Vanguard Defenders: What Top Foundations Are Doing to Protect Abortion Access – Inside Philanthropy

Abortionnot many topics stir up equal passion, matched by high levels of private funding. Forty-seven years after Roe v. Wade, abortion opponents are making historic gains, energized by Republicans in office and a conservative majority on the Supreme Court. Meanwhile, U.S. philanthropies continue to spend hundreds of millions each year defending sexual and reproductive care and rights. Pro-abortion funders and advocates fighting to preserve past victories are maintaining their footing and gaining new ground on quickly shifting political terrain.

Government funding for sexual and reproductive health does not meet the needs of the many people who seek services. As with most enormous social or medical issues, philanthropy cannot (and many would say, should not) take on full responsibility for this issue. The political controversy surrounding some forms of reproductive healthcare is not likely to be resolved anytime soon, sayas Gretchen Ely, Ph.D., who studies access to reproductive healthcare at the University at Buffalo. She says the U.S. should cover all forms of healthcare, including reproductive health, and that, while advocacy toward this goal is underway, philanthropy can play a very important role in bridging the gap between unaffordable care and people who need the care.

Some of Americas biggest foundations have long worked on abortion access and reproductive health and rights in the U.S., including the foremost player in this space, the Susan Thompson Buffett Foundation (STBF), as well as the David and Lucile Packard Foundation and William and Flora Hewlett Foundation. Today, these and other grantmakers operate in a landscape thats seen dramatic change in recent years. Abortion advocates face daunting political setbacks, but are also energized by growing and diverse grassroots leadership. While grantmakers support for reproductive health, rights and abortion fell in 2018, interviews with funders and policy experts underscore that private philanthropys involvement in one of the most contested issues of our time remains expansive. (Well also examine anti-abortion funding in an upcoming article.)

Abortion in the United States: a Mercurial Landscape

In 2017, Trump reinstituted and broadened the scope of the global gag rule (GGR), which denies U.S. funding to groups abroad that provide, refer or counsel patients for abortions. We previously covered how some funders stepped up in response, and how philanthropies like the Gates Foundation and STBF, with billions to draw from, could potentially do even more.

Then in 2019, the Trump administration banned organizations receiving Title X federal funding from providing or referring patients for abortions, initiating what some call the domestic gag rule. Since 1970, Title X funding has supported health centers that provide free or low-cost annual exams, screenings, birth control and other health services to about 4 million people with low incomes annually.

A 2019 report from the nonprofit Power to Decide found at least 900 clinics have now lost their Title X family planning funding. Planned Parenthood, which served over 40 percent of all Title X patients, exited the program in response to the new rules, as have all recipients in five states. According to the National Latina Institute for Reproductive Health (NLIRH), people of color make up about half of Title X patients, and 32 percent of these patients identify as Hispanic.

The people most harmed by abortion restrictions are women of color, and poor and low-income women, says Christine Clark, Hewlett program officer for family planning and reproductive rights grants.

A growing wave of state abortion bans and restrictions have been introduced and passed, though some have been temporarily blocked. Other states responded by enacting abortion protections. Axios is keeping a running list of legislative developments.

Clark predicts the trend of states limiting abortion access will continue and accelerate, and that private philanthropy will not be able to meet the rising demands. She says that as the landscape continues to shift, the greatest challenge for providers and funders [is] to be ready to rapidly respond equipping providers in states where access remains to help many more people, making sure women can get where they need to go, and making sure there are effective communications channels so women know where they can go.

Many 2020 Democratic presidential candidates have voiced support for both codifying Roe v. Wade and repealing the Hyde Amendment. In 2018, about three-quarters of Americans said they did not want to see Roe v. Wade overturned, NPR reported.

However, Jethro Miller, PPFA and PPAF CDO, says, Biased politicians have kicked their efforts into high gear to control the narrative on abortion care, spreading misinformation and fear. He adds that the Supreme Court has taken up an abortion case on a law in Louisiana, and their ruling could have dire consequences for abortion access across the country. Several pro-abortion organizations (and their funders) are already directly addressing this upcoming case.

