When Texas officials effectively banned abortion in the state in late March, Kamyon Conner and her staff rushed to figure out how to compassionately tell clients that they could no longer access care. Conner doesn’t run an abortion clinic, she’s the executive director of the Texas Equal Access Fund, an abortion fund that provides financial assistance to women in north, east, and west Texas. Their hotline was already busier than normal even before Texas used the coronavirus pandemic to restrict access to abortion.

The TEA staff spent the next few days in a whirlwind of emergency meetings, calling abortion clinics, attorneys, and other reproductive rights groups to make sense of the ban, as well as clinics in other states, where their clients would now be forced to venture. Then they turned to their clients: The week of the initial order, 26 TEA clients were forced to reschedule their appointments or forgo them indefinitely, including a mother who lost her job due to COVID-19 and couldn’t afford to go through with an unplanned pregnancy.

“There was so much anxiety, confusion, anger, and sadness,” Conner said. “Our clients were crying when we had to tell them ‘we’ll hold your funding [for the procedure] but you can’t get care here in Texas anymore.’ Our hotline staff were in tears, too. They felt helpless being placed in this unimaginably difficult situation, knowing that there was nothing they could do in that moment.”

A string of head-spinning legal twists and turns over the past month has upended abortion care in Texas and sent clinics into chaos. On March 23, Texas Attorney General Ken Paxton, following an order from Gov. Greg Abbott, declared that abortion is a “non-essential” medical procedure that should be prohibited amid COVID-19 to ostensibly conserve personal protective equipment (PPE) and hospital space. Abortion clinics that performed the procedure for reasons other than to save a pregnant person's life would be subject to penalties of up to $1,000 or 180 days in jail. The order resulted in abortion services becoming largely unavailable in Texas for the first time since Roe v Wade.

Abortion providers sued state officials and a federal judge granted them a temporary restraining order, lifting the ban on March 30. But the state appealed and just one day later, the Fifth Circuit Court of Appeals put a halt on that order, banning abortion once more. The legal whiplash continued through April: The federal judge granted a second restraining order that allowed medication abortions to continue, which the Fifth Circuit promptly overturned. Abortion providers appealed to the U.S. Supreme Court for emergency relief to allow medication abortion to continue. The Fifth Circuit then reinstated medication abortion—for a week, until the court sided with the state once more, banning abortion again on April 20.

While the governor’s initial order expired on April 22 and, according to an AG legal filing, abortion providers can resume services again, they are understandably cautious given the state’s relentless anti-choice zealotry.

Over the past few weeks, providers have been forced to cancel hundreds of abortion appointments, then call patients back in to their clinics, only to send them home without care once more. And abortion funds are helping providers and patients manage the fallout. The TEA client who lost her job due to COVID-19 couldn't afford to travel out of state while the ban was in place, and now it’s uncertain when she will access care as clinics in her community are booked until mid-May.

While the struggle of abortion providers and patients navigating the ban has been well-documented, perhaps overlooked amid the mayhem are abortion funds, groups on the frontlines of helping women, the majority of whom are low-income women of color, directly pay for abortion care and related costs. Their clients—desperate, afraid, and struggling to make ends meet—must already contend with a slew of state-mandated barriers amid the pandemic including a sonogram 24 hours before the procedure; restrictions for people under 18; bans on private insurance coverage of abortion; and a ban at 20 weeks of pregnancy.

Amanda Williams, executive director of the Lilith Fund, a non-profit that assists Central Texas women, said that nearly half their clients were forced to travel out of state for care while the ban was in effect, trekking an average of 700-plus miles to access a clinic. A Houston woman recently traveled 1,500 miles round trip even though she lived only three miles away from her local provider. Those who can afford to travel out of state are stuck in hotels for three to four days and many clients are traveling by plane, placing them at greater risk of COVID-19 exposure.

