Emily Clingan remembers the panicked messages that started as the COVID-19 pandemic set in: Women out of work were seeking abortions and not sure how to pay for them.

"Many people already face financial difficulty accessing abortion, and this just compounded it," said Clingan, who volunteers with Our Justice, a Twin Cities-based organization that runs a fund to help pay for the procedure.

In Minnesota and across the country, organizations that help cover the costs associated with getting an abortion have seen a spike amid the economic fallout of COVID, of which women — who are more likely to hold the kinds of jobs that disappeared early in lockdown and more often shoulder family and child-care demands — have borne the brunt.

Though the number of abortions nationwide has been on the decline, the pandemic has made it more difficult for women seeking abortions. Advocates, who say they don't expect the pressure to lift anytime soon, are bracing for the challenge to Roe v. Wade taken up by the U.S. Supreme Court that could further reduce the amount of time women in many states have to access and pay for abortions.

At Our Justice, demand for financial assistance jumped nearly 90% from 2019 to 2020. Midwest Access Coalition, which serves people traveling to or from the region for abortion care, served 635 clients in 2020 compared with 380 in 2019, according to Executive Director Diana Parker-Kafka.

The National Abortion Federation, which operates the nation's largest abortion assistance hotline, has also felt the squeeze. The hotline generally gets about 100,000 calls a year, said the Rev. Katherine Ragsdale, president and CEO. But after an initial decline in March 2020, calls have been up every month since.

"The pandemic has hammered down on us and the folks we serve in a variety of ways," Ragsdale said. "This particular confluence of pressures has escalated in ways that, no, I don't think we've seen before."

Increased barriers

Abortion funds do more than help pay for abortions. They're also used to counsel women through the logistics of finding and traveling to appointments and to help cover those associated costs.

At Midwest Access Coalition, Parker-Kafka said the average cost per client is about $350, though financial needs can vary from $30 for a bus ticket to more than $2,000 for airfare, accommodations, transportation, food and child care.

Funding generally doesn't pay for everything, so help from other organizations, friends or family needs to be tracked down. Navigating those logistics became more complicated during the pandemic, Ragsdale said.

Women have had to contend with not only their own income losses, but those of people in their lives who otherwise might have been able to help. And new barriers to abortion access have cropped up nationwide, from pandemic-related state mandates categorizing abortion as nonessential health care to a rise in targeted harassment of providers and patients.

Hurdles are higher in some states than others, pushing some women to seek abortions away from home even as the pandemic has made travel more complicated.

Evelyn and Ann Griesse have run South Dakota Access for Every Woman since the 1980s, and most of the calls they get are from women in the region. But last year, South Dakota's only clinic, in Sioux Falls — which relies on providers from out of state — was closed for several months due to the pandemic.

Evelyn Griesse said that the roughly 350 women helped by the South Dakota fund since the beginning of 2020 — women who experienced domestic violence or trafficking, who were sexually assaulted, who were as old as 45 and as young as 14 — have scheduled appointments at clinics as far away as Colorado and Maryland.

"There are more low-income women with this circumstance than all the funds combined," she said.

Pressure on Minnesota

Restrictions in other states have put pressure on Minnesota, where women from other parts of the country were traveling for abortion care even before the pandemic.

Dr. Julie Amaon, a family medicine doctor who completed her residency at the University of Minnesota Medical Center with abortion training at Planned Parenthood in St. Paul, said she saw patients last year who came to the Twin Cities from Texas after Gov. Greg Abbott's executive order halting "all surgeries and procedures that are not immediately medically necessary," including abortions.

Abbott has since signed a law, scheduled to take effect in September, that prohibits abortions as early as six weeks into a pregnancy.

Amaon is medical director at Just the Pill, which since late 2020 has provided medication abortions to women in Minnesota and surrounding states via telemedicine — a service she expects will become more in-demand as state restrictions increase.

The pandemic prompted the Food and Drug Administration to temporarily allow doctors to mail the drugs used in medication abortions to patients. The agency is expected to make a final decision on whether to continue doing so by the end of the year.

"I am actually cautiously optimistic for the first time in a long time," Amaon said.

But depending on how the Supreme Court rules on Mississippi's 15-week abortion ban, "trigger laws" outlawing abortion could take effect in 10 states including North Dakota and South Dakota.

Though abortion access is constitutionally protected in Minnesota, there are restrictions including a 24-hour waiting period, mandated counseling and a requirement that minors notify both parents.

And even as COVID vaccinations rise and cases remain relatively low, Clingan said, "that doesn't automatically mean that all of these people are now back to where they were financially prior to COVID starting."

"People here need help, too," she said.

Emma Nelson • 612-673-4509