The U.S. Supreme Court’s devastating decision to overturn Roe v. Wade has brought renewed attention to the barriers patients face seeking abortion care—but these obstacles are anything but new. Over the nearly fifty years that it stood, Roe represented a right to abortion that existed in name only for countless women and pregnant people. In particular, people of color, people struggling to make ends meet, young people, immigrants, and people with disabilities have felt a disproportionate impact of restrictions on abortion access.

For decades, abortion access has been dependent not only on a patient’s zip code, due to disparate access to clinics and varying unnecessary state regulations and restrictions on abortion, but also on an individual’s income and source of health insurance. Because of harmful policies that dictate public spending on health care, such as the Hyde Amendment, insurance coverage of abortion care is heavily restricted.1

Abortion funds are organizations that help meet the need created by the restrictive landscape of abortion funding—a need that, to be clear, should not exist in the first place. Abortion funds assist patients in paying for their abortion care through budgets reliant on private donations. This report examines the policy environment that makes these organizations necessary, how they function, and what policies can improve access to affordable abortion care. The report highlights the work of the DC Abortion Fund (DCAF) in particular to de-mystify the work of abortion funds and how they interact with clients.

The Current State of Abortion Funding in the United States

At the moment, many patients seeking abortion care face restrictions on how that care is paid for, even in states that have fewer obstacles to care. Perhaps the most impactful restriction is the Hyde Amendment—an appropriations rider that blocks federal funds from being used to pay for abortion outside of the exceptions for rape, incest, or if the pregnancy is determined to endanger the woman’s life—but there are additional laws and regulations that limit public spending on abortion care. These restrictions on how abortion care is paid for created the need for abortion funds.

Abortion Coverage and Patient Cost

Each year since 1976, the Hyde Amendment has been tacked on to Congressional appropriations bills in order to restrict funding for abortion care. The Hyde Amendment was created explicitly to limit abortion access for people with low incomes by targeting federal Medicaid funding, and has been attached annually to appropriations legislation by Congress. Not only does this approach discriminate against people with low incomes, but also it disproportionately impacts people of color, as Black and Hispanic individuals are more likely to be covered under Medicaid.2

The Hyde Amendment was created explicitly to limit abortion access for people with low incomes by targeting federal Medicaid funding, and has been attached annually to appropriations legislation by Congress.

As a result of Hyde and other similar appropriations riders, people receiving insurance through Medicaid and Medicare, and those receiving care through the Indian Health Service, as well as Peace Corps volunteers and federal employees receiving insurance through the Federal Employee Health Benefits (FEHB) Program—and so many more—have their health care coverage limited when it comes to abortion care. Federal law and regulations, meanwhile, restrict care for both active duty servicemembers and veterans, as well as their dependents.3 Some states go further, limiting abortion coverage under private insurance plans. (A notable exception to these restrictions are the sixteen states that allow funding of abortion care for Medicaid recipients using state Medicaid funds.)

Given these limitations on insurance coverage for abortion, most patients pay entirely out-of-pocket for their care.4 A recent study found that in 2020, median costs ranged from $560 for medication abortion care, to $575 for a first-trimester procedural abortion, to $895 for a second-trimester abortion.5 With three-quarters of abortion patients in 2014 living on low incomes, the cost of abortion care itself—not to mention related expenses such as for travel, lodging, and child care, and wages lost when taking time off from work—is a substantial factor in access.6 These demographics, though, only capture those who actually reach clinics. The costs of abortion care can be not only burdensome, but also outright prohibitive: academic research that analyzed hundreds of postings on the social media platform Reddit, for example, found that financial barriers led to delays in care, being unable to afford a preferred method, or choosing to self-manage their abortion.7

Given these limitations on insurance coverage for abortion, most patients pay entirely out-of-pocket for their care.

The Role of Abortion Funds

Abortion funds were formed to meet the need created by these discriminatory policies and appropriations riders that single out abortion care from other forms of health care when it comes to health coverage. These organizations provide funding to patients to help them cover the cost of abortion care. Often operating entirely volunteer-run or with a handful of paid staff, abortion funds help their communities access the care they need.

