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Preparing for Life After Roe v. Wade

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In southern Texas, where the Rio Grande Valley hugs the Mexican border, people are already experiencing what it’s like to live in a post-Roe world.

In September 2021, Texas passed the SB8 law which banned abortions after 6 weeks of pregnancy and penalized anyone who helps a person get an abortion.

With a conservative majority on the U.S. Supreme Court, the court is expected to rule on Dobbs v. Jackson Women’s Health Organization this month, a decision that could end Americans’ constitutional right to get an abortion.

Abortion has been legal nationwide since 1973, due to the decision in the Roe v. Wade case. The U.S. Supreme Court decided that people had a constitutional right to an abortion before a fetus reached viability in that case. Further decisions said that the state could not put undue burdens on people seeking abortions.

But in May, a draft document published by Politico found that justices are likely to overrule Roe v. Wade which will lead to a near-total ban on abortion in numerous states including Texas.

As a result, abortion providers, people running abortion funds, and other reproductive rights groups have started to prepare for life after Roe v. Wade.

Life on the front lines of abortion care 

In the Texas Rio Grande Valley, the future of abortion care is in the hands of people like Zaena Zamora, the executive director of the Rio Grande-based abortion fund Frontera Fund.

The Frontera Fund, which is staffed by just two people and a small group of volunteers, has kept up with the post-SB8 demand.

Zamora said the abortion fund has seen a surge in pregnant Texans needing to travel out of state to get an abortion. For people traveling from southern Texas, that means money for ground travel, air travel, lodging, food vouchers, rideshare costs, and child care vouchers.

To reach another state from the Rio Grande Valley, the drive can easily take over 6 hours to get to Louisiana and up to 12 hours to get to New Mexico.

For the entire year of 2020, the Frontera Fund spent about $4,000 helping pregnant people get an abortion.

For just the month of February this year, the organization spent close to $13,000 helping people travel out of state for abortion care.

But Zamora and her team know things could get worse quickly if the Supreme Court overturns Roe v. Wade.

If it falls, 26 states — including Texas — are poised to pass bans and restrictions that will outlaw abortion in some way, shape, or form. This means pregnant people in Texas seeking an abortion will have to travel further and spend even more money on abortion care.

The rise of ‘destination states’

While a significant number of states plan on restricting or banning abortion access, multiple states are passing laws with the goal of protecting reproductive rights.

These states are likely to become destinations for people seeking abortions.

Already, the Frontera Fund has sent patients as far as Baltimore, Washington DC, and Virginia — anywhere they can get an appointment.

“The amount of funding that we are providing per person has skyrocketed astronomically because of the additional travel costs associated now with getting an abortion,” Zamora said.

If Roe v. Wade is overturned, the Frontera Fund expects to see a 20 percent increase in call volume and a 20 percent increase in their direct support budget to send people to states that reliably offer abortion care.

Some progressive states like California and New York are planning to set aside money to help out-of-state patients traveling for an abortion.

California has long been an abortion sanctuary for out-of-state people seeking an abortion.

The Guttmacher Institute estimates there will be a 3,000 percent increase in patients whose nearest clinic would be in California. This could result in an increase from 46,000 to 1.4 million people who wind up traveling to California for abortion care.

Jessica Pinckney, Access Reproductive Justice’s executive director, is working with the California Future of Abortion Council on multiple pieces of legislation that would help improve access to abortion in California in the event Roe is overturned.

One of California’s bills, SB 1142, is asking for a $20 million contribution from the state to provide practical support — like child care, lodging, travel, and food — to anyone getting an abortion in California.

“We hope that would really be able to shore up our ability to provide practical support to folks who are coming from other states, as well as those who are in California trying to access care,” Pinckney said.

Another bill, AB 2134, aims to fund abortion clinics that provide free care to low-income people whose insurance does not cover abortion and other reproductive health services.

Both of California’s bills, AB 2134 and SB 1142, are expected to move through the legislative process this summer and be voted on by the end of summer. 

The Hyde Amendment prohibits the use of federal funds for abortion care except in cases of rape, incest, or if the pregnant person’s life is endangered. But some states, like California, use their Medicaid funds to cover abortion care.

That said, even though California’s Medicaid program Medi-Cal covers abortion, the coverage does not apply to out-of-state callers.

