Need An Abortion In Texas? Don’t Be Poor

For women struggling to pay for abortions, the Lilith Fund bridges personal choice and financial reality. But the Texas Legislature is poised to make abortion access even harder.
by Published on
Pregnancy test
Photo by Thinkstock

In a sun-filled home office in Austin, a voicemail crackles to life and the pleas for help begin. “I’m eight-and-a-half weeks along. My appointment is tomorrow. I’m in desperate need. It’s safe to leave a detailed message.” Beep.

“Hi, my name is [Sabine]. I’m 21 weeks. I’m going in tomorrow. You can leave me a message.” Beep.

“My name is [Gabriela]. My appointment is next Friday. You can leave a message. I’m about 10 or 11 weeks. I cannot continue with this pregnancy, because I already have four babies. I’m in school trying to get my certificate. It’s impossible for me to have another baby right now. … If you can help me I’d really appreciate it.” Beep.

Kat Craft cocks her head as she listens to each message. “[Sabine], 21 weeks,” she whispers to herself as she taps details into a spreadsheet. “[Gabriela]: Four kids. Didn’t say we could leave a message. [Alisha]: 15 weeks, needs $100. [Rachel]: Nine weeks. This is her third time calling.” She works rapidly to capture each woman’s predicament. As Craft types, the disembodied voices of desperate strangers—fragile and breathy, resigned and confident and tearful—fill the intimate space of her home office, a small room crammed with a desk, a music keyboard, neatly labeled box files and a friendly dog on the rug. Today there are 19 messages. Within half an hour, Craft’s spreadsheet is filled with names, dates and short summaries of why they need help.

Collateral Damage logoCraft works for the Lilith Fund, a volunteer-run organization that gives small grants to women seeking an abortion. It was founded in 2001 by a group of volunteers from the nonprofit, legal and medical fields. They raised $10,000 at the outset and began providing English- and Spanish-language counseling for women needing financial help to have an abortion. The group now has close to 30 volunteers fielding roughly 3,500 calls per year on its hotlines, which cater to women in South Texas. (Another abortion fund, the Texas Equal Access Fund, serves North Texas.) A pre-recorded message tells callers to leave their name, number, appointment date, how many weeks pregnant they are, and to state whether case managers can leave a message on their voicemail. “If they don’t say that it’s safe, then we don’t leave a message,” Craft says. It’s all governed by president Amelia Long and 14 volunteer board members. Kat Craft is the only paid staff member.

If a woman calls the Lilith Fund hotline, it’s because she wants an abortion but can’t afford one. For these women, the gap between their choice and what is economically realistic is wide. In Texas, the price of an abortion ranges from about $450 to $3,000, depending on how advanced the pregnancy is. For low-income women already struggling with rent, transportation, utilities and childcare (more than half of abortion-seeking women already have children), that sum is out of reach. Economic barriers to abortion are disproportionately high for African-American and Latina women. Long, the Lilith Fund president, noted that 85 percent of the group’s clients are women of color. Last year, the Lilith Fund granted money to 1,214 women—just a third of the women who called.

Having an abortion is expensive, even for women with health insurance. Though some private insurance plans cover the procedure, many abortion clinics require patients to pay up front. The Guttmacher Institute reports that two out of three women pay out of pocket for abortion, a significant challenge for the 69 percent of abortion-seeking women who are economically disadvantaged. The inequalities have grown since the 1977 Hyde amendment forbade Medicaid from paying for abortion in all but cases of rape, incest or life endangerment. As a result, the National Network of Abortion Funds estimates that nationwide more than 200,000 women a year need help paying for an abortion, and that a quarter of the pregnant women on Medicaid seeking an abortion are forced to continue with unwanted pregnancies because of financial barriers—births ultimately covered by taxpayers. To pay for an abortion, the Network notes, “low-income women sell their belongings, go hungry for weeks as they save up their grocery money, or risk evictions by using their rent money.” Low-income women are also more likely to be black or Latina, creating a triple-whammy of poverty, racial inequality and reduced abortion access, meaning that the most-vulnerable women have the least control over their reproductive health.