Abortion funds operate independently, though over ninety are members of the National Network of Abortion Funds, which provides them with technical assistance, development, and other infrastructure support.8 The process for clients seeking funding differs, depending on the organization: each abortion fund has their own set of protocols and procedures in regard to how callers can contact them, method of communication, budgets, and whether other services such as practical support are offered. For example, some funds may have restrictions on funding based on income or gestational age, and some funds may return calls daily while others return calls on designated days during the week, due to capacity.

Patients seeking abortion care generally receive information about funding options from the clinics themselves if they express concern about paying for their care, and are given numbers to call; this highlights the relationships that are built between clinics and abortion funds in order to support patients in a holistic way. Some patients seeking abortion care may also find out about abortion funds online or through word of mouth from fellow community members.

Abortion funds may also be able to assist clients who need to obtain an appointment or access practical support, such as for travel expenses, lodging, or child care. While not every state has their own abortion fund, some funds cover large regions encompassing several states and other states have multiple funds that work in coordination. There is also an understanding among all funds that they may be asked to support folks throughout the country, through what is known as solidarity funding. Solidarity funding is a way all abortion funds work together to ensure folks all over the country are able to access support, no matter where they live.

Particularly for funds in states where abortion is banned or its legality is unclear or in flux, funds have to assess legal risk and determine whether they can operate. Many funds have had to suspend operations in recent months while they do so—and some may need to shift their focus entirely.9

Spotlight on the D.C. Abortion Fund

One abortion fund that has been particularly active and successful in helping people in the region afford abortion care is the DC Abortion Fund (DCAF). Situated in Washington, D.C. and also serving residents in the neighboring states of Maryland and Virginia, DCAF has experience across a varied and changing legal and funding abortion access landscape, and as such can provide insight and lessons for advocates and policymakers.

What Is DCAF?

In 1995, a social worker at the DC Rape Crisis Center raised money in order to help one of their clients pay for their abortion. This was the beginning of the DC Abortion Fund in concept and in its purest form: relying on fellow community members in order to support folks in accessing their abortions. Though DCAF was not officially named such until 2005, and was not established as a 501(c)3 until 2006, the concept has remained the same over the past twenty-seven years. DCAF provides financial assistance for folks who reside in DC, Maryland, or Virginia, and those who travel to the area from anywhere else, including international locations. Because there is an all-trimester clinic located in DC, DCAF is also in a unique position as it works with folks who are seeking third-trimester care—which poses additional barriers in terms of access and is another critical reason so many patients seeking abortion care choose to travel to the area. DCAF’s work with practical support organizations is critical in response to individuals seeking this level of care: on top of travel costs (and increased costs for the procedure itself), lodging is often required for multiple days for later abortion care.

DCAF is also in a unique position as it works with folks who are seeking third-trimester care—which poses additional barriers in terms of access and is another critical reason so many patients seeking abortion care choose to travel to the area.

The DC Abortion Fund runs a “warmline,” meaning that no one answers calls to its phone line in the moment, but instead callers leave a voicemail with needed information, and a volunteer case manager returns the call. A caller can leave a message twenty-four hours a day, seven days a week, and a volunteer is required to return the call within twenty-four hours. Until February 2022, DCAF was an all-volunteer run abortion fund: volunteers engaging in case management working directly with clients, as well as an all-volunteer board of directors managing the operations, fundraising, and case management oversight. As of June 2022, DCAF has four full-time staff members and is shifting from a working board of directors to an advisory board.

Abortion Access in the Region: Washington, D.C., Maryland, and Virginia

Because DCAF serves clients in Washington, D.C., Maryland, and Virginia, the fund works in three different landscapes of abortion access. Virginia’s legislature liberalized abortion access in 2020, passing legislation that repealed medically unnecessary ultrasound and twenty-four-hour waiting period requirements (which had forced patients to make two visits to a clinic),10 removed burdensome and unnecessary regulations known as TRAP laws,11 and allowing advanced practice clinicians other than physicians to provide abortion care. These advances may be in jeopardy, though: the makeup of the state’s House of Delegates has since shifted to Republican control and current Governor Glenn Youngkin has been open about his ambition to pass a ban on abortion care after fifteen weeks of pregnancy.12

Crucially, since DCAF funds individuals travelling to the region for care, the District of Columbia and Maryland are among the few places in the country where abortion care later in pregnancy is available. Because of this, patients often travel long distances to obtain later care, which is also substantially more expensive than first- and second-trimester abortion care.

