Alabama remains one of the most restrictive and challenging reproductive health environments in the country. The state’s laws, healthcare infrastructure, and political climate combine to create conditions where access to basic reproductive care is inconsistent, limited, and often unsafe. Black women experience maternal mortality rates three times higher than their white counterparts, meaning the burden of this hostile landscape is not shared equally. Philanthropy must respond with more than think-pieces and reports. This moment demands deep relationship and monetary investment into the solutions created by Birth Justice Leaders in Alabama and the Deep South.

In 2022, reproductive health, rights, and justice organizations across Alabama began preparing for significant changes when the Dobbs decision leaked, signaling that already fragile abortion access would face further erosion. As a trigger law state, Alabama immediately outlawed abortion following the overturn of Roe v. Wade. In the aftermath, the attorney general threatened prosecution against individuals assisting others in traveling out of state for care. Alabama Department of Public Health attempted to introduce regulations targeting birth centers and midwifery care that would have severely limited their ability to operate, while hospitals known for providing safer care for Black women closed their doors.

For rural communities, the absence of services shapes daily life. More than one third of Alabama counties lack obstetric care, forcing families to navigate long distances to access essential services. For low-income families, the cumulative costs of appointments, transportation, and childcare combined with race-based criminalization place care out of reach even when it technically exists. People living with disabilities face additional barriers through provider bias and inadequate accommodations, further reinforcing exclusion from essential reproductive and maternal health services.

Alabama Birth Equity Initiative exists because we are past time to move beyond theory. Importantly, this initiative is grounded in data and direct community input, not assumptions. Through a 48-county bus tour across rural Alabama, we partnered with PhD candidate Shawnda Chapman, and Abby El-Shafei of Strength in Numbers to conduct a comprehensive reproductive health needs assessment. We engaged more than 500 community members to ensure that the services, advocacy, and systems we are building reflect what communities have identified as their actual needs and priorities from a Reproductive Justice standpoint.

Guided by the lineage of Southern midwives, mutual-aid societies, and organizers, we treat care itself as strategy: a way to dismantle the conditions that produce crisis while rehearsing the liberated future we seek. We witness the need for a new model, for care centered in community.

ABEI’s care-based strategy has three pillars. ABEI’s strategy for the workforce is to Increase the number of Black Midwives achieving licensure to practice within the state. They also want to improve access and provide mobile reproductive health units for rural Alabama. Finally for infrastructure, ABEI will build a Reproductive Justice center for birthing, working, and community resources.

ABEI builds directly on proven work that is already underway. Oasis Birth Center has helped double the number of midwives practicing in Alabama. Yellowhammer Fund has served as a trusted intermediary since 2022. In March 2025, Yellowhammer Fund served as lead plaintiff in the federal case that blocked Alabama from criminalizing anyone who helps residents travel for out-of-state abortion care. The ruling restored our travel-grant hotline, protected volunteers from prosecution, and is now cited in parallel suits across the South—proof that community-rooted organizations can move constitutional law. Alabama Birth Center has functioned as a preceptor site, contributing to workforce development. ABC has worked with countless student nurse practitioners, student midwives, and resident physicians to facilitate training in low-resource settings. Chocolate Milk Mommies works to bridge gaps by providing lactation and breastfeeding support creating safe spaces where mothers feel seen, heard, and valued, Chocolate Milk Mommies also connects families with trusted birth workers and maternal health resources, promoting awareness about disparities impacting Black maternal and infant health. Margins has served hundreds of families to ensure that pregnancy would not become a catalyst into poverty and that they would be able to raise their children with dignity and respect.

There has been a sector wide divide between abortion access and birth equity., That must end. Grassroots organizations like the members of ABEI and local abortion funds like Yellowhammer Fund serve people who are not living single issue lives. When we are asked to isolate our programming because a funder only funds abortion, we are being asked to abandon the framework of Reproductive Justice, which is central to our work. Funders can and must do better. Initiatives like ABEI are gateways to the full spectrum of care. The Combahee River Collective’s statement articulates how Black women face interlocking systems of oppression— race, gender, sexual orientation, and class— and how Black women’s liberation requires addressing all of these simultaneously. The Collective argues that identity politics emerge from material conditions of oppression and that the most radical politics come from those most marginalized. For ABEI, this provides foundational language for understanding why infrastructures of care must address food, housing, healthcare, childcare, and safety together. These needs are not separate, but interlocking. Meeting them is both practical survival work and radical political practice.