The Biggest Players in the Abortion Funding Field

Sorting out abortion-specific funding in the U.S. can be tricky because it falls within sexual and reproductive health and family planning services, as well as reproductive, womens and gender justice initiatives. Sometimes, its given by funders who also support these causes abroad. Planned Parenthood Federation of America (PPFA), a leading grantee in this field, reports abortions only make up about 3 percent of its services. And it has numerous local branches, a global division and an Action Fund (PPAF), its 501(c)(4) political advocacy arm. To further complicate things, many abortion funders donate through donor-advised funds (DAFs), shielding their giving from scrutiny.

In the Foundation Centers database, abortion funding is a subcategory of reproductive healthcare funding, and well mainly focus on these two funding streams. Reproductive rights, a separate funding filter that turns up some of the same funders and grants, will be addressed, as well.

According to the Foundation Center data currently available for 2018, foundation funding for reproductive healthcare in the U.S. that year was about $477 million. This constitutes a decrease in this vein of funding; in both 2016 and 2017, it was over $600 million. And reproductive healthcare funding rose almost every other year since 2010, when it was $247 million. U.S. abortion and reproductive rights funding also fell in 2018 after rising for several years prior. While the 2016 election and resulting Trump presidency spurred donors to give, it also created an increased state of competition among NGOs, as many progressive groups found their causes threatenedperhaps this heightened culture of need created the recent lag in reproductive health funding. The needs in this area certainly havent diminished.

Between 2003 and 2018, foundations targeting U.S. programs gave about $5.8 billion in total for reproductive healthcare, $1.2 billion for reproductive rights and about $495 million for abortion.

STBF lead the pack for U.S. reproductive health funding, awarding about $1.5 billion between 2003 and 2018 (future stats refer to this time frame unless otherwise noted). The Bristol-Myers Squibb Patient Assistance Foundation came in second, but this was due to a single large grant in 2015 relating to infant care.

Gates was third in all U.S.-centered reproductive health funding, in the ballpark of $278 million. But much of Gates funding in this realm supports U.S.-based research institutions and NGOs that work on international issues, like an $11 million grant to Johns Hopkins University in 2018 to support data collection to effect change in policies and programs relating to women and families health in Africa and Asia.

Fourth in U.S. reproductive health funding was Hewlett with $240 million granted, followed by Packard at $181 million. STBF, Hewlett and Packard are also within the top 15 funders in the U.S. overall by grant dollars awarded. STBF was the top grantmaker in the U.S for abortion specifically, by far, at $344 million, followed by Packard at $39 million and Hewlett at $19 million. We previously identified these three as top givers for reproductive health and abortion, and well look at their work in more detail below.

When the funding filter is shifted to reproductive rights, the top grantmakers were STBF ($565 million), Ford ($103 million), Packard ($85 million) and Hewlett (about $79 million). Ford was also among the top 10 funders of reproductive care and abortion. Fidelity Charitable, the Huber Foundation, the Educational Foundation of America, Robert Sterling Clark Foundation, PPFA and Groundswell Fund were also in the top 10 for reproductive rights funding, each giving more than $15 million.

The Susan Thompson Buffett Foundations Monumental Impact on Abortion Access and Reproductive Health

STBF doesnt publicize its grantmaking beyond its scholarship activities in Nebraska and is not responsive to media requests. (Were working on a separate article exploring its funding, following up on earlier coverage.) The foundation was created by billionaire Berkshire Hathaway CEO Warren Buffett and his wife, the late Susan Thompson Buffett, as the Buffett Foundation in 1964. It was renamed for Susan after she died in 2004. STBF focuses on preventing unintended pregnancy and ensuring people can get safe abortions in the U.S. and abroad.

