How Abortion Funds Fill the Gaps and
Overcome the Barriers for Access & Care

part of Funding The Frontlines: A Roadmap To Supporting Health Equity Through Abortion Access

The Obstacles Facing Abortion Funds Looking to Help Pregnant People

Executive Summary

• The costs and logistical challenges of getting an abortion have been increasing and will get worse if SCOTUS overturns Roe v. Wade as expected.

• Abortion Funds help people who need abortion services with logistics such as travel and lodging, and also with the actual costs for the procedure.

• Abortion Funds are significantly underfunded. There is far more need than can be met if current funding patterns persist.

• Foundations and wealthy donors can have a huge impact helping pregnant people get the care they need with just a modest uptick in support.

 

The work to secure access to abortion services is never-ending and happening in multiple capacities across the reproductive rights and justice movement. And while there are several key leaders throughout the movement, a champion on the frontlines of these organizing efforts are the abortion funds assisting pregnant people in accessing the care and support that they need.

As the defenders of bodily autonomy fight to provide abortion access across the nation, the work of abortion funds in supporting both services and organizing comes into greater focus. Regardless of the final fate of Roe. v. Wade, it’s abundantly clear that philanthropy must do more to provide greater resources to overcome the various obstacles that they face in supporting the health decisions of pregnant people.

Abortion funds are collectives who provide pregnant people with practical support (i.e. travel, lodging, childcare) doula and translation services) so that accessing abortion is less challenging. Their assistance includes helping to cover the cost of abortions in the case that people cannot afford it.

That is a situation that is becoming increasingly more common. The median cost of an abortion ten weeks into pregnancy is approximately $560 and can be thousands later into the pregnancy.[1] Stack that up against the fact that in 2020, nearly 1/3 of adults could not afford an emergency expense of $400, or would have to sell something or borrow from friends or family to cover the cost[2]. As a result, almost a quarter (23%) of adults skipped medical care in 2020 due to an inability to pay.[3]

The high cost is not only in the medical procedure. For an individual seeking abortion, delaying or forgoing care can not only further jeopardize financial security, but can also add mental and emotional burdens that can impact workplace relationships and professional productivity. In fact, people who were denied abortions are three times more likely to fall below the federal poverty line and experience a 78% increase in past due debt.[4] In addition, people who were denied abortions experienced more anxiety and lower self-esteem in the short term after being denied abortions than people who received abortions.[5]

Research indicates that abortion seekers that are denied abortions are more likely to fall into the gaps of economic hardships. Those that are denied an abortion are more likely than those that were able to access their abortion care to experience economic hardship and financial insecurity in the years following denial or access to abortion.

While any laws, policies and bans that restrict abortion have the potential to result in a worsened economic outcome for all people, the economic burden may be disproportionately felt by communities of color. According to the Guttmacher Institute, the majority of people seeking abortion care identify as Black, Hispanic, Asian or Pacific Islanders. Three-fourths of those abortion patients were low income—49% living at less than the federal poverty level, and 26% living at 100–199% of the poverty level.[6]


1 Upadhyay UD, Chris Ahlbach, Kaller S, Clare Stewart, Isabel Muñoz, MPH. Trends In Self-Pay Charges And Insurance Acceptance For Abortion In The United States, 2017-20. Health Affairs. April 11, 2022; DOI: 10.1377/hlthaff.2021.01528. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2021.01528  

2 Board of Governors of the Federal Reserve System. “Economic Well-Being of U.S. Households in 2020 – May 2021.” https://www.federalreserve.gov/publications/2021-economic-well-being-of-us-households-in-2020-dealing-with-unexpected-expenses.htm.

3 Ibid. 

4 Cohen, Ronnie. (2018). “Denial of abortion leads to economic hardship for low-income women,” Reuters. https://www.reuters.com/article/us-health-abortion-hardship/denial-of-abortion-leads-to-economic-hardship-for-low-income-women-idUSKBN1F731Z 

5 Foster, Diana G., Bigs, M.A., Ralph, L., Gerdts, C., Roberts, S., Glymour, M.M. (2018) Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States, American Journal of Public Health 108, 407_413, https://doi.org/10.2105/AJPH.2017.304247. 
 
Miller, Sarah, Wherry, L.R., Foster, D.G. (2020). The Economic Consequences of Being Denied an Abortion. NBER Working Paper No. 26662, JEL No. I1, I18. https://www.nber.org/system/files/working_papers/w26662/w26662.pdf 

6 Jerman, Jenna; Jones, R.K.; Onda, T. (2016). Characteristics of U.S. Abortion Patients in 2014 and Changes since 2008. Guttmacher Institute. https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014 

Abortion funds fill in crucial financial and logistical gaps to help relieve some of the financial burden, gaps that oftentimes result in abortion funds often being the first place for abortion seekers to turn for abortion services and support.

