Four weeks after Isabel, a 22-year-old unemployed student, missed her last period, she tried to induce a miscarriage. Going off a instructions she found on the internet, Isabel took 500 mg of vitamin C once every hour alongside varying amounts of dong quai, black cohosh, and blue cohosh once every four hours, plus the occasional parsley tea, and a handful of organic sprigs of parsley fit snugly near her cervix. It seemed like a long shot but with no savings and no means to come up with an extra $610 to pay for an abortion at the Dallas Planned Parenthood, she kept the herbs and tincture routine for 20 days. When they failed to work, she resorted to working odd jobs, selling her guitar, and donating plasma. Twice a week, throughout the majority of her pregnancy, she lied to the plasma donation center about her condition to secure $40 toward her own personal abortion fund. The process wasn't painful, but it did leave her extra nauseated. By the time Isabel was able to secure the $610 needed for the procedure, too much time had gone by. Her pregnancy had advanced to 19 weeks, pushing to the $2,500 mark.
"I knew that if I couldn't afford to have an abortion in time, I would be forced to continue to be pregnant and to give birth when I never want to do either of those things," she told me over email. "I know I would have wanted to kill myself."
If Isabel lived in Massachusetts or California, she could have enrolled in Medicaid, making her eligible for state funding and making an abortion financially feasible well before the 12 week period when costs begin to increase exponentially. But Isabel lives in Texas. A state where more than 2.4 million women live in poverty and as many live without health insurance, Isabel's experiences are hardly atypical. In addition to legislation that has left just 18 abortion clinics within a 268,820 square mile region, Texas is one of 32 states that does not allow state Medicaid insurance to fund abortion procedures.
Together, these organizations create a type of underground abortion railroad for women facing life altering events if they can't come up with the money for a standard, safe medical procedure.
"A person with the resources will always be able to travel to get her abortion," says Nan Kirkpatrick, Executive Director of Texas Equal Access Fund. Others often rely on Kirkpatrick's organization to cover the costs. The TEA Fund, and providers like it, including Lilith Fund and West Fund, work to bridge the abortion access gap by providing low income women with a portion of the funds necessary to access the procedure in Texas. Serving North Texas, West Texas, and the Panhandle, and Central, South, East, and West Texas respectively, TEA Fund and Lilith Fund provide grants between $50 to $300 to a fraction of the more than 5,000 women who call one of the two hotlines each year.
"Everybody thinks what we do is just about abortion. Abortion sounds so specific, but it goes beyond the procedure. It blows mind how much everything impacts the folks that we're serving and you know to sort of build this amazing steel trap that they can't get out of because it's just surrounded on all sides," says Kirkpatrick.
To try to escape that trap, Isabel called the TEA fund.
The hotlines are staffed by small troops of volunteers who answer calls from their own homes—15 to 20 for TEA Fund and 25 to 30 for Lilith Fund. Together, these organization create a type of underground abortion railroad for women facing life altering events if they can't come up with the money for a standard, safe medical procedure.
In 2005, Gretchen Dyer, a University of North Texas feminist theory professor, knew that low-income women's options for abortion were desperate and dwindling. Dyer and a group of students started the TEA Fund to raise money to help supplement the costs of abortions for poor and working women. Their first fundraiser—appropriately, a tea party—managed to secure $1,000 toward abortion services for women in the North Texas area. Eleven years later, the fund has grown into a budget of more than $200,000 annually.
That safety net for women began to deteriorate in 2011 when the state legislature cut its women's health care budget by two-thirds, limiting access to birth control and family planning services. In 2013, it almost disintegrated completely when House Bill 2 passed, shuttering 19 abortion clinics in Texas through stringent and arbitrary medical restrictions.
When TEA Fund was founded 64 abortions providers existed throughout the state. After years of legislative roll backs on abortion rights, there remains only 18.
Altogether, the legislation creates a cycle of poor access and poorness generally: Without Medicaid expansion, women can't get health care, can't get birth control, can't get abortions, and without the ability to control their reproductive rights, they generally can't get ahead.
For the majority of women, finances are the whole point of the abortion in the first place. Research has shown that women unable to access an abortion— one in four of those who seek it—are three times as likely to drop below the federal poverty level after two years, creating "steel trap" like Kirkpatrick said, for those who can't afford to not be able to afford an abortion.
The majority of women who call the hotlines learn of the organizations only after their first visit to one of the state's 18 remaining clinics. There, they fill out a financial intake form and are directed to one or several of the funds, depending on their need.
When TEA Fund was founded 64 abortions providers existed throughout the state. After years of legislative roll backs on abortion rights, there remains only 18.
Demand for the funds' help is huge with Lilith Fund fielding an average of 20 to 35 calls per shift and the TEA Fund recently receiving up to 35 calls per shift. At the beginning of each shift, volunteers sift through voicemails left by clients, returning calls and running through a series of intake questions—How far along are you? Where will your procedure take place? How much will it cost? Are you employed? Where else are you getting funding?—to determine how much to fund.
