It’s very possible that Vice President Kamala Harris could win the presidency after a campaign heavily focused on abortion rights and pledges to pass federal protections. Pro-choice ballot measures may pass multiple states in what some people are gleefully referring to as “Roevember”—if only, for some, to sell merch. But it’s also looking increasingly likely that multiple all-trimester abortion clinics, which between hype-filled campaign seasons remain the safety net for people turned away elsewhere, could shutter in the next few months. These potential closures include at least one facility set to close by the end of the year; what will follow is a disastrous ripple effect for the clinics that remain. So, yes, if Harris wins, the nation will have averted the likeliest avenues to a threatened national abortion ban. And yet, weeks after a historic Roevember, there could be more people denied abortions than ever before.
This is the paradox of the first presidential election after the Dobbs decision: Record numbers of people say they support abortion rights, and pro-choice candidates and statewide amendments have raked in huge sums of money. But because of a lack of investment in the actual infrastructure of abortion care over decades, the electoral victories we may be on the verge of celebrating won’t prevent clinics from closing their doors. And the closures could come at a time when state bans are pushing abortion-seekers ever later into pregnancy and limiting care for people who get devastating fetal diagnoses.
There are thought to be seven all-trimester clinics in the entire country. DuPont Clinic, an all-trimester provider in Washington, D.C., said it has lost more than $500,000 since July 1 after national groups put strict caps on patient funding. Karishma Oza, DuPont’s director of care coordination, said if that rate of loss continues and they don’t get support to close the funding gap, the clinic will have to close by the end of the year.
“Even though technically the clinic is a for-profit, we were never profitable,” Oza said of the clinic, which opened in 2017. “But now with these cuts, we are going from pay period to pay period.”
December 31 is weeks before Inauguration Day, and even if Harris were to pull off the huge upset of a Democratic trifecta, it would take months to pass federal protections that overturn state bans and reduce the pressure on clinics like DuPont. Even so, that kind of legislation doesn’t help them pay off their debts.
Clinics like DuPont are going on the record about their balance sheets to sound the alarm and call for donors to help preserve meaningful access. Oza urged foundations that care about reproductive rights and have emergency funding available to give directly to all-tri clinics or local abortion funds. “I’m not trying to scare people, but it is very real that clinics will need to shut down if we can’t recuperate some of the losses that we’ve incurred,” she said.
These clinics’ financial devastation is an upstream consequence of the National Abortion Federation and Planned Parenthood capping patient funding at 30 percent of their bill instead of 50 percent. The changes have left local abortion funds unable to fill the gap; as a result, patients are getting pushed to seek care later in pregnancy when procedures are more expensive. It has also meant patients showing up for appointments missing thousands of dollars. Remarkably, Oza said that some of the reproductive health–focused foundations they’ve recently spoken to hadn’t heard about the NAF cuts and resulting budget crisis. “People need to know that this is happening,” she said.
DuPont doesn’t turn away people who show up to their appointments without the means to pay, but offering discounted care over the last four months has put them on the brink of closure. DuPont has established a new 501(c)3 arm called the Lavender Fund, in order to accept charitable donations. It has since received gifts from both individuals and family foundations, but those donations haven’t closed their half-a-million-dollar budget gap.
Dr. Diane Horvath, co-founder and chief medical officer of Partners in Abortion Care in College Park, Maryland, said that before the NAF cuts, some of their patients qualified for 100 percent procedure funding because they were unhoused or they were an adolescent seeking care. “Ninety-plus percent of our patients receive at least some kind of charitable assistance to pay for their care,” she said. The financial hit from NAF was so great that she had to consider in September whether to give staff layoff notices—until the clinic received a grant that provided “a few months of breathing room.” Partners also sent a fundraising plea to its email list of supporters who, just two years ago, came through with funding to help them defray their startup costs.
Now, they have to figure out how to survive before the money runs out. Horvath expressed optimism that Maryland lawmakers could increase the amount Medicaid health insurance reimburses providers for abortion care, and the clinic is considering starting its own 501(c)3 abortion fund, following DuPont’s example. She’s determined to stay open because she knows that once clinics close, they may never reopen: Staff move away, and office space gets rented by new tenants. “The financial barrier to reentry is really, really significant.”
Horvath summarized what’s happening as a squeeze. “The care is very expensive to provide, we’re getting a smaller portion of the fee covered by the funds, and the local funds are all being bled dry because they aren’t getting those ‘rage donations’ anymore,” Horvath said. “We’re all kind of in a really tenuous place—even the clinics that have been around the longer.”
