Since its founding in 2003, the legal services and advocacy organization If/When/How has been working to fight back against state intervention in people’s reproductive lives. In addition to training lawyers, working with law students, and maintaining a legal defense fund, the organization also operates a free and confidential helpline designed to help callers navigate legal emergencies and pose questions regarding their right to access abortions and other forms of reproductive care.
While the helpline has operated since 2018, the organization released a new report this summer that details a sharp rise in calls received since the 2022 Dobbs v. Jackson Women’s Health Organization Supreme Court decision that overturned decades-old abortion protections. Since Dobbs, If/When/How has received more than 5,000 inquiries, with more than half of them pertaining to the caller’s legal rights to use abortion pills, the risks of using pills, or judicial bypass, which allows minors to petition a judge to grant them permission for an abortion without telling their parents.
The report, “State Violence and the Far-Reaching Impact of Dobbs,” provides deeper insight into post-Dobbs helpline trends, illuminating the concerns, fears, and questions that have emerged in the wake of the court’s decision and what that means for the organization’s overall work.
In addition to highlighting caller concerns around emergency abortion and fears of being criminalized for obtaining abortions, the report also focuses on calls from those currently under carceral control, whether detained in jails and prisons or on probation or parole.
Barriers to Care
Abortion access varies depending on where incarcerated pregnant people are detained. Even prior to Dobbs, some states did not allow incarcerated people to have abortions, while many others only allowed abortions during the first trimester. Pre-Dobbs, only four states had laws ensuring abortion access to incarcerated people; just 23 states had some standard or regulation regarding abortion access for incarcerated pregnant people.
Still, the experiences of those inside who wish to seek abortions do not always reflect what is enshrined in state legislation. An incarcerated pregnant person’s ability to obtain an abortion is often compromised by discrepancies among state policies, Department of Corrections regulations, and a facility’s actual practices, which can often be shaped by the whims or personal politics of prison or jail staff. In a 2021 study published in the journal Obstetrics & Gynecology, researchers from Johns Hopkins School of Medicine and the Guttmacher Institute found wide discrepancies between abortions requested and abortions received by those incarcerated in U.S. prisons and jails. The study, which used a sample of 22 state prison systems, all Federal Bureau of Prison sites, and six county jails found that the proportion of pregnancies ending in abortion was 1.4% for prisons, while the ratio is about 18% for the entire U.S. population.
For those living in states that are not necessarily hostile to abortion, the financial cost of an abortive procedure can remain a roadblock. The average cost of an abortion can range anywhere from $500 to more than $1,000 depending upon how far along an individual is in their pregnancy — a cost that can be insurmountable to many Americans but particularly to those who are incarcerated and earning wages of as little as $1 per day. Further, the 1977 Hyde Amendment has restricted the use of federal funds to pay for abortions, and in many states, people on Medicaid lose their coverage upon their incarceration.
In addition to the cost of the procedure itself, many carceral facilities also expect those seeking abortions to shoulder the cost of traveling to and from clinics — paying for tolls, gas, and overtime pay for the officers escorting them. With the majority of state prisons located in remote rural areas, these travel costs and the potential unwillingness of carceral officials to grant permission for travel exacerbates the difficulty of securing appointments — particularly given that many abortion providers require patients to come in for multiple visits before the procedure.
Kylee Sunderlin, If/When/How’s legal support director, told Prism that calls made to the helpline from pregnant people inside prison or jail are often made by proxies — most often their lawyers or friends.
“We live in a country where the carceral state has so heavily restricted people’s ability to access information, to make phone calls, and to [have] privacy from monitoring phone calls,” said Sunderlin, “that the only way it is accessible for incarcerated folks to get in touch with us [is through] someone from the outside.”
Sunderlin notes that while the helpline generally received few inquiries from those currently incarcerated, they do receive far more calls from people on probation or parole. For those under community supervision, making decisions around how to secure an abortion often means navigating what Sunderlin and her colleagues deem false choices.
“People who are on probation or parole in a state where abortion is either banned or heavily restricted need to be able to travel elsewhere, but the terms of their probation and parole don’t allow them to [travel] without the permission of their [parole officer],” Sunderlin said. “They’re in this situation where they’re trying to figure out what’s the safest route, and oftentimes there is no genuine safe route. So you either take a risk and travel to get the care that you need and hope that you don’t get pulled over or that your [parole officer] doesn’t ask you to report within the next two hours, or you can ask for permission.”
While some helpline callers have shared that they do feel comfortable requesting permission to travel from their probation or parole officers, others feel that since they are already often denied mundane requests, they can only anticipate a negative response to an issue as sensitive as seeking an abortion.
The report highlighted the story of one caller whose parole officer had been openly anti-abortion and would surely not grant her permission to travel what would be 500 miles to secure an abortion. “During the course of our conversations, she decided she absolutely could not remain pregnant,” the report notes. “Her only option was ‘to take a chance’ and ‘deal with any consequences later.’”
With the increased use of electronic monitoring for those living on community supervision, the likelihood of evading those consequences is growing slimmer. The omnipresence of such surveillance technology can not only alert probation and parole officers that an individual has left the state but can also pinpoint the exact clinic where they are receiving abortions or other forms of medical care.
Information Barriers
The lack of accurate and comprehensive information about abortion care and the confusion around what rights people in various states do have remain shared struggles among all people living under carceral control, particularly post-Dobbs.
For those inside, the lack of information about reproductive care is especially acute as even books and resources about human anatomy are often censored and banned as “illicit” material. In a piece for Inquest, Kwaneta Harris, a currently incarcerated writer, details how these forms of censorship wreak havoc on women’s health, particularly among those who entered prison in their youth and never learned the appropriate medical terms to describe their health concerns or even body parts.
“As a former nurse, it’s frustrating to try and figure out: What and where is the malady? It’s like playing charades, but blindfolded,” Harris writes regarding a younger incarcerated woman who was in pain and to whom she was attempting to offer aid.
In the piece, Harris notes that while texts such as “The Turner Diaries” and “Mein Kampf” remain on the prison library shelves, Jen Gunter’s “The Menopause Manifesto” is banned. While reporting on prison book bans often focuses on how they restrict one’s knowledge about the world around them or about the past — particularly historical atrocities — Harris shows how such censorship also infringes upon one’s knowledge of themselves, particularly their reproductive health, bodily functions, concerns, and curiosities.
Even as these barriers impede people’s ability to exercise autonomy around their own reproductive lives, Sunderlin shared that a highlight of If/When/How’s work is knowing that people have a “direct line” to support from advocates and lawyers via the helpline.
“To know that they have a whole team of defense attorneys behind them who will rally behind them is really my favorite part of this job, and it’s so nice to hear a sigh of relief on the other end of the phone,” Sunderlin said.
Prism is an independent and nonprofit newsroom led by journalists of color. We report from the ground up and at the intersections of injustice.