"My name is Danielle," she says, and immediately begins to sob. "I have three little kids and cannot have another. I cannot. I'm telling you, I cannot be pregnant or have this baby."

Danielle then takes a deep, audible breath, lets out another sob, and slowly resumes talking to the answering machine at the Women's Medical Fund in Philadelphia.

I'm on cash assistance and just paid my electric bill so I don't have any money for an abortion. I need to come up with $250. Please, please help me.

Danielle is followed by Taneisha, Josenia, Courtney, Daisy, Shannon, Monica, Amara - 25 calls total, not including the dozen who've hung up without saying a word.  Each of them says the same thing: She wants to have an abortion but cannot afford one.

It's morning at the Women's Medical Fund and counselors taking calls off the voicemail describe this parade of messages as typical. They seem nonplussed as they prepare to call each woman back, readying themselves to ask hard questions about personal finances, health, and family support systems to ascertain whether the Fund can assist them. It's a daunting task, made harder by the current economic climate, which leaves the Fund with less money to dispense.

It's not even 10:00 a.m. and I'm already overwhelmed. But the counselors - highly trained college interns and volunteers supervised by a paid staff of three - are cheerful, eager to do what they can for low-income women in their five-county catchment area of southeastern Pennsylvania.

The 24-year-old Fund was established in 1985, shortly after the state cut off Medicaid coverage for abortion. As one of the 102 groups in the National Network of Abortion Funds, its mission is to offer grants and loans to women who want to end unwanted pregnancies but lack the means to do so.  Since its founding more than 12,000 Philadelphia-area teenagers and adult women have been aided and more than $1.6 million - all of it raised through individual donations and foundation grants - has been disbursed.

Still, like other members of NNAF, WMF staff look forward to the day when the Hyde Amendment - the hated 32-year-old bill that bans federal Medicaid coverage for abortion unless the woman was raped, violated by incest, or will die or face serious health complications if she carries the pregnancy to term - is overturned. As advocates, they favor expanding Medicaid to include all reproductive health services for low-income women.

Until then, however, WMF counselors have no choice but to ask each woman they speak with a litany of personal questions: Was she forced to have intercourse? Did a family member impregnate her? Was she ever warned that carrying a pregnancy to term might put her at medical risk? A "yes" on any of these queries sends both counselor and patient deep into government bureaucracy. They understand that if Medicaid will pay for the abortion, the WMF can stretch their increasingly limited dollars a bit further.

"We never have enough money," admits Susan Schewel, WMF's Executive Director, "but it has gotten worse. The recession has caused some of our donors to make cutbacks and our fall fundraising did not go as well as we had hoped." In fiscal 2008, which ran from July 1, 2007 until June 30, 2008, the Fund received $100,000 from local foundations; in fiscal 2009 they took in $60,000. Still, in fiscal 2009, more than $165,000 was distributed. What's more, nearly 500 women were assisted in the first four calendar months of this year, up almost 50 percent since 2008; the average grant: $139.

"The typical WMF caller is in her twenties, has a toddler or preschooler already, and is on either cash assistance or has a part-time, minimum wage job. Almost one-third are uninsured and 93 percent live below the federal poverty guideline for their family size," says Schewel. She continues:

A fair number of the women work part-time and go to school part-time.  Their lives are really complicated but the one thing they have in common is that they're all doing the best they can. In fact that's my mantra: Everyone is doing the best she can.

That said, Schewel and WMF's counselors can't help but be frustrated by the fact that privately-run Funds have become an essential component of reproductive health care, filling gaps left by inadequate government funding.

"Our so-called safety net doesn't really act as a safety net," Schewel says. "Women can't live independently even if they access all the benefits they're entitled to: Medicaid, cash assistance, food stamps, child support. Even if she gets everything that's out there she can't live alone unless she has subsidized housing. The low-cost housing shortage in Philly is terrible so lots of women live with family or friends who are willing to put them up for a month, or a week, or a year but they're basically homeless. This crisis is exacerbated when the women becomes pregnant."

Twenty-seven-year-old Melissa, the mother of a three-year-old, faced an unplanned pregnancy crisis in mid-May.  "It was a little more than a month before I was set to begin a nine-month training program to become a phlebotomist," she says. 

When I got the pregnancy results I was scared and unsure about what to do but knowing that I couldn't afford an abortion made it worse. Once I found the Fund they helped me get everything together and slowly but surely things fell into place. I had already come up with as much money as I could on my own, and when I called the Fund, the counselor assured me that they'd help with the difference.

Catherine is in similar straits. Her voice is composed as she describes her predicament: She is 13.4 weeks pregnant and has an abortion scheduled for the following week. Then, slowly, in response to the counselor's questions, she confides that she is in poor health, listing problems including endometriosis, chronic Hepatitis C, asthma, and limited mobility.   

Almost as an afterthought she mentions the horror she lives with: "My ex-husband ran me over with his car a while back. Five vertebrae were broken and my collarbone and left leg were shattered."

She can no longer work, she says, and has applied for Social Security Disability but has not heard back about her eligibility.  In the interim, she and her 11-year-old son live with her sister and she receives a biweekly welfare grant of $158. "I'm extremely poor," she mumbles.

As the interview progresses, the counselor learns that Catherine's doctor has advised her against completing the pregnancy, warning that her already fragile health could be worsened by childbirth. Might this allow her to get Medicaid coverage? The counselor jots down Catherine's doctor's name and number and assures her that she will contact the medical practice to discuss her probable eligibility for Medicaid-funded surgery. The counselor adds that she will also fax the doctor an MA-3 form -a Physician's Certification for Abortion-to get the ball rolling.

This news makes Catherine euphoric; she sounds as elated as a lottery winner.

Not so Jaime, who is 6.4 weeks pregnant and says that she needs $450. That fee, for a general anesthetic, is more than the WMF can provide and the counselor tells Jaime to call the clinic and ask the price for local anesthesia. "Not being put to sleep means that the abortion costs less," she counsels. "Please call me back with the new price and we'll take it from there."   Will she ever hear back from Jaime? the counselor wonders.

Others requests involve more heartbreak: Incarcerated husbands and boyfriends; women suicidal because of unwanted pregnancies; honors students whose contraceptives failed; women unexpectedly laid off from jobs they thought were secure.

"These women are the experts about their lives," says WMF director Susan Schewel. "Not me. Not us."

Erica, who received $130 from the Fund in April, says that she was surprised that WMF staff respected her decision to have an abortion.

I'm 20 and have two kids already, a one-year-old and a four-year-old. This pregnancy came as a surprise. I thought about having it but was so sick throughout the day that I was unable to function. It was too much on me. The total cost of the abortion was $350, but the clinic gave me a discount to $230. I had $50 already and my job advanced me $50. When the Fund made up the difference, I got the abortion done.

"Receiving help from the Fund was the best thing that happened to me in a long time," Erica adds. "I was overwhelmed and happy to get money when I called."

Steph Herold was a volunteer counselor at the WMF for several years while she was in college. Now an abortion counselor, she describes the work of the Fund as extremely important, if limited.  "You have to accept that you are there to help with one aspect of a woman's abortion experience, the cost of the procedure," she said in an email. "Ultimately, though, you play a critical role in her pursuit of reproductive rights."    

The WMF believes that reproductive choice is essential, but recognizes that without access, choice is meaningless. By providing direct financial assistance to low-income women, they equalize the playing field, giving poor females the same options that have always been available to their better-heeled peers.

More information about the Women's Medical Fund is available at www.womensmedicalfund.org or by calling 215.564.4070.

The National Network of Abortion Funds can be reached by calling 617.524.6040.