Abortion funds, telehealth care, biohacked medicines: Crisis planning for post-Roe America

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EDITOR’S NOTE: It remains unclear how the legal landscape may change nationally and within individual states in the wake of the Supreme Court overturning Roe v. Wade, but we wish to draw readers’ attention to warnings issued by abortion advocates and security experts about the potential use of data tracking to criminalize abortion seekers. We encourage all readers to take precautions with protecting their personal data, communications, and search histories. While there are no guarantees that any method will eliminate the threat of criminalization, we recommend consulting resources like the Digital Defense Fund

Reproductive justice activists had long anticipated a devastating ruling on abortion access from the current conservative-dominated Supreme Court. And yet, that did little to dampen the shock most still felt when POLITICO leaked the now infamous draft majority opinion indicating the Court could overturn Roe v. Wade in its entirety.

Instead of a limited ruling that would further erode abortion rights but still allow Roe to stand in some respect, the draft of the majority opinion, written by Justice Samuel Alito, leaves no doubt that the conservative majority aims to obliterate the notion that abortion is a right guaranteed by the Constitution, drawing the “inescapable conclusion… that a right to abortion is not deeply rooted in the Nation’s history and traditions.” This decision, if it stands, could undo 50 years of established legal precedent, ushering in a new standard whereby states could enact stifling and unimpeded restrictions on abortions, with some already angling to fully ban and criminalize the procedure

Patient safety remains the priority, but patient safety is exactly what advocates say is under attack with abortion bans and the decreasing availability of safe resources.

The expected SCOTUS decision would mark the crowning achievement of a decades-long fanatical right-wing crusade by anti-abortion activists—a crusade involving clever legal maneuvering, dogged campaigning, and ceaseless conservative politicking to combat abortion access on a generational timetable. 

At the same time, pro-choice groups have been engaged in their own version of long-term institution building, creating a network of organizations, abortion funds, healthcare support nonprofits, and mutual aid groups that can act as a bulwark in the fight for reproductive justice—and as an increasingly necessary protective fallback for people in states that severely limit access. In an effort to support people seeking abortion care in an increasingly restrictive climate, this network has built a framework that will allow its interconnected organizations to adapt to our impending post-Roe reality and continue to help cis women and other people who may experience pregnancy despite the escalating attacks on reproductive care. 

Abortion Care Across Borders

Abortion access in several states is already heavily restricted, but in the months after the expected SCOTUS decision, abortion access in as many as 26 states could be impeded by measures such as draconian legislation, clinic closures, limited time frames for procedures, frightening additions like potential felony murder charges for doctors, lawsuits filed against anyone suspected of helping a person obtain an abortion, etc. This has led many to be reasonably concerned that women and people experiencing pregnancy could even be prosecuted for allegedly having an abortion or inducing a miscarriage, as was the case for a 26-year-old Texas woman who was recently charged with murder for this exact reason, though the charges were ultimately dropped. 

Abortion access in several states is already heavily restricted, but in the months after the expected SCOTUS decision, abortion access in as many as 26 states could be impeded by measures such as draconian legislation, clinic closures, limited time frames for procedures, frightening additions like potential felony murder charges for doctors, lawsuits filed against anyone suspected of helping a person obtain an abortion, etc.

The original Roe ruling in 1973 pulled some of the decision-making power around reproductive care away from individual states by establishing a federal standard, and a reversal would almost entirely kick that power back to the states. For mutual aid and other reproductive justice organizations, this means that it is imperative to support patients seeking abortion access by helping with cross-state transportation or alternative solutions for those who can’t travel. A good portion of this care can come in the form of remote medical options and facilitating access to abortion medication. “In the states that make it so hard, people right now can get pills through mail order services,” says Elisa Wells, the co-founder and co-director of Plan C. Founded in 2015, Plan C is an educational and support organization that helps people looking for abortion care find information about and access to at-home abortion medication. 

Through many of the resources listed on the Plan C website, such as the European-based healthcare organization Aid Access, patients can secure low-cost telehealth appointments with doctors in places like Austria, who can then write a prescription for abortion medication that is subsequently issued from a pharmacy in India and sent to the patient’s home. Aid Access’s international care network is not governed by any state legislature and served 10,000 patients in 2021 alone. Abortion pills account for more than half of all abortions as of 2020. The pandemic made online pharmacies and telemedicine more available and widely accepted, establishing and expanding structures for remote healthcare access that can be harnessed to create an abortion pathway for people in states facing bans.

