the services he needed at Planned Parenthood. Now living in Georgia, where Governor Brian Kemp has just signed a six-week abortion ban, Jackson’s story is a weapon to destigmatize what he views as a completely normal procedure.

“The larger reason for telling my story is to be able to build [a] movement that’s strong and powerful enough to make real change and to protect ourselves from people who would do us harm,” he says. “We need the kind of power that Brian Kemp has.”

Though abortion funds exist to provide people the money they need to have an abortion, these are small, grassroots efforts that don’t have sufficient resources for every person who needs them.

Running a fund involves calculating, stretching dollars, and weighing different needs. Typically, funds don’t cover the full cost of an abortion, because they can’t; clients often need to fundraise for whatever remains. For example, when funds run too low, Yellowhammer generally funds abortions only for people who are at least fifteen weeks along in their pregnancies, to prioritize the most urgent cases.

“We’re always very close to running out of money,” Reyes says. Even when Yellowhammer depletes its budget, the group keeps its hotlines open. Sometimes, callers just want to talk to a supportive voice about a decision that they’ve been raised to believe is shameful.

For the past ten years, the National Network of Abortion Funds, which represents more than seventy funds in thirty-eight states, sponsors an annual bowl-a-thon to raise money for abortions. When participants on each team raise a certain amount of money by asking their families and friends for donations, they earn an invite to a bowling party—or dance party, or skate party, or whatever celebration the fund decides to hold.

Part of the fun—bowling and pizza—directly combats the stigma that’s tied to getting an abortion.“People think [having an abortion] is [always] this huge emotional, laborious thing,” says Conner of the Texas Equal Access Fund. “For some people, it’s not that difficult of a decision.”

In fact, Conner continues, “We definitely celebrate abortion, because abortion saves people’s lives. It allows them to have the future that they want.”

This year, a handful of funds across the South teamed up to fundraise together. As Conner puts it, “We’ve got a lot of restrictions, and we need all the money we can get.”

While Southern states have the greatest needs, they often receive the fewest donations. Meanwhile, funds in more progressive states including New York sometimes see money pour in, even though the need may be less because Medicaid funds can be used to cover abortions.

The core mission of funds may primarily be mutual aid and direct service, but you will also find them lobbying at the state capitol.

“Unfortunately, the national organizations [like Planned Parenthood] are oftentimes working on a federal level, and it leaves us local organizations to combat state legislation,” says Irvin of the New Orleans Abortion Fund. She stresses the importance of making legislators hear an “alternative narrative,” highlighting ways abortion restrictions disproportionately affect people of color, low-income people, immigrants, and young people. In Louisiana, many of the policymakers introducing anti-abortion bills, including the six-week ban, are Democrats.

And given the many compounding factors that create obstacles to accessing abortion, many abortion advocates seek changes beyond health-care legislation. Conner has advocated for paid sick leave in Texas, while Irvin is pushing to raise Louisiana’s minimum wage.

These groups are also lobbying progressive state governments to pass abortion protections—for example, New York recently codified the promise of Roe into state law.

Ultimately, like any progressive movement, the goal is to work oneself out of a job. “It’s great that we have abortion funds, and people work their butts off to raise money, to get people to donate,” says Jackson, “but I think the larger solution is that abortion should be accessible.”

Sidebar: State Abortion Bans Are Getting More Extreme

In just the first few months of 2019, a number of states have passed sweeping restrictions on abortion. Most of these laws are currently being challenged or will likely soon be challenged. Each is in addition to a slew of other restrictions enacted by that state’s legislature. Here’s a rundown:

Mississippi: The state’s heartbeat ban was signed into law in March and is set to take effect in July. It will join waiting periods, mandatory counseling, and “targeted regulation of abortion provider” laws, which place limits on providers and clinics themselves, often forcing clinics to close. There is now just one abortion clinic operating in Mississippi.

Kentucky: The Bluegrass State’s heartbeat ban is currently stayed by a federal court. This year, Kentucky enacted a “trigger ban” to automatically outlaw abortion if Roe v. Wade is overturned. Kentucky also attempted to ban abortion based on race, sex, or disability, but like the six-week ban, this law was also stayed.

Georgia: This state’s heartbeat ban was passed by the state legislature in March and signed into law by Governor Brian Kemp in May. Before passing this ban, Georgia had already outlawed abortion after twenty weeks.

Ohio: After then Governor John Kasich vetoed Ohio’s heartbeat ban late last year, the legislature reintroduced and passed a new one, which newly elected Governor Mike DeWine signed into law. Ohio also restricts abortion by requiring parental consent for a minor to receive an abortion, waiting periods, and mandatory counseling. Like many other states, Ohio refers people to “crisis pregnancy centers,” which are anti-choice organizations that pressure people into not having abortions.

—Kalena Thomhave