A Guide to Accessing Abortion Care – Even When It Looks Hard
Let’s say one day you find out you’re pregnant. And let’s say that after considering your options – carrying the pregnancy to term and becoming a parent, adoption, or abortion – you’ve decided that the best choice for you is to terminate your pregnancy. That’s fine! Depending on where you live, though, accessing abortion care could be an issue.
Barriers to access to abortion take many shapes. You might face geographic barriers, meaning that you live in a place where terminating your pregnancy is illegal or severely restricted – or that, despite the law, the objection of doctors or the lack of clinics makes it impossible for you to get an abortion there. There could be time-related barriers: in many cases, national laws establish a number of weeks after which doctors can’t perform abortions. In others, underage people who are pregnant must obtain their parents’ consent if they want to terminate their pregnancy. And you might come up against economic barriers: in some places, obtaining an abortion has a cost that is not always covered by insurance and that can be too high for the person trying to terminate their pregnancy.
Whatever your situation is – don’t give up hope. In many cases, there are systems in place that allow people who can’t otherwise access abortion care to get the medical attention they need in order to obtain a safe and effective procedure. We’re going to go through the obstacles that you might face depending on where you live and what your disposable income is, as well as the different ways around potential access issues.
Breaking down the costs
Standard abortion procedures can be divided into medical and surgical abortions. Medical abortions are obtained by administering a combination of medications - RU486, M&M or the so-called “abortion pills” - that block hormones that are necessary for the pregnancy to grow, stop embryonic cells from multiplying and dividing as they need to to continue a pregnancy, and generate uterine contractions that empty the contents of the uterus. Surgical abortions, on the other hand, mean that the pregnancy is terminated by an experienced doctor with a suction method - either manual vacuum aspiration, dilation and curettage or dilation and evacuation.
The price of both medical and surgical abortions can vary greatly depending on where you live, and doesn’t only include the cost of the procedure itself. You may need childcare as well if you already have children, and you may need to consider the costs of taking time off work, school and other appointments. If you can’t order abortion pills to your home, you’ll also need to factor in how much it will cost you to get to the closest clinic (which could be your local hospital or somewhere hundreds of miles away).
In the United States, the cost of the procedure tends to vary between $500 and over $2,000.: The prices tend to be higher in “hostile” states, where reproductive laws are stricter. Late term abortion procedures are also much more expensive, ranging between $8,000 and over $15,000. And your insurance plan won’t likely cover the whole procedure cost unless the abortion is determined to be “medically necessary.”
In countries where healthcare is free and universal, and where abortions are legal and accessible in public hospitals and clinics, the procedure is theoretically free, or at least refundable. If you live in Europe, this is a great website to check out what the precise policies are in your state.
In the United Kingdom, for example, data suggests that 97% of people who have abortions have their treatment paid for by the National Health Service. In Belgium, abortions are reimbursed if performed in clinics that have signed an agreement with the National Institute for Social Security. Of course, reimbursement models still pose accessibility issues for people who can’t afford to pay for the procedure and then wait to be paid back.
And that’s if you can find someone to perform it: some countries have “conscientious objection” laws, which allows individual doctors to abstain from providing abortions. In Italy, for example, 70% of ob-gyns are objectors, meaning that people who want to terminate their pregnancy often have to travel long distances to obtain abortion care - although the procedure itself is completely free when obtained in a public hospital and the patient’s only cost is the price of the medicine they have to take following the procedure.
Unfortunately, in countries where abortions are illegal or heavily restricted, prices skyrocket – and so does the potential danger to your health and safety. In these countries, people who want to terminate their pregnancy have to face a tough choice: spending money on the transportation, housing, time off work, child care, etc -- not to mention the procedure itself -- involved in traveling to a different country where abortion is legal, or getting an illegal abortion closer to home and taking on higher health risks and the risk of being criminally charged.
But don’t despair: There are a lot of options out there for people facing economic, geographic and temporal barriers to accessing abortion care.
Overcoming the barriers
If abortions are legal in your country (If you’re based in Europe, check out the Europe Abortion Access website), but universal healthcare isn’t, or abortions still have to be paid out-of-pocket, give your insurance company a call and find out what your coverage is. Then, contact the clinic to find out what the cost of the procedure is. Alternatively, in some cases you may have the option of having a medical abortion on your own at home by ordering the mifepristone and Misoprostol pills that are needed to terminate the pregnancy and following the instructions on how to use them. In these cases, the risks are the same as those linked to a miscarriage: unless you run into problems such as high fever or heavy bleeding, it is generally considered to be safe.
