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When President Joe Biden signed a measure on January 28 to reverse the previous administration's anti-abortion restrictions, he promised to "undo the damage that Trump has done."
The move was necessary to provide better access to reproductive health care, as the so-called global gag rule blocked U.S. funding for nongovernmental organizations that provided abortion counseling or referrals—domestic and foreign.
But it won't be the president's office undoing real harm in communities stateside.
That work will fall on the shoulders of organizers who've long worked to make sure people received the care they need: the local abortion funders. That's who continues to provide financial and psychological support to those seeking abortions in some of the most restrictive states in the country.
Because despite the new presidential promise, people in need of abortions still suffer under funding restrictions and logistical barriers.
Those barriers can be overwhelming in the South—from limited health care access to a shrinking number of clinics to cultural stigma.
Fund workers in the South have the institutional knowledge to navigate a system that has been deliberately obscured. They know the accessibility and location of the closest clinic, which may be across state lines or recently shuttered thanks to changing state-level legislation. They know the fees for procedures and associated travel costs. They know how to combat the spread of disinformation from pro-life activists. Funds do this to address needs in communities where public health is severely under-resourced, and statehouses continuously attempt to restrict access to care.
"Anti-choice legislators don't necessarily determine our destiny," said Oriaku Njoku, the co-director of the nonprofit Access Reproductive Care-Southeast. "We're the ones who are in control of that."
Fund workers like Njoku are vowing to maintain the public's access to abortion while working in solidarity with organizers addressing racial, economic, and gender justice issues in the South.
"Being able to make the connections between abortion access and other issues that impact our lives like economics, like gender justice, like LGBTQ liberation… really drives us," Njoku, who sees ARC-Southeast as part of a larger solidarity project, said.
Based in Atlanta, ARC-Southeast provides support to Southerners in Alabama, Florida, Mississippi, South Carolina, and Tennessee. Though funds are usually separated by geographic area, funds do cooperate across state lines.
Last August, when Hurricane Laura battered Louisiana causing evacuations and state of emergency orders, ARC-Southeast joined with the New Orleans Abortion Fund to provide transportation support to Louisianians in need of abortion care. That same summer saw a legal battle over Georgia's 2019 ban on most abortions after six weeks. A federal judge struck down the law in July. Throughout this tumultuous period when people were confused and concerned about their rights, the fund kept pledging by delivering financial and emotional assistance to those seeking abortions.
According to Njoku, ARC-Southeast spent more than $450,000 funding abortions and practical support between July 2019 and June 2020.
When someone calls an abortion fund, they usually already know they cannot afford the procedure but may not know the full cost of an abortion in the South. Fund workers or volunteers talk callers through the costs of both the procedure and expenses associated with state requirements. Funds then pledge a certain amount of money to help defray costs, with the average pledge differing between funds. The money comes from one-time and monthly donations from individuals as well as grants from organizations.
The repeal of the Global Gag Rule is a big deal for reproductive health organizations, but the repeal does not mean federal money will widely cover abortions. Instead, foreign nongovernmental organizations can receive U.S. money for health services like cervical cancer screenings and birth control without certifying they do not provide or promote abortions. Domestically, Biden's memo calls for a review of the restrictions on Title X, a family planning program for low-income Americans. Without the Trump-era restrictions, clinics in the South could receive Title X funding for family planning services, excluding abortion. Though abortion funds would remain necessary for funding the procedure and associated costs, independent clinics and Planned Parenthood could use the additional funding.
The average pledge from ARC-Southeast is $150.
That money is necessary, in part, because state-level restrictions mean those needing abortion care may have to arrange for travel to one of the few remaining clinics, accommodation because of medically unnecessary waiting periods, and child care because many people who need an abortion are already mothers.
See also: 'Abortion bans aren't just about abortion'—The fight for reproductive justice in the South
And, the longer these arrangements take, the more the procedure itself could cost. Procedure costs are prohibitive, of course, but Njoku and the fund try to provide more than money.
"We want to make this shift from transactional to transformational," Njoku said.
"What does it look like to be able to receive a service and be treated with dignity and respect?"
The cost of pro-life restrictions from statehouses
The obstacles funders are up against won't be solved with the lift of federal restrictions because of pro-life politicians in the South.
By making the work of funds more difficult by enacting burdensome requirements on abortion clinics, southern lawmakers force clinics to close and limit options for overall reproductive care.
In South Carolina, abortion clinics are subject to excessive restrictions, including nonmedical rules such as the area being "kept free of rubbish, grass, and weeds" and unnecessary measures like requiring providers to have admitting privileges to hospitals. Major medical groups like the American Medical Association, American College of Obstetricians and Gynecologists, and American Academy of Pediatrics oppose laws requiring admitting privileges because they are harmful to patients. The state also bars state or federal money from paying for abortion services and is currently considering a ban on abortion after six weeks, which is often before most people even know they're pregnant.
