April 17, 2024

The Evolving Philanthropic Landscape for Supporting Abortion Access and Reproductive Services

Mounting access and cost issues, combined with substantial limits on public and private insurance funding, put abortion care increasingly out of reach for millions of people. Here we share four ways philanthropy can ensure equitable access to abortion care in the years ahead.

By: Marina Fisher, Julia Finnerty, Kristen Loureiro, Roger Thompson

Prior to the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling in June 2022, the nation’s patchwork of abortion service providers and the organizations that support them operated on shoestring budgets. After Dobbs, which overturned the court’s Roe v. Wade ruling nearly 50 years earlier, that financial shoestring has stretched to the breaking point, imperiling access to healthcare for millions of women.1

In reaction to the high court’s ruling, private investors and philanthropic organizations increased their interest in supporting reproductive care providers. In an April 2023 report, we identified nine types of relevant impact investment opportunities, including those serving systemically underserved individuals and communities. Following publication, several foundations and wealthy givers came to The Bridgespan Group with requests for further guidance on grantmaking opportunities centered on equitable abortion care.

Grantmaking Opportunities

In response to requests from prospective funders seeking to support abortion access and reproductive rights, we've identified a variety of grantmaking opportunities. "Opportunities for Philanthropic Support of Abortion Access and Reproductive Rights" shares opportunities across two categories: surmounting barriers to direct service and advancing reproductive rights and justice.

Given the seismic shift of the Dobbs ruling, the time seemed right to survey its impact on access to reproductive health, including abortion access. We assessed available data and interviewed leaders in the field in late 2023 and early 2024. What we found was a deeply fractured landscape, with many organizations facing a perilous future and access to abortion increasingly out of reach, especially for low-income women of color. We also found opportunities for philanthropists to support abortion access and reproductive services, which we document below.

Following the Dobbs decision, concerned individuals fueled a wave of “rage giving” that temporarily swelled the reserves of organizations directly supporting people seeking abortions. But outrage diminishes over time. The experience of the West Alabama Women’s Center is typical. Immediately after the Dobbs ruling, it had to stop performing abortions and send its patients to states where they could get the procedure. Within 48 hours of the ruling, the center raised $180,000 for patients’ travel, hotel, and other expenses, Robin Marty, the clinic’s executive director, recalled in an interview with The Guardian. “Now, I go and I try to ask for any sort of funding online, and we can get maybe $50 to $100 every time I do it,” Marty said.

Meanwhile, institutional philanthropy historically has played only a minor role in funding abortion care, providing less than 2 percent of the $1.7 billion in foundation giving for reproductive rights between 2015 and 2019, according to research from the National Committee for Responsive Philanthropy (NCRP), an independent philanthropy watchdog. “Foundations and wealthy donors can have a huge impact helping pregnant people get the care they need with just a modest uptick in support,” NCRP noted.

At the same time that rage giving subsided, costs for providers escalated significantly as new restrictions kicked in, says the executive director (who asked not to be named) of ineedana.com, an online abortion information service. “More [abortion] funds and providers are running out of money more frequently than we’ve ever seen,” she adds.

Costs for procedures shot up as more than half the states imposed abortion bans or restrictions that make it difficult, if not impossible, for people to get care without traveling out of state. For the first time since Roe v. Wade in 1973, 14 states have no clinic that provides abortion care. The financial strain of supporting abortion seekers who must travel hits hardest in Southern and Midwestern states with the most severe bans and restrictions.

Rising Costs Increase Inequities in Abortion Access

Financial strain is a constant threat to abortion care providers. Abortion Care Network (ACN), which represents some 346 independent clinics, reports that 32 percent of all such clinics have been forced to close over the past decade, with the number surging after the Dobbs ruling. Forty-two closed in 2022, and 23 more through October 2023.

Losing those clinics drastically reduced essential access to abortion care. But the impact on health access has been even broader. Many of those clinics also provided a wide array of reproductive care before and after childbirth, along with contraception and essential primary and gender-affirming care. Closures eliminated major providers of community health services.

After the Dobbs ruling, 58 percent of women of childbearing age (some 40 million) live in a state hostile or extremely hostile to abortion rights, according to the Guttmacher Institute.

Unless people in those states decide to self-manage their abortion care by obtaining medications on their own (and face potential legal risks in many states), their remaining option is to travel to another state. Emerging data since the Dobbs ruling shows that many patients have turned to this option. More than 160,000 women traveled out of state to seek abortion care in 2023, according to the Guttmacher Institute.