But nudging abortion further out of reach has become the favored strategy of anti-abortion legislators, especially in Texas. In 2004, the state forced clinics providing abortions after 16 weeks’ gestation to meet the same standards as ambulatory surgical centers. Theodore Joyce, a professor of economics at Baruch College of the City University of New York, studied the law’s effect on abortion providers and found that the following year, the number of women leaving Texas for later-term terminations increased fourfold. In 2005, the Texas Legislature enacted a law requiring minors to gain parental consent before having an abortion. Tina Hester, executive director of Jane’s Due Process, an organization that provides legal help for pregnant minors, noted that the requirements create significant barriers for teens. They must now navigate the court system if they wish to terminate a pregnancy without telling a parent. More recently, a 2012 law mandates that women undergo a 24-hour wait and a sonogram, which researchers at the University of Texas say increases costs for women. Meanwhile, in 2011, the Legislature slashed the publicly funded family-planning budget by two-thirds. Public health experts warned that the resulting loss in family-planning services would lead to more unintended pregnancies and more low-income women seeking abortions. To intensify poor women’s difficulties, in the current legislative session a host of anti-abortion bills under consideration would force many clinics to close and drive up prices for those that remain. In Texas, abortion is increasingly an option only for the rich.

 Kat Craft
Jen Reel
Kat Craft

An expensive wait
Craft runs her finger down each line of her spreadsheet, deciding which calls to prioritize. Today’s 19 callers need a total of more than $4,500, but Craft has only $600 to give. She murmurs to herself: “I’ll call the 17-weeks one, the woman with four kids, the 15-weeks one, the 21-weeks one, the woman who needs only $100 more.” She enters the amount she’ll give each caller in her spreadsheet, but a formula turns it red, warning that she’s exceeded her budget. “Who’s not going to get funded?” Craft mutters, leaning toward the screen. A mini version of the spreadsheet flashes in her glasses. “If we just gave her $50? … Okay. Let’s begin.”

Craft does a few stretches before clearing her throat and dialing the number of her highest priority caller. (The Observer has changed the names of women in this story, at the Lilith Fund’s request, to protect the privacy of callers.) “Is that [Sabine]?” Craft says.

“Yes.”

“Hi, it’s Kat from the Lilith Fund. Is now an okay time to talk?”

“Yeah it is.” Sabine sounds self-possessed, as if she were taking a call from a friend.

“Okay, great. So I have here that you are 21 weeks and your appointment is tomorrow and your total procedure cost is going to be $2,670. Is that right?”

“Yes ma’am.”

“Okay. And how much money do you have to contribute toward the total cost?”

“I only have $670.”

Sabine is well into her second trimester. She didn’t say why she’d waited till 21 weeks to have the abortion, and Lilith Fund case workers don’t ask. It’s possible that her fetus has a serious anomaly just discovered at the routine 20-week ultrasound. Or she may fall into one of the determinants identified by a Guttmacher Institute study for having a second-trimester abortion: among other things, being an adolescent, or having experienced recent disruptive life events such as separation, unemployment or childbirth. Rachel Jones, the study’s author, suggests that these groups may have recognized the symptoms of pregnancy later, had a harder time finding information about abortion, or struggled to find the cash for a first-trimester termination. Guttmacher Institute research shows that 70 percent of women who had later-term abortions said that they would prefer to have had an earlier abortion but needed time to raise the money. Abortion-seeking women pay a hefty financial penalty for being poor.

For each week that Sabine delayed getting an abortion, the cost ballooned. Price quotes from two of Planned Parenthood’s abortion-providing affiliates range between $450 and $550 before 12 weeks, about $1,000 at 17 weeks, and roughly $1,600 or more from 18 weeks onward. Planned Parenthood, like most abortion providers, offers financial discounts to low-income clients. Even so, many women, like Sabine, still can’t bridge the gap between what they want and what they can afford.

Craft pauses before delivering the heavy news to Sabine. “We can actually only fund very small amounts. I can offer you $100 to help with this procedure. Do you have the resources to raise the rest of the money?”

“Um, no,” says Sabine. Her voice grows distant.