But, as 60 percent of callers report losing their jobs due to the pandemic, there are many who weren’t able to venture past Texas: Williams shared the story of Alex, a Lilith Fund client whose insurance doesn't cover the procedure and who couldn’t afford to travel for care with her child. Alex was forced to wait for the ban to end, extending her pregnancy into the second trimester, when abortion is more expensive. Another caller, Nikki, told the Lilith Fund she is unemployed with no savings and didn't want to risk getting her children sick by driving to another state for an abortion.

Research from the Texas Policy Evaluation Project (TxPEP) shows the ban would result in “unnecessary economic hardships and increased health risks” for women whose procedures get pushed into the second trimester, or who continue an unwanted pregnancy. And even with the order lifted “it is unlikely” that the existing second-trimester facilities in Texas will even have the capacity to provide care for all the patients who will need it, researchers write.

The heartbreaking stories and anguish from callers have weighed heavily on abortion fund staff.

“Our clients are confused, angry, and scared,” Williams said. “And it’s been really mentally and emotionally exhausting for our staff. We are so dedicated to supporting our clients but things aren’t easy—we are all struggling.”

“We’re all feeling anxiety and stress beyond belief—it’s a world of uncertainty,” Conner said.

Conner’s staff is also struggling to stay up to date on which clinics have resumed services and which neighboring states are still offering abortion care, as Louisiana, Arkansas, and Oklahoma, under similar anti-choice leadership, have had fluctuating bans amid the pandemic. Sometimes rulings change by the day. To keep up, Texas abortion funds were not only in constant contact with clinics but joined a newly created virtual network to communicate with other funds across the country and build a sense of solidarity.

“We are not only triaging the legal ping-ponging in Texas but also the surrounding states—it’s a lot to handle,” she said.

The chaos inflicted by right-wing state officials isn’t necessarily novel for Texas abortion funds, already strained by constant attacks. When the multipart law, House Bill 2, hit the state in 2013, nearly half of abortion clinics shuttered. Abortion funds scrambled to help their clients reach the very few and overburdened clinics standing. (The law was eventually overturned by the Supreme Court in 2016, though some clinics never re-opened.) However, for both Williams and Conner, the recent abortion ban strikes them as exponentially worse than that law not only because all clinics statewide were forced to suspend services, but also because the pandemic meant advocates couldn't protest or mobilize against the draconian order—strategies they used during HB 2.

“Abortion fund workers have been on a roller coaster of emotion—from devastated to fired up into action and then feeling hopeless and devastated again,” Conner said. “It’s been extremely frustrating. We are angry that state officials are playing games with people’s lives at a time when our clients are more scared than ever.”

To adjust to the ban’s impact, The Lilith Fund has increased its voucher amount for each client from $200 to around $370 and extended its hotline hours. The organizations have been able to retain their modest-sized employed staff of around seven each but they say it’s not an easy time to keep their budgets afloat. The groups’ major national spring fundraising event has been indefinitely postponed, leaving the leaders to rely even more heavily on individual contributions—and at a time when millions of people have lost their incomes.

Even without a near-total abortion ban, the TEA fund wasn’t able to meet its demand: In 2019, they received more than 6,500 calls and were only able to help 920 people. “It’s a big loss for us,” said Conner, who hoped to raise around $55,000 from the annual fundraiser. “We are struggling financially and we need donations—we couldn’t meet our need to begin with.” She said she can't afford to take the group's financials day by day and recently spent several hours emailing donors from their database.

While abortion services have resumed in Texas (for now), abortion fund leaders say the painful month-long battle can’t erase the damage and suffering inflicted on hundreds of women during the pandemic and the smaller pool of resources that will be available for people in the future. And they suspect another state restriction is just lurking around the corner.

“It wears on your soul,” Conner said of the constant back-and-forth. “Of course we’re glad our clients can get abortion again but we are all exhausted. And we are even more distrustful of the people in charge of our state.”

Correction 4/29/2020: This article has been corrected to show that a Houston woman traveled 1,500 miles round trip, not 3,000, to obtain an abortion.