Two years after the US Supreme Court revoked the constitutional right to abortion, an increasingly robust body of evidence is emerging that illustrates the myriad harms caused and exacerbated by the Dobbs v. Jackson Women’s Health Organization decision. Several dozen peer-reviewed studies and other rigorous research conducted since June 2022 illustrate key facets of the impact of Dobbs, including data on changes in clinic numbers, abortion incidence and travel for abortion care. This empirical evidence is complemented by valuable insights from other sources, such as reports from advocacy organizations with deep expertise in different areas of reproductive health and rights, as well as stories from reputable media outlets.
It is valuable to examine this growing evidence base to gain a deeper understanding of how the volatile, chaotic legal landscape that erupted in the wake of Dobbs has affected abortion access in the United States. It is also important to acknowledge that our understanding remains incomplete and that the full scope of harms caused by the ruling may not be clear for years to come. However, the evidence suggests that it will not be easy to repair the devastation caused by the Dobbs decision. Documenting its adverse effects is critical to our goals of mitigating and reversing the decision’s impact, and ultimately restoring and reimagining abortion rights nationwide.
Accumulating Evidence Shows a Broad Range of Impacts
Several research efforts—including the #WeCount project by the Society for Family Planning and Guttmacher’s Monthly Abortion Provision Study—were specifically designed to generate high-quality data on an accelerated timetable to help policymakers and others gauge impacts nearly in real time. The empirical evidence is complemented and further contextualized by reports, stories, surveys and other sources that offer a clearer picture of the wide-ranging effects of overturning Roe v. Wade.
Fewer Abortion Clinics and Shifts in Provision
Within 30 days of the Dobbs decision, 43 clinics in 11 states had stopped providing abortion care. By 100 days after the decision, this had increased to 66 clinics in 15 states; no abortion-providing facilities operated in the 14 states enforcing total abortion bans.
Between 2020 and March 31, 2024, the total number of brick-and-mortar clinics providing abortion care in the United States declined by 5%, from 807 to 765, according to forthcoming Guttmacher research. This trend is likely to continue, following the May 1 implementation of a six-week ban in Florida, where 54 clinics provided abortion care, and ongoing legal chaos over potential enforcement of a total ban in Arizona, which has seven abortion clinics.
In the District of Columbia and the 36 states that do not have total bans in effect, 20 additional facilities began providing care, representing a 3% increase for those states, according to forthcoming Guttmacher research. This is welcome news and helps improve access there, but it does not mitigate the loss of access in states with total or early gestational bans.
New Models for Abortion Care
Brick-and-mortar facilities provide more than three-quarters of all abortions, but a new type of provider—virtual, or online-only, clinics—is expanding care options by offering medication abortion services via telehealth. Research by the #WeCount project shows that virtual-only telehealth abortions accounted for almost one in five abortions (18%) from October to December 2023, an average of nearly 16,000 abortions per month.
A critically important subset of telehealth abortions is those provided by clinicians in states supportive of abortion rights to people in states with total or telemedicine abortion bans. Six states (California, Colorado, Massachusetts, New York, Vermont and Washington) have shield laws in effect to ensure that abortion providers can offer said care regardless of a patient’s location. The #WeCount project found that nearly 6,000 people per month in states with bans or severe restrictions on abortion have accessed medication abortion this way.
Post-Dobbs, the importance of self-managed medication abortion has also increased, as more people have been obtaining medication abortion in other, novel ways. An examination of abortion pill distribution by online vendors, telehealth organizations and community networks showed that pills for 27,800 more medication abortions were mailed in the six months after the Dobbs decision than the expected number had the ruling not been issued.
Crossing State Lines to Access Abortion
The proportion of patients traveling to other states to obtain abortion care has doubled in recent years, reaching nearly one in five in the first half of 2023, compared with one in 10 in 2020.
This surge in travel has largely been driven by post-Dobbs abortion bans and restrictions; notably, the sharpest increases in out-of-state patients occurred in Colorado, Illinois, Kansas and New Mexico, all of which border states with total abortion bans. Accessing abortion care likely came at great cost for many individuals who had to navigate the financial and logistical barriers to leaving their state for care.
Despite Bans, the Number of US Abortions Has Increased
The number of abortions in the United States has increased, despite the many total bans and other severe restrictions in effect: Guttmacher documented an 11% increase in clinician-provided abortions between 2020 and 2023, reflecting a continuation of a longer-term increase in abortion that started after 2017. However, the abortion incidence increase should not be misread to mean that everyone who needed an abortion was able to get one. Roe was never enough to ensure full abortion access; additional restrictions imposed since Dobbs—most notably total bans and early gestational duration bans—have made access even worse.
For example, births decreased in almost all states from 2022 to 2023. But these decreases differed depending on whether a state had banned or protected abortion. For the first six months of 2023, the decrease in births in the 13 states with total abortion bans was lower than it would have been in the absence of these bans, compared with the 24 states where abortion was protected.
Contraceptive Care Has Been Impacted
Some research suggests that access to broader contraceptive care is worsening in the post-Dobbs era. Data collected from two surveys conducted pre- and post-Dobbs in Arizona, Iowa, New Jersey and Wisconsin of women aged 18–44 found that barriers to accessing contraceptives increased and reports of receiving high-quality contraceptive care decreased a year after the Dobbs decision.
