Last summer, Crystal Zaragoza drove a 15-year-old patient from her home in rural Georgia to Virginia, the nearest location where the teen could receive the abortion care she needed.
Zaragoza remained with the patient every step of the way, making the 650-mile trip in one, long 12-hour haul and staying with her at a hotel during and after the procedure before driving back.
Access Reproductive Care-Southeast, the abortion fund serving women in six states across the Southeast U.S. where Zaragoza works, provides what's called "practical support" — helping women overcome significant financial, logistical and geographic hurdles beyond just paying for the abortion care itself. Zaragoza locates providers and facilitates lodging, escorts to and from clinics, child care and travel (often doing the driving herself).
Demand for the help groups like Zaragoza's offer has grown in the years the states her organization serves — Georgia, Florida, Alabama, South Carolina, Tennessee and Mississippi — have chipped away at abortion access. The pandemic has also had an impact. But the Supreme Court's decision last month to consider the legality of Mississippi's ban on most abortions after 15 weeks of pregnancy — a move pro-abortion-rights advocates say means the newly conservative bench is eyeing an end to Roe v. Wade — has practical support groups looking to ramp up fundraising, volunteering and staffing with even greater urgency.
"We have been preparing for a long while for an eventual reality where Roe is decimated, and a lot of that has been trying to scale abortion funds,” said Yamani Hernandez, the executive director of the National Network of Abortion Funds, which helps women access and receive abortion care.
"These groups have already been navigating a difficult year-plus, and if things do not go well with the Supreme Court, a lot more travel and a lot more assistance will be needed. Distances to travel will increase and the amount of people traveling will increase," she said.
The groups, which are also becoming the target of a new, restrictive wave of anti-abortion laws, are strategizing for the long-dreaded possibility that the way they operate could represent the future of abortion care for millions of women.
Need spiked during pandemic, groups say
Several organizations said the number of women seeking help from abortion funds and practical support groups spiked during the pandemic and has continued to rise in the months since infection rates began declining.
The number of patients helped by the National Abortion Federation, which runs the five largest patient assistance funds by dollar amount, rose in each month from April 2020 to December 2020 (over the prior year) by an average of 21 percent, the group’s leaders said. That equated to more than 100,000 women receiving financial assistance from the group to pay for abortion care. In 2020, the group grew its staff of regional case managers to 19 from eight and plans to add more.
NNAF's Hernandez, meanwhile, said call volume across her group's 83 member funds doubled in the months since May 2020 over the prior year numbers.
ARC-Southeast saw its call volume double during that time, too, officials said. Before the pandemic, the group was making an average of 350 pledges per month — an accurate way to track demand because it indicates the number of callers who sought care and actually received money, according to the group. Since June 2020, ARC-Southeast has made an average of 600 pledges a month.
Meanwhile, the Brigid Alliance, a New York-based group that pays for women with low income to travel to states where they can receive abortion care, has, since January 2020, seen a 20 percent increase in its client volume and has doubled its budget, via fundraising efforts, in anticipation that it will keep growing.
In 2020, the group helped 661 women travel to receive abortion care. Less than halfway through 2021, it’s already helped 440 women.
“People didn't stop needing abortions just because there was a pandemic. It just became more difficult,” the group’s executive director, Odile Schalit, said.
'Two Americas' when it comes to abortion rights
Leaders of these groups predicted need for their services will only rise ahead of, and following, the Supreme Court's consideration of Mississippi's abortion ban. The law currently allows exceptions for medical emergencies and severe fetal abnormalities.
Abortion-rights activists worry the case will provide an opening for the court to decide whether all bans on abortion before fetal viability — which Roe prohibits — are unconstitutional. (The court will hear the case in the fall and will likely issue a decision next spring or summer.)
"This would basically create two Americas when it comes to abortion. Of course we already have that, but this will make it even worse," said Elizabeth Nash, a state policy analyst at the Guttmacher Institute, a research organization that studies reproductive health rights. "If the Supreme Court really takes a whack at abortion rights and upholds the Mississippi ban or determines that pre-viability bans are OK, you’re talking about having two very different experiences in this country."
"If you're living pretty much anywhere in the middle of the country or the South, abortion could very well be, effectively, banned to a large extent," Nash said.
Abortion funds and practical support groups could then become some of the only avenues for millions of women who can't otherwise afford or navigate abortion care on their own. Groups are already looking to lift their fundraising so they can increase services to meet what they say will be an all-but-certain surge in demand.
"Virtually any ruling other than one that upholds Roe is going to result in more people having to travel farther and raise more resources, whether that's paying for procedures or travel costs or lost wages costs,” said the Rev. Katherine Ragsdale, president of the National Abortion Federation. “People are going to be more and more dependent on abortion funds and the groups like NAF who can provide those resources.”
The NNAF, for example, launched a pilot program this year for several of its 83 member abortion funds that will "fully resource the mid-Atlantic region so they can say yes to every caller," Hernandez said. The group is trying to double its $15 million budget, Hernandez said, via grants and direct appeals to individual donors.
ARC-Southeast, for its part, has grown its small full-time paid staff of 10 by 40 percent and has expanded its volunteer network of 120 unpaid individuals by a similar amount.
Meanwhile, the National Institute for Reproductive Health and its sister advocacy arm, the NIRH Action Fund, are looking to grow their collective budget by about 30 percent, the groups said.
Groups say they are targeted by new state laws
The Mississippi case and its subsequent fallout, however, are far from the the only battle on the minds of leaders of abortion funds and practical support groups.
A unique Texas law enacted in May banning abortions as early as six weeks into a pregnancy also included language allowing anyone, even someone outside Texas, to sue an abortion provider or anyone else who helped someone get an abortion after the six-week limit for up to $10,000 per defendant. (Texas' law prohibits state officials from enforcing the ban and rather leaves enforcement to private citizens' lawsuits; abortion rights activists have vowed to challenge it.)
But that language would also apply to abortion funds and practical support organizations — and lawsuits would cripple those group's ability to operate at a critical moment, they said.
"It's absolutely a new way for state legislatures trying to find ways to end practical support. It could be a model for states considering how to further crack down on that kind of support,” said Guttmacher's Nash.
That would make it even more difficult for people like Schalit to help women like the 24-year-old patient she assisted last year to travel from Tennessee to New Mexico after nearly every part of the system put up roadblocks for her to receive abortion care.
The woman, Schalit said, discovered she was pregnant at eight weeks and made plans to attempt a medication abortion but lost her job (and her medical benefits) around that time after being laid off due to Covid-19. Her unemployment checks were delayed, and by the time she received her first, the closest possible clinics in Tennessee and Kentucky that provided care were booked up. Soon, she had surpassed the gestational limits in both states, prompting her to seek assistance from the Brigid Alliance.
Schalit personally planned the woman’s travel and hotel and connected her to the New Mexico Religious Coalition for Reproductive Choice, which helped her seek abortion care.
"Her barriers were a combination of everything many women are facing in this world right now in trying to have an abortion, pandemic or no," Schalit said. "It’s a phenomenal story, but it’s also typical. And it’s about to become even more typical."