Illustration by Hanna Barczyk.

One afternoon last September, 20 activists logged on to Zoom to learn how to support people who manage their own abortions with pills. Some wore clerical collars; some wore T-shirts. Elaina Ramsey, her black hair piled on her head and a cross visible on the wall behind her, welcomed them with a call for faith communities to fight the stigma around abortion. Then she and a colleague, Kelley Fox, outlined the steps involved in inducing a medication abortion while an orange cat licked its paw in the background of Fox’s screen. Later, in breakout rooms, participants fumbled through a role play, taking turns acting the part of a pastor counseling a desperate woman who is working two jobs and can’t get to the nearest clinic three hours away. Most of the people logged on for the training were from somewhere in Ohio.

“Thank you. I feel much more equipped to help my community!” a youth minister from southwest Ohio typed into the chat afterward.

This training, led by the group Faith Choice Ohio, is the future of abortion rights activism. Already, many people seeking abortions in Ohio have to travel to reach the nearest of the nine remaining clinics in the state, down from 45 two decades ago. In the coming weeks, when the Supreme Court rules in a pending case concerning Mississippi’s 15-week ban, Ohio is expected to heavily restrict if not ban abortion. A draft of the court’s decision leaked by Politico confirms that the justices intend to reverse half a century of precedent, allowing as many as 26 states to ban abortion outright. Ohioans would be forced to travel an average of 186 miles one way to reach the nearest clinic.

Even with Roe in place, abortion has been a state issue. Over the past half-century, almost all of the more than 1,300 restrictions on abortion have been enacted by states, not the federal government. So have almost all of the measures meant to maintain access to abortion. Despite the impending fall of Roe, Congress has so far failed to pass the Women’s Health Protection Act, which would protect the right to legal abortion in every state. This lack of support for abortion in Congress is rooted in the same place where access has always been shaped: state political battles. In the years to come, the struggle to transport abortion patients hundreds of miles to out-of-state appointments, to shore up a waning number of clinics, to elect candidates who support abortion rights, and to push back against efforts to criminalize abortion providers, activists, and patients will take place exactly where it always has: on more than 50 different fronts. Part of this fight is the deep, slow educational work that Ramsey’s organization is doing—organizing that she hopes will not only help people safely access abortion in the short term but will change how people of faith think about abortion in the long term. Part of it is the more immediate task of raising money to get people to appointments, which has long been the realm of abortion funds. Part of it is politics—electing pro-choice candidates and lobbying for measures like Oregon’s creation of a $15 million fund for abortion access or Connecticut’s move to protect providers and patients from anti-abortion laws in other states. And part of it will be the efforts to free people arrested for self-managed abortion—people like Lizelle Herrera, whose arrest in Texas in April galvanized the nation, but only because grassroots groups in South Texas rallied outside the jail and helped provoke a media firestorm that forced the prosecutor to apologize for wrongly charging her.

“How do you disrupt the criminalization of people effectively without being in the community?” Kellie Copeland, executive director of the former NARAL affiliate Pro-Choice Ohio, said. “You can’t do that sitting in an office in D.C.”

Yet state-based organizers face an impending crisis that has come about not only as a result of the Supreme Court’s pending ruling but because the abortion rights movement has underinvested in critical state battles and relied on the inconsistent generosity of a handful of billionaire-backed foundations. Planned Parenthood’s recent announcement that it would spend $16 million on ads to “educate and increase urgency around the abortion access crisis” in states like Arizona, Georgia, Mississippi, Texas, Ohio, and Florida only underscored how much of the movement’s funding remains concentrated in the hands of national organizations. Planned Parenthood’s single ad campaign—albeit one focused on states where access is in jeopardy—cost far more than the entire annual budget of many abortion rights groups. The shortfalls in funding are particularly dire for reproductive justice groups run by women of color that support the people most affected by abortion restrictions and that tackle other urgent issues those communities face, including voting rights and HIV/AIDS.

