Thanks to the Supreme Court docket, abortion access has taken center stage for many individuals who otherwise ignore its fragility. Yet, it continues to be threatened in myriad ways beyond what’s possible through SCOTUS. We have seen lawmakers defy medical experts and weaponize COVID-19 to restrict abortion access. Abortions were treated as “essential” in Pennsylvania, and by mid-April, governors in 23 states had moved to protect timely access to reproductive health services — yet 11 anti-abortion governors seized the opportunity to single out and unconstitutionally limit abortion as “nonessential” health care. Anti-choice lawmakers also tried to ban medication abortion and telehealth, despite the benefit for patient and employees’ safety.

While some wait with bated breath for SCOTUS’s next word on Roe v. Wade, the decision never fully protected abortion to begin with in Pennsylvania or elsewhere. The persistent need for free unrestricted abortion care in Pennsylvania relates directly to the historic abundance of obstructions in our state. Our state’s punitive and unnecessary Abortion Control Act imposes arbitrary restrictions such as a 24-hour waiting period, mandated state counseling, and parental consent — or judicial bypass — for anyone under age 18.

Upheld by SCOTUS, it not only became the benchmark for later inhumane restrictions nationwide but was also devastatingly successful at blocking Pennsylvanians from care. At the Women’s Medical Fund, we uncovered in 2019 that more than 6,300 people in Southeastern Pennsylvania need abortion funding support annually, and at least 3,200 people are forced to carry their pregnancies to term because they cannot afford the care they need.

It is no accident that a state with an incarceration rate that outpaces most of the nation, that denies its population affordable housing, a thriving wage, and suitable employment, also has brutal laws around accessing safe, simple health care. The overlapping systems of violence that keep abortion inaccessible all thrived under Roe.

It was Roe and subsequent decisions by SCOTUS that created 1,200-plus legal obstructions to abortion care that have passed in the U.S. Focusing on Roe misses that this is not a struggle over abortions vs. no abortions, but a fight between forced births and criminalized pregnancies. No court, supreme or otherwise, will stop people from obtaining and providing abortion care. It has been present in caring communities as long as people have gotten pregnant. While the confirmation of Amy Coney Barrett to the Supreme Court — as part of President Donald Trump’s promise to appoint pro-life justices — dramatically illustrates our government’s gross antagonism toward abortion access, the precarity of abortion in the U.S. is sadly nothing new.

Fortunately, on-the-ground solutions are more plentiful than many realize. Utilizing them requires both a shift in understanding and a shift in focus to local protections. In the last few years, some state and municipal governments have begun protecting care access in their jurisdictions through budget appropriations and legislation that guarantees access to care.

At minimum, Pennsylvania authorities should follow that same path. They should repeal the ban on using state Medicaid funds to pay for abortion and create municipal funding streams for abortion care in the commonwealth. They should expand the categories of health-care providers allowed to perform abortion care to include midwives, physicians’ assistants, and advance practice nurses. They should lift the arbitrary ban on abortions after 24 weeks. They should extend telemedicine care and access to mifepristone and misoprostol, prescribed abortion medications which, when taken together, have been proven safe and effective in terminating pregnancies in clinical and nonclinical settings.

Achieving these basic provisions will be an uphill climb. But nontraditional strategies have brought success. For instance, across the nation, there is continued growth of abortion funds, organizations that collect individual donations from communities to help people who are prevented by the state from using their insurance. We also see an increase in practical support networks, typically volunteers who provide transportation, lodging, child care, and other means of support for people accessing abortion care. We like to say that abortion funds were made for this moment.

Abortion funds have a long history in Pennsylvania, including our own work in WMF. That began in Philly 35 years ago in response to federal and state efforts to ban the use of Medicaid to pay for abortions. Our early organizers realized that Black and non-Black pregnant people living in deep poverty couldn’t wait for the resolutions of lengthy lawsuits; they needed an immediate way to get their abortions paid for. That’s where funds came in.

As an abortion fund, we appreciate the critical importance of community organizing and prioritizing the leadership and experience of those most directly impacted by abortion restrictions. Just as it is not enough to declare abortions legal without ensuring access to them, it is not sufficient to simply pay for those abortions allowed by the government while leaving the people beyond those protections without care. We must summon once again our revolutionary values to embrace direct action and civil disobedience, call upon mutual aid and community organizing, center those most directly impacted, and deprioritize legal objectives — like focusing on Roe — in this work. These things are necessary to finally create a world where anyone can have abortions for any reason at any time.

Seneca Joyner is the manager of community organizing at the Women’s Medical Fund.