Chloe Bell is a case manager at the National Abortion Federation. She spends her days helping people cover the costs of abortions and, increasingly, the interstate travel many of them need to get the procedure.
“What price did they offer you?” Bell asked a New Jersey woman who had called the organization’s hotline seeking money to pay for an abortion. Her appointment was the next day.
“They offered me $500,” said the woman, who was five weeks pregnant when she spoke to Bell in November. She gave permission to a journalist to listen to the call on the condition that her name not be mentioned.
“We can definitely help,” Belle told her. “We can cover the cost of the procedure. Just tell them you have a promise from NAF.
Bell is part of a growing network of workers who help people seeking abortions understand what’s legal, where they can travel for treatment and how to get there.
These “navigators” can often recite by heart the names and locations of clinics in their area that offer abortion services at a given point in pregnancy. Often they can name the nearest hotel to the clinic. And some are so familiar with the most common connecting airports that they can help patients find their next departure point in real time.
State abortion laws have always differed, so helping people access legal abortion services is nothing new, but the amount of travel required to get care has increased dramatically.
In the first six months of 2023, nearly 1 in 5 abortion patients traveled out of state to receive care, compared with 1 in 10 in 2020, according to an analysis by the Guttmacher Institute, a national nonprofit that supports abortion rights. This increase in travel, even for early-pregnancy abortions, has caused a corresponding increase in the need for case managers like Bell.
Most callers are like the New Jersey woman — people in the early stages of pregnancy who can’t afford the $500 price tag for a medical abortion. But with elective abortion almost entirely outlawed in 14 states and after six weeks in two more, the logistics of terminating a pregnancy at any stage have become more complicated.
“People are being forced to get pregnant later to access care” because of the difficulty of arranging long-distance travel and the chilling effect of the bans, said Brittany Fontenot, president of NAF, a nonprofit professional organization of clinics that perform abortions. “It increases the cost of care and has a devastating impact on people.”
After ending the relationship with the New Jersey woman, Bell told a Georgia woman she probably wouldn’t have to foot the $4,800 bill for her 24-week abortion. Half the money will come from the National Abortion Federation, and Bell will contact local organizations that have their own abortion access funds to find the rest. After the money was sorted, the woman told Bell she couldn’t decide whether to drive more than 14 hours to Washington, D.C., to care for her or buy a plane ticket. Her appointment was next week.
“I’ve been looking at flights, but most of them won’t be there at the time I need to be there,” she told Bell, a former librarian who talks to up to 40 callers a day. The Georgia woman said she had $1,200 saved up for the trip. Because of the length of the second-trimester abortion procedure, she will likely have to stay in Washington for three nights.
“Sometimes we can help with travel,” Bell told the Georgia caller. “Book the flight and hotel to see if $1,200 covers those things, also food and carpool from airport to hotel. Taking all these costs into account, if you feel that $1,200 does not cover this, please contact me immediately.”
Since July 2022, NAF case managers like Bell have helped patients pay nearly three times as much for hotel rooms and plane, train and bus tickets each month as they did before the Supreme Court’s overturn Roe v. Wade, which had recognized a constitutional right to abortion. The most requests for financial assistance came from people in Texas, Georgia, Florida and Alabama – densely populated states with strict abortion laws. Calls are also longer and more engaging. The nonprofit now spends $200,000 a month (up from $30,000 a month before Texas imposed a six-week ban in 2021) and still isn’t meeting the need, Fontenot said.
In 2020, Fontenot’s organization employed about 30 full-time hotline operators. That number increased when Texas passed its six-week ban. And since Dobbs annulment of the decision Rowethe line employed 45 to 55 people, said Melissa Fowler, NAF’s chief program officer.
Other reproductive health organizations — at the local, regional and national levels — have also added staff like Bell. Planned Parenthood affiliates, including some in states with outright bans, now employ 98 people known as patient navigators. Most were hired after that Dobbs, said Danica Severino Winn, vice president of abortion access for Planned Parenthood of America. She estimates that 127,000 people relied on these navigators as of July 2021.
Planned Parenthood Columbia Willamette in Portland, Oregon has hired three abortion patient navigators from Rowe was canceled, according to spokesman Sam West. Abortion is legal in Oregon, without restrictions, but that doesn’t mean everyone has equal access to services. One of the new navigators speaks Spanish and focuses on rural parts of the state where services are scarce.
The clinic declined a request for a journalist to listen to conversations with its navigators, citing patient privacy. The other two navigators focus on helping callers who are out of state (usually Idaho), under 15, or in their second trimester.
Attorneys contacted for this story who are familiar with current state laws said patient navigators are unlikely to be at legal risk for their work helping people connect to abortion services, although they could make it matter what state they are in when offering help. For example, an Idaho law that states that adults in Idaho are not allowed to “recruit” minors to obtain an abortion may apply to navigators if they answer the phone in Idaho. That law, along with many others in states with bans, are being challenged in court.
Back at his desk in Georgia, Bell takes a call from a 20-year-old woman from North Carolina named Deschel, who is seeking financial support for a second-trimester abortion. Deschel spoke with KFF Health News a few days later, speaking on the condition that only her middle name be used to protect her privacy.
On the day Deschelle became pregnant, it was legal to have an abortion in North Carolina up to the 20th week of pregnancy. About six weeks later, when she discovered she was pregnant, she went to a nearby clinic to have a medical abortion. She went to the first appointment to fill out paperwork. According to state law, she had to wait 72 hours before returning to get the abortion pills. They also gave her an ultrasound, which she did not want. The image of the embryo shook her and she missed the second appointment.
By the time Deschelle again decided to have an abortion, she was almost 15 weeks pregnant and North Carolina law had changed. By July 1, almost all abortions after 12 weeks were banned. He had to leave the state.
With the help of NAF navigators, Deschel made an appointment at a clinic in Virginia where abortion at 15 weeks is legal. Her mother drove, but did not support Dechelle’s decision to terminate the pregnancy. Then there were protesters. By the time Deschel went inside, she was crying. She met with a provider, but again decided not to have an abortion.
None of this came up in her conversation with Bell in November. Dechelle was 26 weeks pregnant at the time. It was the second time she called the hotline and the third time she tried to have an abortion. She just wanted to know if she could still get financial aid. The cost of her care had escalated from about $500, when she could get a medical abortion, to $6,500 for a multi-day abortion procedure.
Bell took a cue from Deschel and stayed focused on logistics. She approved funding to cover half the cost of the procedure and secured a donation to cover the rest. She confirmed that Deschel had a place to stay and the necessary companion to walk to the clinic with her every day. Then they closed. The rest of the trip was on Deschel alone.
“It’s not what I want, but I think it’s the best choice for me,” Deschel said just outside the waiting room on the first day of the procedure. She read aloud a pamphlet about the medications she would be given and the timing of them all. Then her name was called.
A week later, after it was all over, she still felt she had done the right thing.
“You literally have to be really strong to abort your baby and be okay,” she said she would tell anyone else in her situation, “and you also have to be really strong to be a single mom.”KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s core operating programs – an independent source of health policy research, polling and journalism. Learn more about KFF.