Last September, Nandi J., a 29-year-old Black woman from the metro Atlanta area, discovered she was four weeks pregnant. Because of her state's restrictive abortion legislation, Nandi, a mother of two, had to make an immediate decision about her future. Each day she put off the decision would cause greater hurdles, such as having to travel to get an abortion out of state, and could end up costing her hundreds of dollars more.
In Georgia, it's illegal to terminate a pregnancy after six weeks, which is before many people even realize they're pregnant. The law banning abortion was enacted shortly after the Supreme Court ruling in Dobbs v. Jackson Women's Health Organization last June that overturned the landmark Roe v. Wade decision and revoked the constitutional right to abortion, giving states full authority to limit access or prohibit abortion outright. As of this month, which would mark the 50th anniversary of Roe, abortion is banned in 14 states and restricted in several others.
With the closing of dozens of clinics across the country since the Dobbs decision, local abortion funds and other reproductive rights organizations are stepping in to provide logistical and financial assistance to those in need. The potential for pharmacies to dispense medication abortion through a prescription and the expansion of telemedicine could allow for better availability and affordability of abortion in some states. But legal and political battles are still pending as anti-abortion groups lobby for further restrictions on abortion pills.
Nandi scrambled to book the next available opening in a local clinic near Atlanta, but disliked feeling rushed. Nervous that she might be denied due to state restrictions, she booked a backup appointment in North Carolina. "It's a big decision for people. It's not something where you flip a coin," she said.
Abortion is not only an extremely personal and emotional decision — it's an economic issue, in regard to both having one and not having one, according to Carrie Baker, professor of women and gender studies at Smith College.
"Half of the people who need abortions live in poverty, 75% are low income, many are young without resources, and are disproportionately people of color," Baker said.
The (hidden) costs of abortion
The total cost of Nandi's abortion, including the ultrasound, labwork, anesthesia and the procedure itself, came to $630. It was Nandi's third abortion, and she preferred to be put under even though it cost more than just taking a muscle relaxer. Because of state law, clinics were cutting back on staff and weren't offering anesthesia every day, so Nandi said she was fortunate to find an opening in the time frame she needed.
If Nandi had ended up going with her backup plan four hours away in North Carolina, it would have cost $100 more for the procedure. She would have also had to cover gas expenses and find someone who could take a full day off work to drive her there and back.
Because a third of the population now lives in states without legal abortion, people have to travel greater distances and face longer waiting periods to get reproductive health care, which significantly impacts access and cost, especially for underserved and rural populations. "The later the procedure is, the more expensive it becomes," said Baker.
The price of an abortion varies depending on geography, health complications and other factors, but generally, if someone early in pregnancy gets an appointment right away, a first-trimester procedure averages around $600. If the wait is lengthy, or someone can't arrange to get to a clinic immediately or take time off work, they might need a second-trimester abortion, costing up to $2,000.
That's a high price tag, especially since most people pay for abortion services out of pocket due to being uninsured or underinsured, or outright prohibited by law. Only seven states require private insurance carriers to cover abortion, and several states have laws limiting or restricting private insurance coverage of abortion care.
There are also nonmedical costs of terminating a pregnancy, which are less visible but burdensome, including transportation expenses, child care coverage, lodging and lost wages. If there are any post-abortion complications or follow-up care, those costs add to the total.
In her case, Nandi, who hasn't had a full-time job in over a year, was able to get care for her two young children via community support. After posting about it on social media, she was contacted by someone she met through SisterSong, a Southern-based reproductive justice coalition for women of color, who helped her get coverage at no cost. Like Nandi, the majority of those who get abortions already have at least one child.
Abortion funds attempt to bridge the gap
The clinic that Nandi went to provides in-house funding for low-income patients and those on Medicaid, which took around $300 off her bill. Again, she was fortunate. The 1976 Hyde Amendment blocks the use of federal funds for abortion (except in extremely rare cases when the pregnancy is a result of rape or incest, or endangers the patient's life). And while states have the option of using their own funds to extend abortion coverage to Medicaid enrollees, only 15 states actually do.
