Elizabeth Arndorfer, U.S. Reproductive Health Director, The David and Lucile Packard Foundation
Interviewer: Miranda Wesley, Communications Specialist, Grantmakers In Health
The Packard Foundation has a long history of funding efforts that protect, regain, and expand access to abortion and contraception and funding innovations to expand access to these services as part of its U.S. Reproductive Health initiative. To explore the foundation’s current work, specifically at the state level, Grantmakers In Health’s Miranda Wesley spoke with the Packard Foundation’s U.S. Reproductive Health Director, Elizabeth Arndorfer. This interview has been edited for length and clarity.
Tell me about the Packard Foundation’s U.S. Reproductive Health Initiative.
Elizabeth Arndorfer: The Packard Foundation has long supported reproductive health, including access to abortion and contraception. In 2022, our board approved a new strategy to respond to the changed landscape after the fall of Roe vs. Wade. Our new initiative has three grantmaking areas—first, about 60 percent of our grantmaking resources support efforts in states where there’s an immediate opportunity to protect, expand, or regain access to abortion or contraception; 20 percent focuses on innovations in abortion and contraceptive service delivery utilizing both our grantmaking [and] mission investing levers of the foundation; then, a final 20 percent provides targeted grants to Louisiana and Mississippi to mitigate the harms of abortion bans and to expand access to contraception in both states.
How did this initiative start? And how did you determine these funding priorities?
Elizabeth Arndorfer: While our current initiative was approved in 2022, the foundation has a long history of supporting reproductive health and rights starting in the mid-1960s. In the early months post-Dobbs, everything was very chaotic, [and] the landscape was changing daily, sometimes hourly. During that process, we stayed laser-focused on our ultimate goal, to protect and expand access to abortion and contraception in as many states as possible, while mitigating the impact of abortion bans.
We know abortion bans hurt everyone, but their impact falls most heavily on Black, Indigenous, and other people of color communities and families who are struggling to make ends meet. We hope that by focusing on regaining and protecting access in as many states as possible, we can minimize the harms to those most vulnerable.
On the innovations front, the foundation has a long history of using both its grant dollars and its mission investments to support advances in health care. For instance, in 2015, the foundation made a large commitment to bringing the first birth control pill over the counter. Fortunately, that was just approved at the end of 2023 and is now hopefully in the pharmacy nearest you.
What investments are you making in Louisiana and Mississippi?
Elizabeth Arndorfer: I just got back from a trip to Louisiana and Mississippi. I had the same experience that I have every time I go, which is that there are amazing leaders and organizations doing really important work in a very complicated and challenging environment.
Both states banned abortion after Dobbs and seeing the impact has been devastating. A recent report out of Louisiana showed that the abortion bans are having an impact far beyond abortion into other health care issues. For instance, some Obstetrician-Gynecologists (OBGYNs) are delaying prenatal care for patients until they reach 12 weeks of pregnancy—when risk of miscarriage drops significantly—to avoid treating patients who might face miscarriage. They don’t want to be in a health care provider relationship with somebody who might be miscarrying because that might be seen as causing an abortion. That is 100 percent contrary to best practice, especially for people with high-risk pregnancies or other complications. It’s particularly concerning in states, like Louisiana and Mississippi, [which] have some of the highest rates of maternal mortality and morbidity and infant mortality. That’s an example of how the bans are having an impact far beyond just access to abortion.
Ultimately, we’ll see a change in health care providers’ willingness to practice in these states, which will have this ripple effect. We’ve already had one health care provider who we’ve supported leave Louisiana because they didn’t think they were safe practicing medicine in the state, even though they didn’t provide abortion. That’s just the tip of the iceberg, unfortunately.
In Louisiana and Mississippi, our grantmaking is focused pretty narrowly on mitigating the harms of abortion bans and expanding and protecting access to contraception. For instance, we support the Louisiana Abortion Fund (LAAF). More than 75 percent of people who get abortions are low-income and most of them have children. LAAF helps people who have decided that they want to end their pregnancies navigate access and pay for the services.
We also support an organization called Converge in Mississippi. They’re the federal Title 10 grantee for family planning services in the state of Mississippi. They are doing amazing work to expand access to family planning and STI (Sexually Transmitted Infection) services to people who are uninsured or underinsured. They’re in a great position to expand that access and to improve and provide high-quality care that is reflective of the communities in which the services are being provided.
In addition to the Reproductive Health portfolio, the Foundation’s Children and Families initiative, which is focused on maternal and child health and connected care, [is] also investing in Louisiana and Mississippi. I’m excited about the larger ecosystem that the foundation is going to be able to support in these states.