Notably, Maryland allows use of its Medicaid funds for abortion coverage, and Virginia does not—while the District of Columbia is unable to use its Medicaid funds to cover abortion care because of a lack of control over its own budget. Lacking statehood, the District of Columbia has limited self-governance and is subject to Congressional authority. Although the 1973 Home Rule Act created the district’s government in the form of city council and mayor, Congress reviews all district legislation before it becomes law and controls the local budget. Despite the overwhelmingly liberal makeup of the district, abortion access in the nation’s capital could be at risk—some Republicans in Congress have already suggested that they will introduce legislation to ban abortion in the district.13

Even barring Congressional action to limit abortion access in the district, residents there will be affected by the changing post-Dobbs landscape. Places with relatively liberal access, including the District of Columbia and Maryland, will see an influx of patients as more and more are forced to travel out-of-state for their care—as it is, nearly 70 percent of the abortion care in the district is provided to to residents of other states.14 As abortion bans proliferate, there is no guarantee that clinics will be able to meet the demand for care for those who are able to travel alongside that for district residents. Increased wait times due to increased demand may also cause delays in accessing care, potentially pushing patients further into pregnancy. Not only do delays in care force individuals to remain pregnant longer, but as care is delayed, it may require more complicated and expensive procedures, as well as possibly eliminating the option of medication abortion care for some patients.

Nearly 70 percent of the abortion care in the district is provided to to residents of other states.

Abortion Fund Client Experiences

One of the best ways to understand the vital role that abortion funds fill is to listen to their clients tell their stories. What follows is a sampling of a range of experiences of clients, both told in their own words and as relayed by DCAF case managers.

A Client’s Own Words

For Briana, a We Testify storyteller, abortion funds played a crucial part of her experiences accessing abortion care. When Briana had her first abortion, she was getting ready to start college outside her home state of Texas. Even with a supportive partner, she did not have the financial resources to pay for her abortion care. This meant that, on top of navigating the fear of abortion stigma from relatives should they discover her pregnancy, she was also forced to try to raise funds for the care.15

“I just remember starting to sell my belongings just so I could get extra money to get an abortion. . . . I had to pawn my jewelry I got from my grandma over a couple of Christmases. I had to pawn my laptop.”

Fortunately, Briana eventually found out about her local abortion fund. Without that funding assistance, Briana is not sure how she would have received her abortion care—and in turn, was able to follow through with her educational plans to attend college.

When Briana found herself pregnant again later, and decided to seek another abortion—in part because she knew she was unable to support children at the time—abortion funds made that care possible again. Now, Briana works with the Texas Equal Access (TEA) Fund to help Texans pay for their abortions, and this work is deeply influenced by her own experiences.

“I think that’s the reason why it made sense for me to be part of this program—because I’ve had an abortion myself. I had multiple abortions, I had different types of abortions. And I want our clients to know that I’ve been through some of the same experiences that they’ve been through. It may have looked differently but I understand where they are coming from.”

Although the TEA Fund is currently pausing operations in light of the Dobbs decision and evaluating a path forward, the compassion that fund workers like Briana bring to clients is just one aspect of the mutual aid that these organizations provide.

“Some of our clients have nobody, not even their partner. So I felt like I was able to help them in that emotional support area, and just give them a little bit of background and experience. So I did a lot of storytelling when I was talking to our clients. And I think it just made them feel like there was someone out there that’s [also] experienced it.”

Client Experiences As Relayed by DCAF

Like most other funds, DCAF does not ask any client about their decision to seek an abortion, however, many folks view their interactions with case managers as an opportunity to speak with someone without fear of judgement. Over the years, case managers have listened as clients shared stories, various life circumstances, tears of relief and gratitude as well as of guilt and shame (most often resulting from the stigma surrounding abortion)—and everything in between.16

One common theme heard often from DCAF clients is the lack of access to general health care. Clients cite having no health insurance, or for those with health insurance, no primary care physician. A downstream effect of this is their not knowing they are pregnant until further along in pregnancy, which brings along additional barriers, including a cost that rises each week and the choice of clinics dwindling down.

One common theme heard often from DCAF clients is the lack of access to general health care.