“We’re working on everything,” Michelle Colon, a cofounder of the Mississippi reproductive justice group Sisters Helping Every Woman Rise and Organize (SHERo), told me. With Mississippi at the center of the Supreme Court case that will fundamentally reshape access to legal abortion by this summer, Colon has been busy. In Mississippi, a state where rates of infant and maternal mortality are among the country’s highest, where the decision not to expand Medicaid has left 13 percent of residents uninsured, and where almost 16 percent of the voting-age Black population has been disenfranchised because of a felony conviction, Colon and her fellow cofounders can’t afford a single-issue fight. “You cannot be someone who says that you’re pro-abortion and you want to protect abortion rights if you’re not someone who’s working to protect and expand voting rights, because they work hand in hand,” Colon said.

But that doesn’t mean SHERo has the money to support its vision. The organization has a budget of less than $100,000. Colon still hasn’t been able to quit her job as a consultant—nor have her two cofounders quit their jobs.

“Just a couple years ago, I didn’t have Internet in my house. I was using the Internet from my neighbor,” Colon said. “For those of us Black and brown people who are doing this work, we often sacrifice ourselves and our well-being and our health care to make sure our movement and our mission is still thriving.”

As the movement faces the fall of Roe, Colon said that pattern needs to end. Making that happen will require an unprecedented investment in state reproductive justice groups.

“A lot of our groups have been organizing on the ground for decades at the local and the state level, and a lot of philanthropic institutions have been single-mindedly focused on the federal level,” said Meenakshi Menon, interim co–executive director at the Groundswell Fund, a major funder of the reproductive justice movement. Perhaps the most compelling recent example is Texas, where state-based groups that tried to stop passage of a six-week abortion ban felt like they were shouting into the void, without the attention or support they needed. The ban has now been in effect for eight months, and money has been pouring in—too late to prevent the crisis.

By contrast, the most successful national abortion rights campaign of the past decade—the effort to repeal the Hyde Amendment, which bans the federal funding of abortion—has involved organizing at the national, state, county, and city levels. While generating support for a bill in Congress to repeal Hyde and successfully pressing President Joe Biden to reverse his support for the ban and omit it from his budget, the national groups All* Above All and the National Institute for Reproductive Health have worked with local organizers to get cities like Austin and New York to direct public funding to abortion access. More than 20 cities and counties have passed resolutions calling for repeal of the Hyde Amendment, including in battleground states like North Carolina and Pennsylvania.

Yet in response to the crisis surrounding abortion access, some national groups appear to be retreating from state fights. The Washington, D.C.–based organizations NARAL Pro-Choice America and the Religious Coalition for Reproductive Choice (RCRC) have chosen to dissolve their state affiliate networks just as the state fight is poised to intensify—baffling state organizers.

“Why, at the point where this has become a state battle, would you disengage your state assets?” asked Ann Hayman, who leads the California affiliate of the RCRC, comparing the decision by the national office to being “dumped.”

As they gear up for their biggest fight in half a century, state abortion rights organizations are networking with one another and finding new ways of operating to sustain themselves for the marathon struggle ahead.

“There are people out here who are working for near-poverty wages carrying this thing on their backs with little support—just grit, determination,” said Pro-Choice Ohio’s Copeland. “A lot of people have been content to allow that to happen. We want to change that.”

Since September 1, when Texas banned abortions after approximately six weeks, New Mexico has seen a sharp increase in out-of-state abortion patients. On the receiving end of this influx is an organization with an annual budget that only recently topped $500,000—thanks to a spike in funding generated by the Texas crisis. The longest-standing abortion fund in the state, the New Mexico Religious Coalition for Reproductive Choice has relied on a roster of volunteers and part-time staff to shepherd patients to one of the few remaining clinics in the country where abortion is available after 24 weeks. It arranges transportation, gives patients care packages containing frozen dinners, microwavable soup, tissues, heating pads, and notes of support from volunteers, and puts them up in a hotel. Since the six-week ban went into effect, the coalition has been helping facilitate airlifts of Texas abortion patients, flying in groups of them on commercial airlines. Now, even as it faces a surge in need for its assistance, the New Mexico RCRC is going through the messier process of what its executive director, Joan Lamunyon Sanford, compared to a “divorce.” The parent organization voted in December to drop its 11 state-based affiliates.

