The Next Abortion Battlefront

Abortion policy in America is at a stalemate. Republicans will take control of Congress in January, ready to block any national protections—but with a slim majority, making a national ban unlikely. At the state level, pro-choice advocates have focused for the past two years on ballot measures to protect abortion rights. Most of those measures have passed; now there are only two states left that have severe restrictions, allow constitutional amendments, and haven’t already failed to pass constitutional protections.

Since Roe v. Wade was overturned in 2022, U.S. abortion rates have held steady, or even risen. That’s in part because tens of thousands of women in states with extensive restrictions have ordered the two-pill medication-abortion regimen, mifepristone and misoprostol, by mail. Many thousands more have sought out procedural abortions in states with more lenient rules, and that number may soon begin to rise more steeply. The pills don’t work in every scenario, many women who use them to circumvent restrictions fear being prosecuted, and a lawsuit brought by the attorneys general of three conservative states seeks to both outlaw mifepristone for minors and prevent it from being mailed. Project 2025, a blueprint for Donald Trump’s second term created by people with close ties to his incoming administration, outlines a plan to have the FDA pull mifepristone from the market. (Trump himself has flip-flopped repeatedly on whether he might try curbing access to the pill.)

Further restrictions on abortion pills could push more women to cross state lines to receive an abortion. That travel can cost thousands of dollars. Since Dobbs v. Jackson Women’s Health Organization, a network of so-called practical-support groups has played a growing role booking and funding abortion-related travel. Their work is quieter than the fights in courts and legislatures, but perhaps as crucial to determining the future of abortion in America. As options for major policy changes winnow, this approach is likely to play an even more important role in maintaining access to abortion in the U.S.—and to attract more opposition.

Abortion care, like virtually all medical treatment in America, has always been geographically fractured, with people in poor and rural areas traveling farther to reach services. A study published last month found that people who travel out of state for an abortion are more likely to face expenses that threaten their ability to pay for basic needs. The tighter restrictions get, and the more states put them in place, the greater the distance the average patient must cross, and the greater the average cost of doing so. Practical-support organizations might provide gas money, arrange airport pickups and drop-offs, or even fund the purchase of a winter coat if the travel involves a colder climate. Nancy Davis, a Louisiana resident, sought help from a group called the Brigid Alliance in 2022 when an ultrasound revealed at about 10 weeks that her fetus had acrania, a rare and fatal condition in which the skull does not fully form. Her doctor recommended ending her pregnancy, but abortion had just been banned in Louisiana, so Davis booked an appointment in New York. Brigid took care of the cost of plane tickets, a hotel, and food for Davis and her fiancé, as well as funding child care for her three kids at home. Megan Kovacs, a volunteer and board member with the Northwest Abortion Access Fund, told me that this level of logistical support is becoming more and more necessary.

Until recently, practical-support organizations such as the Northwest Abortion Access Fund existed mainly to help, say, someone in rural eastern Oregon travel a few hours to a clinic in Boise, Idaho. But when Dobbs overturned Roe in 2022, aid organizations’ work became more in demand, more expensive, and more complicated, Marisa Falcon, the executive director of a hub for practical-support groups called Apiary, told me. A patient from Arkansas who has scheduled a procedure in Chicago, for example, might rely on a group in Illinois to book flights and hotels and another in Arkansas to drive them to the airport. Because of new restrictions in Idaho, the Northwest Abortion Access Fund spends more money sending patients from eastern Oregon to farther-away urban areas like Portland, as well as helping patients in Idaho leave the state. According to data that Kovacs shared with me, the organization spent an average of $585 on things like hotels and gas money per client in the two years before Dobbs; since Dobbs, the average is nearly $875. The number of clients seeking practical support has almost tripled.

Read: There’s no coming back from Dobbs

Support groups also told me that costs are rising because, as the number of clinics dwindles, appointment waiting lists are getting longer, so people wind up having abortions further into pregnancy. The longer a person waits to end their pregnancy, the more complicated and expensive abortion becomes; patients also take longer to recover. “What used to be a one-day activity is now a four-day activity where people need to leave their kids behind,” Falcon said. “Not only are the logistics more complicated, but it costs significantly more.”

In the Dobbs decision, Justice Brett Kavanaugh wrote that U.S. citizens have a “constitutional right to interstate travel,” including for abortions. But abortion opponents are nonetheless trying to prevent people from crossing state lines for care that they see as a threat to unborn life. In Alabama, for example, Attorney General Steve Marshall has said helping someone travel for an abortion is akin to a “criminal conspiracy.” Last year, Idaho outlawed helping a minor travel out of state for an abortion without parental permission. Tennessee passed a copycat law this year. So far both of these efforts have faced legal challenges, and similar bills introduced in other states have failed to advance. Texas has taken a different approach: Some local laws allow residents to sue anyone who assists a woman in traveling through their city or county to get an abortion in another state. At least one Texas man has already taken legal action against his former girlfriend, expressing an intent to file a wrongful-death suit against anyone who assisted her in allegedly pursuing an abortion out of state.

Even if none of these legal efforts succeed, abortion opponents can try to limit the work of practical-support groups by restricting their funding. The organization representatives I spoke with said that the pace of their funding has not kept up with demand for their services. Some smaller groups simply don’t have enough money to meet demand. If abortion is further restricted—if, for example, mifepristone’s FDA approval is revoked, or if the lawsuit challenging it succeeds—demand for out-of-state travel will skyrocket again.

Read: Abortion pills have changed the post-Roe calculus

Abortion support services rely mostly on donations, but some also receive funding from state or local governments. That government money has already become a target for anti-abortion groups seeking to curtail abortion travel. In 2023, for example, Ohio voters approved a constitutional amendment enshrining the right to an abortion; in response, a state legislator introduced a bill that would withhold state funding from cities and counties that give money to practical-support groups. Last month, ballot measures protecting abortion rights passed in seven states, and legislators in some of them may attempt to repeat the Ohio strategy. Kristi Hamrick, the vice president of media and policy for the anti-abortion group Students for Life Action, told me that the group opposes using any taxpayer funding for abortion travel and has already asked that Trump restrict the military’s funding of travel for service members seeking abortions.

As travel plays a larger role in how Americans access abortions, it will also inevitably become a bigger target for abortion opponents. Practical-support groups told me that in recent years, abortion-rights advocates have focused on funding campaigns to pass legislation, leaving practical support groups short of the money necessary to serve a growing number of would-be travelers. People still need to travel or obtain medication to end their pregnancy in huge swaths of the country—even in places where abortion rights have notched recent victories. In Missouri, for example, a November ballot initiative made abortion legal, but a host of other laws could mean a long wait before abortions are widely available there. “Without abortion support organizations, people just won’t access abortion,” Serra Sippel, the executive director of the Brigid Alliance, told me. If advocates could wave a magic wand and reinstitute Roe tomorrow, it wouldn’t make a difference if people can’t get to a clinic—many of which no longer exist post-Dobbs. The most consequential fights, for now, may be the practical ones, even if they’re just about some gas money, a babysitter, and a winter coat.