A protest over abortion rights in Richmond on May 3, 2022. (Sarah Vogelsong / Virginia Mercury)
Last summer, one of Virginia’s most prominent abortion rights organizations launched a new pilot venture — a volunteer-run service focused on transporting patients to clinics.
Then known as NARAL Virginia, the group was the state’s affiliate of NARAL Pro-Choice America, a national lobbying organization focused on expanding and protecting access to abortion services. In Virginia, work had similarly been focused on political advocacy, from canvassing for pro-choice candidates to opposing proposed new restrictions from state lawmakers.
Just a year before, in 2020, they had scored a major victory with the repeal of some of Virginia’s most significant restrictions, including mandatory ultrasounds and a 24-hour waiting period before the procedure. The state’s recently elected Democratic majority also eliminated so-called TRAP laws — stringent building code restrictions that aimed to require abortion providers to comply with hospital-like standards.
But by the time NARAL Virginia began mobilizing its transport program, the landscape surrounding abortion had changed dramatically. In May of 2021, the Supreme Court agreed to hear Dobbs v. Jackson Women’s Health Organization, a case poised to overturn federal abortion protections granted under 1973’s Roe v. Wade decision. A few weeks later, NARAL’s national office announced it was disbanding its 11 state affiliates to focus on advocacy at the federal level, according to Tarina Keene, executive director of the Virginia chapter.
“We saw this as an opportunity,” she said. On Thursday, after a year of development, the organization will officially relaunch as REPRO Rising (the first half of the name doubles as an acronym for reproductive equity, protection, rights and opportunity). And as abortion rights advocates confront a likely post-Roe landscape, the group is shifting focus, significantly expanding its transportation program and concentrating not just on political advocacy, but on ways to expand services across Virginia.
“What I think people will find — and they really need to understand this — is that there will be a crisis of access if Roe is overturned,” Keene said. “This is going to impact everyone. So even those folks who have been able to mostly access care could find things are vastly changed in the future.”
The availability of abortion services has been a longstanding concern for many providers and pro-choice advocates. In Virginia, the number of facilities offering the procedure has continued to decline over the last several years, and roughly 93 percent of counties don’t have an abortion clinic, according to analysis by the Guttmacher Institute, a global research organization dedicated to reproductive rights. In a policy opinion, the American College of Obstetricians and Gynecologists wrote that barriers to care are disproportionately shouldered by low-income patients, people of color and rural communities, who often struggle more with restrictions on insurance coverage and limitations on where services can be performed.
But the May leak of a draft Supreme Court decision overturning Roe v. Wade triggered a seismic shift in priorities for pro-choice groups across the country, according to Erin Matson, a former NARAL Virginia board member and executive director of Reproaction, a national pro-choice advocacy group. The sweeping draft upended constitutional protections for abortion, raising the likelihood of bans or strict restrictions on services in nearly half of all states. In areas where access is preserved, providers are anticipating a sharp rise in demand from patients in states outlawing the procedure.
“People didn’t need to look at a map to know that Virginia is increasingly becoming an abortion destination,” Matson said. According to the Guttmacher Institute, at least two border states — Kentucky and Tennessee — have so-called “trigger laws,” legislation that would ban abortion within 30 days of Roe being overturned. And even before the draft leak, some providers reported a climb in patients from Texas, where lawmakers banned abortion as early as six weeks into pregnancy.
“All states that don’t have abortion restrictions are anticipating an uptick in folks traveling from those restricted areas,” said Stephanie Nash, the Virginia advocacy director for Whole Woman’s Health Alliance. Since March, the group’s clinics in Virginia and Maryland have already offered abortions to 110 patients from Texas who were pregnant for more than six weeks and couldn’t access services in their home state.
The anticipated growth in demand prompted a recalibration of core priorities, for REPRO Rising and other pro-choice groups across the state. Virginia currently has 16 abortion clinics, many more than other surrounding states including Kentucky and West Virginia, which both have only a single facility that remains open. But some of those locations share medical providers, and many are concentrated in major urban areas like Northern Virginia and Richmond, leaving large portions of the state uncovered.
“And as we learned from seeing how SB 8 in Texas played out, there’s a ripple effect,” said Tannis Fuller, executive director of the Blue Ridge Abortion Fund. “As your appointment availability shrinks, the competition for those appointments gets heavier.” With providers anticipating a similar experience in Virginia, connecting patients with services has become equally if not more critical than state policy for preserving abortion rights.