“Okay, I’m going to ask you some questions about your personal situation,” Craft replies. Working off a script used by all hotline volunteers, Craft prepares to ask Sabine whether she has supportive family or friends, the option of a salary advance, or anything she can pawn. Craft will also refer her to the National Network of Abortion Funds, a fund set up to help women in their second trimesters, but she doesn’t get the chance to do so because Sabine suddenly says that she has to go and hangs up.

“I’ll hold that $100 for her,” Craft says, “just in case she calls back.”

Thank you note written to the Lilith Fund.
Photo courtesy Lilith Fund
Thank you note written to the Lilith Fund.

“I had to tell her because I needed the ride”
Martha, an unemployed mother of two, is 16 weeks pregnant and needs to raise $380 by tomorrow. The abortion clinic has already offered her financial assistance, but she still can’t afford the procedure. The urgency is clear in Martha’s voice. “I want to do this before it gets too far along,” she tells Craft. “If I start feeling it, then I won’t be able to go through with it.” Craft offers her $100 and asks if she has anyone to help her raise the rest. Martha gives a deep sigh. “My mom’s the only one who knows,” she says. “My boyfriend doesn’t work, and he doesn’t even know. I couldn’t ask my mom … she’s already pissed that I’m not working, but I had to tell her because I needed the ride.”

The ride Martha referred to is the 50-mile round trip to the abortion clinic so that she could have a government-mandated sonogram. In January 2012, a law came into effect requiring Texas women seeking abortions to hear a clinician describe the fetus’ physical characteristics and to view it on a screen. They must then wait 24 hours before proceeding with the abortion. The waiting period and mandatory ultrasound has added personal, financial and logistical barriers to getting an abortion. In a 2012 survey conducted by the Texas Policy Evaluation Project at UT-Austin, women had to travel an average of 42 miles to have their consultation. Some traveled more than 400 miles. The research team discovered that almost one-quarter of women found it hard to get to the clinic for the sonogram. On average, the women in the survey spent an extra $146 on travel, accommodation, childcare and lost wages to comply with the sonogram law requirements.

Craft makes a note to send the $100 voucher directly to Martha’s clinic. She breathes deeply before moving on to her next call.

 

Geography is destiny
“Hi Eva, it’s Kat calling from the Lilith Fund. Is now a good time to talk?” Eva confirms that it is, but she is clearly at work because she gives muffled instructions to someone in the background. Eva is a single working mother of two children living in a small rural community. She is 12 weeks pregnant and must travel more than 100 miles to her nearest abortion clinic. Eva needs to raise $300 to pay for the abortion. The loan she’d just applied for was declined.

“Is there anyone else you can ask?” says Craft, patiently waiting to ask her questions during gaps in Eva’s parallel conversation.

“Honestly, everyone’s against what I’m going to do,” Eva says. Her voice is flat, as if she’s discussing someone she barely knows. Craft offers Eva $75 and recommends she ask the clinic for a discount.

For rural women like Eva, geography is often destiny. According to the Guttmacher Institute, 92 percent of Texas counties don’t have any abortion provider. For women past 16 weeks gestation, the problem of access is acute. Following the 2004 ambulatory care center law, there are now only six providers that offer later-term abortions. Women not living in Austin, Houston, Dallas or San Antonio must travel significant distances to receive abortions past 16 weeks; the women more likely to need them are those who couldn’t raise the money in time to do it earlier.

Things could soon get much worse. The Legislature is considering Senate Bill 537, which would force all abortion clinics—even those providing early-term abortions—to comply with the same standards as ambulatory surgical centers. Critics of the bill argue that the law doesn’t improve safety but is rather an effort to close clinics by setting standards that would require costly upgrades. Abortion-rights advocates say only five clinics in the state could meet the surgical center standards. The other 32 clinics would have to either upgrade or shut their doors. In testimony to state senators, Amanda Stevenson, a graduate student researcher with the Texas Policy Evaluation Project, noted that if this were to happen, women not living in one of Texas’ major counties would have to travel 125 miles on average to reach a complying abortion provider.