A leading interfaith organization dedicated to mobilizing faith leaders in support of abortion rights, the RCRC grew out of the underground network known as the Clergy Consultation Service on Abortion, which helped people access abortion before it became legal nationwide in 1973. In the years since, the RCRC has rallied faith leaders in support of the right to abortion, conducting clinic blessings and educational programs on the moral case for reproductive freedom. Though the national organization’s support for its state affiliates had been limited at best, Lamunyon Sanford said the “divorce” was still destabilizing.

“The work happens in the states, and our opposition knows that and invests in it deeply,” Lamunyon Sanford told me in an interview. “And it seems that whenever the threats escalate, our movement’s response—or at least of the national organizations, some of them—is to pull back into their bubble in D.C. rather than proactively and aggressively invest in the states.”

This long-standing disinvestment in the states is one reason the anti-abortion movement has gained so much ground since Roe. Over the decades, anti-abortion groups focused intensely on chipping away at access by targeting state legislatures, rendering abortions off-limits to many low-income people over time. Meanwhile, national abortion rights groups have tended to prioritize national organizing and efforts to fight against restrictions in the federal courts. Facing a loss in funding, the RCRC seemed to double down on this strategy.

In a statement late last year, the RCRC’s board said the group had decided to focus on “education and spiritual care” and no longer had the “capacity to support state-based advocacy.”

“This really was about organizational capacity,” said the Rev. Katey Zeh, the RCRC’s chief executive officer. She pointed to monthly virtual gatherings, note taking, and listserv maintenance as tasks related to the state affiliates that her staff could no longer handle.

But state affiliate organizers say there is a deeper story behind the split. Like many other organizations headquartered in Washington, D.C., the RCRC has had a tense relationship with its state-based groups for years. “There’s always been tension there, which is not uncommon between national organizations and state affiliates,” said Lamunyon Sanford.

Zeh said this tension is caused by the underfunding of the movement overall. “When resources are scarce, that causes tension,” she said.

This tension pervades national organizations with state affiliates across the progressive movement, from Black Lives Matter to the Sierra Club. National organizations tend to have greater name recognition and deeper pockets than the local groups that share their names. Meanwhile, state-based reproductive health groups, often operating as independent nonprofits on shoestring budgets, bear the brunt of policies passed by state lawmakers, whom they often don’t have the resources to unseat.

“What I always heard is, ‘I’m sorry there are no resources for the states,’” former RCRC board chair and Indiana affiliate copresident Sue Ellen Braunlin said of the RCRC’s attitude toward the affiliates.

The way national groups with local affiliates share or don’t share resources varies across organizations, and not just within the abortion rights movement; the ACLU, for example, has a formula whereby the national and state offices share a portion of the donations each of them raise. Planned Parenthood said the vast majority of money its national office raises online goes to affiliates. But in the case of NARAL and the RCRC, the national groups provided funding to state groups only through sporadic grants—which meant donations to the national group mostly stayed there.

A lot of RCRC donors didn’t realize this, said Ramsey, the Ohio organizer; they thought that if they donated via a mailing from the organization’s headquarters in D.C., it would reach the affiliate in their home state.

“National [RCRC] has a lot more reach and resources, so they can send out their mailings and folks don’t necessarily know that when they give, that money doesn’t stay in the state—it actually goes back to national,” Ramsey said.

After what she called “a pattern of replicating our work online and not attributing it to a local affiliate,” Ramsey’s group decided to break away from the RCRC of its own accord and rebrand with a name that would distinguish it from the national organization: Faith Choice Ohio.