The cost of care, regardless of where it takes place, falls mostly on those least able to afford it. Three-quarters of abortion seekers have incomes below the federal poverty line, which means they are eligible for Medicaid for health expenses. Yet, a federal law known as the Hyde Amendment prevents federal funds, including Medicaid, from covering abortion care. Most people (60 percent) pay out of pocket—even those covered by private health insurance. That’s because, according to Health Affairs, “11 states restrict the type of abortion coverage that private health insurance plans can offer, and 26 states have laws that bar all plans participating in their state’s health insurance exchange from covering abortion.”

Even before the Dobbs decision, costs for both procedural and medication abortions had been on the rise. The median out-of-pocket cost for first-trimester procedural abortions in 2023 was $658, according to ineedana.com, up from $475 in 2017. Medication abortions—which accounted for 63 percent of all US abortions in 2023 and is approved by the FDA for use up to 10 weeks of pregnancy—are also becoming more expensive. Although some mail-order providers post-Dobbs charge $105 or less, the average cost at Planned Parenthood is around $580, up from $495 in 2017. Clinic closures and increasing logistical barriers to abortion access also mean that more and more patients face delays in care access. People who do not receive abortion care until the second trimester must opt for procedural abortions that now cost upward of $1,100, according to ineedana.com.

Travel costs also have soared. The Brigid Alliance, which books, coordinates, and pays for transportation, hotel, food, and childcare, reports the average itinerary costs over $2,300.  That’s more than double the average cost in the first half of 2022, when far fewer people traveled for procedures. In addition to travel expenses, mandatory wait times in some states mean abortion seekers need to take more time away from work, sometimes at the risk of losing their jobs. They also incur childcare expenses while away from home. Nearly 60 percent of those ending a pregnancy already have children. All these logistical expenses do not include the costs to pay for the procedure itself.

Without federal or private insurance coverage, most abortion seekers in need of financial assistance turn to local abortion funds for help. Abortion funds cover the cost of their procedures and/or accompanying travel costs. As these costs have risen in the wake of Dobbs, financial assistance needs have overwhelmed abortion funds’ ability to provide resources.

By the middle of 2023, rising costs had depleted many budgets, making temporary closures of funds and clinics commonplace. The Nation found five examples, including the Mississippi Reproductive Freedom Fund, which had to close in August to fundraise. For two months before closing, Executive Director and Cofounder Laurie Bertram Roberts kept the lights on by racking up thousands in expenses on her personal credit card.

The Tampa Bay Abortion Fund served all callers until the summer of 2023. But as call volume climbed along with expenses for those who needed to travel, the money ran out. The fund closed for a month beginning in mid-September, giving it time to fundraise and prepare for the future. “We’ve had to get a lot stricter with our budget, and we can only pledge so much to each person and really stick to it,” says McKenna Kelley, a fund board member.

Because the majority of abortion seekers are low-income women of color in their twenties, the crisis in care “is a huge public health issue; it’s a huge racial equity issue,” says Nikki Madsen, the ACN’s co-executive director. “It begs the question why philanthropy hasn’t provided real, intentional investment in keeping every abortion clinic that currently exists open and helping to expand access,” she adds. “Historically, there hasn’t been a lot of investment by philanthropy in independent clinics even though they provide the majority of abortion care and operate in the most politically hostile states.” 

Four Ways Philanthropies Can Close Abortion-Access Funding Gaps

Mounting access and cost issues, combined with substantial limits on public and private insurance funding, put abortion care increasingly out of reach for millions of people. Individual donors and events like Fund-a-Thons or GoFundMe campaigns don’t provide the reliable, sustainable support needed, which makes philanthropic giving more critical than ever. No other funding source can ensure equitable access to abortion care in the years ahead.

But what does that support look like? Advocates for more philanthropic funding have several ideas, as we document below. To make each of these ideas concrete, we have highlighted a few example funding opportunities. (For a representative list of organizations, see “Opportunities for Philanthropic Support of Abortion Services and Reproductive Rights.”) We encourage prospective funders to look more expansively into each of these categories and identify organizations best aligned with their funding criteria.

Contribute to abortion funds

Most abortion funds are local, independent organizations. The 100 members of the National Network of Abortion Funds (NNAF) raise money to remove financial and logistical barriers to abortion access. Network members report that they have the resources to provide support to only one-third of their callers. In NNAF’s view, philanthropy emphasized protecting the legal framework around Roe v. Wade and paid less attention to local clinics. That “led to funding that overwhelmingly flows to policy advocates and lawyers at large national reproductive rights organizations” rather than grassroots service organizations—an imbalance, NNAF contends, in urgent need of correction. 