STBF has given out more than $5 billion overall, including hundreds of millions to the various branches of Planned Parenthood. The foundation receives annual infusions of Berkshire Hathaway stock from Buffett, with such gifts also going to the Gates Foundation and the three foundations controlled by his children. So while STBFs assets stood at $2.4 billion in 2018, it received $259.7 million from Buffett that year and granted about $624 millionmaking it one of the largest grantmakers in the world, ahead of the Ford Foundation. While many grants range from $100,000 to $500,000, STBF regularly awards millions.

The global nonprofit Population Services International received the largest single grant in 2018 of about $32 million. In terms of domestic funding, STBF gave major support to the Society of Family Planning in 2018 through several grants totaling about $28 million. This Philadelphia-based nonprofit is currently focused on increasing access to pharmaceutical abortion. STBF backed this group in the past, funding that tracks with earlier support for research aiding the development and approval of RU-486, known as the abortion pill or Mifeprex (the brand name for mifepristone).

Other 2018 and repeat grantees include the National Abortion Federation (NAF), the professional association of abortion providers; Planned Parenthood, NARAL Pro-Choice America Foundation, and Guttmacher, a major sexual and reproductive health and rights research and policy organization.

The National Network of Abortion Funds (NNAF) received about $3.4 million from STBF in 2018. Abortion funds remove local financial and logistical barriers to abortion access. And STBF gave almost $3 million to the Groundswell Fund, which coordinates a movement of reproductive and social justice organizations led by communities of color. Here, we see the foremost private U.S. abortion funder investing in grassroots-based organizations, a trend we see with other major funders in this realm, like Hewlett and Packard, lately, as well.

One of STBFs most powerful contributions has been funding research that advances reproductive healthcare and/or influences policy. Starting around 2007, in an effort to ramp up the usage of IUDs, it funded studies, new device development and statewide free distribution trials of the devices. We will look at this contribution in more detail in our forthcoming story on STBF.

STBF also backed research that influenced the Supreme Court case, Whole Woman's Health V. Hellerstedt. STBF funded the Texas Policy Evaluation Project (TxPEP), which gave the court an analysis of the Texas abortion law (HB 2) at the center of the case. Known as a TRAP Law (Targeted Regulation of Abortion Provider), HB 2 introduced new abortion hurdles and restrictions that were found to be unconstitutional. The TxPEP research was cited in the ruling. And an STBF grantee, the Center for Reproductive Rights, argued the case.

According to the Center for Reproductive Rights, a 2014 law in Louisiana, Act 620, requires identical admitting privileges to HB 2. The Supreme Court scheduled a case relating to Act 620 for March 2020. The Center for Reproductive Rights, TxPEP and another STBF grantee, the University of California at San Franciscos Advancing New Standards in Reproductive Health (ANSIRH), have already filed documents with the high court, taking the first steps to respond to the Louisiana law as they did with HB 2.

In recent related news (and a potentially foreboding blow for reproductive rights advocates), in December 2019, the Supreme Court declined to hear an appeal of a Kentucky law that requires doctors to perform and show ultrasounds and play fetal heartbeats to patients before abortions. Then, in early 2020, more than 200 members of Congress sent the high court a brief asking it to uphold the Louisiana law in the spring and consider overturning Roe v. Wade.

Packard Focuses on the U.S. South

The David and Lucile Packard Foundation was established in 1964. At the start of 2018, it had assets of about $7.9 billion, and it granted about $324 million that year. Its reproductive health and justice giving is focused in the United States (Mississippi, Louisiana and nationally), Sub-Saharan Africa, South Asia and globally. Sex education, contraception, abortion, advocacy and policy are among its focuses.

Packard grants for reproductive issues range from the tens of thousands to the millions. It has long backed Planned Parenthood and gave about $10.5 million in total to several of the organizations branches in 2018. It has also funded the NAF, NARAL, the Center for Reproductive Rights and the National Women's Law Center.