Dr. Warren Hern opened Boulder Abortion Clinic in Colorado back in 1975. He said the combination of Dobbs and the funding cuts this summer has been a “national catastrophe.” More abortion bans are in effect than ever before, and there is less financial help available. “By the time they actually get to somebody, they’re too late to have an abortion in that place, and then they wind up at offices like mine,” Hern said, and more and more patients have multiple medical complications. It’s increasingly difficult to make it all work. “If I didn’t own the building, we’d be out of business,” he said. (Notably, neither DuPont nor Partners own their space; they rent.) Hern’s clinic also recently set up its own abortion fund.
CARE Clinic in Bethesda, Maryland, is the last option for people in the United States because it offers care later than any of the other providers. Pia Yoacham, an assistant clinic administrator, said that before the NAF cuts, it wasn’t uncommon for patients to walk in short anywhere from $2,000 to $4,000—but she could often get the money from abortion funds in a matter of hours. Now if those patients show up without their full balance, the clinic is taking hits of several thousand dollars. Like DuPont, they don’t turn people away over money, and they have long helped people who didn’t meet NAF’s eligibility, which is based on federal poverty levels. Even recently, they had a patient with three jobs who wasn’t eligible because she made too much money, she said. “It’s like, how can you not qualify?”
While Yoacham said she couldn’t speak to the clinic’s larger financial picture, it’s unclear how long they can sustain the current landscape. “At any organization, you’re going to hit a point where you’re like, ‘OK, do we need to let people go? Do we need to stop seeing certain gestations?’” she said.
To Yoacham, any reduction in care would be heartbreaking. CARE sees clients with fetal anomalies, sexual assault survivors as young as 12 years old, and people from Europe, Africa, and Australia. “Our clinic is quite literally the last stop for most of these women,” Yoacham said. “She basically can’t hear ‘no.’ ‘No’ means that she has to be forced to become a mother.”
If even one of these all-trimester clinics closes, the strain would be felt nationwide. Oza pointed to real-life experience during the height of the Covid pandemic when another D.C.-area provider closed for a week. “We couldn’t schedule all of the patients who needed appointments over that week,” she said, and that was before the Dobbs ruling. During a different stretch when another clinic was closed, Oza said they had to refer people across the country for care. “It really does have a ripple effect.”
And any closures could also affect people with wanted pregnancies, as data suggests that, post-Dobbs, more of them are being forced to deliver babies that won’t survive.
A paper published last month in JAMA Pediatrics found that infant mortality has increased nationwide since the Dobbs decision. There are about 250 more infant deaths per month, and about 80 percent of the additional deaths can be attributed to congenital anomalies. The hypothesis is that more people are being forced to give birth to babies that won’t survive. (Earlier research found higher rates of infant death in Texas after its ban took effect in September 2021; this data suggests the 21 state bans are having an impact nationwide.)
Horvath said people should be able to choose whether or not they want to give birth and get neonatal palliative care. “But if that’s not what’s right for you and your family, being forced to continue your pregnancy where your baby is going to be sick enough to die is barbaric.”
Elizabeth Bastias-Butler, director of clinical services at DuPont, said regardless of the reason people need all-trimester care, a lot of them aren’t familiar with why people need it in the first place. “That’s often something that we hear from patients. ‘I never knew this was a possibility,’ or ‘I never thought I’d be here until I needed you all, and I’m glad that you’re here,’” she said. “And it would be devastating to not be there for patients.”
Bastias-Butler said that if Harris wins, the challenge facing abortion providers won’t go away. (If Trump wins, things will obviously get worse.) “People need to donate to their local funds and support access because, even in a Harris administration, the reality is what it is on the ground right now,” she said. “A fear that we have is that people will think, ‘Oh, everything’s OK! It’s going to be fine.’ And the need is so immediate that that is not the case.”
While there is a fundraising campaign for independent clinics—that is, non–Planned Parenthood providers—there was no dedicated fundraising effort for all-trimester clinics until earlier this fall. Fund Later Care is a block-grant program started in September to distribute both individual donations and philanthropic grants to all-tri clinics. It’s a collaboration between Patient Forward, an advocacy group for later abortion-seekers, and Midwest Access Coalition, or MAC, a practical support organization. The coalition is trying to raise $5 million by the end of the year, but they’re about 25 percent of the way to their goal.
MAC executive director Diana Parker-Kafka said protecting these clinics is crucial because they provide “urgent, necessary, complex health care” for people who can’t afford it, the majority of whom are already parents. The national funding cuts have created “a domino effect” that lands at these clinics, and while reproductive rights philanthropists have historically been resistant to paying for direct services, let alone later abortion care, now is the time to step up or to lose these providers, likely for good, she said. And that doesn’t change if Harris wins. “We can’t be complacent,” Parker-Kafka said.