The Brigid Alliance and Apiary for Practical Support are two of the few national organizations that provide only logistical funds for people seeking abortion care.

Fund abortion care clinics

Independent clinics provide the majority of abortion care in the United States and make up the majority of clinics providing care after the first trimester. However, these community-based clinics have limited national name recognition—and small marketing and development budgets. So, their fundraising is typically at the local level—mainly from small donors. Because many of these clinics were established as taxable entities, donors may question the permissibility under tax law of giving to a for-profit enterprise.

The ACN’s Madsen downplays this concern. In her experience working with donors, she says, “There are definitely ways for foundations to directly fund for-profit entities.” For those funders who can’t give directly to for-profit clinics, regrantors, like ACN’s Keep Our Clinics campaign, play a vital role. Keep Our Clinics regrants funds from individuals and foundations to clinics to cover expenses such as increased security, building repairs, legal fees, and community education and advocacy. Local and regional funds also provide this financial support. “Foundations can and should invest directly in both nonprofit and for-profit independent clinics,” says Madsen. “If the clinic is a taxable entity, additional due diligence will be required, but this is a small barrier to ensuring some of the most important healthcare clinics in America can keep their doors open.”

Alongside brick-and-mortar clinics, newer abortion care providers are exploring innovative models of service delivery that ease the logistical and financial burden on patients. Just The Pill, for example, combines telemedicine with mobile clinics that can travel along the borders of states with abortion bans or severe restrictions. Funding innovative providers alongside established community-based clinics is critical to maintaining a robust care infrastructure for patients.

Invest in abortion services infrastructure

As abortion bans have gone into effect, some clinics have moved from restrictive states to bordering states. But moving is expensive, and clinics forced to relocate typically don’t have cash on hand to cover the costs.

The Red River Women’s Clinic used the $1 million proceeds from a GoFundMe campaign to relocate from Fargo, North Dakota, when the state banned abortion. The clinic moved five minutes away across the border to Moorhead, Minnesota. Without that windfall, clinic director Tammi Kromenaker says, “I’m not quite sure how we would’ve pulled it off.” Shortly after the Dobbs decision, the Women Donors Network launched the Abortion Bridge Collaborative Fund to assist with such expenditures “by moving money rapidly to build critical and emergent infrastructure to protect and advance reproductive justice nationwide.”

Infrastructure isn’t just bricks and mortar. The ineedana.com website answers basic questions about nearby abortion services. “We’re not a provider or abortion fund, but we play a critical role in making sure people can find them,” says ineedana.com’s executive director. With investment in engineering time, “we can make it easier for individuals to find the best option and efficiently help more people,” she adds.

While ineedana.com’s budget hit roughly $900,000 in 2023 with an infusion of foundation support after the Dobbs ruling, the executive director says her ideal budget is in the $2 million range. “And that’s still operating really scrappily and nimbly. We could do so, so much more than what we’re doing right now,” she says. 

Fund grassroots abortion advocacy and legal services

Without the federal protection of Roe, the legal battles over abortion and bodily autonomy have shifted to state legislatures and state courts. State-based advocacy and legal services organizations need funding to mount challenges to legislative and legal efforts that ban or severely restrict access to abortion care.

Many of those grassroots organizations are led by women of color and focus on improving institutional policies and systems that impact the reproductive lives of those in historically marginalized communities. Among them: the National Birth Equity Collaborative, SisterSong Women of Color Reproductive Justice Collective, and Indigenous Women Rising

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As the post-Dobbs surge in funding has faded, the new reality of increased demand and diminished resources puts equity-minded philanthropists in the spotlight. Their financial clout can provide a more secure future for those on the front lines of abortion care.

“For too long, many grantmakers have avoided funding abortion because of the stigma and controversy around the issue,” Guttmacher’s Jonathan Wittenberg and Wendy Sealey wrote in The Chronicle of Philanthropy. “Now is the time for philanthropists who believe in social justice and human rights to support abortion access,” they continued. “This is a marathon, not a sprint. Donors will need to take the long view and make funding plans that are sustainable for years, and possibly decades.”

[1] In discussing reproductive health, rights, and justice, we often refer to “women” because that is how the vast majority of impacted individuals identify and because that identity is most frequently used in research. At the same time, we recognize that others are impacted and capable of pregnancy, including transgender, nonbinary, and gender-nonconforming people.
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