Packard focuses much of its state-based reproductive-centric philanthropy in the U.S. South, particularly in Louisiana and Mississippi. Both states passed fetal heartbeat laws banning abortion at 15 weeksin a win for abortion supporters, Mississippis law was blocked by a federal appeals court in late 2019. Packard invests in local advocates and movement builders, including women of color-led organizations with strong community connections in these states, says Tamara Kreinin, Packard director of population and reproductive health.

And Packard makes a point to include young people, emphasizing the importance of comprehensive sex ed and services for youth, along with youth advocacy. Young people know what works best for their lives, [but] too often, they are under-represented, Kreinin says. She discusses the importance of supporting youth-led groups and reproductive care access centered around a young persons life and goals.

The Womens Foundation of Mississippi is a repeat Packard grantee, receiving $150,000 in 2018 to increase access to reproductive care. Packard has backed NNAF for several years, including with $100,000 in 2018 to support abortion fund infrastructure in Mississippi. Teen Health Mississippi was another grantee, and One Voice received support for the Sisters Helping Every Woman Rise and Organize (SHERO), a black womens reproductive justice collective.

In Louisiana, recent grantees also range in size and approach, including the Louisiana State University Health Sciences Center ($1.2 million), for a program working with adolescent sexual and reproductive health; the Foundation for Louisianas New Orleans Youth Organizing and Leadership Fund; and the Vietnamese American Young Leaders Association of New Orleans, in support of sex ed for young people in Vietnamese, Latino and LGBTQ communities.

Kreinin says, The deep history of racial discrimination and health inequities across these states, coupled with the current void of political support and lack of resources, make [advocates] work especially critical. Of its grantees in Louisiana and Mississippi, she says, These leaders know their communities best and are essential advocates.

Hewlett Embraces Grassroots and Youth Power

The William and Flora Hewlett Foundation launched in 1966. At the end of 2018, its assets were approximately $9.8 billion and it granted about $417 million that year. It supports family planning and reproductive health abroad, especially in East and West Africa, and in the U.S. The domestic program gives out about $10 million annually and has three general goals: to prevent unintended pregnancy, ensure abortion access, and integrate family planning into efforts to improve womens lives and stabilize families. Research and policy advocacy are key stated strategies.

Every year, Hewlett supports Planned Parenthoods programs in the U.S. and abroad, including with about $2.5 million in 2018. Other past grantees include Medical Students for Choice, the National Campaign to Prevent Teen Pregnancy (also known as Power to Decide), NAF, NNAF, National Women's Law Center and Center for Reproductive Rights.

Hewlett recently expanded its grantee portfolio in an effort to be more representative of grassroots organizing and the leadership of women of color. Clark says women of color and those who have less wealth are the most likely to lose access and face the greatest obstacles. Unlike middle- and upper-middle-class women, who have the means to get to places where they can get an abortion, poor women cannot. For them, abortion is an economic issue, as well as a health issue.

We heard a similar message from Rachel Jones, principal research scientist at the Guttmacher Institute (who was not referencing philanthropy). When we talk about the inequities of access, were talking about who is able to overcome [barriers]; who can afford to take time off work, [transportation, a hotel or child care]. As the number of restrictions increases, those inequities grow, too.

In 2018, Hewletts U.S. reproductive health and rights grants ranged from the tens of thousands up to several million. The Education Fund at UltraViolet, a feminist advocacy nonprofit, received $25,000. Hewlett granted Boston University $100,000 in support of research on women's empowerment. On the other end of the grant spectrum, Groundswell received $2.5 million. The Guttmacher Institute received more than $3 million.

