Last month’s leak of a Supreme Court draft ruling rendered the longstanding fears of abortion rights activists a veritable certainty: Roe v. Wade, the landmark 1973 decision that established a federal right to abortion in the United States, is under dire and imminent threat.
While “safe haven” or “sanctuary” states and cities still offer refuge to interstate abortion seekers, access remains a patchwork, presenting financial and logistical hurdles that most deeply impact the marginalized. Under-resourced abortion funds, clinics and activist groups will be in for a struggle merely to hold onto existing gains; their driven organizers and staffers will face staggering challenges amid an influx of abortion refugees.
Yet many point to the potential of new alternatives — especially medication abortions, legal and otherwise — that may prove pivotal to sustaining access in a post-Roe world.
Safe Havens — for Some
Abortion restrictions across the South and among Republican-controlled states are set to worsen further after Roe’s expected reversal. For many in the Midwest and South, reproductive rights that do still exist hang by the thinnest of threads. Absent Roe, the 13 states that have preemptively established “trigger” laws will enact immediate abortion bans; in total, 26 states are poised to pass extreme restrictions, or to outlaw abortion outright.
Meanwhile, only four states enshrine constitutional protection for abortion; 16 others, along with Washington, D.C. maintain other layers of safeguards. The population dispersal between protected and unfriendly states is close to 50/50 — meaning that the end of Roe would near-instantaneously disenfranchise half of the country.
The 16 “safe havens” represent some of the few remaining options for the millions who reside in the 26 states under threat. States and cities with protections for abortion (pre-fetal viability) include California, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington State. Those that have codified the right to abortion throughout the course of the pregnancy are New Jersey, Colorado, Oregon, Vermont, and Washington, D.C. These places are also home to abortion organizations and the requisite medical infrastructure to facilitate the actual procedure.
Bracing for Roe’s reversal, abortion rights supporters and lawmakers in many of these areas have defensively introduced bills, budget provisions or other legislative actions, or have otherwise announced intentions to buttress abortion rights in their jurisdictions. Measures taken have included reducing waiting periods, disbursing money to clinics and abortion funds, lifting parental notification requirements, and other means of clearing obstacles. Medical providers too are preparing, stressing the need for more resources and better logistical arrangements.
In Connecticut, Oriana Gonzalez reports for Axios, Gov. Ned Lamont “signed into law a bill to protect abortion providers and patients from bans in other states.” Oregon lawmakers, for their part, approved $15 million in state grants to nonprofits, intended to expand abortion access. New York State’s 2019 Reproductive Health Act entrenched the right in legal codes; more recently, New York Gov. Kathy Hochul and other lawmakers, providers and activists have been bolstering protections and preparing for incoming interstate patients. Lawmakers in California have introduced numerous bills, which would fund clinics, create a $20 million travel and cost-assistance fund and empower some nurse practitioners to conduct abortion procedures. Governors and lawmakers in Illinois, Vermont, New Jersey and Michigan, among others, have also reiterated commitments.
But even in these ostensible blue state “sanctuaries,” access to and affordability of abortion can sometimes be severely curtailed — a difference of degree but not of kind with all the other pronounced failures in the U.S. health care system. For instance, in Connecticut, despite a groundbreaking safe haven law, obstacles to access remain.
In certain areas of California, one of the most protected states, access still poses a significant challenge to many residents, especially outside urban areas. Research from the Guttmacher Institute indicates that 40 percent of the state’s counties lack a single abortion clinic. There, too, lawmakers, including Gov. Gavin Newsom, have made financial commitments to defending reproductive rights. However, these millions only constitute “a start,” writes Maanvi Singh for The Guardian, since “even more may be needed to care for those living within the state.” This is truer in rural regions, but even major cities like Los Angeles can sometimes offer only patchwork access, as Singh notes. Setting aside liberal waffling and the political, budgetary and logistical difficulties of fortifying access, the radical right is far from absent in blue states. Even in these “safe havens,” abortion is often still under significant threat.
