Providing abortions rarely paid the bills for Kwajelyn Jackson in 2024.
As the executive director of Feminist Women’s Health Center, an abortion clinic in Atlanta, Georgia, Jackson spent the year navigating Georgia’s six-week abortion ban, dwindling financial support for abortion patients and soaring inflation. The clinic spent more money than it brought in from providing abortions, especially as Jackson strove to pay her staffers a decent wage and the clinic often subsidized the abortions of patients who could not afford to pay.
“Essentially, we are charging about half of what it costs to provide the care,” Jackson said. “Our ability to maintain payroll and our operating expenses on an ongoing basis was really strained for a portion of 2024. We were sort of living paycheck to paycheck.”
Feminist Women’s Health Center is still open, but it’s one of the lucky ones. Over the last year, 11 independent abortion clinics closed, bringing the nationwide total of brick-and-mortar indie clinics in the US to 363, according to a report released on Tuesday morning by the Abortion Care Network (ACN), a network of independent providers. That’s down from more than 500 in 2012.
In the US, “independent” abortion clinics are those not linked to a hospital or run by Planned Parenthood. Their closures can have an outsize impact on abortion access, since independent clinics provide almost 60% of all US abortions, according to the ACN report. More than 60% of the clinics that provide abortions after the first trimester of pregnancy are independently run, as are all of the clinics that perform abortions after 26 weeks. If the US network of independent clinics shrinks further, untold numbers of would-be abortion patients will probably be unable to end their pregnancies.
“Whether it’s abortion bans or extremists outside of the clinic or the financial challenges that come along with having to shift services, move a clinic, comply with new regulations – clinics have been under an enormous amount of financial pressure,” said Jay Thibodeau, communications director for the Abortion Care Network. “The relief that they need is not coming right now.”
In total, 76 independent abortion clinics have closed since the US supreme court overturned Roe v Wade in 2022 and permitted more than a dozen states to ban almost all abortions.But the closures aren’t limited to states with restrictive laws. Of the 11 clinics that shuttered in the last year, eight were located in states with strong abortion protections.
After Roe fell, millions of dollars in donations gushed into the coffers of abortion rights organizations. But in the years since, much of that money has dried up – especially funds going to independent clinics and abortion funds, which help patients pay for the procedure and logistical expenses that may surround it, such as travel and lodging.
Meanwhile, patients’ needs have increased. Despite the clinic closures, US abortion rates have risen over the last two years, largely because people have traveled across state lines for the procedure or accessed abortion pills through tele-health. Medication abortions – which now account for roughly two-thirds of US abortions – require fewer resources to administer and can also be sent through the mail, alleviating the burden on brick-and-mortar clinics.
Still, there is no real replacement for abortion clinics, which provide surgical abortions when medication is not an option, and other services like ultrasounds and counseling.
“As a provider that provides both medication and procedural abortion, we know that people need multiple options,” Jackson said. “Medication abortion is not for everyone.”
Over the summer, as donations slumped, the National Abortion Federation (NAF) announced that it was cutting the financial assistance it offered to abortion patients. Rather than covering 50% of the cost of an abortion in most states – and 100% in some states, including Georgia – NAF started covering only 30%.
A few weeks later, an organization called Resources for Abortion Delivery ended The Access Fund (TAF), another program that helped pay for abortions, providing about $1m in funding each month, according to the Nation. A Resources for Abortion Delivery staffer declined the Guardian’s request for comment on why the organization ended the program. “As a policy, we do not provide comments to the press,” the staffer said in an email.
For Feminist Women’s Health Center, these policy changes dramatically affected their work.
“Our patients were basically getting free care,” Jackson said. “Now most patients are getting about 30% of the cost of their care covered by NAF funding and then other abortion funds are trying their best to fill in some more of that gap.”
Economic forces have made things worse. In part because about half of abortion patients live below the federal poverty line, providers have kept the cost of abortions relatively low. But inflation has led the cost of everything else to surge. If Jackson were to charge patients the true cost of performing an abortion – including the cost of equipment and labor – she says she would probably have to double the clinic’s prices.
Another source of strain is fatigue among would-be donors, more than two years after the fall of Roe. The Abortion Care Network has, for several years, run a fundraising campaign called Keep Our Clinics, which helps clinics pay for rent, security, legal costs and other services. In 2022, the campaign raised $5m. In 2023, it raised $3m.
“We can’t sustain an entire system of healthcare on people donating a little bit at a time,” Thibodeau said. “We need enormous system change.”
