For a week and a half before the Supreme Court intervened in early March, a law restricting abortion access in Louisiana left only one doctor able to provide abortions in the entire southern half of the state. The phones at the New Orleans Abortion Fund were ringing off the hook.
The fund provides women seeking abortions with some extra cash -- the average pledge is $81 -- to cover costs ranging from child care and hotel rooms to the actual procedures, which cost between $500 and $600. Volunteers review each applicant's financial situation on a case-by-case basis in order to effectively divvy up the organization's tiny weekly budget of $600, a process that volunteer Jennifer Chen described as challenging but necessary.
"We have a lot of women who are coming in from out of state," said Chen, who added that the weekly budget sometimes runs out by Tuesday, and the fund struggled to keep up after the clinic in New Orleans became the only provider for miles around.
"When you are looking to get an abortion, every single day counts."
Chen's clients provide a very personal perspective on how a growing number of state laws that restrict access to abortion place incredible burdens on women and their health, especially among the most marginalized and vulnerable. Restricting access to abortion does not reduce demand for the procedure in a meaningful way, but it does make life much more difficult for women who are already in a tough situation.
Most women seeking assistance are already mothers, and many are working low-wage jobs to support their children, according to Chen and other volunteers. Some are low-income students or paying off student loans, and many are immigrants and women of color. They often do not have financial support from their male partners, and some seek abortions in secret to avoid domestic abuse.
Vanessa Shields, a nursing student who takes calls for the abortion fund, said her clients make complex decisions that require taking an in-depth look at their lives as a whole. Can they afford the costs of pregnancy and raising a child? Does their family have access to adequate medical care? Will the father be around? Does he even live close enough to provide real support?
"And of course, does she want to have a baby?" Shields said.
Restrictions on abortion increase the financial burden on women already struggling to support their families. Women living in rural areas where clinics have closed due to legal restrictions must travel hours to reach the few clinics that remain open, especially in Texas, Louisiana and Mississippi. Mandatory 24- to 72-hour waiting periods between an initial consultation with a doctor and the procedure itself force women to miss multiple days of work and spend more money on gas, hotels and child care.
Women often delay seeing a doctor in order to secure more money to pay for services, but the price of abortion procedures increases as pregnancies advance.
"When you are looking to get an abortion, every single day counts," Chen said.
Women Suffer as Abortion Battles Weave Through Courts
Chen said at least 20 women called the fund within days of a Fifth Circuit Court of Appeals decision on February 24 to overturn a lower court ruling and put into effect a Louisiana law that advocates say would close three of the four remaining abortion clinics in the state. Like similar laws that have severely inhibited the work of reproductive health-care providers in Texas and across the South, the Louisiana law required abortion providers to have admitting privileges at a nearby hospital.
This left only two doctors able to performs abortions in Louisiana -- one in New Orleans and another in Shreveport, who does not expect to stay in business long if the law is in effect. A clinic outside Shreveport shut its doors, and a clinic in Baton Rouge was only offering state-mandated counseling before sending patients to New Orleans.
"What was missing from the Fifth Circuit ruling is the real-life experiences of these women who are affected by this law," said Amy Irvin, the director of the abortion fund in New Orleans.
"What was missing from the Fifth Circuit ruling is the real-life experiences of these women who are affected by this law."
The Supreme Court intervened on March 4, reversing the appeals court's decision to remove a stay on the law, allowing the remaining clinics in Louisiana to reopen while the high court decides on a challenge to a similar law in Texas. The Supreme Court recently heard oral arguments in the Texas case and is expected to decide in June whether such measures, known as "targeted regulation of abortion providers" or TRAP laws, infringe on the constitutional right to abortion by placing an "undue burden" on women.
Had the Supreme Court failed to intervene in the Louisiana case, many women in the state would have been forced to travel to Mississippi's only clinic. The clinic is located in Jackson, and has remained open only because of a court order obtained by the Center for Reproductive Rights, which is representing abortion providers challenging TRAP laws across the South.
For years, anti-choice lawmakers in states across the country have placed various conditions and restrictions on abortion access. Women's advocates say the harsh regulations on surgical abortion providers in 24 states are not necessary to keep patients safe, as some proponents claim. The strictest TRAP laws, such as those in Texas and Louisiana, are designed to shut down clinics all together.
Exasperating a Health-Care Crisis
The TRAP strategy is having serious impacts in Texas, where the number of abortion clinics has dropped from 41 to 18 since the TRAP law was introduced in 2013 - and at least 10 more clinics will close if the law is upheld by the Supreme Court.
Women in some parts of the state must now travel hundreds of miles to wait in long lines at clinics, and the impacts are already obvious. Texas women are already attempting to induce their own abortions at rates higher than the rest of the country, and researchers at the University of Texas estimate that 100,000 to 240,000 have attempted do-it-yourself abortions in the state.
Researchers also found that the general health of women and children declines across the board after states impose restrictions on abortion access. In Texas, women have faced increased wait times for abortions since Texas passed its TRAP law, and the sudden closure of clinics has created significant obstacles to obtaining care, forcing some women to have an abortion later than they wanted. This increases the risk and cost of the procedure. Others simply continue with an unwanted pregnancy.
"Other research has documented serious health and social problems for women forced to continue an unwanted pregnancy, including medical complications of pregnancy and intimate partner violence," said researcher Daniel Grossman, a professor of obstetrics at the University of California, San Francisco, in a statement to the Texas Policy Evaluation Project.
The impacts of TRAP laws are compounded by other attacks on reproductive health -- such as efforts to block access to Medicaid and defund Planned Parenthood in Texas and Louisiana -- leaving women without access to IUDs and other contraceptives. It's no surprise that states that have put up barriers to reproductive health care also have some of the nation's highest rates of unintended pregnancy.
[Abortion restrictions] are exacerbating an existing health-care crisis," Irvin said. "Health-care outcomes for women and children are terrible in Louisiana."
The entire situation is "torturous," according to Lauren, a woman who received an abortion in Louisiana in September and declined to give her last name. She described waiting for hours with dozens of other patients at an overburdened clinic, wading through bureaucratic "red tape" and jumping through "a million hoops" to get an initial consultation, endure a state-mandated waiting period and then receive the medical care she needed.
"It's drawn out; it doesn't make it easier," Lauren said. "And you all are in the worst period of your whole entire lives."
All of this came on top of taking time off work, finding transportation and squeezing money out of the man who impregnated her to defray some of the costs -- along with the hormone changes that come with pregnancy.
"You pretty much lose it," Lauren said.
Women with enough money often buy a plane ticket and have their abortions in another state, she added. As for those who are already struggling financially and must travel long distances across the South, often without support from their partners or families, Lauren said she "can't even imagine" what they are going through.
"I want to laugh, except I want to cry," Lauren said.
Lauren's experience inspired her to volunteer as a fundraiser for the New Orleans Abortion Fund. Indeed, in the places where lawmakers have placed restrictions on abortion access, activists are working on the ground to make the process easier for women in need. Abortion funds have popped up across the country, and activist groups in Texas and beyond offer "practical support" to women seeking abortion, ranging from carpools to lodging to doula services.
As for Chen, volunteering for women in need became a life calling. She originally entered medical school to study pediatrics, but switched to obstetrics and gynecology after seeing firsthand what women in the South must go through to maintain control of their own bodies and destinies. She will finish school and start her residency this year, and she plans to be an abortion provider.