While each fund offers varying types of support with varying operating structures, the majority of abortion funds have hotline numbers that abortion seekers can call for an intake and practical support resources. In 2020, leaders such as the Texas Equal Access Fund reported that they responded to a total of 4328 helpline callers, while their budget allowed them to serve 1460 individuals at an average assistance per client was $416. [7]

Nationally, abortion funds’ median budget to fund abortion services for clients in 2020 was $52,585 with an average grant per caller of $215. [8]  In addition to covering abortion costs and supporting additional practical needs to access abortion, many abortion funds are committed to cultural and political change as a core function, leading grassroots efforts through a reproductive justice lens to address the countless barriers to access.

However, it goes beyond directly funding services. Abortion funds have been on the frontlines of securing access to healthcare for decades at the local, state, regional, and national levels working to change laws and practices that make abortions hard to get. Many operate as a safety net of care for abortion seekers, and as experts provide resources for those navigating the many regional and state-specific barriers in place to restrict access to abortion services. This is often a tumultuous process that includes several hurdles, ranging from, but not limited to, state restrictions and requirements, parental consent loopholes, and the immigration status of abortion seekers. [9]


7Texas Equal Access Fund. (2021). 2021 EOY Holiday Mailer. https://teafund.org/wp-content/uploads/2021/12/2021-EOY-Holiday-Mailer-1.pdf 

8 National Network of Abortion Funds. (2021). Seeds and Roots: Fortifying the Network Infrastructure and Leading with Values. Annual Report July 2018-June 2020. https://abortionfunds.org/cms/assets/uploads/2021/07/NNAF-Annual-Report-%E2%80%93-FY-2019-FY-2020.pdf.

9 Chappel, Bill. “Jane Doe’ Immigrant Has Abortion In Texas, After Battle With Trump Administration,” NPR. October 25, 2017. https://www.npr.org/sections/thetwo-way/2017/10/25/560013894/jane-doe-has-abortion-in-texas-after-battle-with-trump-administration

As we know, bodily autonomy is a right deserved by all, regardless of race, class, or age, and abortion funds make it a priority to serve everyone that seeks abortion services. However, abortion fund hotlines are a true reflection of those entering clinic doors.

The work of abortion funds is oftentimes the first point of contact for the most vulnerable and marginalized abortion seekers including callers experiencing homelessness, victims of DV/IPV and minors.

The work of abortion funds varies by need and region. In the South, there are abortion funds like ARC- Southeast, an abortion fund supporting abortion seekers and eliminating the economic barriers to abortion access by providing funding and logistical support to ensure Southerners receive safe and compassionate reproductive care including abortion services.

The South has some of the strictest abortion restrictions, and a study of abortion seekers in the Southeast showed that:

• 81% of people who sought abortion fund assistance identified as Black,
• 84% were between 18-34 years of age, and
• 87% were publicly insured or uninsured.[10]

With shifting state and local contexts, organizations rooted in communities are best equipped to address the specific needs and challenges of each community. In addition to region-specific contexts, different abortion funds also address age-specific needs. Adolescents made up 12% of abortion patients in 2014, and pregnant adolescents that need abortion support often depend on abortion fund hotlines.[11]

The majority of states, 37 in total, require parental involvement in the reproductive choices of a minor, some require the consent or notification of one parent, and others require the involvement of both parents:

• 21 states require only parental consent; 3 of these require both parents’ consent.
• 6 states require both parental notification and consent.
• 10 states require only parental notification; 1 of these requires that both parents be notified.[12]

Abortion Funds like Florida Access Network support pregnant adolescents in the state of Florida navigate parental consent laws and confidentially access abortion by assisting them in obtaining a judicial bypass, a confidential order from a judge that allows a minor to get an abortion without the notification or consent of their parents. This is a service that several abortion funds provide which often includes free legal support, 1-on-1 case management, and stigma-free information on sexual and reproductive health.


10Rice WS, Labgold K, Peterson QT, Higdon M, Njoku O. Sociodemographic and Service Use Characteristics of Abortion Fund Cases from Six States in the U.S. Southeast. Int J Environ Res Public Health. 2021 Apr 6;18(7):3813. doi: 10.3390/ijerph18073813. PMID: 33917408; PMCID: PMC8038751. https://pubmed.ncbi.nlm.nih.gov/33917408/

11Jerman J, Jones RK and Onda T, Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014.