Jenice Fountain is the Executive Director of Yellowhammer Fund, where she leads Reproductive Justice work in Alabama and the Deep South with a focus on mutual aid, health equity, and economic justice. Fountain is a fearless organizer and strategist, building grassroots power in a region too often abandoned by national funders. She brings deep expertise in care-centered leadership and radical community resourcing. “My journey is fueled by rage, radical imagination and fierce love for my community. I am grounded in the belief that we can create what we need.”

Picture a room of student leaders from Historically Black Colleges and Universities (HBCUs) laughing, hugging, and celebrating two years of advancing Reproductive Justice through advocacy that transformed them, their campuses, and their communities. That was the energy in the room at our 2026 Next Generation Leadership Institute Graduation Retreat in Washington, D.C.

I was filled with immense pride as we ushered this outgoing class into the next phase of their journey as budding Reproductive Justice activists. From the moment our 2026 fellows entered the program, they made history as the most inclusive cohort we have ever welcomed, with the largest representation of HBCUs to date. And what makes this distinct class even more remarkable is that they didn’t stop there. They carried that same spirit of excellence and purpose throughout their entire two-year fellowships.

Amid a hostile political climate, our fellows didn’t just show up. They showed out. Across the nation, the Next Generation Leadership Institute fellows organized 64 campus programs, each one tailored to the specific needs of their own campus community. Each fellow conducted a campus needs assessment, surveying their peers to understand what resource and programming gaps existed at their HBCUs. From that data, they built campus events that filled the Reproductive Justice needs outlined by their peers.

The results speak for themselves: more than 4,500 menstrual products distributed, 1,500 safe sex kits placed directly in the hands of students who needed them, and four Reproductive Justice Hotlines launched at Spelman College, Howard University, Xavier University, and Langston University, giving students on-demand access to contraceptives and reproductive health resources.

The beauty of our model is that it puts the decision-making power exactly where it belongs: in the hands of the young people who know their campuses best. A menstrual equity initiative at Xavier University of Louisiana looked nothing like one at Tougaloo College and it shouldn’t have. At Xavier, fellows Christina Anderson, and Alicia Spight, partnered with New Orleans Bounce artist and community advocate Vickeelo, turning what could have been a standard product distribution drive into a vibrant cultural celebration rooted in the spirit of their New Orleans community. At Tougaloo, fellow Nayla McClure, extended her reach beyond campus entirely, partnering with a local middle school in Jackson, Mississippi, to establish a menstrual care closet for young girls who needed it most. Both were made possible by a program design that gave fellows a clear framework and the freedom of trust to adapt it.

Standardized programming produces standardized results. To achieve transformative, community-rooted outcomes, our model proves that funders must resource and trust the people closest to the problem to design the solution.

Supporting Young Leaders Builds Lasting Power

Over the years of leading this work, I have learned that meaningful leadership development builds lasting power but only when it is resourced to do so. I say this not to scold, but because I genuinely believe funders who are paying attention can and will do better. Especially for organizations like ours that are pouring into young people to be fully equipped and prepared to lead the fight for Reproductive Justice. Here is what that looks like in practice.

Multi-year, flexible funding is not a luxury for this work. It is a prerequisite. Our fellows needed a full year to earn trust on their campuses, to build relationships, and to understand the landscape before their advocacy efforts could truly take root. The most powerful results such as new Reproductive Justice hotlines, coalitions, and community partnerships will long outlast our students’ fellowships. A one-year grant cannot capture that arc, and it certainly cannot sustain it.

While longevity in funding is crucial, so is trust. The Next Generation Leadership Institute works because we trust young people to identify their campus needs and design solutions to address critical Reproductive Justice issues at their HBCUs. When funders layer on excessive reporting requirements, rigid deliverable structures, or intense scope restrictions, that can send an unintentional message of distrust. The impact of distrust is not neutral. It costs time, energy, and momentum that our fellows could be spending on activating their campuses.

Black-led organizations are not high-risk investments. In fact, the Next Generation Leadership Institute’s impact including 64 programs created thousands of menstrual and contraception products distributed, and numerous hotlines launched proves that. These programs thrived, even against a backdrop of unprecedented political hostility towards reproductive rights, health, and justice. What we witnessed in those outcomes is not fragility. We saw resilience, resourcefulness, and visionary leadership, which can only be strengthened when it is funded.

