Every Monday morning, the staff of the Abortion Fund of Ohio’s intake line starts fresh, answering calls, following up on voicemails, and doling out cash to people who can’t afford to go to their abortion appointments. The team of three fields as many financial requests as they can until the money allotted for the week runs out. Lately, that’s been by Tuesday. Sometimes they can stretch the funds until Wednesday.
The Ohio Fund, one of the largest abortion funds in the United States, didn’t always operate this way. When I first spoke with the fund in August 2023, it didn’t even have monthly caps on the amount of money it gave callers. Back then, even though the wave of “rage donations” that followed the end of Roe v. Wade had receded, there was still enough money to pay for patients’ medical costs, travel, and child care.
But as costs of care—and daily life—have risen, so, too, has demand for the fund’s services. Ohio’s relatively new constitutional protections for abortion—the result of a ballot measure approved last year—have made it a destination for needy patients from nearby states where onerous restrictions remain in place. When national abortion rights organizations suddenly announced this summer that they would be slashing the amount of money they devote to defraying patients’ medical costs, the financial problems escalated.
To put all this in perspective: In July 2023, the Ohio Fund spent about $100,000 helping 300 or so people get abortions. This past July, they fulfilled twice as many requests for help with half as much money—and the number of calls has continued to rise. People who might once have been able to pay for their own abortions are now begging for assistance, and people who always would have needed financial assistance are begging for more.
“The first word that comes to my mind is helpless,” says Taren Holliman, the Ohio Fund’s program manager. “It feels very helpless when you are not able to fully bridge the gap, or help bridge the gap, in a way that actually allows a person to access the health care that they deserve.”
It’s not just the Ohio Fund that is struggling to meet callers’ needs. Every abortion fund I spoke with, from the East Coast to the Great Plains to the Deep South, is in varying stages of crisis, with many taking unprecedented measures to ward off looming disaster. As the abortion issue dominates the 2024 elections, from Kamala Harris’ campaign to the battle for the Senate to ballot measures in a record 10 states, the frontline groups that have taken on the lion’s share of the post-Dobbs burden—the clinics that provide abortions, and the funds that get people to their appointments—are barely able to keep their doors open and phones on the hook.
“What I’m seeing looks like the collapse of the abortion care system.”
Just days after the state’s voter-approved constitutional amendment officially took effect in December 2023, the Ohio Fund closed shop until February due to a lack of money. That was despite a record-breaking year for the fund, during which it almost doubled the money it doled out, to $1.5 million, and nearly quadrupled the number of abortion seekers it helped.
As Ohio’s courts begin implementing the ballot measure, the financial strains are likely to grow. With its six-week ban permanently struck down, and its 24-hour waiting period and restrictions on medication abortion temporarily blocked, the state is poised to become an even more vital access point for abortion patients from neighboring states with near-total bans, including Kentucky, West Virginia, and Indiana.
Ohio’s abortion-rights measure has been a model for many of the ones on the ballot. But the nationwide lack of abortion funding infrastructure presents a stark reminder of the post-November reality, even if Harris wins: Protecting the right to abortion is very different from ensuring that patients, particularly low-income ones, can access abortion care. Draconian laws, stigma, and a lack of buy-in from large donors and local and state governments have produced a funding catastrophe that has been decades in the making—and is unlikely to be solved anytime soon. Dr. Diane Horvath, director of an independent abortion clinic in Maryland, a state with robust abortion laws and an abortion-rights amendment on the November ballot, put it bluntly: “What I’m seeing looks like the collapse of the abortion care system.”
For low-income women in particular, access to abortion has long depended on the benevolence of donors. For nearly 50 years, the Hyde Amendment has prohibited federal funds from going toward abortions except when a woman’s life is threatened or in cases involving rape or incest. Many states implemented their own versions of Hyde, barring state Medicaid funds from being used for abortions; some states also passed laws banning private insurers from covering abortions in their states.
Despite the promises of Roe, abortion remained far from accessible—and unnecessary regulations on abortion providers and mandatory waiting periods that delayed care only exacerbated the access problem. Grassroots funds, mostly funded by small, individual donations, cropped up in communities across the country to offer financial assistance and, crucially, stigma-free emotional support to people seeking abortion care.
In 1993, an alliance of 22 local organizations in 14 states established the National Network of Abortion Funds to better connect abortion seekers to help and advocate for abortion rights. Now made up of almost 100 funds, the network gave out more than $18 million in grants last year, tax filings show. The fall of Roe produced a swell of “rage donations” to national organizations and local funds alike, enabling some funds to expand their staff, service areas, and funding amounts. But those donations have since dried up.