12Guttmacher Institute. (2022). Parental Involvement in Minors’ Abortions. https://www.guttmacher.org/state-policy/explore/parental-involvement-minors-abortions

In places where abortion access is limited or under attack, the local and state government funding can be just as much an obstacle as legislation. An appalling statistic considering some states are diverting federal money intended for low-income families and state funding to anti-abortion groups. This allocation of federal cash assistance from TANF (Temporary Assistance to Needy Families) is intended for mostly parents and children in dire poverty but is instead going to fake clinics or crisis pregnancy centers.

In Pennsylvania, where about 65,000 Pennsylvanians rely on TANF assistance, records show that for decades, the Department of Human Services has practiced “double funding” by allocating more than $134 Million in both state and federal money to anti-abortion organizations.[13]

In fact, between 2015-2019, $4 million alone was diverted from TANF funding to Real Alternatives, while less than half that amount (just $1.7 million) of foundation funding, benefitted frontline abortion services.[14] This is in a state where according to the U.S. Census, 14% of families with children live below the poverty line as of 2019.[15]

Even in states where abortion is still readily available, reproductive health policy does not equal access. In addition to economic barriers, race and class can also affect access.

In 2021 alone, 108 abortion restrictions were enacted in 19 states, the highest total in any year since 1973, and 26 states have trigger laws in place if Roe is overturned by the Supreme Court.[16] In addition, just a few months into 2022 we’ve seen states introduce even more restrictions. In the first three months alone, 525 restrictions were introduced in 41 states, and 8 restrictions have been passed in a total of four states, including three abortion bans in Idaho, Wyoming and Oklahoma. [17]

This year has also seen:

• 26 states have restrictions on using insurance (private or public) on abortion procedures
• 19 states have restrictions or bans telemedicine, so patients in states that have few clinics, or states with clinics that closed have to travel out of state
• 33 states require counseling before an abortion procedure, and 25 of these states have waiting periods of at least 24-hours, which means patients would have to make multiple trips or travel for multiple days at a time

Unexpected barriers to abortion access are inevitable, whether the barriers are in place due to the above-mentioned restrictive policies or social circumstances

However, even with increased barriers and an increase in the need for support for abortion services, local abortion funds’ abilities to support clients have also increased.  According to an annual member survey of abortion funds part of the National Network of Abortion Funds, between 2018-2020, the number of calls to abortion funds requesting support for abortion services increased by 73%, and the number of calls abortion funds have been able to support increased by 84%.[18] Recent foundation funding also shows positive trends. Foundation funding for abortion funds almost doubled from $4.6 million to $10 million dollars per year between 2015-2019, totaling approximately $34 million total.[19]

However, faced with increasing state restrictions, fewer clinic capacity, the future of abortion funds are still in danger without continued support. Even though abortion funds received $34 million in foundation funding, it still makes up less than 2% of total funding for reproductive rights issues, which overwhelmingly benefits large, national organizations. While national organizations also hold essential roles in the reproductive rights movement, such as advocacy, litigation, and research, the legal right to an abortion is meaningless for people who cannot access the services. State and local abortion funds are on the frontlines of ensuring abortion access financially and logistically.

Between 2015-2019, total revenue for a sample of 28 abortion funds increased five-fold from $3.5 million to nearly $15 million per year, according to data from tax filings of abortion funds who are independently registered as nonprofits.[20] In the same period, foundation revenue only increased two-fold, from $837k to $1.7 million, for the sample of 28 funds.

These data indicate that abortion funds are using the increased revenue to meet the increasing need for abortion support, but foundation funding is not increasing at the same rate as other sources of funding, and foundation funding only makes up about 17% of the 28 funds’ total revenue. According to NNAF’s annual member survey, the majority, or 63%, of abortion funds rely on individual donors and fundraising events for funding.[21] With the Covid-19 pandemic, increasing financial instability, and increasing restrictions to access in the past couple of years, funding from individual donors can be inconsistent, such as spikes in funding when a crisis happens or a decline in recurring donors due to financial instability. At the same time, the need for financial support will keep increasing as inflation rises and restrictions force individuals to delay their abortion care or travel farther.


13Lubrano, Alfred. (2021) ”Pennsylvania uses taxpayer money to fund antiabortion organizations,” Philadelphia Inquirer. https://www.inquirer.com/news/pennsylvania/abortion-crisis-pregnancy-centers-poverty-tanf-welfare-20211025.html

14 NCRP analysis of Candid data

15US Census Bureau. (2021, September 14). Income and Poverty in the United States: 2020. Census.Gov. https://www.census.gov/library/publications/2021/demo/p60-273.html

16Nash, Elizabeth. (2021). “State Policy Trends 2021: The Worst Year for Abortion Rights in Almost Half a Century.” Guttmacher Institute. https://www.guttmacher.org/article/2021/12/state-policy-trends-2021-worst-year-abortion-rights-almost-half-century.

