After advocating for abortion rights professionally for years, Liz Starke, development director at Rose Haven — a day shelter and community center for women, children and nonbinary people — faced a very personal decision earlier this year.

Even though she was in a stable relationship with stable housing, it wasn’t the right time for her to have a baby. She decided to have an abortion.

“It’s a choice that’s hard for everyone,” Starke said.

In a post-Roe world, particularly outside of states with strong reproductive rights laws like Oregon, lawmakers pass policies restricting privacy in doctors' offices and reducing or eliminating access to abortion. However, even in Oregon, geography and finances can determine if someone can actually use those rights. A number of groups are working to change that.

The average out-of-pocket cost for an abortion is $700, according to Planned Parenthood of Southwestern Oregon. Depending on where someone goes and the type of abortion — pharmaceutical or a procedure performed in a clinic — the cost can vary.

Additionally, most Oregon abortion clinics are in Portland. There are 14 in-person abortion providers in Oregon, according to abortionfinder.org. Out of these 14 clinics, only four offer abortions over 13 weeks, and one offers abortions until 34 weeks.

The Northwest Abortion Access Fund, or NWAAF, is one such group helping people overcome transportation and cost barriers and provides advice via a toll-free helpline and volunteers.

The organization, which serves Alaska, Idaho, Oregon and Washington, is one of the many abortion funds across the country working directly to make sure anyone who needs an abortion can get one safely and at no cost.

Megan Kovacs, an NWAAF volunteer in various capacities since 2015, said the Dobbs decision overturning Roe v. Wade increased people's need to travel for care. According to the Center for Reproductive Rights, 25 states have strong regulations on abortion ranging from 6 to 18 weeks, 14 of those states have passed complete bans.

According to NWAAF’s database, the organization helped people from 42 different states travel to Oregon and Washington for abortion care last year.

“Everyone should have the ability to have an abortion in their own community, surrounded by their loved ones to take care of them,” Kovacs said. “And the reality that people are facing right now is having to travel alone to a place that they are unfamiliar with to access health care there, and that, to me, is one of the most cruel and unjust parts of the Dobbs decision.”

While Oregon has its laws guaranteeing reproductive freedom, Kovacs pointed out legal protection isn’t everything when it comes to reproductive health care.

“Even though abortion is legally protected, that does not mean it is accessible,” Kovacs said. “Access is very, very different than what is legally available in Oregon.”

Kovacs said most clinics are located on the Interstate 5 corridor and in the greater Portland metro area. Additionally, age is a big barrier for those under 18 years old.

“Even though abortion is legally protected, that does not mean it is accessible. Access is very, very different than what is legally available in Oregon.”

— Megan Kovacs, 
Northwest Abortion Access Fund Volunteer

"We're very lucky in Oregon to have no gestational limit on access to abortion,” Kovacs said. “So we have always been a safe haven, even before Dobbs, for access to care. But one of the things that I think about all of the time when I'm helping people on the hotline is how massively unjust it is for people to have to travel to access health care at all.”

Lilith Clinic in Portland, which also has locations in Seattle and Las Vegas, offers abortions through 24 weeks of pregnancy.

“No one should have to leave their community for abortion care," Grayson Dempsey, Lilith Clinic public affairs director, said.

Regardless of location, navigating the health care system can be challenging for many, particularly people at the intersection of multiple forms of marginalization. A Rose Haven guest who goes by Pineapple said they’ve encountered situations in which doctors didn’t respect their reproductive health decisions.

For as long as they could remember, Pineapple knew they did not want to have kids. At a young age, they decided to ask their primary care doctor about surgical options to prevent pregnancy.

“They told me they couldn’t do it because I might meet a man who I would want to impregnate me,” Pineapple said.

Pineapple said due to that doctor's reaction, they never approached other doctors about the procedure for fear of what they might say.

Meanwhile, Pineapple’s views on having children were unchanged, and they had to find a different way to protect themselves. Planned Parenthood helped them get their first IUD — a type of long-term birth control placed in the uterus. But after the painful and traumatic procedure of getting the IUD without painkillers, Pineapple said the next time they went to get one, advocating for pain management was an unexpectedly difficult experience.

“(It was) not easy to navigate,” they said.

Beyond the hundreds of dollars it costs for the abortion itself, Kovacs said abortions can come with more barriers for people living on the streets, specifically during the recovery process.

“Oftentimes like a really heavy period, and that is a really uncomfortable thing to have to experience when you're living on the street,” she said.