Building on its inclusion of grassroots advocates within its grantee pool, Hewlett also has a new focus: the next generation of leaders from historically underrepresented communities. Citing the political engagement of #BlackLivesMatter, Dreamers, climate strikers, Parkland students and other young advocates, as well as the growing youth vote, Hewlett is in the midst of a three-year (2018-2021), $2.5 million funding strategy to strengthen youth engagement and leadership around reproductive health and justice. A few current grantees are the Alliance for Youth Organizing, Advocates for Youth (specifically, the Young Women of Color Council Program) and SPARK Reproductive Justice Now.

Hewlett grantee Groundswell has numerous youth-led grantees itself. Groundswell program officer Naa Hammond says young people are the lifeblood of every progressive movement, often pushing for the boldest strategies that leave no one behind Yet their leadership is often taken for granted by organizations and funders.

Fords Commitment to Reproductive Rights

The Ford Foundation gave about $103 million to reproductive rights groups between 2003 and 2018, and about $4.8 million in 2018 alone. It was the sixth largest funder of reproductive healthcare during this ~15-year-span (giving close to $153 million), and the eighth biggest funder of abortion, at about $3.5 million. PPFA is a leading grantee for Ford.

In 2018, in terms of reproductive rights, Ford supported the NLIRH (with about $2.4 million); In Our Own Voice, National Black Women's Reproductive Justice Agenda, and Sisterlove, which formed in the late 1980s as the first womens HIV/AIDS and reproductive justice group in the Southeast. An anticipated outcome of its reproductive and gender justice program is that leadership on these issues is more representative and includes women of color, low-income women and gender non-conforming people who begin to influence the agenda of the larger movement.

Brook Kelly-Green, program officer in Fords Gender, Racial and Ethnic Justice portfolio, tells us many of their grantees, working with strong coalitions, have had a significant impact on policy, especially at the state level. She says state-based organizations are crucial to the reproductive health and justice movement, because they know their members and constituencies best and how to contact, connect and motivate [their] civic engagement. She says Ford backs this kind of work by funding Groundswell, the Astraea Foundation and Ms. Foundation, which have expertise and longstanding relationships with [state] grassroots and policy groups.

The foundation also backs All Above All through its host, the New Venture Fund. All Above All is a reproductive justice coalition and advocacy campaign co-launched by NNAF (another Ford grantee) and NLIRH. Kelly-Green points out that advocacy by All Above All and others was influential in Illinois passing of its Reproductive Health Act in 2019, protecting multiple reproductive rights.

According to data provided by Funders for LGBTQ issues, Ford was the top funder of LGBTQ+ sexual and reproductive rights and justice in 2017an important category well look at, as well.

Other Key Abortion and Reproductive Health and Justice Philanthropies

Back to U.S. reproductive health funding: Big philanthropies like the Kellogg and JPB foundations were also among the top 10 funders, giving approximately $134 million and $70 million, respectively. PPFA was a repeat leading grantee for JPB in this realm, while Kelloggs largest grants in this area went toward maternal-child health. The Harold Simmons Foundation, PPFA, Open Society Foundations and others also gave tens of millions for reproductive health.

The California Wellness Foundation was the 10th-largest U.S. funder of reproductive healthcare at $61 million. Other health grantmakers who were heavily invested in this cause include the Robert Wood Johnson Foundation (at $51 million) and California Endowment ($20 million).

If we zoom in to U.S. abortion specifically, the fourth-biggest giver was the Robert Sterling Clark Foundation, which gave close to $7 million. The fifth biggest was the Education Foundation of America, a family foundation launched by Richard Prentice Ettinger (who co-founded Prentice-Hall Publishing) and his wife, Elsie. Its given about $6 million to this cause. The private Huber and Irving Harris Foundations were also among the top 10 abortion funders.

We dont see corporate philanthropies among the top funders of reproductive health, justice or abortion care. And we know the controversial nature of these issues is a large part of the reason STBF works to maintain a low profile. Of course, private foundations with iconic industry names like Buffett, Hewlett and Ford link their brands to these causes through their giving.

