Loans and pawned belongings: abortion patients are increasingly going into debt | Roe v Wade

Early this fall, a woman desperate for an abortion messaged the Wild West Access Fund, an abortion fund in Nevada, asking for support. She guessed she was nearly 20 weeks pregnant and didn’t have even a few hundred dollars to spend on the procedure. She wanted to prove she was doing everything she could to raise the money, and said she was trying to pawn her vehicle.

Over the next few weeks she bounced from clinic to clinic, trying to put the money together as the price of the abortion she sought continued to increase. The cost of a first trimester abortion is about $500, around $2,000 in the second, and a third trimester abortion can range from a few thousand dollars to around $25,000. Since the US supreme court eliminated federal protections for abortion, more than a dozen states banned the procedure completely, while others set gestational limits, increasing travel costs for pregnant people in those states.

The woman eventually stopped replying to messages, and the fund workers don’t know if she ever received her abortion. Macy Haverda, executive director of the Wild West Access Fund, told me that even for a $600 procedure, “we have had a lot of clients that talk about having to sell off their belongings.”

Abortion debt is increasingly part of the abortion landscape, whether in the form of pawning possessions, putting procedures on credit cards or taking out loans. I spoke with three different clinics, two abortion funds and several organizers – all of them have identified more debt burden falling on patients since Roe v Wade was overturned in 2022.

To call attention to the problem, the Debt Collective, a union of debtors that has challenged the validity of student and medical debt, announced on Monday a grant of $50,000 to a group of abortion funds – organizations that help people pay for abortions and costs surrounding them, such as travel and lodging. “The Debt Collective believes that abortion access is a health justice issue,” said collective co-founder Astra Taylor in a statement. “High costs, including the costs of treatment and travel, are effectively a second ban on care.”

Politically, abortion access and medical debt relief are both popular. Abortion rights ballot measures outperformed Democrats in the 2024 election, and medical debt, which plagues over 100 million Americans, is part of a for-profit system so loathed that the recent assassination of a health insurance CEO drew cheers nationwide. Lindsey Muniak, who runs the Debt Collective’s medical debt project, has described her own experience with hospital bills as “a constricting snake, a boa or a python”.

No one has measured abortion debt on a national scale. While healthcare debt is often measured (inadequately) using credit bureau data that relies on unpaid bills, abortion clinics rarely bill their clients – instead taking money upfront so as not to violate their privacy later. On credit card statements, many additional costs associated with abortion look benign: travel to New Mexico or to Oregon, a hotel room for two days, takeout ordered in New York City or Baltimore.

But while the precise scope of the problem is unknown, the abortion fund workers and clinic workers I spoke to for this story affirmed that as costs rise, patients are going deeper into debt.

Part of the problem is that the network of funding sources is contracting. Large advocacy organizations such as Planned Parenthood are spending millions on political campaigns while cutting financial aid to people who need abortions. At the same time, donations to abortion funds have declined and costs are rising as bans force people to travel further for procedures pushed into later stages of pregnancy.

“Folks are going into medical debt to pay for these procedures that they otherwise might have been able to access when they were cheaper,” said Lucy Font, manager of patient advocacy and coordination at the Maryland clinic Partners in Abortion Care. The result, she says, is that while other sorts of patients might borrow money from loved ones, “abortion is so highly stigmatized and now criminalized in so many places, patients are feeling really scared about revealing their pregnancy to people.” As a result, “they’re stuck borrowing it through their banks or taking out payday loans.”

That patients need to fall back on bad loans is hardly surprising. A study based on data collected before the 2022 ruling in Dobbs v Jackson Women’s Health Organization showed that for over 40% of abortion patients, the procedure resulted in what experts call “catastrophic health expenditures”, defined as 40% or more of participants’ ability to pay. After Dobbs, state abortion bans increased the distance that patients have to travel by hundreds of miles, bringing average travel costs well over $1,000. The Hyde amendment, a law prohibiting federal funds from paying for abortions, means that Medicaid does not cover abortions unless states contribute their own funds. Some states do, but the reimbursement rates vary widely and can be extremely low.

Abortion funds, of which there are over a hundred in the United States, are mostly independent grassroots organizations sustained by donations and operating on shoestring budgets. Destini Spaeth, a care coordinator with the Prairie Abortion Fund based in North Dakota, said she helped one patient pay off a $4,500 abortion payment that she’d put on a credit card. Haverda and Spaeth often participate in what abortion funds call “solidarity pledges” in which multiple funds cobble together money for one person’s abortion. Destini said she’s seen as many as 15 funds come together to pay for a later-stage abortion. They’re all stretched to the breaking point.

Victoria, a woman in her 30s who has worked with the Debt Collective, experienced the debt that can ensue when abortion funds have to triage. (She asked to use only her first name in talking about her medical history.) Victoria was studying in New York City for the bar exam when she discovered she was pregnant in 2021. The abortion added hundreds of dollars of medical debt, paid on credit cards, to Victoria’s education debt. “All of our debt,” Victoria said, “is actually connected.”

The clinics that often shoulder the burden are also struggling. Independent clinics perform more than half of all in-clinic abortion care, and over 80% for abortions over 22 weeks. Their margins are razor thin. As payments from patients disappear due to abortion bans and abortion funding cutbacks their numbers have been in free fall: 76 such clinics have closed since Dobbs. Many clinics regularly discount care for desperate patients leading to deficits on the clinic’s side of the ledger. Font at Partners clinic noted that they see a lot of young people, who are less likely to know when they’re pregnant, and disproportionately likely to be survivors of incest or sexual assault.

How much discounting can clinics survive? Since 1 July, Partners has discounted over $80,000 in costs. In late August, “we met with our accountants,” Font said, “and we thought that if we had continued at the rate that we were going, we would not have been operational past mid-October of now, right now of this year.” In the end, philanthropists helped them fill the hole.

All of this points to a different kind of debt: that of society to the organizations that are providing health care to thousands of pregnant Americans. In April, Polish abortion activists presented a symbolic bill of €11.5m to the country’s parliament, for the activist money and labor that had gone into providing abortion care to Polish people under extremely restrictive conditions. Should activists in the US do the same, one can easily imagine the bill many times that size – the National Network of Abortion Funds alone dispensed over $36m in the year after Dobbs.

The Debt Collective argues that much of the debt people carry should be regarded as a social responsibility. The collective tweeted on Monday: “Abortion is healthcare and healthcare should be free. And that abortion debt is medical debt and medical debt should be canceled and prevented from happening in the first place.”

Maddy Clifford, who works on communications for the Debt Collective, joined because she had six figures of student debt and believed education shouldn’t be a burden. She said she had an abortion nearly 20 years ago in a Seattle clinic called Aradia and got a glimpse of what good healthcare could be like. The feminist doctor and administrators were kind and fit her appointment in right away, she couldn’t pay and didn’t, and the clinic assigned her an abortion doula – someone to be by her side through the process, provide comfort and answer questions.

In 2007, Aradia closed after 30 years – malpractice insurance and rent were up, and too many of their clients couldn’t pay the full fee. “My abortion was free and I want that for everyone,” Clifford told me. She doesn’t want people to have to pawn a car like Haverda’s client, or fall deeper into debt like Victoria. “I’m going to fight alongside them so that they can have it.”