The day’s first caller begged for help to cross state lines and end her pregnancy. “Please,” the woman from Texas said in her voicemail. “Anything would be greatly appreciated.”
Three states away, in southern Illinois, Alison Dreith heard the plea and ground a toothpick between her teeth. She’d started chewing them last year as a stress reliever the day Texas all but banned abortions. Now the stick darted across her mouth, left to right, right to left. She felt shaky.
“It’s starting,” said Dreith. “What we’ve been worrying about for years.”
When desperate people can’t obtain abortions near home — when they need plane tickets, bus fare, babysitters — they reach out to groups like Dreith’s, the Midwest Access Coalition. The demand has become staggering. Now, for the first time, she would have to tell a caller “No.”
The U.S. Supreme Court this summer is expected to gut Roe v. Wade, the 1973 ruling that made abortion a constitutional right. But already, state after state has tightened restrictions, pushing pregnant people further from home, for some hundreds of miles away.
Dreith and her collective are scrambling to pave avenues for them. There are almost 100 grassroots groups organizing as a safety valve for the vast swaths of the South and Midwest where abortion may soon be barred.
On this morning, Dreith’s phone buzzed with messages from her fellow abortion activists across the country, bemoaning the now-constant headlines bearing bad news about abortion rights. They’ve spent years battling abortion restrictions, getting arrested as they bellowed against bans, escorting pregnant people into clinics through throngs of protesters screaming “baby killer.” Now, helpless to prevent the coming crisis, the goal has become purely practical: assist abortion seekers one by one, either legally by helping them travel, or illegally if that’s what it eventually comes down to.
They ask: Which of us would be willing to go to jail? Some conservative states are trying to criminalize helping people cross state lines, and that’s exactly what Dreith does all day.
Dreith runs this resistance from the sofa on her rural pygmy goat farm, an unlikely gateway to abortion access. Nearby, a billboard greets people driving across the border into her state: “Welcome to Illinois, where you can get a safe, legal abortion.” The state is a “blue island,” a likely destination for thousands seeking to end unwanted pregnancies.
It’s already started. In September, Texas passed a ban on abortion after six weeks; courts let it stand. Patients fanned out into surrounding states, clogging up clinics and ballooning waiting lists — weeks turned to months. In Alabama, Dreith’s friend Robin Marty said she was going to have to direct patients to Illinois, an eight-hour drive.
The Midwest Access Coalition’s hotline is swamped and it’s about to get much busier: If Roe is overturned, abortion is expected to be banned in more than half of American states.
Dreith, 41, rubbed her forehead and slumped back into her sofa.
The coalition, funded by donations and grants, will have to make hard choices. There will be too many people and not enough money. They stopped funding partners traveling with adult patients. They’re considering capping the amount of money per client, and the number of clients per month.
Texas is outside the coalition’s coverage area, but it had offered to help when the state’s support groups, called abortion funds, were thrust into crisis. But now it is routing Texas callers back to other groups, which are also stressed.
Listening to the Texas woman’s voice message, the coming tsunami suddenly seemed very real. On their encrypted text chain, Dreith and her colleagues discussed this depressing prospect: In a post-Roe America, no matter how hard they try, some will be left behind.
Dreith sighed deeply and typed her reply.
“I’m so sorry,” she began. “We are unable to support Texans right now.”
When the draft Supreme Court opinion on Roe was leaked, “The Handbook for a Post-Roe America” sold out overnight. “Everybody wants something to do,” said Robin Marty, who wrote the 247-page manual. “I think people want to feel like there’s something within their control.”
It’s inconceivable, Marty said, that measures she described in her book might be necessary in a matter of weeks. “If I try to think about what this would look like, I can’t, because it’s a disaster.”
Her West Alabama Women’s Center sits on the edge of ordinary plaza of squat brick buildings, alongside an ophthalmologist’s office and an insurance agency. It is indistinguishable as an abortion clinic, except for the handful of protesters who gather daily in the parking lot to deter patients from going inside.
The clinic is near the University of Alabama in Tuscaloosa, so it draws in a lot of college students. But because it’s the only clinic for two hours in any direction, people come from all over the region.
Marty, 45, is the clinic’s operations director. She estimates that 75% of its patients are below the poverty line. Many have multiple children and work multiple jobs. Some struggle to make it to this clinic just across town; they cannot travel states away, even if there was an infinite supply of money, which there isn’t.
So when this clinic can no longer perform abortions, people will manage their own at home, she said, and that carries a constellation of risks, both physical and legal.
The dangers of a post-Roe world are not the same as the pre-Roe one, when desperate women would throw themselves downstairs, prod themselves with knitting needles or meet dubious doctors in back alleys. There are now medications that trigger a miscarriage and end a pregnancy safely at home, which anti-abortion lawmakers are also attempting to criminalize. Abortion pills are now provided by doctors, but can also be bought online and shipped in the mail.
Medication abortions are safe in early pregnancy and account already for more than half of terminations in the United States. But some are incomplete and require medical intervention.
“People will be afraid to get help. People will be afraid to go to the doctor, to go to the hospital, to go to the clinic, to get help out of fear of being arrested. And they may instead bleed to death,” said Dr. Leah Torres, the clinic’s physician.