As Rafi Schwartz writes in Mic, states like Minnesota, a crucial “oasis” for Midwesterners in surrounding red states, are set to become a major target for the anti-abortion movement. There, gubernatorial candidate Scott Jensen has cited his desire for a near-total abortion ban. He is not out of step with other Republicans in expressing these hopes — many have hinted they seek to revoke any and all caveats, even in cases of rape, incest or certain parental death. Some anti-abortion groups and Republican lawmakers in blue states are now turning their attention to contraception. Even miscarriages could be treated as a serious crime, as was the case for Brittney Poolaw, a Native woman from Oklahoma who, after miscarrying, was sentenced to four years for first-degree manslaughter.
As the threat from the radicalized, energized right wing mounts, “safe haven” localities, whatever their shortcomings and vulnerabilities, will grow ever more essential. Out-of-state abortion seekers regularly prove willing to take long journeys and spend $1,000 or more to have an abortion out of sheer necessity. Needless to say, these are insurmountable barriers for many — first and foremost, for workers and the marginalized. Time off work, travel expenses, insurance and bureaucratic hurdles — the option of a medical pilgrimage is often impeded by race and class.
Even with Roe in place, tightening restrictions have meant that an increase in abortion seekers has already begun to overfill clinics and extend wait times in blue states. This could soon worsen drastically. As Anne Rumberger writes in Jacobin, if Roe falls, the portion of people living more than 200 miles away from the nearest abortion clinic would increase from 1 to 29 percent.
However, those in need are not entirely without help. Activists of all stripes — from advocacy nonprofits and titanic institutions like Planned Parenthood, to small groups of grassroots, volunteer radicals — are exploring all possible means of fortifying abortion rights, both to assist locals in need and to shepherd abortion seekers across state borders as they come in droves to exercise their right to bodily autonomy.
Blue State Abortion Funds Prepare
Connecting local abortion seekers with appointments, safely bringing those out-of-state into sanctuaries, and other forms of direct assistance are one of the primary functions of abortion funds. Such funds represent a major vector of direct aid, examples of which can be found nationwide.
The Chicago Abortion Fund (CAF) works with 55 clinics across seven states and collaborates with both national and local partner funds. Illinois’s sanctuary-state status makes it a major locus of abortions in the Midwest, with Chicago as a focal point.
CAF’s efforts are distributed across multiple channels: direct aid, advocacy, public awareness, and other campaigns, often launched in coalition with other groups, to influence policy at state and national levels. The Fund is also involved in research efforts. CAF and other funds’ direct aid work is chiefly to provide financial, logistical, practical and even emotional support for individuals seeking abortion. CAF doesn’t have any restrictions or eligibility requirements for those they help — all in need are welcomed.
“We like to say we work with our grantees to identify their needs, and then we figure out how to provide resources for those needs,” Megan Jeyifo, executive director of CAF, tells Truthout. Such needs can involve booking appointments, as well as letting people know what other resources they have in addition to CAF. The Fund’s many forms of aid include providing transportation, booking hotels and providing child care through the organization’s partnership with the Chicago Childcare Collective. CAF staffers, some of whom have had abortions themselves, Jeyifo says, do their utmost to streamline a challenging process.
“Really, anything someone needs, we’re going to figure out how to do it. We’ve paid for people’s tires to get fixed, or when their cars break down on the way here. We’ve sent food or MaxiPads to their hotel rooms. We’ve purchased clothes for people when they end up being here in Chicago for an extended period of time,” Jeyifo says.
The Fund, she says, hasn’t had to turn anyone away since July 2019 — a remarkable sustained effort, especially considering that the number of out-of-state abortion seekers entering Illinois was rising even before the Supreme Court’s draft opinion leaked. Yet Jeyifo worries that, as the influx of abortion seekers inevitably accelerates post-Roe, access to comprehensive care may not be sustainable. “To think that we won’t be able to connect 100 percent of our callers to care is really what keeps you up at night,” she says.
Jeyifo also points to efforts at exerting what she calls a “culture shift.” In part, this involves destigmatizing the term “abortion” itself. Many contemporary advocates also see the “pro-choice” framing as preemptively concessionary.
“I think the ‘pro-choice’ language has failed us. I think the euphemisms have failed us. We need to say what we want, and what we want is abortion that is free from barriers and is not thought of as something to be ashamed of,” Jeyifo tells Truthout. “We know that oftentimes there’s stigma associated with even asking for help, [especially] getting help for highly politicized, time-sensitive, sometimes emotional health care. [We do] anything we can do to break things down and make it easier.”