I return to that Graduation Retreat room, and I find that I don’t want to leave, because what happened in that space deserves to be showcased. The fellows who fill the room know all too well the stakes when young people don’t have a seat at the table. We deliberately designed this celebratory gathering to firmly plant their seats at the helm of the Reproductive Justice leadership table. Watching them claim those seats with confidence and purpose reminded me that this is exactly what investment in young people is supposed to look like.

The lesson for funders is clear: When we trust young HBCU students, invest in their success, and fully resource them as partners in this work, the result is a stronger, more collaborative, and more resilient Reproductive Justice movement for everyone. In short, we all benefit from investing in the next generation of youth advocates.

Giovanteey Bishop is a program strategy executive and leadership development architect dedicated to advancing Reproductive Justice for Black women and communities across the nation. As Director of Programs & Training at In Our Own Voice: National Black Women’s Reproductive Justice Agenda, she leads the strategic vision of high-quality national programs and designs training ecosystems that develop the next generation of Reproductive Justice leaders. She holds a Master of Science in Administration with a concentration in Health Advocacy from Trinity Washington University, grounding her work in health program design, community needs assessment, and program evaluation. Beyond her professional role, Giovanteey serves as a mayor-appointed Commissioner on the Washington DC Commission for Women and is a proud member of Alpha Kappa Alpha Sorority, Incorporated.

To learn more about the Next Generation Leadership Institute and how to support this work, visit blackrj.org.

For 53 years, the anniversary of Roe v. Wade has held a mirror to the sector. Too often, what it reflects back is the cost of our own silence, absence, and hesitation to invest in abortion access at a scale that the frontlines have long demanded beyond survival and beyond sustainability.

Since 2020, the National Committee for Responsive Philanthropy has worked to move research, resources, and guidance toward abortion access rooted in justice, centered at the state, and local levels, and shaped by those closest to the hurt and work. And still, nearly four years after the Dobbs decision, the limits of research alone have become undeniable. Philanthropy continues to underfund, delay, and constrain the movement’s vision, while anti-abortion forces do the opposite. Anti-abortion funders build patiently, plan across decades, and their funding does not excuse itself during legislative fads and ballot calendars.

Meanwhile, much of abortion access-centered philanthropy remains preoccupied with its own sunsets. Convening to discuss exits, legacy, and the vacuums their absence will create, rather than reckoning with the damage already done by years of underinvestment, silence and stigma. As of this anniversary, several major institutions have publicly announced plans to wind down or exit the field, including the Susan Thompson Buffett Foundation, the movement’s largest funder, the Compton Foundation, the Gates Foundation, the Grove Foundation, the Irving Harris Foundation, the Wellspring Philanthropic Fund, and the Tara Health Foundation.

Susan Thompson Buffett Foundation’s decision to sunset has surfaced a reckoning the sector postponed for far too long. Its scale and steadiness created tangible stability and in doing so, made it easier for the rest of philanthropy to avoid building shared responsibility, redundancy, and long-term infrastructure. The panic we are witnessing now isn’t about one foundation stepping back; it’s about a system that never prepared itself to hold the work collectively.

As others wait to make their plans public, philanthropy infrastructure organizations like Funders for Reproductive Equity and intermediaries like Groundswell Fund and Grantmakers for Girls of Color continue to fund grassroots work while also challenging the habits philanthropy has relied on for too long. Those reckonings matter. Because at this moment, abortion seekers, providers, and organizers are exhausted. Their grace is gone, and their patience is low.

And exhaustion on the frontlines is not just an emotional condition; it is the terrain on which opposition infrastructure is built. Appalachia shows us exactly how that transfer of power happens.

Maternal Health Deserts and Manufactured Scarcity

We are naming Appalachia not because it is marginal, but because it is revealing the impacts of a sector that has produced and sustained isolation in a region considered nonessential to national strategy. The expansion of crisis pregnancy centers (CPCs) in the region is not simply the result of opposition strategy; it is the predictable outcome of philanthropic absence. When long-term, values-aligned investment fails to materialize, anti-abortion infrastructure fills the vacuum with discipline and intent.

Appalachia matters in its own right and tells the truth; power is never neutral, and power doesn’t disappear; it reorganizes elsewhere.

