The rhetoric from mainstream Democrats and affiliated organizations in the lead-up to the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and took away the federal right to an abortion, was always full of promises about what they would do if the Republicans managed to complete their decades-long political project. Democrats promised that they would be the last line of defense against abortion criminalization and many analysts predicted that there would be a nationwide movement in the streets. However, some abortion advocates from states where abortion has been banned or severely limited do not feel like this support has materialized—instead, they feel that the ongoing public health crisis in their states has almost been forgotten. “The whole ‘we are going to be in the streets’ thing was bullshit, it always was bullshit, it’s always been a fundraising line… ‘Republicans are going to overturn Roe, Republicans are going to overturn Roe,’ and it’s like okay, they did it, where are you?” asks Hayley McMahon, an abortion researcher and advocate based in Georgia.
After the Dobbs opinion was leaked on May 2, 2022, protests sprung up across the nation, including in front of the homes of Supreme Court justices. While these protests have continued sporadically, they have significantly tapered off. “I feel like people are waiting for the Dobbs anniversary in the same way they were waiting for the Supreme Court decision to come down in the first place, so yeah, it’s just turned into another anniversary, like the Women’s March,” said Robin Marty, director of operations for West Alabama Women’s Center and author of The New Handbook for a Post-Roe America, “People can’t stay engaged and I guess that’s because there are so many simultaneous atrocities happening to our communities across the country.”
While the protests may have died down, this public health crisis led to record-breaking fundraising for political candidates and abortion rights organizations, with fundraising emails from national Democrats going out within minutes of the release of the decision. In the fiscal quarter surrounding the Dobbs decision, Democrats reported that they raised more than a half billion dollars, which was more than double the amount they raised in the same quarter in the 2018 midterm elections. Large abortion rights organizations also saw record fundraising in the fallout of Dobbs, with Planned Parenthood alone reporting a combined donation total of $694.9 million in 2022 between their affiliates and the national organization.
While some of this money has been spent on patient care (Planned Parenthood spends about 61% of their money on medical care, with abortion services constituting about 4% of that care) a large portion of the amount raised by these organizations has not gone to directly assist people seeking abortions in states with bans. Much of the money raised has been funneled to the same lobbyists who unsuccessfully protected abortion in the decades before the Dobbs decision. Further, while Democrats had fewer losses than expected in the last midterm election, the massive amount of donations did not keep them from losing the majority in the House of Representatives and no financial support has been directed to help individuals in ban states on a national level. On the state level, only California has pledged money to directly help patients from ban states, although several states have pledged money to expand their own services.
The exception to this lack of direct support to patients in ban states is the money raised by abortion funds, which spend most of their money directly funding abortion and related expenses. The National Network of Abortion Funds reported raising $8 million in the five months after Dobbs. However, this funding for direct services has already dried up despite a steep increase in need for these funds. Crystal*, an abortion worker based in Pennsylvania, expressed concern that people did not understand that, if they want to help fund abortions for people in states with abortion bans, donating to Planned Parenthood was not the most effective action. “If you’re donating to Planned Parenthood and they aren’t fighting the fight then the money is not going to organizations who are fighting it, which are abortion funds,” she said.
People who live in states which now have bans faced challenges accessing abortion care long before the Dobbs decision. Many restrictions were already in place, including waiting periods and requirements for several in-person visits that made abortion inaccessible for many individuals even when it was legal. In fact, many states that now have complete bans previously had only one clinic that was often located several hours from patients in need. “People [post-Dobbs] have to struggle and beg and scrape and drive hours and pray that funding comes through so again, very similar to before Roe,” said Christine*, an abortion advocate and former clinic escort in Kentucky. “But at least people could access [care] in the state. Now they have to drive even further.”
An estimated 36,000 fewer legal abortions were reported in the United States in the six months after Dobbs than would normally be expected. This lack of care has led to horrific healthcare situations. Morgan*, a traveling labor and delivery nurse who has worked in many states with abortion bans, has seen firsthand how these bans have impacted her patients. She recently cared for a patient whose fetus had been diagnosed with anencephaly, a condition that is incompatible with life. The patient was unable to obtain an abortion early in her pregnancy and had to deliver the baby instead. “While we would usually have patients on a fetal heart monitor throughout the entirety of their labor, this patient opted against that. While her baby did have a heartbeat, it is ultimately incompatible with life still so she did not want to have to listen to the heartbeat on the monitor,” she said. “Such a terrible thing to carry a child you know will not survive. Hard to watch as a nurse as well, knowing there was a better solution we were unable to provide to her as healthcare workers.”
In addition to the tragic consequences of being denied abortion care, people in ban states also face the closing of many clinics, which not only provided abortion care, but also other much-needed healthcare in underserved areas. Marty has managed to keep her clinic open to provide other healthcare services despite a full ban on abortion in Alabama, but has found that people are still delaying care for a variety of reasons. “In the first six months post-Dobbs people were scared to even come into our clinic, they were afraid that would somehow open them up to suspicion that they could be investigated that they were trying to have an abortion,” said Marty, “Most of what we are seeing is uninsured patients or Medicaid patients, and that means not only are they lower income and not bringing in patient income for us, it means that they are usually far more medically complicated to deal with. Just today we have had three pregnant patients come in for their first prenatal exam and none are in their first trimester, two were in their third.”