Neither Lilith nor TEA Fund ask exactly how much income a particular client makes. Accordingly, there are no qualifying financial requirements for grants and everyone who calls in gets a fair shake at what money there is, regardless of income and without having to prove their need. Volunteers do, however, give some consideration to women who are further along, simply because their abortions cost more and will continue to cost more the longer they wait.
"If they're calling us," says Amanda Williams, Lilith Fund's Executive Director, "we believe that they need our support and we don't really ask too many questions to see how true that is. We just kind of trust all of our callers and we think that everyone deserves to get an abortion so that's kind of why we don't ask too many details about income, it kind of doesn't matter to us. We just want to help them if they need help." Williams is Lilith Fund's first full-time paid employee in the history of the organization—a sign of its expansion in he past few years.
The funds continue to give until the budget for the day—$1,600 every Monday and Thursday for TEA Fund and $1,400 every Monday, Wednesday, and Friday for Lilith Fund—runs out, as it almost always does. Oftentimes clients have to call back multiple times before they receive funding. Isabel called TEA Fund three times before receiving $300 towards her abortion procedure. She was also granted $750 from the National Abortion Federation, $100 from the West Fund, and $200 from Women's Reproductive Rights Assistance Project for a combined $1,350 toward the $1,500 procedure she eventually obtained in New Mexico at 19 weeks pregnant.
Both funds have grown in recent years, thanks in part to the national attention heaped on Texas' restrictive abortion laws and to the state's widespread reputation as 'ground zero' of the reproductive justice movement. For TEA Fund, that translates to a current operating budget of $227,800 with $158,003 of that going to Texas women and to the organization's infrastructure, like the voicemail system needed to field calls and the client database needed to dole out funds. The Lilith Fund operates on an annual budget of $350,000 and has seen its hotline budget increase $100,000 from $175,000 in 2015 to $185,000 in 2016.
Despite the culture of trust, money is never exchanged directly. Instead, funds are sent off to clinics in the form of vouchers to be redeemed on the day of the appointment. Once funded, clients must work to piece together the remaining portion of the procedure cost by either reaching out to more funds, pawning or selling things, asking friends or family for small amounts, taking payday loans, or, most commonly, forgoing rent, groceries, or bills. During the holiday season, one TEA Fund volunteer heard from many women who were unable to buy presents for their children—a majority of both funds' clients, and of abortion seekers generally, are already mothers.
Then comes the hard part.
Without having been to Texas, it's difficult to understand just how huge it is. In some portions of the state, you could drive for four hours before reaching to the next city, let alone the six cities in the state that have abortion clinics. Entire countries fit within the state's borders.
So the question is not just: Can a woman afford the procedure? It's also: Can she afford to travel to the procedure?
"It's very disproportionately affecting people of color, non-English speakers living in rural areas that are less wealthy than urban areas. Those are the people who no longer have [the option of] abortion in their back pocket. And those are the people who don't have the same access to birth control in the first place," says Natalie St. Clair, Operations Manager of Fund Texas Choice, an organization that offers financial support in the form of plane and bus tickets, hotel stays, and gas money.
The necessity to secure both travel funds and procedure funds makes access an elusive, moving puzzle made up of ever changing pieces for women who are often piece-mealing funding from two or more providers on the side of coordinating travel plans.
While organizations like TEA and Lilith Funds take care of the procedure, organizations like Fund Texas Choice take care of the travel. Practically all the clients who utilize Fund Texas Choice also use abortion fund providers like TEA and Lilith Funds, according to St. Clair.
Fund Texas Choice was founded in 2013 in response to the passing of House Bill 2, when it became apparent that only a handful of clinics would survive to serve all of Texas. Unlike TEA and Lilith Funds, Fund Texas Choice works on a monthly budget, with every client receiving funding so long as they meet that month's requirements.
When I shadowed St. Clair's shift this January, those requirements included lacking a vehicle or needing to drive more than two hours in one direction to access an abortion clinic. If St. Clair goes over the $5,000 budget this month, she'll scale back in February with tighter guidelines. It works this way so that women seeking access at the end of the month have the same opportunity as those at the beginning of the month. Altogether, the fund raises about $100,000 a year from private donors, with donations going up with each new legislative abortion restriction and/or wave of abortion restriction coverage.
Kirkpatrick noted a similar spike in TEA Fund donations after restrictions, as well as an increase in out-of-state donors, as it becomes more and more difficult to access abortion in Texas.
The necessity to secure both travel funds and procedure funds makes access an elusive, moving puzzle made up of ever changing pieces for women who are often piece-mealing funding from two or more providers on the side of coordinating travel plans. Flights can be missed, appointments can be canceled or rescheduled, funding can fall through forcing appointments to be canceled or rescheduled, and so on.