Even if they do seek medical help, she worries that physicians will be afraid or unwilling to help them: This clinic has already seen four patients who arrived bleeding and said they’d been turned away by hospitals.
The anti-abortion movement has long held that it doesn’t intend to criminalize pregnant people. But last month, a woman was arrested in Texas after seeking care at a hospital, where staff suspected she’d self-administered an abortion, and called the sheriff. The charges against her were later dropped, but not until her name and mug shot whipped around the world.
Marty posted online about the arrest, pleading with people to not only support organizations like Dreith’s that help people travel, but also red state clinics like hers that will try to survive for those who can’t.
“Because if our doors do close,” she wrote, “the only options left truly will be death or jail.”
Marty had been a journalist. But she saw abortion access collapsing, felt constrained by the journalistic mandate of impartiality, and so she left the business to work on the front lines.
She recruited Torres, an outspoken activist for abortion access in red states, to move to Alabama to turn a Southern abortion clinic into a full-service gynecological office, offering Pap smears and family planning, that might allow them to remain open even if abortion is banned. That way they will be here to treat people managing their own miscarriages, intentional or not, and no one will call the police.
In one examination room, a mother sat with her shaking 16-year-old daughter. The high schooler’s mother said they can’t afford a baby. She has four kids and one grandchild to take care of already.
She wants her daughter’s life to be better than hers. She was 15 when she had her first child and she dropped out of school.
“I want her to have a bright future,” the 34-year-old mother said. “I want her to graduate, go to school, become something in life, maybe a nurse or a doctor. I just wish the best for my kid.”
The woman, who is Black, had taken a day off her job at a roofing company without pay to drive her daughter here.
These are the families that frighten Marty the most. A 2013 study analyzed 413 cases from 1973 to 2005 where women were prosecuted for pregnancy outcomes: 71% were poor and more than half were women of color.
It was difficult for this mother to contemplate what they would have done if this clinic, an hour from home, no longer existed. Her daughter, in a swirl of childhood ignorance and fear, was four months along by the time she arrived here — and abortion with pills is authorized only up to 10 weeks. Her mother stared off, doing a silent calculation of days and money and miles.
“How far is Illinois from here?” she wondered.
Five hundred miles away, Alison Dreith took a break to visit with her friend, Pamela Merritt, who had come to visit the goats born just days before on Drieth’s Illinois farm. Merritt brought them onesies.
“I’m your grandma,” she cooed as she cuddled one named Albert. “You’re going to call me gamma.”
After years in the trenches fighting what Dreith calls the “abortion wars” together, they’ve become like family. Merritt officiated at Dreith’s wedding. They’ve already planned that when they get old and Merritt can no longer live alone, she’ll move in with Dreith and her husband.
Their careers have converged with the volatile rhythms of the abortion divide. Dreith, fresh out of college, started her internship with Planned Parenthood the day after Dr. George Tiller, an abortion provider in Kansas, was murdered in 2009 by an anti-abortion extremist.
Merritt, too, went to her job at a clinic that Monday.
“I got up in the morning and walked through a parking lot, down a sidewalk and into an abortion provider and it was the most profound and emotional walk I’ve ever taken,” she said. That day changed them both: Each resolved that a movement some died for was vital enough to become her life’s work.
Both Dreith and Merritt were some of the most outspoken activists in Missouri, a state with among the nation’s strictest abortion laws. Dreith led NARAL Pro-Choice Missouri and was on television so much she couldn’t go to the grocery store without someone stopping her to talk about abortion.
At Brett Kavanaugh’s Supreme Court confirmation hearing in 2018, she screamed that people shouldn’t have to travel to get an abortion. She was dragged away.
Merritt, meanwhile, started an unabashedly loud and liberal advocacy organization, Reproaction.
Merritt introduced Dreith to Robin Marty. In time, they realized those friendships were a foundation for the network they must build.
“It’s a lot like when people go to war. And I have been to war with Robin and Alison,” said Merritt, now the executive director of Medical Students for Choice. “I fought tooth and nail. I left it all on the court, as we used to say in tennis. And we lost.”
It took a toll on them. Dreith lost 40 pounds and wasn’t trying. Merritt started breaking out in hives; her sister had to remind her to eat.
“I needed a little bit of recovery,” said Dreith, so she left Missouri and bought a farm across the state line in Illinois, where there are no streetlights and they know their mailman by name.
She finds solace in the quiet, the goats prancing around the barnyard, and the knowledge that abortion will remain legal here and her representatives wouldn’t prefer to see her in handcuffs. She convinced Merritt to move to Illinois, too. Merritt adopted one of her goats and visits often.
“Did you bring me any books for my library?” Dreith asked, and they walked to the Little Free Library she erected along the country road. She keeps boxes of emergency contraception amid the books and pickle jars, and someone recently took one. She was delighted that word of her stash might spread.
That is her mission now: finding inventive ways to reach people who don’t want to be pregnant.
She picks clients up at the airport to drive them to the Hope Clinic for Women in Granite City, Illinois, a half hour from her farm.