The Bank of America Charitable Foundation gave approximately $1.2 million for reproductive healthcare, including to Planned Parenthood. A few other corporate funders that gave less than a million to this cause include the GE, Pfizer, Prudential and Liberty Mutual Foundations, among others.

The Capital Group Companies Charitable Foundation makes contributions from associate's donations, and gave about $648,000 to reproductive health, including to Planned Parenthood. Some other companies supported reproductive health through their corporate giving programs with grants in the tens of thousands, including Kaiser Permanente and Altria Group. Companies whose corporate giving programs supported abortion include Microsoft, Maritz and Voqal.

As we mentioned, DAFs play a big role in abortion fundingFidelity Charitable, Schwab Charitable and the Vanguard Charitable Endowment Program funneled tens of millions to PPFA. Fidelity Charitable, the second-biggest U.S. funder overall behind Gates in terms of dollars granted, is a standout in particular. It gave about $109 million for reproductive healthcare (making it the eighth-largest funder of this broad issue) and close to $5.7 million specifically for abortion.

Community foundations with a womans giving program or an interest in reproductive health, and womens foundations, funds and giving circles can all play a crucial role in supporting local reproductive wellness and movement-building. While we cant explore all of their contributions in-depth, below are a few examples.

The Silicon Valley Community Foundation, a DAF powerhouse and the largest community foundation in the world, is the ninth-largest U.S. abortion funder, having given close to $3 million. The Philadelphia Foundation is the only other community foundation in the top 15 abortion fundersit gave about $1.7 million to the cause.

The Foundation for the Carolinas, Greater Kansas City Community Foundation, Community Foundation of Greater Memphis and Coastal Community Foundation of South Carolina, along with others, gave tens of millions to reproductive health causes. The New York Community Trust gave in the range of $13 million to reproductive healthcare, including consistent support for Planned Parenthood of New York City (PPNYC)

Irfan Hasan, NYCT program director for Health and Behavioral Health, says the trusts support for this group helped advance the passage of New Yorks Reproductive Health Act and earlier this year, [we] gave [PPNYC] a grant to develop and test a sex education curriculum for young people with developmental disabilities.

The Womens Fund of Greater Omaha gave close to $9.5 million to reproductive healthcare. The Ms. Foundation for Women has given close to $6.8 million for reproductive healthcare and about $1 million for abortion. Groundswell has given about $1.4 million for abortion.

American Abortion Funds

The National Network of Abortion Funds has received backing from STBF, Packard, Ford and Hewlett. Its a coalition of about 70 abortion funds that remove barriers to abortion access. An abortion fund may pay for an abortion directly or provide support such as transportation, translation, child care or accommodations. The Yellowhammer Fund in Alabama and Holler Health Justice in West Virginia are examples of state funds. The Third Wave Fund supports Yellowhammer. And before its own Emergency Abortion Fund closed in 2011, Third Wave aided more than 2,000 people seeking abortions throughout the U.S.

Abortion funds, much like giving circles or bail funds, allow groups of people to pool resources to assist specific communities and causes, and build political clout. They can shift money and power to populations that experience greater barriers to wellness and/or justice in the U.S., including in the realm of sexual and reproductive health. NNAF Development Director Debasri Ghosh says the funds use private philanthropy to weave together a compassionate, community-led and values-driven social safety net, which she says is necessary because the government does not provide adequate services to the nearly 1 million people who have abortions each year. She says the funds rely primarily on individual donations and grassroots campaigns like an annual Bowl-a-Thon, through which abortion funds raised $2.4 million in 2018.

Ely of the University at Buffalo studies abortion funds, and her research found people served by one national fund got an average of $1,000 in combined financial aid each to help pay for abortions that cost about $2,000, on average. She says these findings prove the importance of the funds for people with lower incomes.