The bigger picture surrounding these conflicts over organizational structure and local affiliates is the underfunding of reproductive health and justice, which is partly by design. The anti-abortion movement has systematically cut public funding of abortion, leaving the abortion rights movement heavily reliant on sympathetic private donors. Because of the long-standing ban on federal funding of abortion care, enormous amounts of private dollars are raised and spent each year just on covering the cost of abortions that Medicaid recipients can’t otherwise afford. Contrast that with anti-abortion crisis pregnancy centers that have received millions each year in public funds. Patching this gaping hole in the public funding of abortion are billionaire-backed private foundations. The backbone of these funders is Warren Buffett and his constellation of family foundations. Known within the reproductive health field as the “Large Anonymous Donor,” the foundation named for Buffett’s late wife, Susan Thompson Buffett, has such a titanic pull in the nonprofit reproductive rights world that the loss of its funding can cause entire organizations to restructure. I know this impact personally, having been laid off in 2019 after the reproductive health publication Rewire lost a large chunk of its Buffett funding.

The most recent available tax forms show that a huge percentage of the RCRC’s funding came from the Susan Thompson Buffett Foundation, including more than $2 million that was part of a multiyear grant it lost in 2019.

Foundations tend to operate on these “boom/bust” cycles, said the Groundswell Fund’s Menon. And this landscape may be facing its biggest boom/bust of all, as the 91-year-old Buffett has made clear his intent to have the proceeds from all of his Berkshire Hathaway shares “expended for philanthropic purposes” within 10 years after his estate is settled. “Nothing will go to endowments; I want the money spent on current needs,” he has written. That could mark a huge funding cliff for the movement.

In 2020, another Buffett family philanthropy, the NoVo Foundation, founded by Buffett’s son Peter and Peter’s wife, Jennifer, laid off half of its staff and went through a restructuring that sent shock waves through the reproductive justice field. “When that happens—especially if that happens without a plan, which is how it felt with NoVo—it’s part of the boom/bust business,” Menon said. “One day it’s there, and the next day it’s not there—without a plan for who will fill that void. Because the scale of the money and investment is so high, others can’t just jump in and fill that without any sort of notice.”

It’s unclear whether anyone can fill the void that will be left by the departure of the Buffett fortune. The billionaire ex-wife of Jeff Bezos, MacKenzie Scott, gave Planned Parenthood its single largest donation in history this year—$275 million to the national office and 21 affiliates—and another $15 million to the reproductive health research organization the Guttmacher Institute. But the wider solution may require ending the reliance on a single billionaire, which is what the Groundswell Fund is trying to do. The foundation’s money comes from 40 national foundations and more than 1,000 individual donors. Menon said that Groundswell does not currently receive funding from NoVo or the Susan Thompson Buffett Foundation, though records show it has in the past.

Ninety percent of Groundswell’s funding goes to organizing led by women of color, while in the field of philanthropy overall, that number is less than 1 percent. When uprisings over the police killing of George Floyd in 2020 sparked a new level of interest in funding to address racial injustice, Groundswell and other foundations led by people of color issued an open letter encouraging white-led foundations to stop calling them and asking how to replicate their model—and instead just give them their money.

T he anti-abortion movement has a crucial base of financial support that the abortion rights movement lacks: churches. Churches also shape how people think about abortion. Growing up surrounded by farmland in the city of Chillicothe, Ohio, Ramsey was someone who believed that abortion was immoral, because that’s what she heard in services at the Assemblies of God Church. After she was raped in college, Ramsey’s thinking shifted, because she realized that she would likely have an abortion if she became pregnant from the assault.

Now her work involves chipping away at the power of the Christian right. To do so, her group is partnering with Catholics for Choice, a Washington, D.C., nonprofit that represents the majority of US Catholics who support legal abortion. Ramsey hopes the group can help her reach out to the 18 percent of Ohioans who are Catholic. Catholics for Choice will offer funding and training to Faith Choice Ohio as part of a plan to invest in a handful of states where it has strong relationships and believes it can shift people’s thinking.

“There’s a very unfortunate history of national organizations plowing into states and taking over,” said Jamie Manson, the executive director of Catholics for Choice. “That’s a model I absolutely want to dispense with.”