While these changes cannot be causally attributed to the fall of Roe, the Dobbs decision came just three years after the “domestic gag rule” was imposed—Trump-Pence administration regulations that included sweeping and destructive changes to the Title X program, which is the only federal program dedicated to providing family planning services for low-income patients. As a result of the domestic gag rule and related anti-abortion policies, some patients shifted to a less-preferred contraceptive method. While the domestic gag rule was rolled back by the Biden administration in 2021, its effects continue to linger.
Impact on Providers and Patients
One qualitative study interviewed 54 obstetrician-gynecologists practicing in states with a total ban on abortion. They reported needing to delay necessary care until patients were at risk of death or permanent injury, confusion about whether providers could counsel patients on abortion, legal fears and uncertainties, and moral distress, among other concerns. About 60% of physicians considered leaving their state to practice elsewhere, and 11% actually did so. As providers leave hostile states, pregnant patients may suffer: “Maternity care deserts,” which are areas with few or no obstetric care resources, can mean long travel times for access to both basic and emergency care.
A separate survey of 569 ob-gyns showed that, nationally, one in five providers felt constraints on their ability to manage miscarriages and other pregnancy-related emergencies since Dobbs; in abortion ban states, four in 10 ob-gyns felt this way. Clear majorities also believed that their ability to manage pregnancy-related emergencies worsened and that racial inequities in maternal health increased.
Impact on Medical Students and Training
The post-Dobbs legal landscape also implicates medical training; medical students in states with total abortion bans must seek abortion training out of state. They may take a state’s abortion legality into effect when considering residency applications. Diminished training opportunities can potentially lead to a decline in clinical skills, knowledge and experience, ultimately impacting patient experience and access to care.
Potential Erosion of People’s Mental Health
The fallout from the Dobbs decision is one of many crises that people across the United States coped with in recent years, including the COVID-19 pandemic and other disruptive events. Data show that communities already marginalized within the health care system experienced worsening mental health during this time. Additional research is needed to understand how the mental health of these communities and the broader public is affected by anti-abortion policies and laws.
Potential Risks for Maternal Health
Research prior to Dobbs found that certain abortion restrictions were associated with higher rates of maternal mortality. One analysis highlighted that states that have banned abortion or are planning to ban abortion have fewer maternity care providers, more maternity care deserts and higher rates of maternal mortality and infant death than states where abortion is accessible. These inequities disproportionately harm Black and Indigenous communities, which have historically faced significantly higher rates of maternal mortality than their White peers.
Researchers have provided preliminary estimates regarding the risk of maternal mortality for individuals who can become pregnant if a national ban on abortion were to be enacted. Assuming that abortions were banned in all states, at the highest end, maternal mortality would increase by 24%; non-Hispanic Black people would face a 39% increase in maternal deaths.
Patients Facing Obstetric Emergencies
Journalists have tracked tragic stories of pregnant women desperately seeking emergency care to protect their own lives and health, only to be blocked from treatment by hospitals fearful of misinterpreting their state’s abortion ban or because they do not qualify for the exceptions that may exist.
One report found that hospitals in Oklahoma could not clarify consistent policies for how clinicians should handle emergency obstetric care. Ongoing litigation in Texas documents how pregnant patients suffered during obstetric emergencies—risking their health and, in some cases, their lives—because of the hostile climate caused by Texas’ abortion ban.
The Evidence Calls for a Robust Policy Response
Overturning Roe did not resolve the debates on abortion that have characterized the US political system for the past 50 years. Instead, it enabled the implementation of policies and laws that have significantly altered the provision of abortion care, exacerbating the harms faced by individuals who are most marginalized in the health care system.
For instance, in the first quarter of 2024, four states introduced legislation—and one passed a law—criminalizing adults who support adolescents seeking abortion care. Earlier in the year, the Alabama Supreme Court’s decision to classify frozen embryos as “children” wreaked havoc on fertility treatment services and patients seeking in vitro fertilization (IVF). Moreover, the decision advanced the anti-abortion movement’s long-term goal to enshrine fetal personhood in both law and policy. These attacks on bodily autonomy, coupled with major cases before the US Supreme Court on abortion this term, signal that the policy and legal landscape will continue to shift, significantly affecting abortion provision.
We are just beginning to understand the scale of the Dobbs decision’s effect on providers, clinics, patients, support networks, maternal health and contraceptive care. Current research confirms what advocates have long known: that the loss of Roe would only create confusion, chaos and a deeply fractured landscape where a person’s zip code plays a consequential role in determining whether, where, when and how they can receive care. Future research will need to make sense of how policies that are either supportive of or antagonistic toward abortion rights will affect the sexual and reproductive health care delivery system overall.
It is imperative that advocates and policymakers at all levels of government take heed of this evidence and use it to champion a bold vision of abortion care that goes beyond what Roe promised. Only policies rooted in evidence and human rights will guarantee that all people have meaningful access to high-quality, affordable abortion care where they live and via the method they choose.