"It's coordinating with the clinics and coordinating with the individuals and making sure that everybody gets where they need to be by the time their funding falls into place. I love Fund Texas Choice. I love funds, but it's not a permanent solution. It's not a permanent solution to getting abortion access out there," says St. Clair.
When Isabel set out for New Mexico, for example, with $125 of Fund Texas Choice money to cover both gas and food, a blizzard hit west Texas, stalling her trip and pushing her appointment back a week. Another client made it all the way to New Mexico only for her procedure funding to be canceled the morning of her appointment, sending her right back home. Fund Texas Choice funded her return trip once she secured money.
The majority of women who call Lilith and TEA Funds will not receive any funds. For every one woman it helps, Lilith Fund is unable to fund two more.
Half of Fund Texas Choice's clients make the trip to New Mexico where, unlike Texas, abortion is legal past 20 weeks and where at least one clinic in Albuquerque will go up to 28 weeks. New Mexico is also just closer to the isolated towns and cities of Texas' western border—close enough that Texas lawyers even argued its proximity to El Paso proved HB2 "does not impose a substantial obstacle in the path of abortion patients."
The logistical minefield of managing 20 different cases each month, plus the added irritant of planning travel — "Nobody likes booking plane tickets, let's be real," St. Clair says — is a small window into the stressors that Texas women must navigate on their own, often on top of working part- or full-time jobs and managing families. It's draining, but St. Clair sees all the funds' work as an absolute necessity.
"It is such a sense of urgency. It is just shit that needs to get done," she says. "This has to happen. People will not get their abortions if they cannot travel to access the clinic or if they do not have money to pay for the procedure. People won't get the abortion that they have the right to get."
To get shit done, St. Clair MoneyGrams, wire transfers, PayPals, and mails checks and cash. Sometimes she forwards funds to the abortion clinic to offset the cost of travel. Once, she drove from Austin to Dallas to hand deliver cash to a minor who didn't have the ID necessary to pick up a wire transfer or board a bus.
To the external observer, it might seem overly trustworthy of humanity to dole out straight cash to any person who calls in, but to St. Clair, it's unimaginable that anybody would take advantage of the funds.
"This is an incredible pain in the ass; talking to me, calling, having to wait two days for me to call back, having the phone call," she explains in her South Austin home as cats Duke and Dwight mewl about. "Just for how much? Honestly, how much did I just sent [client's name]? I sent her $100 for gas. Nobody would go through all of that for $100."
There's also just not a lot of time for any kind of income screening that St. Clair would never submit clients to. The sense of urgency she references is real: the closer a woman gets to Texas' 20 week abortion ban, the more expensive her procedure gets, creating an exponentially growing hurdle of cost.
HB2 affects not only the specifics of travel, but also the cost of the abortion procedure itself. As clinics continue to shutter, wait times at those that remain are skyrocketing, reaching four to five weeks in some parts of the state. Those waiting periods push women further and further into their pregnancy, ratcheting up the price so that it reaches between $700 and $1,100 between 12 and 18 weeks and upwards of $4,000 up to 21.6 weeks since the last menstrual period, according to Fatimah Gifford, marketing manager of Whole Woman's Health. Seeing an increase in need, TEA Fund has since increased the maximum amount of money they will give to any one individual.
"Sometimes people know at four weeks and so an [abortion] procedure at four weeks is going to be hundreds of dollars less expensive than a procedure at 12 weeks, but the thing is, the clinic may have to schedule you 8 weeks from the day you call them because they're so overworked with so few clinics. The circumstances are beyond their control, so a woman might be pushed into having a procedure that upwards of 1,000 dollars just by sort of the way the die fall," says Desirae Embree, a hotline volunteer with the TEA Fund.
The majority of women who call Lilith and TEA Funds will not receive any funds. For every one woman it helps, Lilith Fund is unable to fund two more. And for those that don't receive grants, time again becomes a factor as procedure costs compound. Inevitably, some women never come up with the funds and are forced to carry to term a pregnancy that they probably can't afford. A study by the University of Texas' Texas Policy Evaluation Project estimated that number at 22,200 as a result of the admitting privileges provision of HB2.
"[I'm] seeing how the numbers are shifting like later and later, and hearing too the people who are at 18 weeks, 19 weeks and having to tell them, 'I'm sorry, I don't have any money this week or I do have money but it's not as much as you need. I think there's a lot of people who wind up not getting the help that they need and you know having, definitely having that baby," says Embree.
"We're stepping up to the plate, we're really starting to respond, but the need has been greater." says Williams of Lilith Fund. "We wish we didn't have to exist."
Correction: An earlier version of this story stated that there are 10 abortion in clinics in Texas. While the ambulatory surgical center provision of House Bill 2 would leave just 10 abortion clinics in the state, that provision was stayed by the U.S. Supreme Court in anticipation of Whole Women's Health v. Hellerstedt case to be argued in March. Currently there are 18 abortion clinics in Texas. We regret the error.