Aid Access operates through an online intake system that directs patients where they need to go according to their location and situation. Patients living in states that allow for telehealth abortions are connected to a US-based clinician and a domestic pharmacy for their medication, or, in those states where this telehealth solution is prohibited, get set up with an Austrian physician and the Indian pharmacy. 

“It’s important to recognize that [telehealth] is a help, it’s a band-aid, but it’s not an overall solution,” says Christie Pitney, a nurse midwife and clinician with Aid Access. “A solution is legal and accessible abortion in every state without all of these restrictions.” Pitney says she originally got into this work because abortion care was often inaccessible in the rural community she used to live in due to the distance from providers and low incomes of the residents. 

Aid Access is attempting to fill some of these gaps in care, but restrictive abortion measures also cause problems that Aid Access can’t solve: medication abortion is only possible in the earlier stages of pregnancy, for instance, and restrictive measures actually increase the number of later-term abortions, which may have to be performed as in-clinic procedures. In the face of a total ban, getting abortion medication to patients as early as possible has become a high priority. 

At this point, it is better to plan for the worst than to hope for the best, and these are among the many worst-case scenarios abortion seekers, activists, advocates, and providers are planning for.

Some patients have an option called “advanced provision,” which allows you to go on the Aid Access site, fill out your information and check for contraindications, and then get pills shipped out to you even if you are not currently pregnant. “We know a lot of people are doing [this] now to prepare for what seems to be the eventuality of [an] adverse Supreme Court decision… triggering these abortion bans in so many states and also really opening it up for states to take restricted access,” says Wells, who notes that individuals around the country are already, often on their own, taking actions such as getting medication from Mexico. Right now, Plan C is seeing a surge of traffic from “trigger states” such as Texas and Florida (so-called because of the anti-abortion “trigger laws” that are likely to go into effect if Roe v. Wade is struck down).  

While these telehealth solutions currently comply with existing laws, there’s still an increased risk of criminalization even without total abortion bans, meaning that in a few rare situations, self-administered medication abortion has already been interpreted as a crime. “People need to know there is a risk of criminalization. The risk falls heaviest on people of color, people who don’t have financial resources, youth, immigrants, trans folks… it falls on the people who already are facing oppression through our systems,” says Wells. She adds that connecting with a legal support organization, such as the Repro Legal Helpline, can help a person understand how each state interprets the legalities when it comes to medication abortion. 

As some state legislatures attack access to abortion care, there will be attempts to go after currently legal resources such as telehealth. Zealous district attorneys could try to single out a particular case of legally obtained abortion medication in an effort to set a sweeping precedent of criminalization. At this point, it is better to plan for the worst than to hope for the best, and these are among the many worst-case scenarios abortion seekers, activists, advocates, and providers are planning for.

Criminal charges are only one potential danger. The shrinking number of clinics, plus the diminution of resources and available services, means that abortion has already become prohibitively expensive for many patients, and the cost could increase if blanket bans are allowed in a plurality of states. This is where abortion funds come in.

“For us, [overturning Roe] doesn’t really change anything because we have seen all of these burdens. Just because there’s not a ban doesn’t mean that abortion is accessible for everyone.”

Madison Lyleroehr, Midwest Access Coalition

Abortion funds can help patients cover not just the cost of the procedure, but the added costs incurred from moving around the country to obtain the care they need. Dozens of abortion funds have been operating for years, supporting patients in areas with particularly limited access to abortion like the South and the Midwest, where tightened restrictions mean people with fewer resources may not be able to get essential care for no other reason than they are not wealthy or privileged enough. One of the best known abortion funds is the Midwest Access Coalition, which was founded in 2015 under the guiding principle that financial access to abortion is key to ensuring safe care. The Midwest Access Coalition raises money and distributes funds to hundreds of patients in need, going beyond the bare cost of the procedure and covering travel bookings and hotel accommodations, food stipends, and gas reimbursements.

“There have been incredible barriers for a lot of folks for a long time. That’s why all these [abortion funds] have existed and do exist,” says Madison Lyleroehr of the Midwest Access Coalition, who notes that the majority of the people needing funds have no choice but to travel across state lines to receive care. “For us, [overturning Roe] doesn’t really change anything because we have seen all of these burdens. Just because there’s not a ban doesn’t mean that abortion is accessible for everyone.” 

