Comment New restrictions from one of the nation’s largest abortion funding agencies could add new hurdles for many patients in anti-abortion states seeking the procedure elsewhere-somewhere else. From Roe v. Wade overturned in June, patients have flooded clinics in states where abortion is legal — with many driving long distances to obtain medical abortion, a two-part regimen that includes mifepristone and misoprostol. These patients usually receive mifepristone at the clinic before driving home with the misoprostol, which should be taken between 24 and 48 hours later. The National Abortion Federation and its NAF Hotline Fund will now require patients receiving their funding to get both abortion pills in a state where abortion is legal, according to emails sent Aug. 22 and obtained by the Washington Post. The nonprofit, which is heavily backed by billionaire Warren Buffett, helped finance at least 10 percent of all abortions in the U.S. by 2020. The new rules could affect thousands of patients a year, providers say. Patients who need funding for abortions can either call the NAF hotline or apply for financial assistance at clinic authorized to offer support. Under the new NAF regulations, which come into effect on August 29, patients whose procedures are funded by the NAF will now have to confirm to clinic staff that they won’t take their second pill in a state where abortion is illegal. Clinics need only enforce the new NAF restrictions on patients receiving NAF funding, according to an email to abortion providers from NAF Hotline Fund Director of Operations Chloe Hanson Hebert. The restrictions would disproportionately affect poor women and women of color, several providers said. These new restrictions go beyond what is expressly required by abortion bans enacted since then Roe reversed. Various state anti-abortion bans prohibit providers from performing abortions within state borders, but do not prevent providers elsewhere from prescribing pills to out-of-state patients they know will return home. NAF did not respond to a request for comment on this story. But in previous interviews, NAF officials have said they are struggling to adapt to the changing legal landscape in order to protect the agency and the patients they serve. This latest policy change underscores the ripple effects of the Dobbs decision, which has created widespread uncertainty about how state laws will be enforced, even against providers and doctors in states where abortion is legal. Some abortion providers and advocates say the restrictions are unnecessary and burdensome for patients who already face steep barriers to abortion care after the Supreme Court ruling, which left 1 in 3 women without access to the procedure. NAF restrictions mean that out-of-state patients traveling to receive a medical abortion may have to spend up to two additional nights in a hotel, in addition to additional food and child care costs. “It’s hard enough to make that trip even if you get home the same day,” said one New Mexico abortion provider subject to NAF regulations. Like others interviewed for this story, the provider spoke on condition of anonymity because about 50 percent of their patients rely on NAF funding. “Now my patients are being further screened unnecessarily by a so-called ally.” The new NAF restrictions, the provider added, “sound like something an anti-abortion lawyer would write.” Abortions are now banned in these states. See where the laws have changed. With an annual budget of $7 million, the National Abortion Federation works with hundreds of clinics across the country — including independent clinics and those affiliated with Planned Parenthood — offering staff training and safety support, among other resources. NAF-affiliated staff regularly visit member clinics to “ensure they are providing the highest quality of care,” according to the NAF website. In a mid-July interview with The Post, NAF CEO Veronica Jones acknowledged that the Supreme Court decision changed the abortion landscape. “Failure to incorporate this new reality into our decision-making would put our entire operation at risk, ultimately leaving hundreds of thousands without access to care,” he said, adding that NAF had helped 3,000 people access abortion in the weeks since Supreme Court. decision. Medication abortions now account for more than 50 percent of abortion procedures in the United States, according to NAF estimates and data from the Guttmacher Institute, a research organization that supports abortion rights—with many patients choosing to take pills rather than undergo in surgery. While both abortion pills — mifepristone and misoprostol — can be taken at the same time if the misoprostol is taken vaginally, that method is much less popular and would make immediate travel dangerous, providers say, because the patient could start passing the pregnancy on the way. Home. With abortion now banned or mostly banned in 15 states, organizations like NAF that offer abortion funding play an even more important role in helping patients access care. To get a legal abortion, some patients in anti-abortion states must raise money to travel — sometimes hundreds of miles — on top of the price of the procedure itself, which costs an average of $500 in the first trimester. Under the new regulations, providers must certify that the patient either took the pills at the clinic or promised to take both in a state where abortion is legal by the time the patient received care. “Many patients are [traveling out of state] without telling their community, their friends, their partners,” said an abortion provider who works in her Kansas, where abortion remains legal up to 22 weeks of pregnancy. “Poorer and more disadvantaged patients will need to arrange even more childcare, time off work and change their story about what’s going on.” Some abortion providers have grown increasingly skeptical of NAF since the agency threatened to pull funding from any Texas clinic that did not fully comply with the state’s strict ban that took effect last fall, several abortion providers said, some of whom worked in Texas when abortion was still legal there. This decision, first reported by Jezebel, prevented legal challenges that could have led to an injunction and allowed abortions to continue as normal. Some abortion providers say they understand the NAF’s decision. When Michigan abortion provider Renee Chelian heard about the new policies, she wasn’t surprised: Within weeks of the Supreme Court’s ruling, her clinics began requiring patients to take both pills before leaving the state. Chelian and her staff put together a form for patients to sign, promising to start and complete their medical abortion in Michigan. Chelian said she became more concerned about legal liability after an Ohio pharmacist called to ask about the pain medication her clinic had prescribed to an abortion patient who lived in Ohio, where abortion is now prohibited after six weeks of pregnancy. The pharmacist wanted to know if the patient had a miscarriage. “We have to do everything we can to make sure NAF is protected, our doctors and our patients are protected,” Chelian said. “It’s after-Roe,” she added. “Nothing is safe anymore.” Christopher Rowland contributed to this report.