 

Birth control out of reach
Not long after her local family-planning clinic stopped providing free birth control, June became pregnant. “I had to start paying out of pocket, and I couldn’t afford it,” she tells Craft. June is a 21-year-old community college student and is 15 weeks along. The total cost of her abortion is $660, and she has raised all but the last $100. June tells Craft that she recently lost her job. “I’ve been really stressed out trying to find the money,” she says. Craft offers her a $50 voucher, for which the young woman is profusely grateful.

Craft tells me later that June is her first caller to say she’d become pregnant because she couldn’t afford birth control. But she may not be the last. In 2011, the Legislature voted to defund family-planning clinics, causing many to reduce their hours, charge for services previously free, or close shop. More than 60 family-planning providers have closed—the large majority of them not affiliated with Planned Parenthood, the target of lawmakers’ ire. Affordable contraception is now much harder to find. The Texas Policy Evaluation Project found that 23 percent of the women in its survey had problems accessing birth control due to cost, lack of insurance coverage, or inability to find a clinic. Indeed, The Texas Tribune reports that the Texas Medicaid program is bracing for the cost of an additional 24,000 births as a result of reduced access to family-planning services. Each birth will cost the state roughly $11,000.

Craft finishes the last calls of her shift. Her spreadsheet shows a few green strips for the women she can fund, amid a screen of unfunded red. Craft has spent hours brainstorming fundraising opportunities with women, urging them to advocate for themselves, or simply listening to them talk. She has spent her whole budget but has barely aided the women who can afford neither to terminate or carry to term. Craft pauses to rest, peeling a clementine while staring pensively out the window. The room, brimming with stuff yet immaculately ordered, seems an extension of Craft herself—busy, creative (she also runs theater workshops at the county jail) and practical. She politely bats away my questions about abortion politics, emphasizing that what matters most to her is that she provides direct services—solid, tangible help—to women at a crossroads in their lives.

I later asked Craft what happened to the callers. Lilith Fund records don’t show whether June, the college student who lost access to birth control, went ahead with the abortion, and her phone was switched off. Martha, the woman who needed a ride from her mother, did use the Lilith Fund’s $100 voucher for an abortion. Though she initially agreed to a follow-up interview, she never responded to calls. Eva, the one who lived in the small town, did get an abortion but later couldn’t be reached because her phone had been disconnected.

Sabine, the woman who needed $2,000 by the next day, never called the hotline again.

  • http://twitter.com/sp0ka sp0ka

    Thanks so much for writing this, Ms. Jones. I feel that most Texans do not understand the hurdles faced by these people trying to access care, and that most are also unaware of the sheer cost of an abortion.

    Articles like this serve the necessary and heartbreaking purpose of showcasing our class-segregated healthcare system, based more on politics than helping people, and by doing so offer us a greater chance at changing that system to be beneficial to ALL Texans, rather than just the wealthy or those making choices with which a popular majority agrees.

    Also, many thanks to Kat Craft for being an empathetic and brave person doing this work!

    • astralislux

      Abortion isn’t healthcare.

      • aspee

        Yes, Abortion is healthcare. The fact you do not get this shows how little you understand the human body and what constitutes healthcare. I hope God is more merciful with you then you are with others.

        • DRJJ

          God is clearly against killing children FYI, your hope is misplaced.

          • alym

            Didn’t he set a bear on some children once for making fun of a bald man?

  • http://www.facebook.com/fdelafuente Flavia de la Fuente

    Thank you so, so much for writing this. This is such an incredibly important story and you’ve done an amazing job of telling the stories of real women who need help.

  • http://www.facebook.com/profile.php?id=100003673762361 Swizzle Stix LemNhed

    How do we donate?

  • http://www.facebook.com/heather.busby.359 Heather Busby

    Thank you, Carolyn, for this thoughtful, well-written article on the reality of abortion access for women in Texas!

  • http://twitter.com/missjuliesunday Julie Sunday

    Women in Texas are also more likely to attempt to induce an abortion on their own–the ‘back alley’ continues to be a reality here for women who can’t get the funds together. Thank you, Kat, for your work!!

