Abortion providers, pills and patient networks have transformed access in the face of bans and shifting laws.
This week marks the third anniversary of the Supreme Court overturning Roe v. Wade and ending the constitutional right to an abortion. But perhaps unexpectedly, people on both sides of the abortion issue find themselves in a surprising environment: Abortion numbers continue to rise. In other words, after the Supreme Court paved the way for a dozen or more states to ban abortion for the first time in almost half a century, abortion access is thriving in ways no one predicted.
Newly released data from WeCount provides details on this trend.
- In 2022, the year in which the Supreme Court ended Roe, there were just under 80,000 abortions per month (for the nine months WeCount was collecting data).
- That increased to 88,000 per month in 2023 and to 95,200 per month last year.
Together, that means abortion numbers have increased almost 20 percent in the two full years post-Dobbs. And almost everyone recognizes that this number is an undercount of actual abortions taking place, as these figures do not address the uncountable abortions from people ordering abortion pills online.
How did such a counterintuitive phenomenon happen? Our recent book, After Dobbs: How the Supreme Court Ended Roe but Not Abortion, helps explain what’s going on behind the numbers. In simplest terms, this increase came about through a combination of an extraordinary mobilization on the part of abortion providers and their allies, the grit and determination of people who decide to have an abortion, and the massive amount of money poured into pro-abortion groups after Dobbs.
Our research revealed that providers, seeing the proverbial handwriting on the wall, began strategizing for the post-Roe world long before Dobbs was announced. In some cases, those in states where abortion was sure to be banned or severely restricted moved their clinics across state lines into abortion-friendly territory. If unable to move their clinic, those who managed to stay open by offering other services developed referral plans for patients who needed abortions. Providers in states where abortion remained legal anticipated a flood of out-of-state patients and made every effort to scale up operations by hiring more staff and extending hours, in some cases to seven days a week.
Travel to get an abortion has become much more common. Before Dobbs, one out of ten abortion patients traveled to another state to get care; after Dobbs, this number doubled to one out of five. For some, travel is not that difficult. But for others—those without a car, gas money, a supportive boss, a family to watch the kids, or the privilege of traveling without being harassed for being a racial minority or because of immigration status—travel can be almost impossible. However, clinics have risen to the challenge by establishing robust patient navigator systems that help patients with every aspect of travel. And where clinics can’t get the job done, vast networks of volunteers with practical support organizations are driving patients—sometimes just a couple of miles, other times a couple hundred miles—to get to appointments and housing them overnight.
Abortion funds, both in national organizations like Planned Parenthood and the National Abortion Federation, and in local and state organizations, have also played a crucial role in navigating abortion travel but also helping women pay for abortions and the expenses of travel.
These organizations, often led by women of color who draw on the long history of the reproductive justice movement, have made abortion a reality for those for whom it is economically out of reach. The sustainability of these efforts is always a question, as “rage” donations that poured in post-Dobbs have dwindled over the past three years. But for now, abortion funds are working tirelessly to meet all the need they can.
Finally, abortion pills have changed everything. Now accounting for almost two-thirds of all abortions, pills are cheaper and more accessible than ever. Most patients still get their pills from brick-and-mortar abortion clinics, but more and more are availing themselves of telehealth to obtain abortion pills. Even in states with abortion bans, patients are able to obtain pills from licensed medical practitioners thanks to innovative telehealth shield laws, which allow doctors in states where abortion remains legal to mail pills into states with bans. Almost 10,000 abortion pill packs are being sent every month into states with bans because of these new laws. And for those who don’t want to avail themselves of pills through a licensed professional, online pharmacies and informal networks are there to fill the need.
To be clear, the environment has not been uniformly good for abortion. Some undeniably negative things have occurred thanks to the Supreme Court. Due to the lack of clarity about what constitutes a permissible exception, women dealing with pregnancy emergencies have been subject to egregious medical treatment, with some even dying because of withheld treatment; infant and maternal mortality rates have risen in states that have banned abortion; and people undergoing miscarriages have been arrested and jailed because of suspicion that they purposely caused the miscarriage.
Moreover, an unknown number of women wanting an abortion have been unable to get one. These include those unable to travel because of childcare responsibilities or an uncooperative partner, or those unable to risk losing a job because of an absence. People unable to obtain an abortion will suffer the well-documented negative consequences known to occur when a desired abortion is not possible, including increased poverty and increased susceptibility to partner violence.
The political future is also uncertain, as no one knows just what the Trump administration will ultimately do with abortion. So far, it has not made attacks on abortion a central focus of its agenda. Trump has pardoned antiabortion extremists who were in jail for violent attacks on clinics and his administration announced that it will cease enforcing the federal law protecting against anti-abortion violence. It has also ended funding to international organizations that refer or counsel on abortion.
But it hasn’t yet taken the two actions that the abortion community has most feared: enforcing the Comstock Act to ban mailing anything that can produce an abortion and limiting access to mifepristone (or even rescinding approval altogether), the first of the two drugs used in medication abortion. If the Trump administration were to take either of these two actions, there would certainly be legal challenges but if successful, abortion access in this country would be significantly impacted.
For now though, and maybe long into the future, surprising almost everyone, abortion access is thriving. Relentless providers and advocates are supporting patients who are resolved to get care. And they are all doing it in spite of the Supreme Court.