If you are having your abortion in a clinic, add in the other side costs that you would have to sustain: transportation to and from the clinic, accommodation and food if you have to stay overnight, childcare costs, and the cost of taking a day off work, among other things. Once you’ve come up with a total figure, decide whether you can afford it on your own. If you don’t think you can, here are some possible solutions.
If you’re comfortable with it and it’s a viable option, discussing your situation with your partner, your friends and/or your family is a good place to start. If you think they would be supportive of your decision and they’d be able to help, you might even consider asking them to help you cover the cost, either by loaning or giving you money directly, or helping out with child care, loaning you a car, etc. They may be really glad you asked and gave them an opportunity to support you.
If you’re still short on funds after appealing to your community, or if asking people you know isn’t an option, your best bet are abortion funds.
There are a great number of abortion funds set up worldwide to provide financial and logistical assistance to people who can’t otherwise afford the costs of an abortion. Most of them serve a particular geographical region, but others work internationally to help people travel abroad to obtain abortions. These groups of people are there to help you juggle and organize all the logistics that could otherwise prove challenging: from travel to childcare, from finding a doula to making sure you have translation services if you have to go to a country where you don’t speak the language, they specialize in helping out people just like you. Funds are usually run by volunteers or by a small staff that takes the calls from people who need a hand.
The way they work changes from association to association, but the basics stay the same: People working with the fund will talk with you privately about what your financial situation is, and to evaluate the estimated cost of your procedure. As the National Network of Abortion Funds’ (NNAF) FAQ section explains “Every fund has a different amount of money and different requirements, and some have no requirements at all. Because every fund is different, the best thing to do is search for your local fund and give them a call”.
In the United States, NNAF unites all of the different local funds throughout the country. In Europe, the UK-based Abortion Support Network mainly helps women from English-speaking countries where abortion is still illegal, such as Northern Ireland, Gibraltar and Malta, and there’s a fund called Women on Web that works from Denmark. Women Help Women is targeted especially at underfunded countries around the world and specifically does not provide services to the USA and Canada – but it does answer to emails in English, Spanish, Portuguese, French, Italian, Polish and Thai to provide medical abortion and contraception. The MARIA Abortion Fund for Social Justice provides funds to low-income people seeking abortion in Mexico.
If you call one of these funds and they don’t pick up in person, don’t hang up! Leave a message with all the information relevant to your situation, and your best contact information. They’ll get back to you as soon as they’re able. If the situation is particularly urgent – as it often is – consider contacting more than one fund at once, if you’re eligible. You can sometimes get help from more than one fund.
The funds will give you as much as they can based on your situation, but they may not be able to pay for the whole cost of your abortion. What they’ll do in all cases, though, is provide expertise, knowledge and logistical help to make sure that the procedure is as low stress as possible for you. If you have to travel for care, having a helping hand that’s familiar with the process and already has contacts with good clinics can be a huge help.
As Mara Clark, an expert who has been working for years with the London-based Abortion Support Network, explains, “We don’t ask our clients how they got pregnant or why they want abortions because rich women don’t have to justify this. We only ask how much money they have and we do our best to help make up the difference. There is often an idea that what people need to get an abortion is a ‘cup of tea’ or a ‘shoulder to cry on’ and while some women may want those things, the fact is what they really need is help with logistical support in navigating abortion restrictions”.
Since new, restrictive state laws have threatened access to abortion in the United States, countless people on social media have published posts inviting people who need help terminating their pregnancy to contact them for help with money or logistics. Although the intent of these individuals is certainly praiseworthy, it’s still better to rely on official and established funds that have been doing this job for years and know what to do in specific cases.
“We know how to do this in a way that makes people feel safe – it’s scary for someone to reach out to a stranger on the Internet, and there are risks of people who are not acting in good faith infiltrating these networks. Also, even if they are acting out of the goodness of their hearts, if someone is not familiar with the logistics, they might not be the best advocate or supporter for the person who needs an abortion”, says Lindsay Rodriguez, communications director of the National Network of Abortion Funds.
Whatever situation you’re in, you have the human right to terminate your pregnancy if you want to. Despite the limits that governments may try to place on your reproductive choices, there are always activists and volunteers who are working to help you along a path that could otherwise feel lonely or confusing.
And if you’re not currently considering abortion, and you have the means, you can support people who need to access the procedure by donating to these funds or volunteering yourself!
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- The World's Abortion Laws Map from the Center for Reproductive Rights
- Abortion Clinics Online which offers a database of clinics, both in the United States and internationally