Abortion rights and anti-abortion rights activists demonstrated outside the U.S. Supreme Court in June 2024 to mark two years since the court’s Dobbs v. Jackson Women’s Health Organization ruling, which reversed federal protections for access to abortions. (Anna Moneymaker/Getty Images)
In the days following President-elect Donald Trump’s win last November, a national abortion-assistance hotline was being inundated with calls.
“They were confused about whether abortion was even still legal in the country, because they have heard the rhetoric around Trump’s position on abortion,” said Brittany Fonteno, the president and CEO of the National Abortion Federation.
The association of abortion providers runs what Fonteno says is the largest financial assistance program for people seeking abortions and is among the many groups preparing for another potentially destabilizing shift in U.S. reproductive health policy after Trump takes office Monday.
The Republican who appointed, in his first term, three U.S. Supreme Court justices who helped overturn Roe v. Wade in 2022, has said he will leave abortion policy to the states. But the reality is the Trump administration will likely have to take some federal action on abortion, including on several pending federal lawsuits that have major implications for access to abortion drugs and emergency health care.
Many activists that spent the last year trying to fight off a subsequent Trump term are now focused on how to maintain and expand access to abortion and birth control but also maternal and prenatal care. All has been affected in states with abortion bans, but activists fear people in states with liberal abortion policies could soon be impacted.
“Everything has changed,” Fonteno told States Newsroom. “We are heading into absolutely the most hostile landscape for abortion access in 50 years in this country, without the legal protection of Roe and with the most hostile administration to abortion access.”
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Maintaining access abortion and miscarriage drugs
As legal confusion over abortion persists across the country, the Abortion Defense Network is going into its third year providing free legal advice to abortion providers.
“Right now, we are readying ourselves for whatever may come and getting ready to respond to any changes and understand those changes so that we can best serve our clients,” said Cassie Ehrenberg, senior counsel for pro bono initiatives for the Lawyering Project, which manages the intake calls and operations of the network.
Ehrenberg would not specify how many clients the network serves, but said they field a lot of provider questions about medical licensing and what different state laws allow. She said that November 2024 saw more than three times as many inquiries to the hotline as the year before.
Many of the ongoing federal abortion fights involve two medications approved in 2000 by the Food and Drug Administration for first-trimester abortions but also used for miscarriage management and other health conditions: mifepristone and misoprostol. These drugs and their loosened restrictions under the Biden administration have made it possible for more people, including those living in states with abortion bans, to terminate pregnancies. They accounted for an estimated 63% of all abortions in 2023, according to the Guttmacher Institute, up from 53% in 2020.
However, states such as Texas and Louisiana have begun cracking down on the mailing of these drugs and restricting their use even for non-abortion purposes. And many anti-abortion activists are lobbying the new Trump administration to ban telehealth abortions and reinstate other old FDA restrictions, or to enforce the 1800s-era Comstock Act to ban the mailing of abortion drugs and information. During his campaign, Trump said he would not order the U.S. Justice Department to enforce Comstock. But after the election, he gave TIME Magazine conflicting statements about whether his administration would try to restrict access to medication abortion, saying both that he was open to the FDA reversing the approval of abortion pills and committed to maintaining access to abortion drugs.
Fonteno said the National Abortion Federation has prepared for different contingency plans, including giving clinics guidelines to administer medication abortions without mifepristone, were the drug to become unavailable.
Helping patients finance abortions with dwindling resources
As the director of case management at Tampa Bay Abortion Fund in Florida, Bree Wallace said a big part of what her organization does is not just help people pay for abortions they can’t afford, but also teach them how to fly.
Many of the people who call in, Wallace said, are really young or poor or on the verge of being unhoused and have never been on a plane before.
“It’s a lot of having to explain, like, here’s how you get to the airport and get your boarding pass; this is how you get off and get a ride share; this is how you check into a hotel,” Wallace told States Newsroom. “It’s definitely really scary for them, and we’re not next to them to really help, so we’re just kind of helping through the phone.”
In addition to the logistical and informational support, these patients depend on the money to be able to take a short-notice plane ride or to pay for lodging or child care or the abortion itself. Most abortion are not covered under public insurance in about half the country.
Like many independent abortion funds across the country, Tampa Bay Abortion Fund is struggling to meet the rising patient need as ballooning abortion and travel costs outpace donations to these independent funds. Wallace told States Newsroom that the average pledge for appointment costs per caller grew from $340 to $430 between 2023 and 2024.
The increase in patient need is partly because many abortion clinics have had to increase their prices to stay open but also because national organizations like Planned Parenthood and NAF cut their patient funding last summer. NAF reduced its patient grants from 50% of the cost of care to 30%, which abortion funds leaders told States Newsroom has put major strains on their budgets.
Wallace said that Tampa Bay Abortion Fund assisted nearly 2,000 people in 2024 and spent nearly $700,000. But the situation has also shifted in Florida, which had been a major abortion access point for the Southeast until last May, when the state began enforcing a 6-week abortion ban, a law that was ultimately not overturned by a much anticipated citizen-led ballot initiative that narrowly missed the 60% required approval. As of Dec. 31, more than 60,000 abortions happened in Florida in 2024, according to the Florida Agency for Health Care Administration, down from around 84,000 in 2023.