Not having access to general health care also leads some clients toward crisis pregnancy centers. These organizations seek to dissuade pregnant people from accessing abortion care by providing biased counseling and prenatal services. Although meant to appear as legitimate medical clinics, crisis pregnancy centers often have no medical professionals on staff, and are exempt from the regulatory oversight that apply to actual health facilities.17 It is no coincidence that folks living in poverty, who lack health insurance, or have no one to turn to for support are more likely to walk through the doors of these centers—it is in fact precisely the goal of these centers, as they often buy Google ad space to ensure they are the first result to come up during a search.18 In many areas, crisis pregnancy centers far outnumber abortion clinics. DCAF case managers have spoken to clients citing they went to “a clinic” and were told conflicting or misleading information. Some clients cited being given an estimated gestational age (EGA) that did not match the date of their last menstrual period. According to clients, these centers have misled them by telling them either that their EGA was further along (which could lead them to believe they did not have the option to obtain an abortion) or a less than expected EGA (which could cause them to delay their care further and potentially be unable to obtain an abortion).

DCAF case managers often speak to clients who cite, in one way or another, the challenge of income instability, whether this be from unemployment or being underpaid. This lack of financial resources is often paired with a lack of overall support from their community of family and friends. Clients often cite not feeling like they are able to share their choice with others, mentioning the negative ways society paints and stigmatizes abortion. In March of 2020, the COVID-19 pandemic brought further income instability that was reflected among DCAF clients, as it was throughout the country. As a result, many clients were not able to put any funds toward the cost of their procedures, leaving bigger gaps to be filled by abortion funds.

Through the years, DCAF has worked with thousands of clients. The constant theme is always present: people in need are calling complete strangers to ask for money in order to access health care. Occasionally, when a case manager communicates the amount DCAF can pledge, clients will ask, “When do I need to pay it back?” Clients are often surprised by the no-strings-attached nature of funding, received without having to demonstrate need or eligibility.

Clients are often surprised by the no-strings-attached nature of funding, received without having to demonstrate need or eligibility.

The difficulties that clients discuss having only increase when they are in communities that face other obstacles to care, such as for clients whose primary language is not English. For example, while DCAF has a dedicated Spanish line and multiple Spanish-speaking case managers, this is not the case at every fund or organization.

These obstacles can compound, making accessing abortion care extraordinarily difficult. In a recent case, a DCAF client worked with a Spanish-speaking case manager to make an appointment for her abortion, and due to her EGA, she needed to go the all-trimester clinic in the District of Columbia. Because this clinic provides abortion care for folks in all trimesters, the threat of violence and harassment for providers is all too real, and so this clinic has extra safety measures in place, such as not letting anyone enter the clinic’s space without an appointment. In order to secure an appointment, however, a deposit is required, which has to be paid by a credit or debit card, as they don’t allow people to stop by the clinic to drop off a check or pay in cash. For this Spanish-speaking client, not having a credit or debit card was an additional barrier in obtaining an appointment and ultimately accessing her abortion. Fortunately, DCAF is responsive to these types of obstacles, and now has a credit card on file for making appointments at this particular clinic. However, as in all its work, DCAF is simply responding to barriers to health care that its clients face that only exist because of discriminatory restrictions on abortion funding.

Though there are countless stories and client experiences, one common theme that runs throughout each is the fact that systemic barriers disproportionately impact folks who are at the margins of society, and the stigmatization of abortion only aggravates this.

FIGURE 1


DCAF has been funding an increasing number of clients, and at higher funding levels over the past five years (see Figure 1), due to a couple of factors. DCAF has, for example, seen increases in its budget resulting from changes in the abortion funding environment. A major source of funding nationwide, a fund operated out of the National Abortion Federation, changed its guidelines a while back, limiting funding, and has done so again post-Roe.19 But also, the increase in DCAF clients is reflective of the fund’s response to an increase in demand in general as the abortion access landscape has become more fractured.

Just this past June, DCAF pledged funds for 642 clients—compared with 434 in June of the previous year, a nearly 150 percent increase in volume. And the amount pledged per client has increased over the years, too: the average amount pledged per client January through August of 2022 was $335, compared with $176 for that period in 2017 (see Figure 2). In August of 2022, the average pledged amount jumped up to nearly $700.