“We are in quite an unprecedented moment, and it’s important our organization reflect the reality of reproductive health rights on the ground,” Keene said. “That’s what our relaunch is all about.”
So far, the organization has expanded its initial pool of 15 volunteers to more than 80, collaborating with abortion funds like Blue Ridge to connect with patients in need of transportation. Keene said REPRO Rising also partnered with the Richmond Reproductive Freedom Project to certify volunteers as abortion doulas, training them to offer emotional support along with rides to clinics.
Fuller said many of the group’s volunteers still seem heavily concentrated in certain parts of the state — particularly Hampton Roads, Richmond, and Northern Virginia — which sometimes limits the availability of their transportation services.
But as word spreads, REPRO Rising is still bringing on new volunteers, particularly in Southwest Virginia, according to Keene. It’s work that often takes hours of time and covers significant distances. She noted a recent volunteer who drove from Virginia Beach to Williamsburg to pick up a patient for an appointment at an abortion clinic back in Virginia Beach, then provided the return trip home again after the appointment.
“For some of these trips, we’re talking about at least a couple hundred miles,” Keene said. “So, it’s just one example of how this is working.”
Transportation isn’t the only roadblock to accessibility. With an expected rise in out-of-state patients, some of Virginia’s frontline advocates are hoping Roe might incentivize more providers to begin offering abortion services — another limiting factor in appointment availability. The state currently allows midwives and nurse practitioners to provide first-trimester abortions, and doctors can generally perform the procedure at all stages of pregnancy (Virginia law bans most abortions after the second trimester except in severe medical circumstances).
Despite that eligibility — expanded after a 2019 court decision — it’s rare to find providers who offer the procedure outside specific clinics. Doctors cite ongoing institutional and cultural barriers that still make it difficult for most offices to perform abortions, even if practitioners are willing.
In some cases, hospitals or individual practices — especially those with religious affiliations — prohibit their providers from offering abortion services through contracts or practice agreements, according to one Virginia physician who does perform the procedure in-office. Lack of insurance is another barrier. Public dollars, including Medicaid funding, can’t be directed toward abortion, and she said most private plans still won’t pay for the service, despite 2021 legislation that repealed a statewide ban on coverage for plans offered for sale through a health benefits exchange.
“I see that every single week,” she added. One of the single biggest deterrents, though, is ongoing stigma against the procedure. For decades, anti-abortion activists have outed doctors willing to perform abortions — in some cases targeting their friends and relatives with calls or, in one recent incident, covering their neighborhood with flyers. The fear of harassment is so great that the Mercury extended anonymity to the Virginia physician, who worried her home or office could be targeted by protesters.
“With abortion, all the stigma breeds silence,” she said. “So when you’re talking provider barriers, that’s probably the most overarching of all of them.”
Some advocacy groups are hoping to overcome those concerns with ongoing outreach, gradually expanding the number of locations where patients can access the procedure. But the renewed focus on services also underscores Virginia’s new political reality.
Amid disagreements with advocacy groups over the best way to expand protections, Democratic lawmakers did not attempt to codify the right to abortion in state law, despite a last-minute push in December. Though the Senate remains controlled by Democrats, the state’s House of Delegates now has a Republican majority, and Gov. Glenn Youngkin has publicly expressed support for a 20-week abortion ban.
So far, it’s unclear if the governor or House leadership plan to attempt to implement restrictions in Virginia after the overturn of Roe v. Wade. The House Republican caucus did not respond to a request for comment, and Youngkin has repeatedly declined to specify whether he has plans for any specific policy proposals. Macaulay Porter, a spokesperson for the governor, referred the Mercury back to a previous statement, in which he described himself as “pro-life” but focused on the state’s budget negotiations.
Sen. Scott Surovell, D-Fairfax, said he believed there were enough votes in the Senate to strengthen abortion rights through a proposed constitutional amendment or legislation that would establish reproductive choice as a fundamental right, similar to a bill he drafted in 2020. But with those efforts dead on arrival in the House and the governor’s office, the chamber has few options for expanding their 2020 gains.
“As a practical matter right now, we’re a little bit on the defense,” said Sen. Jennifer McClellan, D-Richmond, a long-time advocate for abortion rights. “Virginia is and will remain a safe haven for abortion in the South. But it’s clear this is a battle that’s coming back to the states.”
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