The Health Divide: Nobody expected this would happen after the Dobbs decision
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A doctor walks towards an exam room to administer abortion medication to a patient at the Center for Reproductive Health in Albuquerque, New Mexico.
Photo credit: (Gina Ferazzi/Los Angeles Times via Getty Images)
Published on
June 3, 2025
Veteran journalist Fran Smith’s new column for our Health Divide series examines the sweeping, often confusing changes in federal health care policy and funding, and how reporters can cover the impacts and inequities in their communities. She contributes every other week. Send ideas, comments and links to your own coverage to editor@centerforhealthjournalism.org and follow Fran on Bluesky @fransmith.bsky.social
Thirteen states have abortion bans, 28 others have imposed restrictions, and scores of clinics have closed. In states with bans, birth rates have increased among low-income people and people of color, and infants, Black babies especially, are dying at higher rates.
Many people predicted all this when the Supreme Court overturned the constitutional right to abortion in the Dobbs decision three years ago. Yet there’s one thing almost nobody expected. Instead of falling, the number of abortions across the U.S. has steadily increased:98,000 a month on average in the first six months of 2024, up from 88,000 in 2023 and 81,400 in 2022.
“I was very surprised,” said David Cohen, a professor of law at Temple University. “But in retrospect I feel like I shouldn’t have been. This is the story post-Dobbs, that people are doing everything within their power and expertise to make sure that people can still get care.”
Cohen and Carole Joffe tell that story in a new book, “After Dobbs: How the Supreme Court Ended Roe but Not Abortion.” Most obviously, abortion has survived in large part through the use of pills. Medication accounts for nearly two-thirds or more of abortions nationwide, and 80% to 95% of abortions in some states. Telehealth consultations with abortion providers, and mail-order pills, have made it easier and cheaper to end a pregnancy, and offer discretion in states with punitive laws.
For Cohen, the story is less about changes in how abortions are administered than about the doctors, midwives, nurses, activists, lawyers and volunteers who have refused to back down. They have tested, skirted and maneuvered around ever more forbidding laws to provide care for more than 1 million people a year.
In just about every state, nonprofit organizations raise funds to help women pay for abortions, travel and related expenses. Volunteer navigators on distant cell phones guide people as they drive or fly, often solo, across state lines for an abortion. “Many of them are very poor — half are below the federal poverty line — which means many of them have never, literally, been in an airport,” said Joffe, a professor of obstetrics, gynecology and reproductive sciences at UC San Francisco.
In the lead-up to the Dobbs decision, Cohen and several other lawyers began exploring the idea of shield laws to protect licensed clinicians in pro-choice states who provide abortions for patients traveling from states with sharp restrictions. Now 18 states and the District of Columbia have laws that protect abortion providers from prosecution and lawsuits by another state for caring for a patient in their office.
Eight of these states, New York among them, include a telehealth provision, a safeguard for doctors who prescribe abortion pills remotely for patients no matter where they are, even if they’re in states where abortion is illegal. Just a handful of doctors — Cohen estimates 15 to 20 — facilitate about 12,000 abortions a month through telehealth under shield-law protection.
These laws are the latest battleground in the abortion wars. The Texas attorney general sued a New York doctor and a Louisiana grand jury filed criminal charges against her for prescribing abortion pills to a pregnant patient in each of their states. New York rejected a Texas court judgment fining the doctor $100,000 and refused a request to extradite the doctor to Louisiana. Such interstate tugs-of-war and the pressure they put on doctors won’t let up anytime soon.
Even with the successful efforts to keep abortions available, many people cannot obtain the care they want. And those who do often travel inordinate distances, disrupting their lives, sometimes draining their savings and jeopardizing their jobs. Women have died or been grievously injured because care was denied, and some have faced criminal prosecution after a miscarriage or stillbirth. We’re now watching the tragic spectacle of a brain-dead woman in Georgia forced to carry her pregnancy to term against her family’s wishes.
Nor is it clear how long abortions will continue at the current volume. Abortion services dependent on the sweat of volunteers, the commitment of providers, and the generosity of private donors may not be sustainable in the long run.
Meanwhile, anti-abortion activists keep trying to get the abortion pill mifepristone pulled off the market. U.S. Health and Human Services Secretary Robert F. Kennedy Jr. recently announced a federal safety review of the drug — one that has been on the market for 25 years.
And the Trump administration has stopped enforcing the Freedom of Access to Clinic Entrances, or FACE Act, a 30-year-old measure outlawing obstruction, harassment and vandalism aimed at shutting down patients’ access to reproductive health services. Trump recently pardoned 23 anti-abortion activists convicted under the act, a move that encourages others to block clinic access and terrorize patients and providers — or worse.
As the third anniversary of Dobbs approaches this month, I asked Cohen and Joffe for ideas and tips for reporting on an issue that has been covered heavily for years.
“I would urge journalists to contact local abortion funds and see if they can identify a patient they can accompany on their journey to another state,” Joffe said. “I would also urge journalists to visit clinics in states with a six-week ban and try to talk to patients.” In pro-choice and restrictive states alike, journalists can examine the growing use of telehealth, which now accounts for one in five abortions. Talk with abortion providers operating under shield laws and patients who self-manage abortions that are illegal in their states.
Like Cohen and many others, I thought abortions would plummet after Dobbs. I imagined that many women who wanted to end a pregnancy would simply be stuck, as my mother was when she became pregnant in 1962, 11 years before Roe v. Wade legalized abortion nationally.
It was her third pregnancy, after me and my brother. She didn’t plan it, want it or feel she could afford another child. She had just returned to work after years at home and knew she’d have to quit.
Around the third month of her pregnancy, she started spotting blood. The same thing had happened during her first pregnancy. That time, she’d moved in with her parents and, on a doctor’s orders, spent six months in bed before safely giving birth.
This time she saw her way out.
She launched into furious activity, running up and down the stairs to our fourth-floor apartment, cleaning the place with a vengeance, moving heavy wooden furniture to vacuum hidden corners. When she started bleeding profusely, she was rushed to the hospital and treated for a miscarriage.
She told me the story years later. It always reminded me, as Cohen and Joffe’s book now does, that no matter how many obstacles and threats the government imposes, it can’t legislate, regulate or litigate away a person’s need to control their own body and destiny.