Abortion Networks Adapt To a Post-Roe World

For organizations that work with pregnant women, it has been a year of seismic change.

With access to abortion becoming more restricted, aid networks that support abortion rights have rushed to adapt, seeking new ways to help women travel across state lines and distributing abortion pills.

Anti-abortion groups are stepping up efforts to support women preparing for childbirth by providing formula, diapers and counseling.

The year since the Supreme Court rescinded a constitutional right to abortion by reversing the landmark Roe v. Wade decision has been a time of fear and retrenchment for groups that provide abortion services and support abortion rights. It has been a period of elation and opportunity for those who oppose them. And it has produced widespread confusion as organizations across the ideological spectrum scramble to keep up with legal, political and social fallout from the court decision.

The first few months after the decision in Dobbs v. Jackson Women’s Health “just felt like the Wild, Wild West,” said Maren Hurley, who works as an abortion doula in North Carolina.

Ms. Hurley’s state, which provided abortion access up to 20 weeks of pregnancy, saw an influx of patients from states with tighter restrictions for much of that first year. But as of July 1, access was rolled back to 12 weeks in most cases as part of a new state law.

Groups that provided funding for abortions in Alabama and Louisiana, where the procedure is mostly illegal now, have had to change their approach. Providers of telehealth services and medication abortion have felt obligated to restrict their client base to roughly half the states in America or fewer at any given time.

Hey Jane, which prescribes abortion medications that can be delivered to homes, has grown busier. Indigenous Women Rising, which provides abortion services to Native women across the country, has doubled its abortion budget to help women travel to states where abortion remains accessible. Private pilots established Elevated Access, which provides free flights to out-of-state abortion seekers.

Some groups that were once focused mostly on abortion access are now providing more prenatal and birth support, including defraying medical expenses and some costs of raising children.

“We don’t want people terminating pregnancies they want simply because they can’t afford it,” said Jenice Fountain, the executive director of the Yellowhammer Fund in Alabama.

On May 9, volunteer pilots flew a pregnant Minnesota woman more than 1,000 miles to obtain an abortion.

Photographs by Julia Rendleman for The New York Times

Erica, a 30-something mother of four, puffed a cigarette on a clear afternoon at a suburban Midwest airfield where she was waiting to board a small plane for the second leg of her trip. The flight from the Twin Cities area that morning had been her first plane ride. Though it had gone smoothly, she was anxious about the abortion itself, she said during an interview conducted on the condition that she be identified only by her first name.

She had a drug problem, she explained, and was unable to have a healthy pregnancy. She fought tears as she recalled waiting a month for an appointment with Planned Parenthood, only to learn there that it was too late to receive her abortion in Minnesota. The waiting list in nearby Illinois was also a month long.

Although the two states protect abortion rights, the wait lists put Erica’s abortion access in potential jeopardy under the states’ laws at the time. A patient coordinator had arranged for Erica’s abortion to take place in Maryland — and had found the pilots who could fly her there for free.

“I think this is the best thing to do for sure,” Erica said, “and I’m glad that I’m able to get it done.” She fiddled with a sunflower ring her best friend had given her for good luck.

Erica’s pilots that day were volunteers with Elevated Access, a nonprofit set up last year to help people obtain abortions, often across state lines.

The pilot who had flown Erica to the layover spot, who spoke on the condition that he be identified only as Andy, watched her climb aboard a second eastbound plane with two Elevated Access pilots from the Washington, D.C., area. He then returned to his white Cessna 182.

Andy, a 51-year-old tech executive and self-described liberal, generally avoids talking politics. But the state limits on abortion, he said, have made him want to help women like Erica.

“I don’t like how some of these people have to suffer for this political game,” he said as the plane cruised 8,000 feet above southern Wisconsin. “It’s tragic.”

After assisting people who sought abortions for years, the Yellowhammer Fund in Alabama has broadened its mission.

Photographs by Gabriela Bhaskar for The New York Times

Until the Dobbs decision, Yellowhammer, a nonprofit based in Birmingham, Ala., was funding 100 to 200 abortions per week with an annual budget that had reached $150,000, said the organization’s deputy director, Kelsea McLain. After Roe was overturned, incoming calls about abortion access dwindled to three to five per week.

Because Alabama placed strict limits on abortion — and because of the possibility that people who assist abortion patients could face legal consequences — Yellowhammer staff members try to avoid speaking directly to callers about how and where to obtain an abortion, even out of state. Instead, said Ms. McLain, they send out emails with links to information from third parties.

Since the Dobbs decision, Yellowhammer has refocused on sex education and contraception, which had previously been one piece of the operation. The fund also recently trained two dozen people based throughout the Southeast to share information with people in their communities about self-managed medication abortion and supplies like condoms and emergency contractive medication, also known as the “morning-after pill.”

On a recent Friday evening, Ms. Fountain, the Yellowhammer executive director, held a “packing party” at her Birmingham home to prepare supplies for mailing out as well as for a six-week bus tour the fund had planned through Alabama. As her team stuffed emergency contraception tablets, pregnancy tests and personal lubricant into colorful bags, she reflected on their work.

Reproductive justice groups “need to transition to full-spectrum services,” Ms. Fountain said — including abortion support where possible, but also pregnancy support when needed, including baby supplies or clinic referrals.