The end of Roe and the subsequent state restrictions won’t just ensure that some patients in trigger states have to travel out of state to get the care they need, but it will also, by necessity, end up increasing the density of cases in states with more open abortion access, potentially raising costs and overwhelming systems. This means that fundraising and support for clinics, including in deep blue areas that seemingly have a lot of resources, will be crucial. 

Abortion clinics have always been under threat. Given the jubilant reaction from the far right to Roe’s potential defeat, however, clinics around the country are now faced with the credible, escalating threat of anti-abortion attacks.

For the Northwest Abortion Access Fund, a post-Roe reality means moving people across different geographies to match specific needs. For example, Seattle is home to one of only a handful of clinics nationwide that can handle later-term abortion procedures, so they’re likely to get an increase in requests from people searching for care from around the country. Of the four Northwest states that the fund serves (Oregon, Washington, Idaho, and Alaska), Idaho residents are the ones facing the activation of a trigger law that could effectively prohibit abortion in the state. The majority of the patients receiving logistical support through the Northwest Abortion Access Fund, then, could very well be Idaho residents. 

“As people who do a lot of [the] on-the-ground work of helping people access abortion, we have all understood as long as we have been doing this work… [that] what the law says has not been applicable to a lot of circumstances,” says Iris Alatorre, Program Manager at the Northwest Abortion Access Fund. She notes that much of the work performed by abortion funds involves supporting people who already don’t have fair access to abortions. “We understand… that abortion having been legal the last several decades has certainly not made abortion more accessible for most people… We’re anticipating [that] we are going to be doing the same work—maybe a higher volume—after Roe falls.” That increase will fall on the clinics that are still open, increasing their patient load exponentially. 

“The reality of what’s coming down the pike…  is just the sheer workload of people moving around and how overtaxed the remaining clinics are going to be,” says Kat Green from the Abortion Access Front, a group that has used humor and volunteer support to help build a sense of community around the fight for accessible abortion services. The Abortion Access Front started in 2015, raising the profile for many clinics by posting satirical web content and hosting regional comedy nights where abortion providers could come and pitch participants on getting involved. Beyond jokes, they have helped to organize direct support for clinics, including facilitating proper maintenance and connections with building contractors (in the current political climate, because of the polarized views on abortion clinics, it can be difficult to secure this type of work).

“The bigger thing that people need to be cognizant of is that [the result of overturning Roe] is going to be a mass incarceration event.”

Kat Green, Abortion Access Front

The truth is that, when it comes to securing abortion access, many different kinds of organizations are needed. “We try to act as a connector between all of the great groups doing the work, from abortion funds to practical support organizations, to independent clinics and grassroots advocacy organizations,” says Max Carwile, Programs Director at the Abortion Access Front. They do this work, according to Carwile, “so that people can learn more and find their home in this movement.” 

Carwile also says that a key part of this mutual aid work is figuring out how to coordinate and direct an influx of volunteers and funds to the organizations that both need them and have the capacity to orient new people in the midst of the current chaos. “There’s a lot of marches and rallies that are going on these next few weeks, which are great for raising attention [and] bringing people together. But anyone who can plan a march can also plan a fundraiser, and thinking about those sorts of creative ways is how we help people prepare… how we help people stock up on [the] supplies they may need,” she says. This is why the Abortion Access Front is organizing the Operation Save Abortion livestream event on July 17—an event they are putting on in partnership with various access groups in order to let interested people know when and how they can volunteer.

Criminalization and Patient Risk

Abortion clinics have always been under threat. Given the jubilant reaction from the far right to Roe’s potential defeat, however, clinics around the country are now faced with the credible, escalating threat of anti-abortion attacks. In response, the Abortion Access Front has taken on a defensive role, coordinating with clinics and safety teams around the country to monitor anti-abortion activists for potential violence and to notify clinics when a threat emerges. “A lot of clinics can’t count on support from local law enforcement, so we started this record-keeping as a means to better prepare their security and legal teams,” says Green. 

This work will have to expand, Green notes, both because of increased threats of far-right attacks and because abortion patients may be at heightened risk of criminalization. “I think [the need for patient defense] is going to grow because part of what we’re also tracking is threats to people seeking care. So there’s the criminalization of people’s data and just the nature of trying to seek care across state lines… The bigger thing that people need to be cognizant of is that [the result of overturning Roe] is going to be a mass incarceration event.” 