Crisis pregnancy centers are not a deep south problem, not a midwest problem, and not a rural problem. They are a national infrastructure. They show up everywhere, but they grow fastest where care has been stripped away. CPCs thrive in the absence of full-spectrum reproductive healthcare. In places where entire zip codes, counties and even states have been abandoned, leaving CPCs with the space to redefine what care looks like. Their expansion is not accidental. It is the predictable result of policy failure and philanthropic neglect. Additionally, CPC density in Appalachia did not emerge in isolation.

It grew alongside a collapsing maternal health ecosystem as hospitals closed, midwives were criminalized, and OB/GYNs were pushed out by policy, cost, and political hostility. Leaving rural families forced to navigate pregnancy and birth under conditions that qualify as a humanitarian crisis.

This is what underinvestment produces, manufactured scarcity that leaves people desperate for any form of support, real or not. CPCs have stepped into that desperation with precision, embedding themselves in places philanthropy has too often labeled too complicated, too conservative, too small, or too politically risky.

Our data above reflects how care actually moves. Bordering states, many shaped by Appalachian care networks and migration, often serve people traveling for pregnancy-related care. We also include a small number of rural areas outside of the region facing similar disparities, to make visible how these systems operate across places.

Appalachia makes this truth impossible to ignore. The region stretches across more than a dozen states and holds deep diversity, people whose lives cannot be flattened into a single story. What binds most Appalachian communities is their shared history of extraction and divestment. That history shows up in today’s conditions, including the more than 160 crisis pregnancy centers embedded across the region.

To focus on West Virginia, the only state entirely Appalachian, is not to single out the state, but to see the pattern clearly. Nearly half of the state’s counties, 47.3%, are maternity care deserts, and another 12.7% offer only low or moderate access, not full-spectrum care. The imbalance is obvious, one abortion clinic serving 1.8 million people, in a state where there are roughly 6.8 CPCs per million residents. In a maternal health desert with little abortion access, pregnancy is no longer a choice or a journey; it is a gamble with people’s lives, shaped by policy, neglect and abandonment.

Fear, Faith, and Falsehood

The CPC model thrives on its ability to weaponize fear by exaggerating medical risks and exploiting uncertainty, leveraging faith through deep integration into church networks, and deploying falsehoods by presenting themselves as legitimate medical providers.

And in Appalachia, trust is currency. Anti-abortion networks understand this and have invested accordingly, building volunteer pipelines, leadership benches of medical professionals and political leaders, and long-term relationships over decades.

They have stayed where philanthropy that professes concern for the access and reproductive justice space cycles in and out, and they have built while many funders shift focus during crises and retreat once attention shifts. Unless philanthropy is willing to learn from that strategy, not to replicate its ideology, but to match its commitment, anti-abortion infrastructure will continue to outpace and overshadow our own.

A National Call to Build What Comes Next

We have to tell the truth about our own delay. Too often, those of us with access to platforms and decision-makers, including NCRP, softened language where it should have sharpened. We trusted proximity over pressure, and we allowed politeness to stand in for accountability. A restraint that by no means protected the movement, but protected funders from having to change.

We have used research to try to move resources to the frontlines, and we are listening as organizers tell us plainly: research is not what is missing, reports cannot substitute for action, and data cannot replace decisions. Additionally, its delivery must demand action and leave no room for delay between plenary sessions and abortion bans. In this moment, our responsibility is not to produce more proof, but to use proximity, platform, and relationships to interrupt harm as it is happening.

That means speaking less about the crisis and speaking bold intentions into the rooms where money is held, and decisions are delayed, naming risk aversion for what it is, challenging hoarding in real time, and refusing to let delay masquerade as strategy. What comes next is a grounding in southern-rooted frameworks and leadership for understanding reproductive access and gendered violence that helps funders and frontline partners move out of silos and toward integrated, survivor-centered strategies with real resources behind them. In 2026, NCRP will curate spaces grounded and curated by the people who built this analysis, inviting funders not just to learn, but to act.

Our commitment is to use research as a door, not a destination. To leverage proximity, platform, and relationships to surface the quiet parts in real time, disrupt harmful funding patterns as they are happening, and push resources toward frontline abortion access and care infrastructure with urgency, not permission.

Working from a place grounded in values aligned between what we name, what we build, and a refusal to separate analysis from responsibility. Not cautiously. Not eventually. But now, creatively, collaboratively, and with the courage to build the future we imagine.

Brandi Collins-Calhoun is the Movement Engagement Manager at the National Committee for Responsive Philanthropy (NCRP). A writer, educator and reproductive justice organizer, they lead the organization’s Reproductive Access and Gendered Violence portfolio of work.