Florida’s law limits abortion before many people even know they are pregnant. Wallace said the fund is now serving fewer out-of-state patients but receives many calls from Floridians who are around five weeks pregnant and racing against the clock to come up with $500. She said the fund also helps people travel outside of Florida.
Less than three weeks into 2025, Wallace said things are incredibly busy at the fund.
“I think I’ve talked to over 70 people in the past three days,” she said, noting that her organization is working hard to raise more money. “No matter who’s president, I think abortion funds and organizations are going to help people get abortions as long as they possibly can.”
Some states with liberal abortion policies, like California and Illinois, have started allocating funding to some abortion funds. But Chicago Abortion Fund executive director Megan Jeyifo said that even with $1 million annually from the city along with county and state funding for wraparound services like transportation, lodging, child care, and meal stipends, she’s constantly worried about her organization’s budget. Illinois has become a major access point serving people from the Midwest and South, where abortion has been largely restricted or banned.
Jeyifo said CAF supported around 15,000 people last year, compared to around 800 in 2019, many of them coming from Indiana and Missouri, but also from nearly all 50 states. In response to greater patient need, Jeyifo said new clinics have opened in the state and many have increased capacity. She said CAF’s helpline budget for appointment costs rose by more than 93% in November 2024 compared to the previous year.
“For five years … we funded every single person that reached out to us,” Jeyifo told States Newsroom. “And we just can’t guarantee that anymore because of the constraints on our budget.”
Fonteno said NAF’s decision to cut patient grants last year was necessary to keep pace with their growing need — more than 100,000 patients last year, many of whom had to travel out of state — despite having the largest budget in the program’s history. She said NAF has the same $55 million budget for this year, which will allow them to bump up some of the funding they cut and restore what Fonteno calls the “exception budget,” which before last summer would help fund later abortions (which can cost as much as $10,000) as well as help patients weather extreme circumstances like intimate partner violence.
“We anticipate that the need for practical and financial support for abortion care is only going to increase with this incoming administration, with the potential for additional threats to abortion access,” Fonteno said. “So we’re going to be really doubling down on our patient support.”
Advocates on edge over Trump’s deportation pledge
While playing coy about his abortion policy intentions, Trump has been firm on immigration, pledging to deport millions of undocumented immigrants, which has put reproductive health and justice advocates on edge.
“We’re seeing that, for immigrants specifically, the [abortion] bans have created impossible situations,” said Lupe M. Rodríguez, executive director of the advocacy group National Latina Institute for Reproductive Justice. She said undocumented immigrants are scared of traveling even within border states like Texas, noting there are internal immigration checkpoints. She said those who live in areas without affordable reproductive health clinics may not be able to access prenatal, contraceptive or wellness care.
But even for people without immigration status concerns, Rodríguez said the Latinx community is disproportionately impacted by abortion bans. In addition to policy advocacy, Rodríguez said her organization is focused on informing people how and where to access abortion and reproductive health services.
Fonteno said NAF’s member clinics have been advised not to ask questions about a person’s immigration status when it comes to providing funding.
Pushing for broader reproductive justice
On Saturday, two days ahead of Trump’s second presidential inauguration, thousands of progressive advocates will march in Washington, D.C., at an event organized by the Women’s March, now called the People’s March to signify a more inclusive and expansive civil rights movement focused on democracy, immigration and climate issues in addition to gender and reproductive justice.
Juxtaposing Trump’s Make America Great Again message, the march’s theme is “We Are Not Going Backwards,” or as is relayed in a promotional video, “Er’ew ton gniog sdrawkcab.” Women’s March managing director Tamika Middleton said about 40,000 people RSVP’d to rally and march from Franklin Park to the Lincoln Memorial. The event will also include informational sessions on bodily autonomy and reproductive justice, the principle that people have the right to control their reproductive health care, including the ability to birth and parent safely.
Regina Davis Moss, a reproductive justice advocate and public health expert, told States Newsroom that the legal abortion framework enshrined in Roe v. Wade, which marks its 52nd anniversary on Jan. 22, was not enough to guarantee abortion access especially for people of color and those living in poverty. But more crucially, Roe did not address high poverty and infant and maternal mortality rates among Black women, which Moss said her group, In Our Own Voice: National Black Women’s Reproductive Justice Agenda, is focused on.
This week, Moss said she met in Las Vegas with some of the original founders of the reproductive justice movement, looking for insight on how to move forward with Trump and the Republican majority in Congress that could limit reproductive health access further and fail to address the impacts of state abortion bans.
“This is a time that we can really spend on education,” Moss said.“I’m more than certain that we’re going to see the unintended impact of some of these [abortion bans] in real time. … We are going to continue to see … people having to be brought to the brink of death before hospitals will intervene, and more and more health care providers leaving rural areas. And so hopefully that helps people understand, on both sides of the aisle, why it’s important.”
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