Post-Dobbs abortion access has been propped up by donor outrage and heroic work—but that fragile system is already leaving people behind.
Now, almost three and a half years after the Supreme Court overturned Roe v. Wade, the numbers are clear that abortion in the United States has, to the shock of most, continued to rise. But we also have data showing that a small but not trivial number of people are continuing their pregnancies to birth due to abortion bans. To us, what this shows is clear: that overturning Roe has prompted ingenuity, persistence and resistance among providers and patients, but is also leaving many people behind. Ultimately, this is no way to deliver healthcare.
As long-time students of the abortion issue in America, we were not surprised when the Supreme Court, in the Dobbs v. Jackson Women’s Health Organization case in 2022, overturned Roe, putting the legality of abortion in the hands of individual states.
We were initially surprised, however, when researchers reported that the number of abortions actually increased immediately after Dobbs, despite the fact that roughly a third of states quickly banned abortion altogether (with an exception for threats to a pregnant woman’s life) and many more severely restricted it.
The #WeCount project of the Society of Family Planning has been periodically tracking the number of abortions since Dobbs and comparing them to pre-Dobbs numbers. The project has reported a steady increase in the number of legal abortions reported, including in its latest release from last month, which covered the period from January through June 2025.
This increase in abortion numbers became much less surprising to us as we worked on a book about how the abortion providing community and its allies were first preparing for and then responding to a decision they saw as inevitable. Our interviews with healthcare workers, clinic managers, staff working in abortion funds, and various others revealed a community working furiously to assure as much abortion access as possible to those living in states where abortion was not available.
How did they do it?
- Clinics extended hours of operation and hired new staff.
- When feasible, clinics relocated to the nearest bordering state where abortion remained legal.
- Providers experimented with new and often cheaper delivery mechanisms for abortion pills.
- “Patient navigators” in national and local organizations worked tirelessly helping individual abortion seekers with appointments, travel and lodging, as well as payment for the procedure itself for those who could not afford it.
The increase in abortion numbers has been due not only to the herculean efforts of the provider community but also to the money that poured into clinics and support organizations immediately after Dobbs by Americans incensed by the loss of legal abortion. “Rage spending,” as these donations became known, brought in millions of dollars needed for the huge costs associated with transporting thousands of people across state lines and paying for the abortion itself along with other costs.
Despite the continuing increase in abortion numbers, data crunchers have also found that these resources aren’t reaching everyone. A recent study estimates that between 3 and 11 percent of those wanting an abortion after Dobbs have been unable to obtain one. Some among this group, and their children, will suffer the well-documented health and economic consequences of forced childbearing. Maternal and infant mortality rates have already risen in states that ban abortion.
How to account for these seemingly different findings? That abortion continues to go up but that a small, but not insignificant, number of people are facing the harshest consequences of abortion bans?
The explanation is that as essential as the hard work of the abortion providing community has been post-Dobbs, we should not lose sight of the fact that the current system is far from an optimal way to deliver healthcare: People should not have to travel far from home, lose several days of wages, and need coverage for their children to obtain a basic and, in most cases, quite simple procedure.
Nor should they have to depend on the whims of donors. One of the conclusions we reached in our research was that one of the biggest issues for abortion access in the post-Dobbs landscape is sustainability. In the past year, there have been numerous reports of dwindling contributions to abortion funds.
As the anger over the Dobbs decision subsides and has been replaced by new outrages in the Trump era, outrages that that are clamoring for donations, abortion funds are hurting. The director of a Texas fund told a reporter in June that her fund received requests from 500 people but was only able to help 87 of them.
… Between 3 and 11 percent of those wanting an abortion after Dobbs have been unable to obtain one.
This most recent report from #WeCount, which covers the period from January through June of this year, highlights this concern about sustainability. Although the number of abortions in that report is higher than the previous period studied, the increase is only about 4 percent—the smallest increase reported by #WeCount to date.
It is possible that this smaller increase reflects a growing number of people obtaining abortion pills outside the medical establishment, such as through international pharmacies or community networks, abortions not included in formal counts. But it is also possible that, coupled with the studies showing the small number of people carrying their pregnancies to term after Dobbs who otherwise would have had abortions, this new data shows that this post-Dobbs system is not working for everyone.
What the precarious and volatile nature of the donations that abortion funds receive illustrates is the limitations of the dependence on private charity and volunteer time for human needs such as healthcare. Private funders, big and small, are not always reliable partners, as their commitments shift. Monetary contributions also vary by region or even locale, and are not consistent over time. The same is true of the volunteer hours often needed to support patients on long drives crossing state borders.
The provision of healthcare—and abortion is healthcare—must be publicly supported in order to be equitable and accessible. To be sure, from the start of the Roe era, the U.S. government, with the passage of the Hyde Amendment, made it clear abortion would not receive federal dollars. A minority of states have stepped in to use their own funds for this purpose, but not enough. The heroic efforts we have seen since that decision on the part of abortion providers and allies are only a greatly magnified version of what always had existed since Roe: the need for financial assistance for the impoverished women who make up the vast majority of abortion patients.
When this assistance relies on inconsistent large-scale private donations, as well as the almost-supernatural work of abortion providers and supporters, it’s no wonder that some people are slipping through the cracks, even while abortion numbers are rising. Everyone deserves reproductive freedom—not just those who are lucky enough to more easily access it.
