The National Abortion Federation and its NAF Hotline Fund will now require patients who receive their funding to take both abortion pills in a state where abortion is legal, according to emails sent on Aug. 22 and obtained by The Washington Post. The nonprofit, which is backed largely by billionaire Warren Buffett, helped fund at least 10 percent of all abortions in the U.S. in 2020. The new rules could impact thousands of patients a year, providers say.
Patients in need of abortion funding can either call the NAF’s hotline or request financial help at a clinic authorized to offer support. Under NAF’s new regulations, which go into effect on Aug. 29, patients whose procedures are funded by the NAF will now need to affirm to clinic staff that they will not take their second pill in a state where abortion is illegal.
Clinics need only impose the NAF’s new restrictions on patients who receive NAF funding, according to an email to abortion providers from NAF Hotline Fund Operations Director Chloe Hanson Hebert. The restrictions will disproportionately impact poor women and women of color, several providers said.
These new restrictions go beyond what is explicitly required by abortion bans enacted since Roe was reversed. The various bans in antiabortion states prohibit providers from performing abortions within the state’s borders, but don’t bar providers elsewhere from prescribing pills to out-of-state patients they know will be returning home.
The NAF did not respond to a request for comment about this story. But in earlier interviews, NAF officials have said that they’re struggling to adapt to the changing legal landscape in order to protect the organization and the patients they serve. This latest policy shift highlights 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 already facing steep obstacles to abortion care in the wake of the Supreme Court decision, which has left 1 in 3 women without access to the procedure. The NAF’s restrictions mean that out-of-state patients traveling to receive medication abortion may have to spend up to two additional nights in a hotel, in addition to extra food and child care costs.
“It’s hard enough to make that trip even if you return home the same day,” said an abortion provider in New Mexico who is subject to the NAF’s regulations. Like others interviewed for this story, the provider spoke on the condition of anonymity because approximately 50 percent of their patients rely on NAF funding.
“Now my patients are being further regulated unnecessarily by a so-called ally.”
The new NAF restrictions, the provider added, “look like something that an antiabortion lawyer would write.”
Abortion is now banned in these states. See where laws have changed.
With a $7 million annual budget, the National Abortion Federation partners with hundreds of clinics all over the country — including independent clinics and those affiliated with Planned Parenthood — offering training for staff and security support, among other resources. NAF-affiliated personnel visit member clinics regularly in order to “ensure they provide the highest quality care,” according to the NAF website.
In a mid-July interview with The Post, NAF chief operating officer Veronica Jones acknowledged that the Supreme Court decision had changed the abortion landscape. “Failing 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,” she said, adding that the NAF helped 3,000 people access abortion in the weeks since the Supreme Court ruling.
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 preferring to take pills rather than undergo a surgical procedure.
While both abortion pills — mifepristone and misoprostol — can be taken at the same time if the misoprostol is taken vaginally, this method is far less popular and would made immediate travel risky, providers say, because the patient could begin passing the pregnancy on their way home.
With abortion now banned or mostly banned in 15 states, organizations like the NAF that offer abortion funding play an even more important role in helping patients access care. To get a legal abortion, some patients in antiabortion states have to raise money to travel — sometimes hundreds of miles — in addition to the price of the procedure itself, which costs an average of $500 in the first trimester.
Under the new regulations, providers need to certify that the patient either took the pills at the clinic or promised to take them both in a state where abortion is legal up to the point when the patient received care.
“Lots of patients are [traveling out of state] without telling their community, friends, partners,” said an abortion provider who works in Kansas, where abortion remains legal up to 22 weeks of pregnancy. “The poorest and most disenfranchised patients will need to arrange even more child care, time off work and change their story of what is going on.”
Some abortion providers have grown increasingly skeptical of the NAF since the organization threatened to withdraw funding from any Texas clinic that did not fully comply with the state’s strict ban that took effect last fall, said several abortion providers, some of whom worked in Texas when abortion was still legal there. That 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 she heard about the new policies, Michigan abortion provider Renee Chelian wasn’t surprised: A few weeks after the Supreme Court decision, her clinics started requiring patients to take both pills before leaving the state. Chelian and her staff drafted a form for patients to sign, promising to start and finish their medication abortion in Michigan.
Chelian said she started to worry more about legal liability after an Ohio pharmacist called to inquire about pain medication her clinic had prescribed to an abortion patient who lived in Ohio, where abortion is now banned after six weeks of pregnancy. The pharmacist wanted to know if the patient had a miscarriage.
“We need to do everything we can to make sure NAF is protected, our doctors are protected, and our patients are protected,” Chelian said.
“It’s post-Roe,” she added. “There is nothing that’s safe anymore.”
Christopher Rowland contributed to this report.