Right now there are no laws openly criminalizing abortion funds that support patients traveling over state lines, but some bills have been floated that could try to target out-of-state travel.

One of the necessary steps that needs to be taken in the fight against potential state repression is patient education: People seeking abortion need to know how they can safely communicate about their care and how state laws could affect them if they are traveling to other states for care that is prohibited at home. This may also mean that organizations have to shift resources away from simply doing policy and legal advocacy work to actually providing legal—and potentially jail—support to those targeted for seeking care.

The largest legal burden is likely to fall on trigger states like Kentucky, which is facing a potential statewide ban. Organizations like the Kentucky Health Justice Network, which manages its own abortion fund while also offering healthcare resources for trans people and supports for birth control access in underserved areas of Eastern Kentucky, currently focus a significant amount of their efforts on helping patients who are traveling within the state for care. This will change after a Roe decision, and Illinois will likely become the primary receiving state for Kentuckians seeking abortion care. Right now there are no laws openly criminalizing abortion funds that support patients traveling over state lines, but some bills have been floated that could try to target out-of-state travel. “It seems really hard to [enforce] that, because how are you going to stop someone from going to another state for healthcare?” says Ashley Jacobs, the Operations Director at the Kentucky Health Justice Network. 

Abortions performed without the direct supervision of a physician may also come under increased legal scrutiny. The term “self-managed abortion” can refer to independently managed abortions that are done outside of the purview of a medical professional, such as the telehealth-obtained medication abortions mentioned above, as well as other home, herbal, and “DIY” remedies. In the days before Roe, even when such work entailed defying local laws, groups like the Jane Collective coordinated care for abortion seekers, including self-managed abortions, ensuring that women and people experiencing pregnancy had access no matter what. Today, hearkening back to the pre-Roe days, many people are coordinating options beyond those prescribed by the narrowing legal barriers; for some, that includes various abortion methods that people can choose to use at home on their own.

“There’s all this really great medical technology that exists, but it says something really tragic about the state of humanity that we spend all this time and energy on creating all this great medical technology and then we don’t deliver it.”

Mixæl Laufer, Four Thieves Vinegar Collective

“If one operates within the current parameters,” says Mixæl Laufer of the Four Thieves Vinegar Collective, “the choices are: (1) the infrastructure supports you and takes care of your health, or (2) the infrastructure fails you and you get sick, or die, or have any number of other medical outcomes that you don’t want. That’s not much of a choice.” The Four Thieves Vinegar Collective posts guides for making all sorts of medication, including a recipe for creating your own “EpiPen” after pharmaceutical companies like Mylan and Pfizer dramatically raised the price. “There’s all this really great medical technology that exists,” Laufer says, “but it says something really tragic about the state of humanity that we spend all this time and energy on creating all this great medical technology and then we don’t deliver it.” 

The Four Thieves’ mission has prompted them to release information about drugs that treat potentially lethal diseases like hepatitis C, an illness that can be managed if one is able to take a drug that remains prohibitively expensive for many. The collective has also made a recipe available for abortion pills similar to those someone might receive from a physician, along with instructions about the risks, uses, and legal complications. Regardless of one’s views on DIY medications, the fact is this type of self-managed care has been part of the abortion landscape for decades, both before and after the original Roe ruling, and could become even more common if these expected prohibitions take place. 

“Self-managed abortion is inevitable. So as a larger collective of people that care about humanity, I hope that people can be more compassionate about that and more supportive about it in such a way… that people [can] get information [they need so] that they can do it safely.”

Kat Green, Abortion Access Front

The goal of groups like the Four Thieves Vinegar collective is to make such choices about self-administered care as safe as possible and to give people options when circumstances may have left them with few (if any) to choose from. But this approach does come with certain risks and difficulties. “I support community care. I think that people self-sourcing pills and using herbal remedies… can all be safe and appropriate in certain situations,” says Christy Pitney of Aid Access. “But I think that there is a lot of information around it and it’s not something that someone can necessarily just pick up and decide to do in one day. And so my hope, or my request of folks, is that they are plugging into the knowledgeable people in the communities that have done the work and know the information.” Patient safety remains the priority, but patient safety is exactly what advocates say is under attack with abortion bans and the decreasing availability of safe resources. 

