Abortion is many things in America. Divisive. Politicized. A fact of life. It is also, in the world of health care, unique.
Part of what makes abortion provision unique is that it happens amid relentless efforts to create as many obstacles to it as possible. The preternatural determination of abortion providers overcomes most of these obstacles, but for too many women, there’s something else that makes their abortion possible: volunteers.
As researchers studying barriers to abortion, we are deeply moved by the stories we have heard of the many volunteers who donate time, money and space to make abortion a reality for so many patients who otherwise would be denied necessary health care. Our research, which involved almost 70 interviews with abortion providers and allies in all 50 states, shows that volunteers are playing a role in almost every aspect of abortion care.
We question whether this deep dependence on volunteer efforts is the optimal and just way for a health care service to operate.
Forty-five years after Roe v. Wade legalized abortion nationwide, abortion care is extremely challenging for patients to obtain and for providers to deliver. Increased state restrictions and an uptick in aggressive incidents at clinics have put safe legal abortions out of reach for many women. Compounding the problem, the majority of current abortion patients are poor: Nearly 50 percent have incomes below the official poverty line, and another 25 percent are classified as low-income. For many of these women who seek abortions, volunteer assistance often makes the difference between ending an unwanted pregnancy and remaining pregnant against one’s will.
In no other area of medicine would we accept such a heavy reliance on the altruism of volunteers.
One of the most prevalent barriers to abortion is the cost of the procedure. First-trimester procedures, which account for over 90 percent of abortions in the United States, average about $550; later abortions can cost several thousand dollars. Many patients who seek abortions live in poverty, and Medicaid doesn’t cover abortion in most places in this country. In response, advocates of equitable abortion access have established abortion funds, which provide grants and loans to help patients pay for the procedure. Several of these funds have paid staff, but most of them are run by volunteers who hold fundraisers, connect patients to clinics and arrange payments.
Even when women can pay for the procedure itself, they often need help getting to the clinic. As clinics have closed, the distance to the clinic can be an insurmountable hurdle. This is especially true for women in rural areas who live in states with only one or two clinics that are located in the most populous area of the state. In states without public transportation, many patients, especially those who don’t have cars or companions to drive them, rely on networks of motivated volunteers to get them to the care they need ― an abortion equivalent of Uber/Lyft, but with volunteer drivers and no cost to the patient.
One of the most inspiring stories we heard in our research was from Diana, who belongs to a network of volunteers in a southern state who transport patients on short notice. Several years ago, just before Christmas, Diana volunteered to transport Kim, a patient who lived about an hour away from the only remaining clinic in the state. Diana drove to Kim’s home and then to the clinic, expecting to bring her home after the procedure. However, once there, Kim was told that she had medical issues that the local clinic was unable to address.
The closest clinic that could care for Kim and her condition was in Washington, D.C., many hours away by car. Diana, committed to helping Kim, drove her to D.C., where the two of them spent the night in a motel. Kim expected to have her abortion the following morning.
The D.C. clinic was not able to treat Kim, either, so the odyssey continued. Diana drove Kim another four hours to New York City, where a clinic was finally able to perform Kim’s abortion safely. The pair then embarked on the 12-hour ride home, Diana driving almost nonstop through fierce storms, all so she could keep her promise to get Kim home in time to spend Christmas with her two children. Diana and Kim’s story is extraordinary, and it is emblematic of the lengths to which volunteers go to help patients access abortion.
Once they have found a way to get to the clinic, many abortion patients need help securing overnight accommodations. Some abortion procedures take place over two days, and for women who may have driven many hours to get to a clinic, it is not practical to drive back home after the first day of care. Some women may need housing assistance because of state-imposed waiting periods between the first visit to a clinic and the procedure itself. Twenty states require women to wait 24 hours, and seven require them to wait between 48 and 72 hours. Spending more than one day to get an abortion means multiple days of lost wages and covering the cost of lodging and child care (about 60 percent of abortion patients are already parents).
Several providers told us that they’ve seen patients spend the night in their cars in the clinic parking lot because they couldn’t afford a hotel room. Because no person should have to resort to that for any reason, especially the night before a medical procedure, abortion volunteers have stepped up to take patients into their own homes for one or more nights.
Volunteers also play a vital role in helping clinics deal with protesters. Almost every woman who goes to a clinic will have to endure harassment from protesters. Sometimes the protesters are relatively subdued, but often they are aggressive, screeching through bullhorns that women are “murdering” their “babies.” Sometimes, this harassment has a racial component, with almost exclusively white protesters telling African-American patients that they “may be killing the next Barack Obama” or that “black babies’ lives matter.”
Volunteer clinic escorts help patients get through this mess at the front door, accompanying them as they walk the gauntlet of protesters and into the clinic for their appointment. Often, they shield women with coats or even tarps as patients are forced to walk through shouting protesters. These escorts literally put their bodies on the line to get women in to see their doctors.
Volunteer assistance often makes the difference between ending an unwanted pregnancy and remaining pregnant against one’s will.
Again, we are most impressed by the generosity and tenacity of these abortion volunteers. Even in an ideal world, where abortion care is a normalized part of health care ― when abortion is destigmatized, not targeted by lawmakers, and available in a broad range of medical offices, not just clinics ― there’s a place for volunteers. After all, there are plenty of volunteers in general hospitals. However, in no other area of medicine would we accept such a heavy reliance on the altruism of volunteers.
Only if abortion is routinized as a normal part of women’s reproductive health care will abortion providers and patients not have to depend on the kindness of strangers.
David S. Cohen is a professor of law at Drexel University’s Thomas R. Kline School of Law. Carole Joffe is a professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco. They are working on a new book about barriers to abortion.