And while some states require private insurers to cover abortion care, many states have some restrictions against abortion coverage in insurance. 

Similarly, Vermont, New Jersey, New York, and Connecticut are approving legislation that will protect the right to abortion and provide support for out-of-state patients traveling for care. 

The cost of abortion care post-Roe v. Wade

Abortion funds have become a go-to way for people to afford and navigate travel to other states for abortion.

These nonprofit organizations are funded by individuals and organizations that are passionate about helping people that need to access abortion. They provide financial and logistical assistance to anyone who cannot afford an abortion and people from all over the globe can donate.

Zamora said that the Frontera Fund has seen bursts of what she calls “rage giving,” an uptick in funds whenever a new abortion restriction takes effect.

“People are just angry and they need to do something, right, so they give money to help with that and we’re very fortunate to be recipients of a lot of rage giving,” Zamora said.

According to the National Network of Abortion Funds, there are over 90 organizations scattered across the country. Most, if not all, are currently working to ensure they have the infrastructure in place to support the surge in callers that are expected if and when Roe v. Wade is overturned.

The Frontera Fund is hiring a third staff member, recruiting more volunteers, and ramping up its fundraising efforts in anticipation of the overruling.

“We’re a tiny organization and we have a lot of big things to do — and we get them done, but there’s a lot of growing pains right now,” Zamora said.

Access Reproductive Justice, the only statewide abortion fund in California operating outside of clinics, supported people who called in from 18 states in 2021. They expect to see a surge in out-of-state patients coming to California if Roe is gutted. 

Pinckney said Access Reproductive Justice has the infrastructure in place to support a surge in out-of-state patients — it’s something they’ve been working toward for decades. They anticipate that the number of out-of-state people calling for help will increase by 30 percent to 50 percent, if not more.

Last year, they supported 500 people calling for care, both in and out of state. And if Roe v. Wade is overturned, they expect that number to at least double to 1,000 people.

“We have been preparing for this moment and there are systems and structures already in place to support folks in getting from one state to another to get the support they need,” Pinckney said.

Pinckney added that abortion funds vary in how they financially support people who call in for help. Most funds have a monthly budget to support callers. Once that runs out, the helpline closes until the next month.

The group can make adjustments so people who call in can still get help.

“Abortion funding is an art, not a science, so we make a lot of adjustments and whatnot in real-time, as we cannot predict just how large or small an influx in callers might be, or when it might occur,” Pinckney said. 

If Access Reproductive Justice hits its limit, Pinckney and her team assess if funds can be pulled from other work. If for some reason that isn’t possible, they direct callers to other abortion funds across the country that can provide support — “although we’ve never found ourselves in a situation quite like that,” Pinckney said.

How clinics are preparing

There are over 700 clinics scattered across the country that provide a variety of care services, including abortion pills, abortion procedures, abortion referrals, ultrasounds, and post-abortion follow-up care.

For years, laws that restricted abortion rights have led to clinic closures nationwide. 

As of 2017, at least 89 percent of counties in the country do not offer abortion care services, and past restrictions have made it near impossible for many pregnant people to find care in their communities, according to the Guttmacher Institute.

In May 2017 there were 6 states that only had one remaining clinic. According to the American Civil Liberties Union (ACLU), if Roe v. Wade is overturned, more clinics will close, leaving some states with no clinics.

With abortion likely to be banned in many states, many of these clinics are working to figure out how to connect patients to services in other states.

Planned Parenthood, which operates over 600 health centers across the country, has been expanding its patient navigation efforts to help pregnant people in restrictive states figure out where and how they can get an abortion. 

When a patient calls a clinic in Texas, for instance, the health center will help the patient secure an out-of-state appointment along with transportation, lodging, child care, and funding for the abortion itself in a nearby state that permits the procedure.

“Texas presents a case study of what we’re going to see in these 26 other states,” Lauren Kokum, the director of affiliate communications at Planned Parenthood, told Healthline.

Moving patients and helping them navigate the healthcare and legal systems has always been a part of accessing abortion care.

According to Erin Grant, the deputy director at Abortion Care Network, clinics are all too familiar with working with very little to provide services.

“We are definitely seeing clinics be their resilient selves — find staff, train staff, and find really creative solutions to deliver the care that patients need,” said Grant.

