Abortion After Roe

Surveying America’s Post-Dobbs Landscape

For nearly 50 years, Roe v. Wade was the single most important factor influencing abortion legislation in the U.S. Then, in June 2022, the Supreme Court overturned Roe with Dobbs v. Jackson Women’s Health Organization. Despite widespread misinformation, which began circulating before Dobbs (and still has not let up), the ruling did nothing to outlaw or curtail abortion. Rather, it ended its status as a court-constructed “right” and returned to the individual states the legislative authority to make their own decisions about how to regulate it. As a result, talking about abortion law has become more complicated, as each state has its own evolving regulations.

The repeal of Roe led to a great deal of consternation among pro-choice activists, who lamented anticipated difficulties obtaining an abortion and the loss of “reproductive freedoms.” Some claimed the government would punish women who sought an abortion; others said that investigators would use technology, such as period-tracking apps, to investigate and prosecute them. Nearly three years post-Dobbs, outlandish predictions such as these have not come to pass. It is true that many states now limit or prohibit abortion where they once could not, but the abortion industry is still thriving, and in some ways it has even grown.

Abortion by the Data

Many people fail to recognize how widespread abortion is in post-Dobbs America. According to the Guttmacher Institute, as of January 2025, in 12 states abortion is “completely banned with very limited exceptions,” and in four states, it is “banned at 6 weeks and later.” At the other end of the spectrum, 19 states allow abortion up to viability, generally recognized at 24–26 weeks, and nine states, along with Washington, D.C., allow it through all 40 weeks of pregnancy.¹

Guttmacher estimates that more than a million abortions took place in the U.S. in 2023, an increase of 11 percent since 2020.² This number only includes those abortions overseen by a clinician; it does not take into account what are now being called “self-managed” abortions, such as when someone orders abortion pills from an out-of-state or overseas pharmacy and takes them at home apart from any medical oversight. Thus, the actual number is undoubtedly higher. For comparison, there were approximately 3.6 million live births in 2023.³

The number of abortion clinics in the U.S. has declined slightly, from 807 in 2020 to 765 in 2023. However, this reflects the fact that clinics have closed in 14 states where abortion is largely banned. In the remaining 36 states, there has actually been a three percent increase. Even with this increase, though, brick-and-mortar clinics are not where the majority of abortions are taking place—in 2023, 63 percent of the reported abortions were performed via clinician-provided abortion pills.⁴

Chemical Abortion, Telehealth & Shield Laws

The expansion of chemical abortion is one of the primary factors driving the increase.⁵ Mifepristone was approved by the FDA in 2000 and is typically used in conjunction with misoprostol. The widespread availability of these drugs has contributed to the uptick in abortion nationwide. It has also greatly complicated attempts to understand the full number of abortions in the U.S., since only abortions that take place in a clinic or under a clinician’s supervision are tracked. Some estimate that tens of thousands of untracked, self-induced abortions are taking place in states where abortion is ostensibly banned.⁶

In 2021, the FDA removed the requirement that a woman attend an in-person appointment before receiving abortion-causing drugs, meaning that the pills can now be obtained not just from abortion clinics but also from online pharmacies. Beyond the potential health risks this poses for women, some have pointed out that this also makes it far easier for human traffickers and abusive partners to force abortions on women and girls who do not want them.

Prescribing abortion pills is illegal in states with a total ban, but many providers are now protected by shield laws. Following Dobbs, many pro-abortion states passed laws shielding abortionists from “criminal, civil, or professional consequences” that might have otherwise resulted from facilitating an abortion.⁷ While the exact laws differ, they generally protect abortionists from any judgments or penalties originating from another state. So, for example, if an abortionist who practices in a state with liberal abortion laws did a remote telehealth consult and prescribed abortion pills to a woman in a state where that was illegal (and where the physician was not licensed to practice), the abortionist would be shielded from legal consequences.

Despite panicked predictions that women seeking abortions would be criminalized, this has never happened, and in fact is not likely to ever happen under current law. The Charlotte Lozier Institute analyzed abortion statutes and found that even pro-life laws exempt women from prosecution in 27 states: “Most state laws regulating or prohibiting abortion contain explicit carve outs exempting women from criminal or civil liability, others exempt women implicitly by specifically targeting physicians or others who perform abortions rather than the women who undergo them.”⁸

It is also important to note that, even in states with a total ban, abortions are still permitted when the life of the mother is at risk.⁹ Some supposed horror stories have made the news about how a woman was denied a “medically necessary” abortion, but closer examination usually reveals that either (1) an abortion was not in fact medically necessary, or (2) the case involved accusations of providers denying services due to a fear of prosecution.

Still a Critical Issue

Though the U.S. is now a few years past Dobbs, abortion continues to be an issue of hot interest and debate in all 50 states. While it is good that states have more freedom to regulate it, this has not substantially reduced the number of abortions taking place; those wishing to end their pregnancies are still finding ways to do so—and those wishing to help them do so are as well.

Notes
1. “Interactive Map: US Abortion Policies and Access After Roe,” Guttmacher Institute.
2. “Abortion in the United States,” Gutt­macher Institute (Jun. 2024).
3. Joyce A. Martin, Brady E. Hamilton, and Michelle J.K. Osterman, “Births in the United States, 2023,” CDC (Aug. 2024).
4. “Abortion in the United States.”
5. Rachel K. Jones and Amy Friedrich-Karnick, “Medication Abortion Accounted for 63% of All US Abortions in 2023—An Increase from 53% in 2020,” Guttmacher Institute (Mar. 2024).
6. “Babies Unprotected: An Analysis of Self-Induced Abortion Numbers in States with ‘Bans,’” Foundation to Abolish Abortion (Oct. 2024).
7. Mary E. Harned, “Abortion ‘Shield Laws’: Pro-Abortion States Seek to Force Abortion on Life-Affirming States,” Charlotte Lozier Institute (Aug.   24, 2023).
8. Amanda Stirone Mansfield, “Pro-Life Laws Exempt Women from Prosecution: An Analysis of Abortion Statutes in 27 States,” Charlotte Lozier Institute (Jan.   10, 2024).
9. Mary E. Harned and Ingrid Skop, “Pro-Life Laws Protect Mom and Baby: Pregnant Women’s Lives are Protected in All States,” Charlotte Lozier Institute (Sep.   11, 2023).