NNAF provides its member funds with infrastructure and organizational support, and leadership development, while also partnering with networks and groups on advocacy agendas. Its political priorities include ending all abortion coverage bans, including the Hyde Amendment. NNAF co-launched the All Above All campaign with NLIRH in 2011. All Above All centers on a four-part BOLD Action Plan, that calls on activists across the country to educate themselves, get involved in local and creative advocacy, contact lawmakers and support and share the movements agenda on social media.

Supporting LGBTQ Sexual and Reproductive Health

Members of LGBTQ+ communities often face barriers to healthcare. As one meta-study pointed out, heteronormative attitudes imposed by health professionals can make care-access more difficult. According to Human Rights Watch, Many LGBT people are unable to find services in their area, encounter discrimination or refusals of service in healthcare settings, or delay or forego care because of concerns of mistreatment.

The American Cancer Society stated that lack of insurance for unmarried or domestic partners is another roadblock. These barriers also exist and can grow more complex within the territory of sexual and reproductive healthcare. Cultural biases and misinformation, such as the perception that only cisgender women seek access to abortions and other forms of reproductive care, can make it more difficult for LGBTQ+ communities to experience sexual and reproductive wellness.

Kelly-Green of Ford, the top funder in this area, says the foundation centers traditionally marginalized communities, like women of color, trans and gender non-conforming people. She says many of their grantees [expand] the definition of who needs access to reproductive services and work to ensure that access.

After Ford, Groundswell and Borealis Philanthropy are the top funders of LGBTQ+ sexual and reproductive rights and justice, Funders for LGBTQ Issues Vice President of Research and Communications Lyle Matthew Kan says. In 2017, we recorded a record high in funding for [these issues] of $2.9 million, he says. Funding was at $1.9 million in 2014, but dropped to $1 million in 2016. I think it's too soon to see if this increase indicates a trend that will continue, but its encouraging, nonetheless, he says.

Ryan Li Dahlstrom, program officer for the Fund for Trans Generations (FTG) at Borealis Philanthropy, says Borealis supports reproductive justice organizing led by LGBTQ+ people of color, who are often the most impacted by healthcare barriers and discriminatory policies.

Dani Martinez, Borealis Transforming Movements Fund Officer, says this fund backs advocates for reproductive care for vulnerable communities, especially in the U.S. South. And again, we hear a funder discussing youth engagement; she says the fund supports the bridging role young, queer leaders play across social movements.

Avoiding Reproductive Coercion

Historically and on a large scale, reproductive health and rights have often been tied to complex and controversial issues of global development and population. Within reproductive health and justice advocacy and philanthropy, the question persists of whether services are ever pushed on women, particularly those who already face societal injustice.

A 2014 report from Guttmacher explores the history of coercive practices related to contraception, especially those targeting disadvantaged groups. It discusses a spectrum ranging from involuntary sterilization programs as recent as the 1970s to the Norplant controversies of the 1990s, when legislators in multiple states introduced bills to give women receiving public assistance financial incentives to obtain an implant or even mandate its use. In 2015, a Republican state representative in Arkansas proposed a bill to pay unwed mothers on Medicaid $2,500 to use an IUD.

One important consideration, whether its a philanthropist or a government, is to avoid reproductive coercion, Liz Borkowski, a researcher in the Department of Health Policy and Management at George Washington University, recently told Vox in an article on philanthropy and reproductive care. Advocates like NNAF and Groundswell state it is essential that reproductive services be readily available but not coercive, with a focus on choice and bodily autonomy.

Kreinin of Packard says, Every individual, no matter their age, race, marital status [or] income, should have access to quality reproductive health information and services, and be able to make decisions that are right for them without stigma or interference.

The most important thing we can do to make sure reproductive healthcare is available but not coercive is listen to the people receiving the care, Clark of Hewlett says. She says the foundation has funded several research projects recently in an effort to better understand womens wants and needs in this area.

When private individuals and organizations with vast resources wield enormous influence over vital aspects of others lives, concerns of abuse are natural. One potential way for reproductive health and rights philanthropies to build just relationships with grantees and the people they serve is by supporting diverse leadership and grassroots movement-building, which we see more funders doing. This leads to our final topic: what reproductive health and justice philanthropists should do with their money.