The data regarding abortion care and unwanted pregnancies post-Dobbs is confusing, with FiveThirtyEight reporting that decreases in abortion care in ban states were not made up for by the increases in abortion care in states still providing abortion. But Marty points out that there has not been a sharp increase in patients seeking maternal care in any of these states, which suggests that people are safely self-managing their own abortions, but she worries that there may be a more concerning reason. “I still believe that there are a lot of people who are accessing their own [abortion] care, but the number of patients that we had come in that have not had any prenatal care now has me wondering how many people are literally just waiting until the end and that’s when they are showing up for doctors, they are just not getting any sort of care,” said Marty. “There is a possibility that people are just getting pregnant, staying pregnant, and ignoring it, and that terrifies me.”
Crystal, who works with patients from ban states trying to access abortion care, points out that even patients who have the means to obtain an abortion and the ability to travel to get one face major hurdles in figuring out how to do so. She often has to refer people to the If When How Repro Legal Helpline to figure out their options. “No matter what the law or ban is, the biggest obstacle that I find is that people don’t really understand the law, nobody understands the law, regardless of the state that you are coming from and it’s hard to understand,” she said.
Many advocates and providers wish that larger organizations would step in and help fill these holes in both access to care and access to information for patients in ban states. “They could be opening more clinics… there’s absolutely places in Pennsylvania where they could be opening new clinics to alleviate the burden of the amount of patients that are being received from Kentucky and Tennessee and even Ohio, which is not a ban state but has lots of restrictions,” said Crystal. “They could be providing more travel support than they are… they could be providing more practical support.”
McMahon echoes this call for practical support from larger reproductive rights organizations. “Organizations on the ground are not asking for federal legislation right now, they are asking for help getting people emergency contraception, getting full rides to their appointment, getting people the thousands of dollars they now need [to access abortion], she said. “But these [large reproductive rights] organizations are not willing to take any risk whatsoever because they are not actually showing up for people who need abortions.”
Christine also wishes that larger organizations would take on some of the financial and legal burden of providing care in ban states. “[They should] fund abortions, but they won’t because they could ‘get in trouble.’ They also have enough money to legally fight it, but again, they don’t want to get in trouble,” she lamented.
Having organizations or individuals with deeper pockets challenge these laws is also something that Marty thinks could be impactful, especially because people providing care and advocacy in the state could risk their ability to do so if they blatantly disrespected the bans. “I want things to happen so quickly, and in some places it would be very easy for someone to come in and very publicly provide an illegal abortion and we go from there,” she said. “I think I’ve mentioned before my fever dream of having 50 really well-heeled celebrities come down and say they are going to be giving out medication abortion, and do it very publicly, and watch them get arrested, because they are the ones who will be able to get legal help to get out of jail right away and then it doesn’t impact the people who are actually providing [health care in the state].”
But McMahon believes that, since the Dobbs decision, people in ban states have been underserved or even forgotten by national politicians and large reproductive rights organizations. “The people who are doing the most work have the fewest resources right now,” explained McMahon. “So all these front-line organizations, the independent abortion clinics, the abortion funds, the practical support groups, the self-managed abortion with pills, education and distribution [organizations], these organizations that are directly serving people [in ban states] do not have the types of resources that the big organizations have, and they never have.”
McMahon thinks that this lack of support can be at least partially tied to the attitude that people in ban states did not do enough to prevent their own situation and that they are just being punished for their poor electoral choices. “People here know what they’re doing, we aren’t here from not trying, we live in states with extreme levels of voter suppression and gerrymandering,” she said. “People are still doing the work and doing it very, very successfully here. It’s so frustrating for me to see people from blue states write that off and say ‘we all deserve what we got’.”
There is also a high level of frustration from some abortion advocates in ban states with the inaction at the national level by Democrats. Many advocates wish that the party would use some of their power to try many of the innovative solutions that have been proposed by activists and advocates around the country. “What have [national Democrats] done?” asks Crystal. “They haven’t done a single thing. I can’t think of a single thing they have done that has been useful… They’ve done a lot of things that are performative and not useful.”
McMahon points to the decriminalization law which was championed by Black- and Brown-led organizations in Tennessee as a good model for actions that could be taken on a national level (a move that Rep. Ayanna Presley proposed after McMahon spoke to TRNN). “One of the easiest things they could do right now is decriminalize self-managed abortion and pregnancy. That seems like it should have been a day one conversation. If the Republican supermajority in Tennessee can decriminalize self-managed abortion and pregnancy laws, the narrowly split congress should be able to do that,” she said. “At worst it’s a great reelection strategy [by forcing Republicans to say they are for criminalizing pregnant people]. At best it will keep people out of prison right now and help people feel safer in self-managing an abortion.”
On the one-year anniversary of Dobbs, advocates in ban states are asking for the help that was promised for decades if anyone ever tried to overturn Roe. “I’m begging groups to do something. Fund abortions. Drive people to clinics. Get people Plan B. Hell, get people pills. Yeah, it’s illegal. So fucking what. People need pills,” said Christine.
Crystal points out that if empathy isn’t enough for people to support individuals in states with abortion bans, self-interest should be. “The overturn of Roe v. Wade meant more than just people didn’t get abortions that wanted and needed them, it also was a signal that it was a free for all on the most vulnerable and other groups as well,” she said. “They are literally going to come for everything. This was the green light for everything else when it comes to control over your life and autonomy.”
*Some last names have been withheld for privacy reasons.