In North Carolina, the Center for Reproductive Rights is challenging five state restrictions in court, arguing the additional barriers disproportionately harm Black people and those living in rural areas. The restrictions are common across the South: a clinic licensing requirement, telemedicine ban, 72-hour waiting period, required counseling, and a ban on who can perform abortions. Restrictions, especially waiting periods, have the secondary effect of driving up the costs associated with an abortion.
Mars Earle is the director of engagement for Carolina Abortion Fund, which works in both states. Earle said the abortions themselves are already expensive for Carolinians. The cheapest abortion in North Carolina is around $300. In South Carolina, a first-trimester procedure is closer to $600, compared to California, where some procedures are provided at no-cost through state-funded assistance for low-income residents. The pandemic has shown how few households have $600 on hand for emergencies.
Without savings to dip into, patients need to find outside help to pay for an abortion. In December last year, CAF pledged $50,000, according to Earle. Recently, they estimate the fund receives anywhere from 300 to 500 calls a month.
Under the new administration, Earle worries people may become complacent and "[check] out, not only mentally, but with their pocketbooks."
CAF and ARC-Southeast include support for post-abortion care as a way to comprehensively address community members' ongoing needs.
Those needs are exacerbated by limited access to broader healthcare.
Texas and other Southern states like North and South Carolina, Tennessee, Georgia, Alabama, and Mississippi, did not adopt Medicaid expansion under the Affordable Care Act. This means fewer low-income people have access to government-supported healthcare.
A 2020 report by the Center and Budget and Policy Priorities found expanding Medicaid access narrowed long-standing racial disparities in health care coverage. Additionally, that preliminary research suggested people of color saw better health outcomes. More than 12 million people gained healthcare through ACA expansion, with communities of color, in particular, seeing large increases in those insured. According to their annual report, 70 percent of Texas Equal Access (TEA) Fund's clients are Black, Indigenous, and people of color.
Barriers are as much cultural as political, but care is personal
To Njoku, connections between family and friends are at the heart of her work.
Njoku works on community education around abortion and the related topics of racism and destigmatizing the healthcare procedure. Destigmatizing abortion could also make it easier for a person in need to call up a family member or friend for that remaining $20 to fund their procedure.
"We're doing this because these are the people that we live with and work with and love every single day."
Earle, too, said they know what the fund's callers are experiencing. "Me and my co-director are both queer, Black people who have had abortions and navigated this process," they said.
"How do we authentically talk about abortion access without talking about racial disparities in abortion?" Laurie Bertram Roberts asked. Roberts is the executive director of Yellowhammer Fund, which serves Alabama and the surrounding region. Despite the hostile statehouses, Mississippians and Alabamians have a more complicated view of abortion, according to Roberts.
"A lot of times people aren't necessarily against abortion. They're just like, 'You know, I wanted to have an abortion, and I couldn't have an abortion.' Man, I know that story!"
Mississippi only has one remaining abortion clinic and two other facilities providing abortions.
Roberts supports government funding for healthcare that includes abortion and said abortion funds fulfill a larger purpose.
Yellowhammer distributes diapers, period supplies, and emergency contraception to address individuals' full range of needs. "We were funding all these people who were also parents, who had these other needs," Roberts said.
"We do reproductive justice work, not abortion rights. The difference is that reproductive justice encompasses things beyond abortion rights. Abortion is one piece of the reproductive justice framework."
See also: Doctor who performed hysterectomies on ICE detainees 'operated by a different set of rules' in rural Georgia
TEA Fund executive director Kamyon Conner said funds are forced to battle stigma and misinformation while getting money to those in need. Last year, a handful of Texas towns declared themselves "sanctuary cities for the unborn." Politicians said their goal was to prevent future abortions in their cities. None of the cities involved had abortion providers, but, according to Conner, these political decisions have the wider-reaching effect of spreading disinformation. "People in small towns in rural Texas think that it is illegal for them to access abortion when it is a completely legal right," Conner said.
Each week that misinformation delays treatment could mean higher costs. The fund increased ways to connect with clients with a new text line.
Texas requires multiple trips to an abortion provider, a sonogram, counseling that contains medically inaccurate information, and a waiting period, according to ACLU Texas.
Conner's 2021 agenda is to think big. "We just know that we have to hold elected officials accountable to a bolder vision, bolder than they can even imagine," Conner said.
That includes going on the offensives by filing a joint lawsuit with the Lilith Fund and The Afiya Center against anti-abortion activists for defemination. The TEA Fund also supports the filing of proactive bills to increase access to abortion. Still, Conner said trying to preserve access through legal battles is not enough.
"We don't think the courts will save us," Conner said.
"Our country is trying to reckon with the harm caused by centuries of racial injustice and white supremacy, but you're not seeing our elected officials take that analysis and look at these systemic structures that will continue to harm folks. It is not even just abortion care; it's all health care."