When Emily, a 41-year-old from Louisville, Kentucky, found out she was pregnant earlier this year, she decided to get an abortion. (Her name has been changed because she fears retribution at work if her colleagues found out.) Confident in her decision, she wanted to move through the process quickly―but soon realized that living in Kentucky, that wouldn’t be possible.
Since he took office in 2015, Kentucky’s Republican governor, Matt Bevin, has ushered in some of the most restrictive abortion legislation in the country. This year, the legislature approved a ban of abortion when the pregnancy reaches 20 weeks; a requirement for a vaginal ultrasound before a patient’s abortion was recently struck down after being contested by the American Civil Liberties Union.
For over a decade, Kentucky had just two abortion clinics, both owned and operated by EMW Women’s Surgical Center. At the end of 2016, the Bevin administration blocked a license for Planned Parenthood to perform abortions at its Louisville location, citing a new regulation requiring facilities to have transfer agreements with a nearby hospital and ambulance service. In January, the Lexington EMW clinic officially shuttered after a year-long legal battle. The administration denied a request to renew its license, and according to an EMW Facebook post, the landlord refused to renew its lease.
So when Emily called to schedule her appointment at EMW in Louisville, she was contacting the last abortion provider left in the state.
EMW sits in the middle of bustling downtown Louisville. Emily planned to schedule the appointment on a weekday, when it was less likely she would be seen en route. It was also when the sidewalk outside EMW would be less likely to be swarming with anti-abortion protesters. She’d initially called around to other clinics in the region, trying to get an appointment out of state, but Ohio, Indiana, and Tennessee have waiting periods or other restricting laws that would require her to spend at least two days away from home and miss too much work.
Though EMW is only 20 minutes from her house, Emily didn’t have someone who could drive her to and from the procedure, which the clinic requires. Her boyfriend couldn’t get off work to take her, and she didn’t feel comfortable asking other friends or family members to do it. Worried she was running out of options, she started to panic. An EMW employee told her to call the Kentucky Health Justice Network (KHJN), a nonprofit that advocates for reproductive justice and has an abortion support fund. One of 70 abortion organizations that belongs to the National Network of Abortion Funds, KHJN is a lifeline for Kentuckians trying to access the medical procedure, using its volunteer network and donations to help with transportation, gas money, lodging, and payment for abortions.
She scheduled the appointment, and the day of, a KHJN volunteer showed up at her doorstep and drove her. Emily still had to face protesters outside of EMW. “They’re basically, without touching you, assaulting you,” she said. She made it safely inside, and after the procedure was finished, the volunteer dropped her off at home, and called to check on her a few days later.
Months later, Emily still thinks often about the help the volunteers at KHJN provided, at absolutely no cost to her. “At every turn [in this process], there’s a barrier, but this was one less to worry about,” she said.
The Louisville clinic is currently in the midst of a trial that will determine whether Kentucky becomes the only state in the nation without an abortion provider. The trial wrapped up in early September, and a verdict is expected at any moment. With just one clinic left in Kentucky, and few left in surrounding states, the work of organizations like KHJN is becoming more expensive and logistically challenging.
“There’s a lot of pressure at this moment,” said Meg Stern, the Abortion Support Fund director for KHJN. “The clinic could close, and here we are with all these people who still need access to abortion. What’s going to happen?”
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Since 1976, when the Hyde Amendment was signed into law, the US government has banned federal funding for abortion, and many states have followed suit. Abortion funds cropped up to help people overcome logistical and financial barriers to the procedure. “They were an underground railroad of sorts,” said Marcie Crim, KHJN’s executive director.
Founded in 2013, KHJN now has five full-time employees and around 60 volunteers. Until now, the organization has attempted to keep a low profile. But as GOP lawmakers further diminish access to reproductive healthcare by introducing targeted regulation of abortion provider (TRAP) laws, fund leaders like Crim are speaking to the public and press more often.
“People didn’t know we existed, so they weren’t asking us for our services,” Crim said. “My goal [since coming on in 2016] was to raise our profile.”
According to the Guttmacher Institute, a research and policy organization focused on reproductive health in the US, more than a third of state abortion restrictions instituted since the 1973 Supreme Court decision legalizing abortion in Roe v. Wade have been enacted within the last six years.
“It’s this cumulative impact from restrictions and lack of access that creates such a dire situation for some women,” said Elizabeth Nash, senior state issues manager for Guttmacher. “The distances they have to travel—to be able to climb that mountain is very hard. And then they have to think about raising money for the procedure and the travel.”