While the Fund has proven adept at guiding local and out-of-state abortion seekers through these difficulties, Jeyifo makes clear that only systemic change will alleviate broader adverse conditions.
“I always point to House Bill 40 passing here in Illinois, and the transformation that that created for the people,” she says. “[HB 40] is what mandated Medicare coverage for abortion care. It has completely changed everything. [A] small abortion fund, no matter how resourced we are, can never create that kind of transformational change. But the states around us are so far from that.”
As a National Committee for Responsive Philanthropy report released in January 2021 indicated, abortion funds like CAF only receive 3 percent “of the overall philanthropic commitment to reproductive rights initiatives nationwide,” notes the Brennan Center.
Meanwhile, support for abortion funds, while spiking after the Texas Heartbeat Bill, has fluctuated. Jeyifo underscored that, after Roe, the allocation of financial support for abortion funds will have major ramifications for even more lives. “Funders need to understand Illinois’s responsibility to people in this moment. And people who live in Illinois need to understand Illinois’s responsibility to people in this moment,” she says.
The anti-abortion movement enjoys the advantage of vast funding from religious institutions and wealthy right-wing oligarchs. The largest abortion rights and services nonprofits, meanwhile, receive their primary funding from the philanthropic world, bankrolled, in many cases, by individual donors with purported feminist sympathies. Some, especially top nonprofits like Planned Parenthood and NARAL, can count billionaires in their corner. (Among them are the Susan Thompson Buffett foundation and Amazon CEO Jeff Bezos’s ex-wife MacKenzie Scott.)
This reliance on the ultra-wealthy has developed in the absence of adequate government funding. Unfortunately, as Amy Littlefield writes in The Nation, this arrangement can have lopsided outcomes: “State-based organizers face an impending crisis that has come about not only as a result of the Supreme Court’s pending ruling but because the abortion rights movement has underinvested in critical state battles and relied on the inconsistent generosity of a handful of billionaire-backed foundations.”
The truly enormous multimillion-dollar organizations like Planned Parenthood and NARAL exhibit different emphases and tactics — focusing on lobbying and legal strategies, for instance, in lieu of devoting more resources to direct aid for abortion seekers. This is not to paint with too broad a brush; the “nonprofit-industrial complex” is far from a monolith. Still, the anti-capitalist left has major criticisms of where some of the largest institutions have placed their focus.
The American Civil Liberties Union (ACLU), Planned Parenthood, the National Organization of Women (NOW), and NARAL have fought a seemingly endless legal battle for decades. The leaders of these mainstream groups claimed their gradualist strategy would ultimately triumph without prompting anti-abortion backlash…. [T]his argument is no longer convincing.
The nonprofit-industrial complex and the Democratic Party, critics charge, have proven inadequate breakwaters against a rising reactionary tide.
From the Grassroots Up
The work of ensuring that blue state “safe havens” live up to their moniker has also been taken up by myriad small networks, many of whom have a more radical bent.
Amy Wilson is an organizer with NYC4AR, an explicitly socialist feminist activist collective. Despite New York City’s legal protections and liberal bona fides, vulnerable abortion seekers often find themselves confronted by anti-abortion harassers, on top of the logistical and financial challenges that still exist in liberal metropolitan centers.
In response, NYC4AR launches clinic defenses in which the organization’s members counterprotest crowds of right-wingers who jeer at vulnerable people outside facilities, while also shielding and escorting abortion seekers from such protests as they enter clinics.
“We’re trying to call attention to the fact that these people are still conducting clinic harassment, even in a deep-blue city like New York,” Wilson tells Truthout. “If you’re trying to get an abortion in New York, you’re just as likely to be confronted. [We don’t] buy into this narrative of ‘New York City exceptionalism’ — that we’re somehow outside of this struggle, that we’ve already won it.”
While Wilson noted that some feel clinic defense is a problematic tactic because it “adds to the furor around abortion clinics,” she feels it’s ultimately a necessary strategy. “We don’t want to be there,” she says. But “letting things go on as the status quo isn’t going to be an appropriate way of dealing with it.”