There’s another historical example that these state groups are drawing on—a grassroots network that was run out of churches and makeshift offices across the country in the years before Roe. Back then, pastors and rabbis used landlines and brick-and-mortar offices to help hundreds of thousands of abortion seekers reach safe providers. “These are really, really daunting times, and our work feels like it’s going backwards,” Ramsey told me. “We’re educating a lot of our folks about the Clergy Consultation Service on Abortion and how that is a part of our legacy and we’re going to have revive that.”

Now, despite the advent of the Internet and the easy availability of safe abortion-inducing medication online, one aspect of this work has not changed: Both the immediate task of helping people get abortions and the long-term work of regaining political ground are local endeavors.

“Once we get to a place of Texas times 25, it will be the state organizations shuttling people between states,” Lamunyon Sanford said. “I’m confident that our other affiliates will step in and help meet that need. That’s our history; that’s what faith-rooted organizations do.”

Another set of state groups, the former NARAL affiliates, have banded together over a painful “divorce” of their own. Last summer, NARAL announced it would dissolve its state affiliate structure and shift to a chapter model to give the nonprofit more control over messaging. The 11 remaining affiliates joined counterparts in Colorado and Texas that had already left NARAL, forming an alliance called the State Abortion Access Network; together they’ve raised $1.9 million to see one another through the transition. Sources said much of that funding came from a large anonymous donor—that familiar code name.

“Those folks with good relationships with funders went to those funders and asked for help, and got it,” said Rebecca Hart Holder, the executive director of Reproductive Equity Now, the former NARAL affiliate in Massachusetts. She and the other leaders of former NARAL affiliates are trying to raise another $2 million to bolster state-based organizing. The plan is for the state groups to decide democratically how the money should be distributed—rather than having it filter through a national organization.

In some ways, these leaders said, the disaffiliation from NARAL has been a good thing, freeing up state groups to create their own messaging. In Washington state, abortion is protected under state law, but a large number of Catholic hospitals refuse to provide reproductive health care. “[We’re] a lot more focused on broader health equity and justice issues, because that’s essential for a location like Washington, where we have basic abortion protections,” said Kia Guarino, the executive director of the former NARAL affiliate Pro-Choice Washington. “We have partners in Ohio who have a very different conversation that they need to be having.”

Indeed, in Ohio, the success of advocates in keeping the state’s nine remaining clinics open has been a major victory. In North Carolina, victory has meant preventing the passage of anti-abortion laws—which state groups including the former NARAL affiliate have successfully fended off since 2015. With a wide variation in what’s achievable state to state, national messaging can move “toward the middle out of perceived necessity,” Guarino said.

For its part, NARAL says its commitment to state work is “unwavering and long-standing,” with existing chapters in Georgia, Nevada, and California, trained volunteer leaders in 49 states, and staff on the ground in Michigan, Wisconsin, and Arizona. “We will be ramping up our work in additional states as we get closer to the 2022 elections,” president Mini Timmaraju said in a statement.

Meanwhile, the former affiliates have already pushed the boundaries of what local organizing can do. In March, the former NARAL affiliate Pro-Choice Oregon announced that, as part of a coalition of fellow state groups, it had pushed state lawmakers to authorize $15 million in federal funding to create a Reproductive Health Equity Fund to support abortion access.

“That is where this movement absolutely needs to head,” Christel Allen, the executive director of Pro-Choice Oregon, told me after the victory. “That is how we are going to create conditions that ensure that folks who are forced to travel to receive essential health care like abortion are going to be received in a way that is welcoming, and that our state can actually have the capacity to provide additional care.”

Copeland, of Pro-Choice Ohio, said that in contrast to NARAL’s old model, the new network these state groups are creating “is going to be in service of the state and local organizations; it’s not going to be in charge of state and local organizations.”

“There’s an opportunity for this to be a phoenix moment,” she added, “where we build something better from whatever those ashes are.”