  • http://twitter.com/MsNovember MsNovember

    Thank you so much for writing this article and illuminating the work that Lilith Fund does, and that Kat in particular shoulders. Many people who consider themselves pro-choice are unaware at just how hard it is to get a legal, safe abortion, and how incredibly expensive it can be. This is a critical issue to our state, our citizens, our families, and our society, and I really appreciate you writing about this. Hopefully, people will donate to Lilith Fund to help others, but it’d be even better if it didn’t have to exist in the first place and people could have access to quality healthcare regardless of their income.

    Also, if you are reading this and you would be a friend, family member or employer who would loan money, help with transportation, help with childcare during the multiple days that Texans need to take off of work to get an abortion, please be vocal about it. Most people who need abortions feel very alone because the opponents are so vocal, and that’s tragic. The majority of Texans support access to contraceptives and abortion, so if you are one of them, please make it known so that if someone you care about is in this situation, they don’t have to feel like they are completely alone. Lilith Fund can only give money for a small amount of the need, and together we can build a society where people don’t have to be afraid of being forced to give birth when they don’t want to or can’t afford to.

  • http://www.facebook.com/carmen.d.llanes Carmen D Llanes Pulido

    Thank you, Carolyn, for this story. Thanks to Kat for being amazing, and for all the people who fund abortion and dispel myths, and shatter stigmas about our reproductive rights. I have been volunteering with the Lilith Fund Spanish hotline for about four months, and every shift I am reminded of how important it is. Please, join the volunteer list, donate generously, and do not be afraid to spread the word.

  • astralislux

    A second chance for life? The baby had no chance.

    • aspee

      A fetus is not a baby. In the Bible and the Torah it says “Then God gave Adam the breath of life”. Even the Bible does not see a fetus as alive as a fetus does not breath air. Actually you can get a recipe for an abortion in the Bible. It’s a stupid one involving dirt but it is in the Bible. Something you would know if you actually READ the whole bible.

    • Cailyn Smith

      I am with you on that one. Why don’t these women especially the one 21 weeks along, more than halfway through a pregnancy opt to have the child adopted? At this point it is a human life albeit unborn. If a woman wants an abortion fine, however there should be a cut off where you don’t get it done before say 10 weeks or so, it can’t be done.

      Too many of these women use it as a birth control method rather than after having 4 plus kids getting fixed so it doesn’t happen if they don’t want more kids. I know that if women used bc 100% of the time 100% correctly the chances of pregnancy are greatly reduced. Also asking their partner or man to put on a condom kind of helps too, but many don’t want to do that. I understand difficult times, but when you are this far along, adoption would have been a far far better option.

      While I don’t agree with them not funding such things, I do agree with lessening it so that maybe less women will go for one and think of possibly having the child adopted.

      Another thought I had is if men had to give birth and carry the child, there would be less pregnancies in the world.

      • Virginia B.

        Neither abortion nor adoption are good options. The only good option is not to get pregnant, but shit happens. Adoption agencies are overrun and underfunded, and it is, in fact, likely that a baby put up for adoption will NOT experience a good life (or at least not better than their mother who could not afford an abortion). An adoptive parent has less incentive to raise a child in a loving, tender, respectful way since they are not biologically related. It’s instinct, pure and simple.

  • http://www.facebook.com/Rainbowwarrior04 Tom Pierce

    I have the solution to the abortion issue.

    STOP FUCKING!

    You are most welcome! :-)

    • http://www.facebook.com/people/Ayinde-Truxon-Flores/1196187056 Ayinde Truxon Flores

      I hope you are practicing celibacy as well.

    • http://www.facebook.com/people/Glenna-Jones-Kachtik/1258771759 Glenna Jones-Kachtik

      Yeah, you let me know how that works out when your significant other/wife/girlfriend tells you NO all the time.

    • http://www.facebook.com/caren.osgood Caren Osgood

      Or you could provide affordable or free women’s healthcare, including birth control pills, and save the government boatloads of dollars in welfare, food stamps, and other costs associated with unplanned pregnancies. Providing planned parenthood services is a whole heck of a lot cheaper than providing for the unwanted kids, and access to birth control results in a lot less abortions, too.

