About every other day in Alabama, a woman suspecting she is pregnant seeks abortion counseling at an Alabama clinic without knowing how far into the pregnancy she is. She may be a mother with three young children at home. She might be in an abusive relationship. Or perhaps she is a student who someday wants children — just not now.
Once a clinic nurse determines the approximate stage of the pregnancy, she will refer the patient to an out-of-state abortion facility where the procedure is still legal. Meanwhile, staff at the Birmingham-based Yellowhammer Fund would work to guarantee a financial contribution for her travel, hotel and child care costs, if necessary, and cobble together funding for the abortion care from additional funding sources. Yellowhammer’s work is a lifeline for pregnant people in Alabama, providing grassroots support and resources when they need it most.
This kind of crucial financial and logistical support to patients seeking out-of-state abortion care would not be possible if not for a favorable March 31 court ruling in Yellowhammer Fund v. Marshall. The decision affirmed the rights of advocacy groups to assist those in need without fear of prosecution, marking a significant victory for reproductive justice and civil liberties.
In its 2023 lawsuit, Yellowhammer argued that Alabama Attorney General Steve Marshall’s threats to prosecute abortion funds for helping people travel out of state to obtain lawful abortions violated its constitutional rights to interstate travel, free speech and expressive conduct. The court agreed, and after the ruling Yellowhammer restarted this assistance, after nearly three years of fear of prosecution kept the abortion fund dormant.
Despite a decisive win, the state’s abortion ban still forces Alabamians who seek abortions to travel to other states for care, where they may need to submit to exhausting, panic-inducing and lengthy obstacles when even a day’s delay can disqualify them for the procedure in that state and require additional travel.
No other circumstance in health care in this country asks citizens to flee their home state to access care and makes geography a privilege.”
— Andrea Gallegos, executive director of the Alamo Women’s Clinic in Carbondale, Illinois
“Systemic barriers to abortion across the Southeast leave pregnant people with no option but to travel, even when help with funding and logistics is available,” said Krista Dolan, a senior supervising attorney in the Southern Poverty Law Center’s Criminal Legal System Reform litigation team. The SPLC co-counseled the lawsuit with The Lawyering Project.
In states like Alabama, where abortion is illegal and attorneys general are eager to prosecute, nonprofit organizations are bridging the medical-care chasm that geography has created for women, especially in the Deep South.
“The state wasn’t going after gambling, smoking weed, bachelor parties in Las Vegas,” said Kelsea McLain, health care access director of the Yellowhammer Fund. “But they were going after people who were driving out of state to access medical care. We knew it was going to be an uphill battle, because the AG wouldn’t roll over. And it was clear that he was targeting us because he didn’t like what we were doing.”
Heavy burdens
A person seeking an abortion often wants their partner to remain unaware of the pregnancy, according to several people interviewed for this story. No one who has undergone an abortion since the ruling wanted to be identified for fear of legal or social repercussions.
Andrea Gallegos, executive director of the Alamo Women’s Clinic in Carbondale, Illinois, one of the clinics receiving Yellowhammer clients, said it’s not uncommon for a patient to cry before the procedure, telling her nurse that her abusive partner would forbid it if he knew. Fortunately, staff at clinics active in the reproductive sphere ask few questions about a patient’s personal circumstances except those necessary to keep her safe and healthy during and after the procedure.
The assurance of privacy removes a heavy burden from the patient’s shoulders, but in the Deep South, those who must travel for an abortion due to their state’s abortion ban or gestational limits face traumatic hurdles before obtaining the procedure.
Allowing no exemption for rape and/or incest, Alabama law makes intentionally performing an abortion in the state a Class A felony that carries a prison sentence of 10 years to life and a fine of up to $60,000.
More stressed, more exhausted
Alabama banned abortion with few exceptions on June 24, 2022 — the same day the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization that abortion was not a constitutional right but a decision left to states.
After the ban, Attorney General Steve Marshall repeatedly and publicly threatened during interviews that his office would criminally prosecute any organizations or operations that provided aid — including financial or travel support — to individuals seeking lawful out-of-state abortions. During one August 2022 interview, he made an unmistakable reference to Yellowhammer.