NYC4AR is also engaged in other forms of direct action and aid. Activists work to share information on accessing abortion, distribute reproductive health kits that include contraception and pregnancy tests, and help seekers procure abortion pills. The group regularly tables, distributes leaflets, and organizes panel discussions and other types of political education, and partners with a group that does mutual aid in Washington Square Park on Friday nights, Wilson says. She also cites NYC4AR’s efforts in legislative advocacy, including supporting bills that would prevent the criminalization of abortion providers.
Plenty of liberals, progressives, socialist feminists, and other radicals are engaged in similar efforts to NYC4AR. But in addition to a general dearth of funding, the movement is perhaps hamstrung by its strategic isolation, as Wilson notes. “There are a lot of strong local groups but not a lot of national coordination…. We’re not formally connected with [similar groups in other cities.] Certainly, no shared funding or coordination or staff — because we don’t have funding or coordination or staff. We’re all-volunteer, grassroots [organizations].”
The End of the Coat Hanger
NYC4AR’s Wilson and many other advocates are hopeful that access to pills that induce abortion — namely, mifepristone and misoprostol — in both blue and red states can help mitigate the strain on “safe haven” states as they attempt to accommodate the growing influx of abortion seekers. “With these [state] bans coming down and the shift in the national landscape,” Wilson says, “accessing abortion pills by mail is going to become a lot more important.”
Medication abortion accounts for half of all U.S. abortions today, passing that benchmark for the first time in 2020. (It is critical to emphasize that, contrary to fearmongering, medication abortion is an extremely safe and effective option — safer than acetaminophen, in fact.)
Still, abortion pills are not a panacea. For one, they’re most effective in early pregnancy, and it’s true that complications, while “extremely rare,” are “not impossible,” says Hayley McMahon, a Ph.D. student at the Emory Rollins School of Public Health who researches the social and structural determinants of abortion access.
Yet the primary limitation of abortion pills is that too few people are aware of their existence (nearly 80 percent of U.S. adults have never heard of them), or cannot access them. Additional factors like a lack of internet service and potential risks from oppositional family members, as Becca Andrews details for Mother Jones, can present obstacles to safe acquisition and use.
McMahon argues self-managed abortion needs to be decriminalized on the federal level. While only three states explicitly ban self-managed abortion, around 20 have laws that prosecutors could misuse to arrest pregnant people. At least 22 people have already been arrested, and several have served time in prison.
Furthermore, access to the pills themselves is not safe from the right-wing threat: Several states have already begun to put bans on mail-order drugs in place. Availability, NYC4AR’s Wilson notes, also relies on the U.S. Postal Service, which has been gutted under Postmaster General Louis DeJoy, being a reliable courier.
Wilson and other activists also point out other areas of abortion access in blue states that can be further shored up. She highlighted, for example, the importance of protecting campus clinics as well as telemedicine — virtual consultations in tandem with prescribed medication. As The New York Times reports, residents in states with post-Roe bans, “would be legally prohibited from having telemedicine abortion consultations from any location in their state, even if the doctor were located in a state with legal abortion.” They might also be subject to digital surveillance.
Redefining Inalienable Rights
Abortion is health care — safe, routine and normal health care, at that. Two-thirds of the U.S. population wants to uphold Roe. The severity of the threat demands far more than the haphazard, and often half-hearted, resistance that the Democratic Party has put up over the decades. Accordingly, some on the left are calling for abortion defense by a labor-based mass movement. (An article by C.M. Lewis in In These Times offers a glimpse at this possibility, reporting on how some unions are stepping up to help protect their members.)
Only structural change will mitigate the degradation of reproductive rights. As Lillian Cicerchia reiterates in Jacobin, “the Left should emphasize … the need to create ties between feminists, the labor movement, and health care campaigning.”
If — or, more likely, when — the Supreme Court fulfills one of the radical right’s most enduring fantasies and does away with Roe, the sum total of suffering resulting from innumerable forced births, imposing intolerable strains on the already strained, is difficult to contemplate. Yet, though the end of Roe would affect millions, the empowerment of the fascistic fringe would ramify further still.
As NYC4AR’s Wilson tells Truthout, “These issues are really interconnected. Abortion isn’t an issue that stands alone, as much as the culture wars try to make it seem that way.” She continues: “These are all political choices that we’ve made — restrictions that disproportionately affect low-income and Black and Brown people. That’s the way our country is set up. Abortion bans codify that violence, that restriction, that control that’s already there.”