FIGURE 2

Policy Recommendations

The chaos caused by the Dobbs decision has done innumerable damage in the past three months, and the challenges will only increase going forward. Yet the precedent established in Roe was never enough to truly guarantee access to abortion, and in this post-Roe world, it is time to think more expansively about what is means for abortion care to be truly accessible—and this accessibility must include affordability.

In addition to restoring the federal right to abortion (by passing the Women’s Health Protection Act),20 abortion care must be made affordable for access to be equitable. Abortion funds have been meeting a need created by a patchwork of discriminatory restrictions on abortion coverage and for too long have been carrying an outsized burden. It is past time to implement policy solutions not only to support these funds but also expand coverage of abortion care.

Eliminate Federal Funding Restrictions

First and foremost, the Hyde Amendment and other discriminatory abortion riders should be removed from Congressional appropriations bills. Following the example set by President Biden’s proposed budgets and appropriations efforts in the House of Representatives, it is within Congress’ power to eliminate these funding restrictions that disproportionately harm people of color and people with low incomes.

The Equal Access to Abortion Coverage in Health Insurance (EACH) Act is legislation that would both reverse the Hyde Amendment and other riders and prohibit the federal government from preventing private insurance plans, including those under the ACA marketplace, from providing abortion coverage.21 Congress must pass this necessary legislation, introduced by Representatives Barbara Lee (D-CA), Ayanna Pressley (D-MA), Diana DeGette (D-CO), and Jan Schakowsky (D-IL) in the House and Senators Tammy Duckworth (D-IL), Patty Murray (D-WA), and Mazie Hirono (D-HI) in the Senate.

States Must Ensure Abortion Coverage

Even with federal abortion riders in place, states can take action to cover abortion care, and many have. As mentioned earlier in this report, sixteen states currently use their state Medicaid funds to cover abortion care. Not only should more states join this list, but they should also ensure that these policies translate into actual Medicaid coverage of abortion care. Research has demonstrated that poor implementation creates barriers that make it difficult for providers to obtain reimbursement—and when reimbursement is obtained, those rates are far from sufficient.22

At the federal level, the Centers for Medicare and Medicaid Services (CMS) has a role in enforcing state coverage of Hyde-eligible abortion care. A report by the U.S. Government Accountability Office identified states that are failing to comply with federal requirements, and CMS must take action to ensure compliance.23

In addition to Medicaid, states can require coverage of abortion care in private insurance plans, including those offered through the marketplace established by the Affordable Care Act—as some states already do.24

Invest in Abortion Funds

Abortion seekers need more than equitable insurance coverage, though. As evidenced by the demand for assistance from DCAF and the nearly 100 other abortion funds nationwide, people are in need of funding for abortion care now—care that cannot wait. Actual funding is needed, in addition to supportive insurance coverage policies.

In recent months, champions on Capitol Hill have demonstrated how the federal government can lead boldly in this moment. In July, the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) released its draft 2023 funding bill with a groundbreaking new Reproductive Health Care Access Fund.25 This $350 million fund would expand access to services by providing financial assistance for the cost of abortion care as well as related expenses including travel, child care, and lodging.

This past July, in the House, Representatives Marilyn Strickland (D-WA), Cori Bush (D-MO), and Lizzie Fletcher (D-TX) introduced the Reproductive Health Travel Fund Act of 2022.26 The legislation would create a grant program under the U.S. Department of Health and Human Services (HHS) to provide assistance to individuals who have to travel to receive abortion care. Grants would be distributed to organizations such as abortion funds to support patients in travel costs and other associated expenses such as lodging, child care, and meals. Of course, the financial ability to travel must be undergirded by the right to do so. Also introduced in July by Representatives Fletcher and Strickland, along with Representative Jamie Raskn (D-MD), the Ensuring Women’s Right to Reproductive Freedom Act27 makes clear the right for individuals to cross state lines for abortion care, as well as protecting the people who help them receive that care. In the Senate, meanwhile, Senators Catherine Cortez Masto (D-NV) Sheldon Whitehouse (D-RI), Patty Murray (D-WA), and Kirsten Gillibrand (D-NY), introduced the Freedom to Travel for Health Care Act of 2022, which would also reiterate the right to travel out-of-state for abortion care.28

Some cities and states are already stepping up to contribute toward the immense need for financial assistance for individuals seeking abortion care. Oregon, for instance, recently included in its budget $15 million toward the Reproductive Health Equity Fund, which will distribute grants to abortion funds and practical support networks.29 New York legislators have also introduced a bill that would establish a program to provide “funding to abortion providers and non-profit organizations whose primary function is to facilitate access to abortion care.”30 Atlanta City Council, meanwhile, authorized a $300,000 donation to a local abortion fund, Access Reproductive Care–Southeast.31 These local investments in—and recognition of—abortion funds are critical, and more municipalities should take action to support the abortion funds that are already doing this necessary work in their communities.

