Abortion Hotlines Feel the Crunch

"It's a sad calculus ... It helps if they are farther along in pregnancy rather than earlier. Or if they are living with their batterer, and he would know if they'd pawn anything. Or, if they are homeless ... like we got this call last week from a woman whose house burned down and her three children were taken away. We were able to get some money for her."

Laura, the case manager at the hotline of the National Abortion Federation, is explaining to me the triage that occurs in the effort to help desperate women raise money for abortions they can't afford. Most of the hotline's approximately 100 callers per day are simply looking for a referral to an abortion provider in their area. But a sizable minority seek the hotline's assistance in raising money from the various nonprofit abortion funds around the country and from NAF's own small discretionary fund.

Because there is not enough money to go around, being poor is not enough. "You have to have 'extenuating circumstances'" Laura says. Not surprisingly, rape is one such extenuating circumstance which the various abortion funds respond to. In fact, if state governments were obeying the law, the hotline would have to raise far less money for rape victims. The Hyde Amendment, a measure passed in Congress shortly after Roe v. Wade, forbids the use of Medicaid funds to pay for abortions but makes exceptions for rape, incest and threats to the life of the mother. Many of those rape survivors who asking the hotline for help are on Medicaid.

The problem however is that numerous state Medicaid programs simply refuse to enforce this provision. Fighting with anti-abortion state bureaucrats often drags on indefinitely and pushes women later into pregnancy — making the procedure even more expensive and a provider more difficult to find. Therefore last year nearly 28 percent of the $136,000 that the hotline helped raise went to those who are theoretically eligible for state funding.

But even those sufficiently high on the "extenuating circumstances" spectrum to qualify for financial aid often don't get enough to pay for their abortion. First trimester abortions costs range from about $300 to $500. Second trimester ones can cost over $2,000. As I sit and listen to Laura work the phones nonstop, I realize that much of what she does is a quite unique, and certainly challenging, form of financial counseling. Her task is to instruct her often indigent callers in the delicate art of fundraising.

"Could you ask your friends for $40? If they say 'no,' maybe ask for 20 or even 10?" I hear her ask in her calm voice. Later she tells me that this woman has been evicted from her house for lack of rent, and is crashing with her three children at a friend's. To another caller, I hear her say, "Well, do you have anything you might pawn? Some jewelry? A TV set?" And to another, "Is it possible you could postpone your car payment until after the abortion?"

Laura's case management is strikingly labor intensive. She averages about 15 phone calls per case -- with the client herself, with the various abortion funds, with the clinic that is the potential site of the abortion -- whether in the end the woman successfully obtains sufficient funds for an abortion or not.

After blocking the callers' names and other identifying information, Laura shows me some of the intake forms of the past month. The meticulously kept log of each call made or received hints at lives lived at the edge. For example, in response to the item on the form that asks about possible funds to be raised from the "man involved with pregnancy," I see the stark one-word response, "Crackhead,” recorded verbatim by a hotline staffer while talking to the patient. "No idea where he is," reads another response, and a third, "Has nothing." The hotline staff assures me, however, that there are numerous instances of "good guys" -- fathers and husbands and boyfriends -- who actively participate in the search for funding.