For years, and especially since Dobbs, local abortion funds and the people they serve have relied on two big national organizations to help defray the medical costs of procedures for patients who meet financial eligibility requirements: Planned Parenthood and the National Abortion Federation. Planned Parenthood funds abortions at its own clinics, and NAF funds abortions at NAF-member independent clinics.
Local abortion funds fill in the gaps, helping pay for things like plane fares, motels, and babysitters; many, like the Ohio Fund, do not have income limits or other eligibility requirements that cut some pregnant people off from national assistance. Although NAF has a limited fund for non-appointment expenses like travel and child care, the overwhelming burden of practical support falls on the shoulders of local organizations.
Immediately after the US Supreme Court overturned the federal right to abortion, NAF and Planned Parenthood committed to funding up to half of patient medical costs, and NAF offered additional assistance to patients in emergencies. Before the Dobbs decision, NAF spent, on average, $50,000 a month to defray abortion costs, president and CEO Brittany Fonteno says. In the two years after Dobbs, it spent $6 million a month.
But this past July 1, NAF cut its abortion funding in half; going forward, it would only cover 30 percent of qualifying patients’ appointment costs. Fonteno says the decision was difficult but necessary to ensure the organization’s future. “Our funding has not been able to keep pace with the need,” Fonteno tells me. “We were set to run out of funds by fall if we had continued to fund at the pace that we were funding at previously.”
Planned Parenthood, meanwhile, joined a campaign called Abortion Access Now that aims to pass federal abortion protections in the next decade. On the two-year anniversary of the Dobbs decision, the campaign launched with $100 million from national groups including the ACLU, National Women’s Law Center, and the Center for Reproductive Rights. A week later, Planned Parenthood’s patient appointment funding cuts, which mirror NAF’s, went into effect. Planned Parenthood did not provide comment by publication time.
“It is disheartening to be engaged in this work and, in moments of political crisis, to witness groups that should be our partners in the fight—uplifting, investing in, and centering our expertise and critical role—fail us, too.”
Local organizations like the Ohio Fund felt the impact immediately; they were inundated with more patients needing more money, even as their own donations were drying up. “It actually feels repulsive to offer someone $200 who has a $1,500 appointment cost and says that they can’t afford to eat or pay their rent,” says Lexis Dotson-Dufault, the Ohio Fund’s executive director. “What do we do? Because if we cover your whole appointment cost, that’s our budget for the day.”
And big institutional donors, like foundations, haven’t stepped in to help. Dotson-Dufault pointed out to me that when large donors decide to fund reproductive rights, they usually pour their money into national organizations. Planned Parenthood, for instance, which has over $330 million in net assets (despite losing nearly $68 million last year), received a $275 million donation in 2022 from billionaire MacKenzie Scott, the ex-wife of Amazon founder Jeff Bezos, to increase abortion access nationwide.
More than 30 local abortion funds went public with their frustrations in an open letter published in August in The Nation. “Abortion funds exist because governmental and political systems have failed our communities—primarily Black, Indigenous and Native, immigrant, rural, and low-income—and abandoned us in times of need,” the letter reads. “It is disheartening to be engaged in this work and, in moments of political crisis, to witness groups that should be our partners in the fight—uplifting, investing in, and centering our expertise and critical role—fail us, too.”
The leaders behind national groups counter that local abortion funds are partly to blame for the low cash flow. An anonymous organization leader working on abortion ballot campaigns in multiple states told Vox in September that local funds’ visions for the future—for example, making abortion (and all health care) free and eliminating parental consent laws—alienate more mainstream would-be donors. “If you’re only communicating in very extreme messaging about abortion access, you’re not broadening your base of donors, you’re just talking to the 12 people who already agree with you,” the anonymous source said. “A lot of people who would love to donate to funds and probably don’t understand the need are turned off before they even get in the door by the language and behavior.”
Dotson-Dufault offers a different perspective. She attributes the lack of institutional funding to deeply rooted stigma around abortions, which large donors share and are continuing to perpetuate. “I think a lot of people want to say that they’re supporting abortion,” she tells me, “but not go as far as paying for the abortion itself.”
The thing about abortion is that it is inherently time-sensitive. And with each week that passes, the procedure gets significantly more expensive.
In Ohio, the cheapest option—medication abortion—costs about $650, and it’s only available until 12 weeks’ gestation. Costs for an in-clinic procedure, which is legal until 22 weeks, range from $735 to over $1,600, depending on how far along the pregnancy is. Just delaying care for a week—for example, to secure money from an abortion fund—raises the cost by several hundred dollars. That’s because patients having later-term abortions require more complex care; what can be completed in one appointment in the first trimester requires multiple days and pricey anesthesia in the second or third trimester.