Crucially, legislation to support abortion funding must be created in collaboration and consultation with abortion funds. These funds represent a well-established infrastructure that is best suited to ensure that efforts support communities—because the funds are of the communities themselves. As members of Congress and the administration think through solutions, they should prioritize partnering with abortion funds.

Looking Forward

Coverage of abortion care in the United States is restricted in ways unlike that for any other form of health care, limiting access inequitably even before the overturning of Roe. Abortion funds, reliant on private donations and volunteers, have for decades been meeting the resulting need. These organizations, based out of the communities they serve, provide support to patients seeking abortion care, and are critical in translating the legality of abortion care to access for abortion patients.

In the wake of the Dobbs decision, as advocates, organizers, and policymakers envision the abortion access landscape after the fall of Roe, equitable abortion funding must be centered. At the federal, state, and local level, policymakers need to ensure that patients can access abortion care regardless of insurance status or source. At the same time, it is necessary to support and invest in abortion funds. These funds are well-established resources that can help provide patients the care they need in the devastating aftermath of the U.S. Supreme Court’s decision, as the consequences continue to reverberate and escalate. Abortion funds represent not only an infrastructure for this moment, but also a roadmap for providing community-based support to people seeking abortion care.

Notes

  1. Jamila Taylor, “Let’s Get Rid Of Abortion Coverage Restrictions Once and for All,” The Century Foundation, September 26, 2019, https://tcf.org/content/commentary/lets-get-rid-abortion-coverage-restrictions/.
  2. “State Health Facts: Distribution of the Nonelderly with Medicaid by Race/Ethnicity,” KFF, https://www.kff.org/medicaid/state-indicator/medicaid-distribution-nonelderly-by-raceethnicity/.
  3. “Serving Those Who Serve? Restrictions On Abortion Access for Servicemembers, Veterans, and Their Dependents,” Center for Reproductive Rights, November 2019, https://reproductiverights.org/wp-content/uploads/2020/12/Serving-Those-Who-Serve_Abortion-Access.pdf.
  4. Jenna Jerman, Rachel K. Jones, and Tsuyoshi Onda, “Characteristics of US abortion patients in 2014 and changes since 2008,” Guttmacher Institute, May 2016, https://www.guttmacher.org/sites/default/files/report_pdf/characteristics-us-abortion-patients-2014.pdf.
  5. ​​Ushma D. Upadhyay, et al., “Trends in Self-Pay Charges and Insurance Acceptance for Abortion in the United States, 2017–20,” Health Affairs 41, no. 4 (2022): 507–15.
  6. Rachel K. Jones, Ushma D. Upadhyay, and Tracy A. Weitz, “At what cost? Payment for abortion care by US women,” Women’s Health Issues 23, no. 3 (2013): e173–e178.
  7. Jenny A. Higgins, et al., “Real-time effects of payer restrictions on reproductive healthcare: a qualitative analysis of cost-related barriers and their consequences among US abortion seekers on Reddit,” International Journal of Environmental Research and Public Health 18, no. 17 (2021): 9013.
  8. See the National Network of Abortion Funds website at https://abortionfunds.org/.
  9. Tina Vásquez, “Abortion funds have been inundated with donations and volunteer requests, but some are still struggling to survive,” Prism, August 17, 2022, https://prismreports.org/2022/08/17/despite-donations-abortion-funds-struggle/.
  10. “Virginia Legislature Removes Medically Unnecessary Barriers to Abortion Access,” Center for Reproductive Rights, February 27, 2020, https://reproductiverights.org/virginia-legislature-removes-medically-unnecessary-barriers-to-abortion-access/.