“I think that self-managed abortion has always had a place and will continue to,” says Green. “There are people who have not been able to access abortion through standard channels this entire time.” She adds that ensuring patient safety, no matter what the approach is, should be the top priority. “Self-managed abortion is inevitable,” she says. “So as a larger collective of people that care about humanity, I hope that people can be more compassionate about that and more supportive about it in such a way… that people [can] get information [they need so] that they can do it safely.” 

Resources such as Aid Access and Women on Web give people options that they didn’t have in the past, and those who work in the patient advocacy world are trying hard to ensure that those resources are shared widely. “We have resources [now] that we didn’t have before, but I still think that you have to know that those things are there,” says Jacobs. “And while those resources are available, everyone is still not aware. So I think that there still [is] a risk of people doing dangerous things to miscarry, but not as often as we would have seen in a pre-Roe time.”

Some of the new proposed laws are much more restrictive than those that existed pre-Roe. This is why abortion funds, as mentioned earlier, may become limited in the support they can legally offer, even when it comes to telehealth. “We support people getting the abortion care they want and they need by any means necessary,” says Alatorre of the Northwest Abortion Access Fund. However, Alatoree continues, “legally speaking, we can’t necessarily coach or advocate for [all forms of telehealth] because of the legal ramifications around procuring abortion pills from out of the country or even out of a state where abortion is illegal.” Under a total abortion ban, providing funds for abortion medication could create a legal gray area, but organizers like Alatorre are committed to providing whatever support they can, whenever they can, for as long as they can. 

Abortion pills and other at-home solutions remain critical and safe in some circumstances, but in others, an in-person procedure is more appropriate. “Telemedicine is going to help, but it’s not as simple as that,” says Green. “People are going to need abortions later than [what’s apropriate for medication abortion], no matter what. And the very real concern is that, in desperation, people will take medication abortion later than it’s intended to be taken.”

A Post-Roe World

While demonstrations at the homes of Supreme Court Justices by pro-choice activists have caused controversy, Democrat-appointed judges are facing death threats from the far right and clinics are seeing a massive uptick in calls for violence.

The Supreme Court’s decision on Dobbs v. Jackson Women’s Health Organization could be announced any time in the coming days. Already, dueling protests have emerged around the country as pro-choice activists rally and march, while fears persist that anti-abortion activists will turn to violence once again. While demonstrations at the homes of Supreme Court Justices by pro-choice activists have caused controversy, Democrat-appointed judges are facing death threats from the far right and clinics are seeing a massive uptick in calls for violence. The work of supporting patients in this increasingly intense climate will continue to be necessary, particularly as many clinics book what could become their final appointments and families needing medical interventions look around the country for appropriate care before it’s too late.

To mitigate as much harm and provide as much aid as possible, abortion care advocates and providers urge the public to listen intently to the needs, voices, and circumstances of those who will be most affected by the escalated attacks on abortion rights—and to support groups (like the Indigenous Women Rising’s abortion fund) providing direct support to those who will be most affected—instead of recycling sensationalist imagery of coat hangers and Handmaid’s Tale costumes. “People who are already systematically oppressed will be most affected, especially Black, Indigenous, and other people of color, working-class people, rural and LGBTQ people,” says Carwile, noting that it’s critical for supporters to follow the lead of BIPOC, rural, and LGBTQ organizations since they understand what is most at stake—and what to do about it. 

As we enter the hard dystopian reality of a post-Roe US, every piece of the reproductive justice movement will be critical to fighting for access, but those that directly serve patients will experience the greatest need. And there are ways for people around the country to contribute to mutual aid efforts to support those whose lives, liberties, and health are directly at risk by helping to meet their actual, material life needs, such as securing a safe abortion and the funds to pay for it. Whether it involves donating to abortion funds, legal support networks, or other access-focused organizations, volunteering time and labor to these organizations, or just ensuring that accurate information is safely available to those who need it, there are many ways to help—and help is desperately needed. 

“It’s a large portion of the population who will need to access abortion at some point in their li[ves],” says Madison Lyleroehr, “and think if you’re just a person who cares about other people, then this is something you should take seriously, because it’s an issue of bodily autonomy and having a basic kind of control over their lives… The right to an abortion is a basic human right to me.”

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