Later, she added: “We need to support people who are going to birth, whether it’s by force or whether it’s by choice,” given the limited options available in the wake of the Dobbs decision.

In North Carolina, an anti-abortion, church-backed pregnancy center called Mountain Area Pregnancy Services confronted a harassment incident.

Photographs by Mike Belleme for The New York Times

Overnight on June 7, 2022 — after a version of the Supreme Court’s Dobbs ruling was leaked but before it was finalized — the center’s front walk in Asheville, N.C., was painted with the message: “If abortions aren’t safe, neither are you!” An abortion rights group called Jane’s Revenge took credit.

Employees at the center were disturbed, said Jeff Porter, the assistant director. But he said they were not deterred from providing alternatives to abortion through counseling, parenting classes and material support for local women — most of whom are unmarried and without obstetric care. Two-thirds of them live on an average of $29,000 or less per year.

“We called it our Genesis 50:20 moment,” said Mr. Porter, quoting that scripture as “‘What you intended for evil, God used for good.’ And so that became our story.”

Michelle Fenton, a 35-year-old event coordinator, discovered the center’s satellite office in Waynesville, N.C., earlier this year. As someone who had struggled with fertility issues, she was thrilled to be pregnant. But when an early ultrasound indicated the possibility of Down syndrome, she began contemplating abortion. She called the center for emotional support.

“I told them I didn’t have a good experience, is there any way I can get in there soon to have an ultrasound, just to make me feel better about the situation?” Ms. Fenton recalled through tears. Within three days, she received an ultrasound at the center, where women on staff prayed for her and her baby. “They made me feel better about everything,” she said.

A few weeks later, blood test results indicated that the risk of Down syndrome was extremely low.

Though Ms. Fenton, who is expecting a boy in September, continues receiving prenatal care at a local medical practice, she has taken free parenting classes at Mountain Area Pregnancy Services to learn more about pregnancy and infant care, earning credits along the way. Those credits are exchangeable for supplies like a portable crib, bottles and a nursing pillow.

The center offers free supplies to women undergoing other types of counseling, too. Among them: a stuffed animal containing an audio recording of the fetus’s heartbeat for pregnancies likely to end in a very brief life or stillbirth.

Serving the needs of Indigenous women has become especially complex.

Photographs by Sharon Chischilly for The New York Times

Indigenous Women Rising helps Native women in states with tribal populations. Based in New Mexico, which allows expansive access to abortion, it provides funding for medical care and logistical support for abortion seekers as well as funding for midwifery services for clients who give birth.

Since the Dobbs decision, the group has seen an influx of requests from women in Oklahoma, Texas, North Dakota and South Dakota, where abortion suddenly moved out of reach.

Abortion access has always been limited for tribal communities, where clinics and medical centers that receive federal funding are barred from providing the procedure, forcing women to travel.

Before Dobbs, the group’s abortion services operated on a budget of $20,000 per month. Since the court decision, the rapidly growing costs of transporting women further and further from home to reach somewhere allowing abortions has forced the group to double that budget.

Indigenous Women Rising had typically financed abortions for 30 to 40 people per month. Now it can fund only about 30 abortions per month, even with a budget twice as large.

“Costs have gone up so much, and people are just starting to travel longer distances as well, and so that’s more on a lot of us,” said Jonnette Paddy, the group’s abortion fund director.

Founded in 2018, it caters to particular needs of Native communities. Fund organizers match clients with tribal healers and help arrange for traditional ceremonies to handle fetal remains. They have encouraged clinics to provide smudge spray, an herbal fragrance used by some Native midwives to aid in the birthing process that can also provide comfort to abortion patients.

“We can’t just approach reproductive rights, health, freedom, sovereignty for Native people in the same way that non-Native communities operate,” said Rachael Lorenzo, the group’s executive director, said.

The online pharmacy Honeybee Health has become the country’s biggest abortion medication dispenser.

Photographs by Tracy Nguyen for The New York Times

Tucked away on a side street in Culver City, Calif., Honeybee’s unmarked headquarters belies its central role in the post-Roe United States.

During the pandemic, when Honeybee began shipping abortion medication packages directly to patient homes, it was a small and experimental effort for the company, which primarily handled prescriptions for allergy pills, antidepressants and other common drugs. But the dearth of pharmacies willing to offer abortion medication meant that Honeybee soon became the main provider of the online-ordered, home-delivered pills. Abortion medication — which now accounts for more than half of abortions in the United States — produces roughly 40 percent of Honeybee’s revenue.

Honeybee ships to about 24 states where medication abortion is legally permitted, said Dr. Jessica Nouhavandi, the Los Angeles native who co-founded the company and runs it. She relies on a team of lawyers to stay abreast of state-by-state developments.

This spring, while awaiting the outcome of a federal lawsuit over access to medication abortion, Dr. Nouhavandi began stockpiling the drugs.

When the case moved to an appeals court, Honeybee filed a court brief arguing that suspending access to the drugs would inflict “immense harm” on the public.

As long as the federal government deems the mailing of abortion medication to be safe and legal, she expects Honeybee to continue with the practice.

“We came this far,” she said. “We cannot go backward now.”