And for nearly all people whose pregnancies are beyond the point of viability, getting an abortion requires travel and a lot of time. There are just four clinics in the US that offer third-trimester abortions, and three of them are in the DC metropolitan area. The Brigid Alliance, which helps cover travel costs for patients beyond 15 weeks’ gestation, spends an average of $2,300 per client on non-medical expenses. Between plane tickets, childcare and multiple-day hotel stays, the costs for some clients can approach $10,000, says The Brigid Alliance’s Sarah Moeller. That’s on top of costs for the procedure itself, which can exceed $15,000 in the third trimester.
Abortion patients have always relied on local funds to fill the funding gap, especially low-wage patients who can’t afford to take time off from work, much less pay for travel and child care. But those gaps are increasingly urgent—and nearly insurmountable. “Something that’s become more common is people are coming to us with these gaps the day before or the day of their appointment,” says Alisha Dingus, development director at the DC Abortion Fund. Patients are calling the fund needing as much as $10,000, sometimes from inside the clinic waiting room. In the months after Dobbs, such last-minute requests were something the DC Fund, one of the most well-resourced local funds in the country, used to be able to cover without a second thought. Not anymore.
Now, it’s not unusual for the DC Fund to put out emergency requests for donations on social media. It’s not a policy change that came lightly; the DC team had decided against such callouts before. “We don’t want to create this sense of panic across our community, because we are such a critical fund,” Dingus says. “The other funds say, ‘Oh, if DCAF is in trouble, then what’s going to happen to callers who need care after 28 weeks?’”
We have two callers with appointments on Tuesday with a $8,300 gap. We are calling on this community to dig deep & show up to close this gap. We have seen y’all do it before & we hope you can again We keep us safe! https://t.co/IWBAHrRgG3
— DC Abortion Fund (@DCAbortionFund) August 29, 2024
The answer, increasingly, is that the independent providers who offer the costliest and least accessible abortion care are operating at a loss so as not to turn patients away. Even in states like Maryland, which has no gestational limits on abortion, Planned Parenthood does not offer third-trimester abortions. So later-pregnancy abortion care falls to a handful of independent clinics, many of which don’t have years of savings to dip into when patients come in crisis.
The DuPont Clinic in DC, for example, spent about $100,000 to offset patients’ funding gaps in the first two months after the NAF cuts, Karishma Oza, the clinic’s care coordination director, says. DuPont is often a clinic of last resort; by the time someone ends up there, they’ve likely been turned away from other providers that can’t afford to subsidize their medical care. “Every week, our case management team has to reassure patients to come to their appointments despite not having all their funding together,” Oza tells me.
“We are in a position where, if things don’t change, if we’re not able to find alternative sources of funding, then we will have to close.”
It’s a similar situation at Partners in Abortion Care, a clinic in Maryland that provides abortions up to 34 weeks’ gestation. Since opening after Dobbs, Dr. Diane Horvath, its medical director and co-founder, says the clinic has always helped cover medical costs for patients. But since NAF slashed direct patient subsidies, women are coming in with significantly greater funding gaps. Partners in Abortion Care, like many independent clinics, relies on block grants from NAF to offer emergency financial help. With its own grant cut in half, the clinic now shoulders the bulk of patient medical costs.
“We’re operating at a loss,” Horvath told me in September. She and the clinic staff want to give people the care they need, “but we are in a position where, if things don’t change, if we’re not able to find alternative sources of funding, then we will have to close.”
Even in states with strong abortion protections, abortion providers and funds don’t often receive local or state government support. Horvath’s clinic receives no grant from Maryland, for instance. Many abortion funds told me they rely on small donations from community members for the bulk of their money supply. As costs rise, and demand for funds’ help alongside it, small donations aren’t enough.
Faced with increased need and a declining cushion of cash, the DuPont Clinic in DC has formed The Lavender Fund to beef up its emergency reserve of money for patients who can’t afford their appointments. Meanwhile, many funds, like Ohio’s, have implemented monthly or weekly funding caps or have slashed limits already in place. It’s not just money funds are worried about; they are trying to balance a drastic rise in demand with their workers’ and volunteers’ emotional wellbeing.
Many of the people who volunteer or work at abortion funds—especially those who staff call lines—have themselves had abortions. The Ohio Fund’s Holliman, for instance, became involved in reproductive justice after facing barriers to her own abortion care while in college. It’s not just passion that drives the people who operate local abortion funds; it’s the intimate knowledge of everything that impedes care, from appointment fees to confusion about laws to a lack of support—and what it means if a fund cannot make up a person’s outstanding cost.
“You’re literally looking at a crossroads of two completely different futures in front of you,” Holliman says. “As much as I hate to say it, there are going to be people who are not able to access the care that they need.”