  11. “Targeted Regulation of Abortion Providers (TRAP) Laws,” Guttmacher Institute, January 22, 2020, https://www.guttmacher.org/evidence-you-can-use/targeted-regulation-abortion-providers-trap-laws.
  12. Myah Ward, “Youngkin will pursue 15-week abortion ban in Virginia,” Politico, June 24, 2022, https://www.politico.com/news/2022/06/24/youngkin-to-seek-15-week-abortion-ban-in-virginia-00042321.
  13. Harry Jaffe, “Republicans Are Sending Abortion Back to the States. But D.C. Isn’t a State,” Politico, June 28, 2022, https://www.politico.com/news/magazine/2022/06/28/dc-abortion-ban-00042675.
  14. “State Health Care Facts: Percentage of Legal Abortions Obtained by Out-of-State Residents,” KFF, https://www.kff.org/womens-health-policy/state-indicator/abortions-by-out-of-state-residents/.
  15. Quotes from Briana in this section are from an interview with author Anna Bernstein, conducted via Zoom, July 22, 2022.
  16. Kate Cockrill, Steph Herold, Kelly Blanchard, Dan Grossman, Ushma Upadhyay, and Sarah Baum, “Addressing abortion stigma through service delivery: A white paper.” The Sea Change Program, Advancing New Standards in Reproductive Health, and Ibis Reproductive Health, https://www.ibisreproductivehealth.org/publications/addressing-abortion-stigma-through-service-delivery-white-paper.
  17. Amy G. Bryant and Jonas J. Swartz, “Why crisis pregnancy centers are legal but unethical,” AMA Journal of Ethics 20, no. 3 (2018): 269–77.
  18. Carrie N. Baker, “Google Improves Flagging of Fake Abortion Clinic Ads—But ‘There’s Much More To Be Done,’ Say Advocates,” Ms. Magazine, June 14, 2022, https://msmagazine.com/2022/06/14/google-fake-abortion-clinic-ads/.
  19. Caroline Kitchener, “New restrictions from major abortion funder could further limit access,” Washington Post, August 25, 2022, https://www.washingtonpost.com/politics/2022/08/25/national-abortion-federation-restrictions/.
  20. Jamila Taylor, “Testimony: Pass the Women’s Health Protection Act to Safeguard Abortion Access,” Then Century Foundation, June 16, 2021, https://tcf.org/content/commentary/testimony-pass-womens-health-protection-act-safeguard-abortion-access/.
  21. S.1021—EACH Act of 2021 117th Congress (2021–2022), https://www.congress.gov/bill/117th-congress/senate-bill/1021/text.
  22. Amanda Dennis and Kelly Blanchard, “Abortion providers’ experiences with Medicaid abortion coverage policies: a qualitative multistate study,” Health Services Research 48, no. 1 (2013): 236–52.
  23. “Medicaid: CMS Action Needed to Ensure Compliance with Abortion Coverage Requirements,” Government Accountability Office, February 4, 2019, https://www.gao.gov/products/gao-19-159.
  24. Salganicoff, Alina, Laurie Sobel, and Amrutha Ramaswamy. “Coverage for abortion services in Medicaid, marketplace plans and private plans.” Kaiser Family Foundation (2019).
  25. S.4659—Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2023, 117th Congress (2021–2022), https://www.congress.gov/bill/117th-congress/senate-bill/4659.
  26. H.R.8452—Reproductive Health Travel Fund Act of 2022, 117th Congress (2021–2022), https://www.congress.gov/bill/117th-congress/house-bill/8452.
  27. H.R.8297—Ensuring Access to Abortion Act of 2022, 117th Congress (2021-2022), https://www.congress.gov/bill/117th-congress/house-bill/8297.
  28. S.4504—Freedom to Travel for Health Care Act of 2022, 117th Congress (2021–2022), https://www.congress.gov/bill/117th-congress/senate-bill/4504.
  29. “The Oregon Reproductive Health Equity Fund,” Seeding Justice, https://www.seedingjustice.org/reproductive-health-equity-fund/.
  30. Senate Bill S9078, New York State Senate 2021–2022 Legislative Session, https://www.nysenate.gov/legislation/bills/2021/S9078.
  31. Jess Mador, “Atlanta City Council approves donation to an abortion fund,” WABE, August 2, 2022, https://www.wabe.org/atlanta-city-council-approves-donation-to-an-abortion-fund/.

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