Where Reproductive Funding is Needed

Miller of PPFA calls philanthropists who fund sexual and reproductive wellness vanguard defenders of comprehensive healthcare. But where are their defenses best constructed? Where do abortion rights grantmakers need to go on the offense? We asked advocates, funders and researchers which populations were underserved in this arena, and where reproductive health and justice funding dollars should be spent. Most concentrated on three intersecting areas: supporting direct services, especially for people most often lacking access; backing advocacy movements led by the people most impacted by abortion restrictions and other compounding inequities; and getting more people engaged in achieving long-term political progress.

Its clear that many people who face abortion barriers face other societal obstacles, as well. Diana Greene Foster, Ph.D., ANSIHR director of research, tells us the following populations are currently underserved by Americas abortion services: women who live in rural areas, far away from abortion providers, and/or in states with multiple abortion restrictions; undocumented women and women of color; and those with complex medical conditions or drug dependencies. She also mentions young women who live in states with parental involvement laws but no strong organization facilitating judicial bypass, and women who discover pregnancy later (who tend to be young).

Jones of Guttmacher says the institutes data underscores abortion-access inequities in the Midwest and the South. Along with several groups already mentioned, she says people with disabilities are an underserved community.

Kreinin of Packard says that in the short term, as abortion restrictions grow, especially for women of color, low-income women, young people and people with limited mobility, there is a need to cover the full cost of abortion care including travel, lodging and child care. In the long term, she says investments in movement building and civic engagement are needed.

Third Wave also favors support for both reproductive health service access and grassroots movement-building. Co-Director Kiyomi Fujikawa says, We need to be funding local service providers on the ground, like abortion funds, and also, the movement-building work of cis and trans women of color, and trans and gender non-conforming people of color is key. Third Wave recently provided a list of abortion access and reproductive justice organizations at the end of this blog post.

Dahlstrom of Borealis suggests funders in this realm back the work of black and brown trans and gender non-conforming communities, particularly trans women of color and femmes, as well as people with disabilities, currently and formerly incarcerated people, and people with substance use issues.

Ely of the University at Buffalo says, It is young people who are primarily impacted by a lack of access to reproductive healthcare. Hammond of the Groundswell Fund calls on grantmakers to back youth advocacy. She says foundations must resource and support youth activists, who [shine] a bright light on the path forward for this country and for reproductive freedom."

Ely recommends support for many of the populations named above, and also says funders should back reproductive health providers, NNAF and local abortion funds, advocacy groups like All Above All or the Center for Reproductive Rights, Planned Parenthood, and independent community family planning clinics. But she cautions abortion-rights donors to educate themselves and not support resource centers that are religious and provide no contraception, or crisis pregnancy centers, which do not support abortions.

Before the midterm elections of 2018, Mark Rosenman, a professor emeritus at Union Institute and University and nonprofit activist, wrote that nonprofits and funders must concentrate more on organizing and advocacy, instead of forever trying to fill public shortfalls with private philanthropy. He mentioned family planning as one area where this strategy is particularly urgent.

[Now] is the moment for foundations and other donors to support nonprofits doing the grassroots organizing and education work that will help Americans fight back against dangerous and mean-spirited policies when they go to the polls, he wrote.

While the 2018 midterms have passed, yielding some progressive wins and a Democratic House, Rosenmans focus on big-picture advocacy and widespread political change remains relevant.

Ghosh of NNAF says abortion care access and movement-building are intertwined. The central charge of abortion funds is to fund abortion and build power, and we encourage philanthropists to do just that. These two go hand-in-hand because funding abortion is inherently political work. When people have their needs met, they're primed to join and lead movements against injustice.

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Vanguard Defenders: What Top Foundations Are Doing to Protect Abortion Access - Inside Philanthropy