170number of abortion clients helped by Yellowhammer Funds since the March 31 court ruling
As before Dobbs, the majority of abortion patients in the Deep South are Black, but they hail from all socioeconomic backgrounds, are at every stage of reproductive age and are already mothers. Some fetuses have known abnormalities as early as the first trimester, when most abortions are performed. But some pregnant people in states that ban or restrict abortion don’t learn this news until a late-term examination at their out-of-state clinic appointment. If the patient is too sick, the clinic will refer them to a hospital or call an ambulance.
“After Dobbs, we knew a lot of people were going to be forced to bear children against their will,” McLain said. “Even before Dobbs, when someone could still have an abortion in Alabama, sometimes people couldn’t travel three hours to get here. The minute the Supreme Court made the ruling, we ceased performing abortions and leaned into our family justice program.” The program provides material support to pregnant people and parents in the way of diapers, hygiene products and more.
Since the March 31 court ruling, Yellowhammer Fund has helped about 170 abortion clients. Depending on the patient’s stage of pregnancy, it sends clients to out-of-state clinics, primarily in Illinois, Georgia and the Washington metropolitan area that includes portions of Maryland and Virginia. Other referred clinics are in North Carolina and as far away as Colorado, but each state has its own legal abortion requirements the patient must navigate.
“No other circumstance in health care in this country asks citizens to flee their home state to access care and makes geography a privilege,” said Gallegos. Between Jan. 1 and June 30 of this year, Alamo provided abortions to 94 Alabamians.
Alabamians who travel to A Preferred Women’s Health Center (APWHC) in North Carolina, where abortion is legal up to 12.6 weeks, are forced to attend two separate appointments: one to undergo state-mandated informed consent counseling and any pre-procedure testing, and a second at least 72 hours later to complete the abortion. Calla Hales, executive director of APWHC, said that between Jan. 1, 2024, and May of this year, 1,606 Alabamians had abortions at an APWHC facility, 99.6% of whom received assistance from an abortion fund to pay for their care.
Georgia only allows abortion prior to fetal cardiac activity, which begins about six weeks after conception. Patients must wait 24 hours for abortion counseling. Florida also has a ban on abortions after six weeks.
“Patients might arrive for their appointment at 9 a.m. but they may have left their house at 2 a.m. and drove nonstop and then have to turn around and drive back home,” Gallegos said. “And if the patient knows they will be sedated during the procedure and arranges for a driver — a family member or friend or friend of a friend — if the driver backs out at the last minute, they are forced to reschedule for another day. … It’s inhumane. Pregnant people are being treated like second-class citizens.”
‘Angry at the system’
Clinic directors interviewed for this story agreed that patients who are forced to travel out of state are more stressed, more exhausted, more panic-stricken and often further along in their pregnancies due to delays. They may arrive sicker, too, if they are further along in the pregnancy.
Yellowhammer now allocates, on average, an extra $500 to $1,000 per client for travel, hotel and gas money compared to its pre-Dobbs decision expenditure.
The clinic directors all said they have seen an upward trend in abortion patients from the Deep South since the ruling. The numbers from 2024 were comparably high due to the impending end of the federal Resources for Abortion Delivery program on Sept. 1, 2024. The program’s Pregnancy Access Fund began in 2016 and paid for abortions for patients with low incomes and with under 12 weeks of pregnancy who needed to travel from states with abortion bans.
Morgan Nuzzo is executive director of Partners in Abortion Care in Baltimore, Maryland. Abortion is legal in Maryland at all stages, and in February, Gov. Wes Moore signed the first legislation in the nation to provide grants to improve abortion care clinical services for Marylanders. Nuzzo’s clinic is one of the few in the world that serves later abortion patients between 20 and 34 weeks and zero days.
“Patients come here angry at the system that has delayed their access to care,” Nuzzo said. “A patient came in last week from Florida. They had all the tests they could to determine the health of the pregnancy. She was so angry she had to leave her community to get an abortion.”
Image at top: The Alamo Women’s Clinic in Carbondale, Illinois, among the clinics where Alabama-based Yellowhammer Fund refers clients. (Credit: Andrea Gallegos)