17Nash, Elizabeth; Cross, L.; Dreweke, J. (2022). “2022 State Legislative Sessions: Abortion Bans and Restrictions on Medication Abortion Dominate.” Guttmacher Institute. https://www.guttmacher.org/article/2022/03/2022-state-legislative-sessions-abortion-bans-and-restrictions-medication-abortion.

18National Network of Abortion Funds. (2021). Seeds and Roots: Fortifying the Network Infrastructure and Leading with Values. Annual Report July 2018-June 2020. https://abortionfunds.org/cms/assets/uploads/2021/07/NNAF-Annual-Report-%E2%80%93-FY-2019-FY-2020.pdf.

19NCRP analysis of Candid data.

20NCRP analysis of 990 tax filings. See methodology for more information.

21According to analysis of responses to NNAF”s annual member survey, as provided from NNAF to NCRP.

Foundation funding is not the largest source of abortion funds income –on average, 63% of abortion funds’ income comes from individual donors and events like Fund-a-thon, while foundation funding makes up 37% of abortion fund incomes, on average. [22]

And since philanthropy has not prioritized funds nor their sustainability as a priority, of the 83 abortion funds that are members of NNAF, only 44 of those funds are staffed and less than 25% of those staff are full-time employees.

A reminder that even though abortion funds received $34 million in foundation funding between 2015-2019, or just under $7 million per year, on average, it is still only 20% of funding for broader abortion work including policy and research. Abortion funds also received less than 2% of the $1.7 billion in funding for reproductive rights. Considering that grantmakers in the US gave $82 billion in 2019 alone, $34 million is far from enough of an investment to sustain the work and those that are leading it.

And while philanthropies’ absence has motioned for calls for support to increase, there has been a shift in funding opportunity. Even with increased resources to support requests for abortion assistance, faced with increasing state restrictions and fewer clinic capacity, the future of abortion funds are still in danger.

If the sector invests even 1% in additional funding of the $1.7 billion in reproductive rights funding per year, abortion funds would receive an addition $17.5 million per year in foundation funding, which is currently more than three times what they receive per year, on average.

It is no doubt that philanthropy should be funding peoples’ abortions and the practical support many require to access abortion services. As we approach and move past this June’s Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, it is essential that the sector deepens its investment in abortion funds as many of them will be the ones responding to urgent needs and organizing around the unfortunate barriers that are to come.


22Ibid.

Money certainly helps, as increased investment in abortion funds would help frontline groups and networks address the continuing uncertainty as the pandemic and anti-abortion legislation leaves abortion advocates under protected and overwhelmed.

However, maximizing the impact of additional dollars will also require a shift in funding practices in order to avoid harming the very communities they hope to help.

Foundation Funding 

NCRP gathered data on philanthropic funding from Candid. We created a dataset of over 30,000 reproductive rights grants by combining all grants which included Candid’s “reproductive rights” subject code with all grants to specific reproductive justice organizations and abortion funds which were known to NCRP and to reproductive justice movement experts.

To measure funding for abortion services specifically, we combined a) grants with Candid’s “abortion” subject code, b) grants which mentioned “abortion” in their grant descriptions, and c) all grants to specific abortion clinics and abortion funds.

Revenue information 

The IRS Form 990 includes revenue and expense information for each organization which files. Inconsistencies in organizational names and addresses can make finding the correct Form 990 challenging, and this is especially true for smaller grassroots organizations. Employee Identification Numbers (EINs), IRS-assigned numbers that are unique to each filing employer, enable researchers to connect organizations to their tax information in spite of these name and address changes.

NCRP obtained the EINs for abortion funds that were part of the National Network for Abortion Funds by searching ProPublica’s nonprofit explorer database and examining abortion fund websites. Of the 72 abortion funds, NCRP found EINs for 69 of the funds.

Next NCRP gathered all federal Form 990 filings from 2015-2019 which were filed by the 69 organizations for which we’d found EINs. Forty of the 69 unique EINs filed at least one Form 990 in those years. The other 19 funds did not have any tax filings in that period.

Out of the 40 organizations which filed at least one Form 990 between 2015-2019, 6 were abortion clinics as well as abortion funds. It is usually not possible to differentiate revenue and expenses for specific programs of an organization from that for other programs from the Form 990 alone. To keep our analysis focused on the resources available specifically for abortion fund purposes, we excluded these 6 clinics from this analysis.

Of the remaining 34 organizations, Candid’s grants database did not include (when these data were accessed in April 2022) any foundation grants for 6. That left 28 organizations in the subset for which NCRP could do a direct comparison of revenue and foundation funding data.

Abortion and Gender Affirming Care

Abortion Funds

Crisis Pregnancy Centers

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