      So perhaps you’d like to explain to me why people are so keen on de-funding planned parenthood, which is MORE costly and actually results in MORE abortions due to lack of availability of affordable birth control pills?

    • http://twitter.com/AdamAWanderer William

      Start teaching people how to “69″ much more often, and several other techniques that don’t result in babies. Or do you object to that as well???

    • Blakely Knight

      Haa!!!! Ya….you first saint stupidass. lmao!!

  • kirsten zielinski

    if you don’t control your body, you control nothing. the law and men should have no say in what a woman does with her body. men will never understand it and use the law for control.

  • http://www.facebook.com/people/Patricia-Neal-Moreno/1617333102 Patricia Neal-Moreno

    There are plenty of people who would love to adopt these unwanted children. Women who have abortions are killing their unborn babies so they can have a better life. If they cannot afford to raise a child then why not let someone else do it? There is no legitimate reason for abortion unless their own lives are in danger such as, an ectopic pregnancy, placenta previa, or some other life threatening condition. Being poor is not a legitimate reason to terminate someone else’s life. This article doesn’t even mention adoption.

    • Guest

      The article doesn’t mention adoption because the women who call an abortion fund hotline are looking for help paying for an abortion.

      For a low-income woman trying to provide for her family and most likely working multiple non-exempt jobs with no benefits or time off, continuing a pregnancy to term truly may not be an option. Not to mention those seeking employment and/or education.

    • Kat

      So in your mind, poor women should be forced to bear children for wealthier women who want them. You think wealthier women who can’t have children should get to control the bodies of poorer women who can. That sounds like it will work out super well for everyone.

      And there are untold numbers of children in the US waiting to be adopted, but they’re not precious widdle babies. They’re children and teenagers who desperately need to get out of foster care and into a safe home. How many of those have YOU adopted?

    • Aquaria

      No, there aren’t plenty of children, you liar.

      There are 400,000 children in foster care at any given time. 25,000 a year age out of the foster system.

      Until all of them are adopted, you have NOTHING to stand on, hypocrite.

      Besides, I’m not a brood mare for people who can’t have kids. Tell them to just deal with being infertile, or adopt some of those foster care kids, rather than thinking that I should pop out a brat simply to fuel their empty-headed, selfish, brainwashed baaaayyyybeee lust.

      • PattyFromTexas

        You’re funny. Your post made me laugh. ” I should pop out a brat simply to fuel their empty-headed, selfish, brainwashed baaaayyyybeee lust.” absolutely hilarious, best satiric comment I’ve read in weeks.

  • Kathleen Kelly

    LOL how much does a condom cost?

  • rogerrramjet

    I do feel for them I do not understand why an abortion is so expensive. Especially in the 2nd Trimester WHY? Just because they can? Are their no volunteer doctors?

    Or is everyone out to just make as much money as possible out of poor women’s misery? Two Thousand Six Hundred Seventy dollars? WHY?

    I don’t even understand five hundred dollars. It is a very short and simple procedure. My niece got pregnant and the local Planned Parenthood (no freebies there) wanted five hundred in cash before they would do the procedure at 12 weeks.

    And then of course once the baby is born the cost from taxpayers will be a thousand times the amount of an abortion and the woman will be attacked for being a welfare queen popping out babies just to get free money from so called hard working real muricuns..

    I just don’t get it.

    • Aquaria

      It’s expensive because there are so few providers, and there are so many legal barriers to overcome. 99% of those problems come from the woman-hating anti-choice crowd. The rest comes from your usual politician idiocy.

  • YellowDog

    I am against abortion but I realize that there are people in some pretty tough situations, I cannot make this decision for a mentally ill person, a rape victim, a scared 12 year old or a woman in any number of difficult situations. Sex education, living wages, access to birth control and access to healthcare for families are better methods than jailing abortion seekers. Why are the anti-choice people also against helping the poor?

    It is possible to be anti-abortion and pro-choice, it just requires empathy.

  • DRJJ

    Pay for your own dang abortions. More than half of us still have a big problem with the pro death world view. Why is it that when a pregnant mother is killed, it’s a double homicide? Any guesses?

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