What other state-based work do you do?
Elizabeth Arndorfer: Since 2022, we’ve provided 501(c)(3) permissible support to organizations working in states with ballot initiatives, [including] Kansas, Michigan, Ohio, Florida, Colorado, Missouri, Nevada, [and] New York. Our grantmaking has focused on educating people, non-partisan Get Out the Vote (GOTV), and deep canvassing. One of the things that we were hoping to do with our new strategy was to be responsive, able to pivot when needed, [and] to fill gaps. We’re trying to listen to the needs of the organizations who are working in these states and provide the kinds of resources that they need.
One thing about those investments that I am excited about is the deep canvassing work that we’ve been able to support. Deep canvassing is quite different from traditional political canvassing, which tends to be very transactional and tries to identify, persuade, and then basically move on. Whereas deep canvassing [includes] long form conversations. I liken them to conversations with your neighbors, where you’re listening to their perspectives and sharing both your thoughts and experiences.
What we have learned is that those kinds of conversations, which are deeper, more authentic conversations, are more transformational than trying to go in and persuade people of your point of view. It takes a lot longer and a lot of skills to have those conversations, but the more we can have conversations across differences, the better we’ll be in our country. We need more of that on abortion and beyond.
Tell me about how you navigate these different political environments.
Elizabeth Arndorfer: One of the things that we’ve learned since Dobbs is that abortion actually isn’t a partisan issue. People across the political spectrum, from so-called red states to blue states to purple states, the majority of people support the freedom of individuals to make their own decisions. That’s also reflected in poll after poll after poll. In every ballot initiative to date, about 20 percent of registered Republicans have voted in support of access to abortion.
It’s not that people don’t have deeply held beliefs; they do. We all do, and we have them based on our own experiences. I have three children. Every pregnancy was different, every child is different. I’ve also had an abortion and I’ve had a miscarriage. I’m grateful for the health care that I received and for the decisions that I was able to make that were best for me and my family. That’s the point that we agree on as a country, which is that it’s individuals and not politicians who should be able to make these complicated decisions.
Recognizing that there is a lot of common ground, we’ve supported organizations like Galvanize USA to educate, engage, and mobilize moderate women in small towns and rural areas. It’s not about “convincing” them, it’s about encouraging them to vote their values. Likewise, we support Americans for Contraception Education Fund, who are educating people on the importance of, and threats to, contraception. They have been mobilizing faith communities, including evangelical Christians, in support of the right to contraception.
What advice might you have for funders wanting to get involved in protecting reproductive health care?
Elizabeth Arndorfer: For a long time, many people thought of abortion as too controversial to touch. What Dobbs has taught us is that access to abortion is deeply connected to health care [and] our basic democracy.
The case of Kate Cox, a woman in Texas, captures all of those elements. First, it’s about health care. She was pregnant with her third child when she got a devastating diagnosis of Trisomy 18. Her doctors recommended she have an abortion. The state denied it. They basically said, “You’re not sick enough to merit an abortion,” even though she was in and out of the emergency room because of health complications with the pregnancy. The state said, “No, we want you to sacrifice your future fertility, even your life; we would rather your kids grow up without a mom than permit you to have an abortion.”
What she and her family went through goes beyond abortion, beyond health care, it was about the retaliatory power of the state to punish and interfere with an individual citizen. Even though she got a court order saying she could have an abortion, the Attorney General wrote a letter to all of the hospitals saying, “If you give this woman, this individual citizen from our state an abortion, we will come after you with a full force of the law, and that includes jail time.” This kind of retaliation that is targeting individuals is not what a democratic government should be doing.
If you zoom out from the case of Kate Cox and look at ballot initiatives, you see a similar pattern, where state governments twist their power to prevent citizens from voting on abortion ballots. Take the state of Ohio—the state government did everything they could to prevent an abortion ballot initiative from going on the ballot because they knew that it would pass. They challenged the language; they fought it in court. When that didn’t work, they put another initiative on the ballot to change the rules, which the citizens rejected. Citizens eventually got to vote on the abortion access ballot initiative, which they also approved. Although it passed, the state government is still trying to thwart what the citizens have clearly said they want. Both stories demonstrate the deep anti-democratic tactics that are being used.
My advice would be [to] jump in. There are no shortages of places to plug in, whether it’s services, advocacy, communications, organizing, or innovations and mission investments. I welcome people to reach out to me. I’m happy to have conversations to talk through different avenues of support, connect, and share information.