The Hope Clinic sees up to 7,000 patients a year, said Dr. Erin King, the clinic’s executive director. Workers routinely field phone calls from their colleagues in other states: New laws took effect, and they have people in their waiting rooms. “How can you help us?” they ask. Now they’re preparing to absorb patients from half the country.
Twenty minutes away, a Planned Parenthood opened a first-of-its-kind support desk called the Regional Logistics Center, in suburban Fairview Heights. It functions as a sort of travel agency for abortion seekers.
Merritt has heard people say that there is no abortion resistance, because they don’t see this. It’s not a march or a rally. It is this group of friends and colleagues organizing, usually quietly, from their living rooms and cars and cubicles.
On the day Dreith had to turn away the Texas caller, she booked a hotel room for a 22-year-old from Tennessee who was traveling 250 miles to the Hope Clinic. A restaurant server who makes $2.13 an hour called from Kentucky to beg for help with a babysitter, hotel and food.
She started this job with the Midwest Access Coalition in November, and she said it feels good to keep her head down and do the pragmatic tasks of booking flights and telling pregnant people to feel no shame.
“That fills me up a little bit more than constantly being on the defensive, and I need to be filled up a little bit more right now because I was on the defensive for a really long time,” she said.
The clients are often among the most vulnerable, those who’ve never flown on a plane before, who have no phone, no car, no credit card to book hotel rooms. She doesn’t ask questions about what brought them to this point, she said, but many offer explanations anyway: homelessness, domestic violence, fetal abnormalities during pregnancies that were very much wanted.
“Your heart just breaks for people,” Dreith said. And so she tries to make their travels as painless as possible.
One woman from Arkansas said she’d never eaten White Castle and she’d heard it was delicious, so Dreith booked her a hotel next to the restaurant. The woman said it tasted as good as she’d always imagined.
A week earlier, Dreith took a road trip to a tattoo parlor in Richmond, Indiana, for a fundraiser with activists from Kentucky, Indiana and Ohio — all places where abortion is likely to be banned or restricted.
The day’s choices of special tattoos included a coat-hanger, the famous symbol of the dangerous back-alley abortions women endured before Roe v. Wade. “Never again,” it said.
There was one that featured a flower curling around two pills — one a circle, one a hexagon, together representing the cocktail of medications taken to induce an abortion. There was a tattoo of a staircase hidden behind an arch, a traditional design meant to signal its wearer knows how to find secret things.
But this network doesn’t want to keep their work a secret.
They tucked a business card for the Midwest Access Coalition onto a shelf at the tattoo parlor. They contemplated designs for magnets with their contact information to fasten to every metal thing they come across. Dreith considered stickers to put in bathroom stalls — in cities, in suburbs, in rural areas — because all kinds of people in all kinds of places get pregnant and don’t want to be, she said.
“I understand that some part of secrecy for some people needs to happen. Not everyone can go to jail,” Dreith said. “But we’re looking for the most vulnerable, and not just the people who can be clever enough to find us.”
This group gets together occasionally, the last time for a campout on Dreith’s goat farm last year, where they swam in the creek, slept on the lawn and contemplated a post-Roe world. It seems to them that the coming reality is just now beginning to dawn of much of a public that hasn’t been in this fight as long or as actively as they have been.
“We’re not the ones who are panicking,” said Meg Sasse Stern, who until recently ran the Kentucky Health Justice Network. “It’s because we’re already deeply traumatized from living this up until now. We’re beyond panic.”
“Now it’s more like, what’s the plan?” said Keli Foster, who escorts pregnant people past protesters into an Indiana abortion clinic.
They fretted over how to help their people.
“Send them to us, just send everybody to us,” Dreith said, because her safe haven in Illinois will be all they have left in the region.
Isolated on the farm, Dreith felt like she was living in a bubble, unable to process that in a matter of weeks the Supreme Court might ravage her life’s work. She’d felt guilty for not being more outraged.
But reality was starting to wash over her. When the draft Supreme Court opinion was leaked, Dreith cried for five days straight. She left the house for a drive, and found herself sitting at her father’s grave, listening to George Harrison’s album “All Things Must Pass.” She doesn’t know how long she sat there, maybe for the whole album, until she stopped crying and felt a deep resolve to finish her mission.
She knows the risks. Conservative politicians are now specifically targeting people like her. Lawmakers in some states, including nearby Missouri, are attempting to make it illegal to “aid and abet” abortions out of state, even driving people across a bridge into Illinois.
At the tattoo parlor, Dreith and her colleagues said they have to plan for this reality.
“Just to be completely honest, some of us are going to have to be willing to go down,” Keli Foster said. The rest sighed and nodded.
Dreith chose the tattoo design of the abortion pills, and had the artist put it on her arm, next to a tattoo of a bundle of herbs that have been used to induce abortion for millennia. People have always tried to end unwanted pregnancies, and they always will, she said. After all these years, she sees it as her responsibility to help them do that as safely as possible, regardless of the law.
So she talked with her husband, her lawyer and her friends.
“There will be a price,” Dreith said.
She told them she is willing to pay it.