That means Medicaid, in which one in five women of reproductive age are enrolled, doesn't cover abortion services in more than half the country, disproportionately affecting Black, minority and marginalized communities.
The remainder of the cost for Nandi's abortion -- around $330 -- came from the abortion fund ARC-Southeast, which offers financial assistance as well as practical support in Alabama, Florida, Georgia, Mississippi, South Carolina and Tennessee. Nandi contacted the fund after she made her clinic appointment, and it was able to pick up the rest of her bill.
Since the reversal of Roe, abortion funds have seen an uptick in demand. Groups like the National Network of Abortion Funds, made up of nearly 100 autonomous organizations throughout the US, and a few abroad, work tirelessly to help with the cost of the procedure as well as other financial and logistical barriers -- rides, housing, child care, gas money.
The first question one of these organizations will ask is how much someone can realistically pay for an abortion, according to Oriaku Njoku, co-founder of ARC-Southeast and now executive director of the NNAF. "Most people don't have $500 in their checking or savings account for an emergency," Njoku said. In one instance she recalled, the price of the abortion procedure was $1,500, but after adding airfare, lodging and food, the cost came out to almost $4,000.
Class and economics play a role in the ability to access care, she said.
Abortion funds are not a recent phenomenon, explained Njoku. Before the overturning of Roe, nearly 90% of US counties had not a single abortion provider. "That post-Roe reality that folks were so afraid of was actually the lived reality of many people in the South and Midwest before the Dobbs decision came down," she said.
Except now, the impact of Dobbs is reverberating nationwide as remaining abortion clinics are flooded with patients from across different states.
Telemedicine and abortion pills will help many, but not all
In the face of increased delays and costs, reproductive justice organizations and abortion providers are finding ways to make health care available to patients through telemedicine and medication abortion, which accounts for over half of US abortions. "There are various ways that providers are trying to enable some appointments to happen virtually so you can arrive and have your procedure right away," said Baker.
Earlier this year, the Food and Drug Administration announced that retail pharmacies in states where abortion remains legal would be allowed to stock and distribute the abortion pill mifepristone. Pharmacies would have to go through a certification process to qualify, and patients would need a prescription.
There's also Plan C, a website that provides information on accessing abortion pills by state or territory, regardless of restrictions. Abortion pills cost anywhere from $40 to $600 or more, and online pharmacies and telehealth abortion services charge $150 and up. For those who can't travel or take time off work, abortion pills through Plan C could be an option, though cost and availability vary depending on state and provider regulations.
But given many states' harsh legal penalties, anyone seeking to terminate a pregnancy should exercise caution. For example, in Texas, helping someone seek an abortion after six weeks could lead to a civil lawsuit with minimum damages of $10,000. And the use of telemedicine to prescribe medication for abortion is already restricted or banned in at least 20 states, according to the Guttmacher Institute.
In the post-Roe terrain, the divide between the haves and have-nots is only increasing, according to Baker. In states that support reproductive rights and telemedicine, abortion is becoming more accessible. But in states where abortion is banned, reproductive care is more difficult and expensive -- and even if you can obtain an abortion somewhere else, you can't always afford to get there.
If someone needs or wants an abortion but can't get one, it can have devastating, long-term emotional and economic consequences on the entire household, including the child, Baker noted. A study co-authored by researcher Diana Greene Foster entitled The Economic Consequences of Being Denied an Abortion found that patients who were denied abortion saw their overdue debts climb by almost 80% in the years following birth, with higher rates of bankruptcies and evictions, and were at greater risk of poverty compared to those allowed to have an abortion.
In a country where nearly half of all workers are in low-wage jobs and where child care is out of reach for millions, the lack of abortion access severely impacts women's educational and employment outcomes. As Baker pointed out, "The greatest cost of all is being denied an abortion and having to carry to term a pregnancy that's unwanted."
This article was edited by CNET's Laura Michelle Davis.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.