At EMW, a medical abortion costs $750, and a surgical abortion can reach up to $2,250. The costs of abortion procedures vary widely by clinic, state, and how far along the pregnancy is. KHJN, which is funded largely through individual donations, typically pledges up to $500 a week total, which goes toward procedures, then works with other abortion funds to help fund the rest if necessary. But most clinics require patients to pay for a portion of the procedure themselves, so Stern and volunteers have to ask uncomfortable questions: can the patient in need of an abortion use someone’s credit card? Can she pawn belongings?
“By far, that’s the worst part of this job,” Stern said.
With the increased restrictions, the organization is stretching itself thin. Before 2016, Crim said KHJN got 11 requests for financial or transportation help a week. Within the last year, she said, they’ve started getting up to 30. Part of that is because the organization is becoming more well-known, Crim said, and part of it is because people have to travel farther now that there is only one clinic. About 95 percent of people KHJN assists―many of whom live four to six hours away, in rural Kentucky—go to EMW, she added. But the 20 week ban in the state has made that more difficult.
Stern said KHJN volunteers pick people up in gas station parking lots and outside abandoned homes because patients fear repercussions in their personal and professional lives for their decision. Many of them, she added, find themselves at risk of longer wait times because there are so few providers left, or due to abrupt changes in state laws.
“Losing one clinic in Kentucky would be additional motivation for abortion opponents to try to close other clinics, or adopt so many restrictions that abortion is impossible to access,” Nash said.
This year, Crim said a pregnant 16-year-old girl drove an hour to Louisville with her mother to EMW. She was two days over the 20-week limit, and got turned away. When they reached out to KHJN for help, Crim took the case on herself. After days sorting out logistics, KHJN forked over $1,750 to fly the girl and her mother to a clinic in Maryland—since closed—as a last resort to obtain the procedure.
Situations like that are already becoming more common for Kentuckians, Crim said. Out-of-state travel is something KHJN is increasingly unable to afford, but she said they exhaust all possibilities until patients get what they need. Otherwise, the consequences can be grim.
“The girl was in the backseat, telling me she googled how to give herself an abortion because she didn’t think she was going to be able to get it done,” she said. “But I hear this a lot now.”
Along with limited abortion access, many in Kentucky, especially those living in rural areas, lack resources for reproductive health, including contraceptives and family planning services. According to a 2014 study by the American Congress of Obstetricians and Gynecologists, 76 of the state’s 120 counties don’t have an OB-GYN. And Kentuckians need care: according to the most recently available data from Guttmacher, there were 7,220 pregnancies among teens aged 15 to 19 in Kentucky in 2013, making it the state with the eighth highest rate of teen pregnancy in the country.
This summer, Crim helped launch an initiative to improve birth control access in Eastern Kentucky. The two-year program, in partnership with the National Campaign to Prevent Teen and Unplanned Pregnancy and Appalachia-based media center Appalshop, combines educational outreach, storytelling, and local policy change to make sure people in the region have access to all types of contraceptives.
For now, KHJN and pro-choice advocates are anxiously awaiting the ruling on EMW. “This case is incredibly important,” Nash said. “It also puts on the court not only what kind of regulation is appropriate, but how important is it to protect access.”
If the Kentucky judge rules for EMW to stay open, it would set a precedent that may mean Planned Parenthood could resume abortion services as well. In the worst-case scenario, if the clinic is closed, KHJN will have to transport people out of state, which means more money for travel, lodging and gas, and more logistics to sort out with other clinics. “Paying for the procedures will be easy at that point,” Stern said.
The battle over abortion access in Kentucky has emboldened people like Stern and Emily to advocate more strongly for reproductive justice. "The time to remain neutral and not choose a side has passed," Stern said. "For me it feels necessary now, which makes it a little easier to have these conversations."
For Stern, that means pushing harder to raise KHJN’s public profile. For Emily—who says she will never forget the help she received from the organization when she needed it most—it means sharing her story and offering up her time to the cause; her experiences have made her consider becoming a KHJN volunteer herself. “I have a hard time with them trying to pass the laws they’re trying to pass, not for my sake but for others,” she says. “I wouldn’t want someone not to have these resources like I did.”
Correction: A previous version of this article stated that the $500 a week KHJN provides for patients goes toward gas, transportation, lodging and food expenses as well as procedures. The $500 is for procedures, and other expenses are covered separately.