One of the services NWAAF provides is a hotel to recover in.

“Particularly with our folks who are unhoused, I like to be extremely generous with the amount of time that we are able to put them up in a hotel to recover,” Kovacs said.

Another organization working to break down barriers to reproductive health care is Black Thistle Street Aid, which assists people living on the streets in the Eugene area.

Sophia Ricci, Black Thistle Street Aid co-founder, noticed a need for an organization supporting homeless people in getting medical care. As a volunteer-run nonprofit, a group of volunteers provides weekly non-emergent medical outreach and monthly pop-up clinics with medical professionals, wound nurses, EMTs and clinical herbalists.

While Black Thistle, founded in 2020, supports people with various medical needs, Ricci works specifically with reproductive care and access. She said working with pregnant people on the streets is one way she ensures they get the care they want and need.

“When folks are just in day-to-day survival, sometimes it is hard because periods are all over the place, and so people don’t always know right away that they’re pregnant,” Ricci said.

In the area where Black Thistle provides its services, no providers offer late-term abortions, according to Ricci. For the people Ricci works with, this means traveling to Portland might be the only way to access abortion care when they find out about their pregnancy after 15 weeks.

Ricci said one of the biggest barriers for homeless people, especially those living outside of Portland, is accessing specific prenatal and reproductive care. For most, the emergency room is the first place they’ll go. But this isn’t the perfect solution for many.

“A lot of what we do is (emergency room) prevention,” Ricci said. “Either folks would go to the ER, or they would not have access to care. And a lot of the information we get around why people don’t have access to care is ... people don’t want to go to the ER because they have warrants out for their arrest, and they’re going to get arrested if they go to the ER.”

Ricci said her role shifted after learning about the obstacles homeless people face when trying to access care.

“Instead of coordinating providing services (it turned) into an advocacy role around how can people get treated better in the hospital or how can people get treated better within these systems,” Ricci said.

Organizations weather the cost of care through a variety of channels, including individual donors and state funding.

Since the Dobbs decision two years ago, NWAAF reports spending $4.6 million on services, including $1.7 million in Oregon.

The Oregon Reproductive Health Fund allocated $15 million from the Oregon Legislature to expand access for reproductive health care for communities in Oregon that are historically underserved.

“We really believe that full scope reproductive health care is just as important to people’s well-being as checking your blood pressure or managing your diabetes,” Sen. Elizabeth Steiner, D-Portland, told Street Roots. “It’s all a part of keeping people healthy, and it’s not optional.”

Nonprofit Seeding Justice manages the fund, and after it passed, the organization put together a steering committee determining how to allocate the money and which projects or groups to fund.

“A right is not a right if you can't access it,” Se-ah-dom Edmo, Seeding Justice executive director, said. “And the first tranche of funding that came through for the Reproductive Health Equity Fund was rapid response care, specifically focused on expanding clinics and their capacity to serve patients directly.”

The Reproductive Health Equity Fund donated to NWAAF and Black Thistle Street Aid, among many others. Additionally, it helped fund a Planned Parenthood facility on the Oregon-Idaho border in Ontario, Oregon, which opened March 2023. It is now the only clinic in Eastern Oregon, providing a vital lifeline not only to rural Oregonians but to Idahoans needing to travel for care due to the state’s outright ban on abortions.

“We need to be investing even more state resources for those individuals, as well as the individuals who are already lacking in care,” State Rep. Andrea Valderrama, D-Portland, said.

The fund will do a lot of good for Oregonians and people traveling to Oregon for care, but there’s more that needs to be done, Amanda Whalen, Seeding Justice interim chief of staff, said.

“There is still such a great need,” Whalen said. “There are tons of fantastic projects that we weren’t able to fund. We would love to be able to fund those projects in the future with continued support.”

Dr. Sara Kennedy, CEO of Planned Parenthood Columbia Willamette, said her goal for PPCW is everyone who walks through the clinic's doors gets the care they need, even if they cannot afford the services. The clinic serves everyone, she said.

“If patients need our care, and they can’t afford that care or don’t have insurance, we provide that care for free,” she said. “And that’s done every single day in every single center in our entire catchment area across Oregon and Southwest Washington.”

In her experience, Ricci said, people living on the street face extreme difficulties accessing care.

“Our core intention is we're trying to heal people and heal the traumas that have been caused by these institutions that are meant to serve,” Ricci said. “So a lot of times, it's like we meet people where they're at, metaphorically and literally.”

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