According to Grant, the interworking of clinics, abortion funds, and patient support networks are there and may be key to providing abortion services for many.

Planned Parenthood says they are ramping up patient navigation services and working with abortion funds more closely to coordinate people’s abortion care journey every step of the way. 

Planned Parenthood clinics in critical access points — such as those along the border of New Mexico and Colorado — are also bolstering their patient navigation efforts to coordinate care, travel, and lodging for the influx of patients, according to Kokum. They’re expanding their health centers, extending clinic hours, and training more providers.

Telemedicine abortion providers prepare 

Abortion provided via telemedicine has become more popular in recent years. Medication abortion now accounts for half of all abortions in the United States — a jump from 39 percent in 2017. 

Research has shown that abortion pills are effective and can be safely taken at home in the first 10 weeks of pregnancy.

Online abortion pill providers are planning to work within state restrictions and bans to get pills to people who need them. 

Honeybee Health, an online pharmacy that ships the pills, says that they will only ship to patients in states where the medications are legal. But they’re doing all they can to ensure access — where it’s legal — remains fast and accessible to support the influx of patients traveling for care. 

They’ve also teamed up with abortion funds to help people who can’t afford the medication.

Choix, which provides telehealth abortion medication to people in Colorado, California, and Illinois, is prepared to scale up its services to meet the increased demand they expect to see from out-of-state patients seeking telehealth care from the states it serves.

AidAccess, an organization based in the Netherlands that sends abortion pills to patients regardless of state law, has started prescribing abortion pills to people who would like to have the medications on hand just in case they eventually have an unintended pregnancy.

In addition to helping people get access to pills to end a pregnancy, telehealth medication can also help people cut down on the amount of time they would need to spend with a healthcare professional in person. 

Planned Parenthood’s sites and other clinics say they are ramping up telehealth services to reduce the amount of time patients need to spend at a clinic along with the amount of in-person appointments they have to go to. 

So instead of traveling to three in-person appointments, for example, patients will only need to travel for one or two, said Kokum. 

“We’re doing whatever we can in order to meet the patient demand [in access points],” Kokum said.

Restrictions may limit the effect of telehealth providers

Telemedicine abortions are restricted in 13 states and banned in 6.

At least 20 states are expected to pass stricter restrictions on medication abortion via telehealth.

Proposed bills in 10 states would require patients to pick up the pills from a healthcare facility, rather than receiving them by mail. Proposed bills in four other states would ban telehealth consultations and require patients to take the pills under a provider’s watch.

However, if Roe v. Wade is overturned and these states ban abortion fully, then telehealth appointments for abortion in those states will be illegal.

Providers can only consult with a patient in the state where they, the provider, are licensed and the patient is based. The pharmacies can only ship to patients where the pills are legal, according to Kristen Moore, director of the EMAA Project, an organization that works to expand access to medication abortion. 

Patients in states that ban abortion could potentially travel to a nearby state that permits medication abortion via telehealth, do a telehealth appointment from there, and have them shipped to a mailing address in that state (or look into mail forwarding). 

But people may still face legal risks if they have a complication.

While people are legally allowed to take the pills at home, no matter where they live, if they have some type of medical complication and need to go to the emergency room, a healthcare professional in a state like Ohio or Texas that bans the pills could turn them in, if the patient tells them that they took the pills.

Bleeding due to a miscarriage versus bleeding due to abortion via medication may appear similar or indistinguishable in a medical setting.

“To be clear, that healthcare provider will have no evidence that [an abortion] is what happened. They can just make that person’s life a living hell,” Moore said.

Who loses access to reproductive care? 

If Roe vs. Wade is overruled, an estimated 36 million people will be at risk of losing access to reproductive care, according to Planned Parenthood.

Even with all the work being done by clinics, abortion funds, and patient support networks, getting an abortion is about to get a lot more difficult for millions of people in the United States.

That means many people will opt for the other two options: self-managing an abortion or carrying the pregnancy to term.

“No state can absorb the amount of people experiencing pregnancy that may be looking for care,” Grant said.

And just because a government bans abortion does not mean that people are not going to try to get one. 

Data from the Guttmacher Institute shows that abortion rates are similar in countries where the procedure is restricted and where it is legal.

“While states may make abortions illegal or criminalize abortion providers or patients, they have done nothing to the human right and need for abortion,” Grant said.

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