One year after Dobbs, US abortion landscape transformed

It is the most personal of decisions, yet it has become a defining issue of our time: whether to bear a child.

And in the year since the United States Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization, eliminating a nearly 50-year federal right to abortion, the impact has been profound.

Overnight, U.S. women of childbearing age went from having a largely nationwide right to bodily autonomy to living in a country where one’s reproductive rights can vary dramatically from state to state. In post-Dobbs America, tens of thousands of fewer abortions have taken place, compared with the prior year, according to the Society of Family Planning, which specializes in abortion and contraception science. Several dozen clinics have closed.

In many cases, pregnant women and girls seeking abortions, even in the earliest stages, must travel out of state to receive services, either at great personal expense or with the help of travel aid organizations. Use of medication to terminate a pregnancy, whether under physician supervision or not, has skyrocketed – and accounts for more than half of all abortions.

Legal challenges abound, in both state and federal courts, and abortion promises to be a hotly debated topic in the 2024 elections up and down the ballot. But if there’s one thing activists and scholars on both sides of the divide agree upon, it’s this: that the U.S. abortion landscape, dramatically altered on June 24, 2022, by the overturning of Roe v. Wade, is still in flux. And no one is resting easy.

“It’s certainly been a nonstop year,” says Kristan Hawkins, president of Students for Life of America. Her organization’s volunteers have not relented, continuing to go door to door nationwide since the day Roe went down to tell people about alternatives to abortion.

From the abortion-rights perspective, the sense of urgency is no less evident.

“The biggest surprise is that people had predicted the worst – that all the states that had expressed hostility toward abortion would have fully banned abortion” by now, says Tracy Weitz, a sociology professor at American University and director of the Center on Health, Risk, and Society. “We’re not there.”

Abortion on the ballot 

Outside a courthouse in Florida’s Broward County on a recent spring day, Democratic volunteers are registering people to vote – and gathering signatures to put a state constitutional amendment on the 2024 ballot that would guarantee abortion rights up to the point of fetal viability, which is when a fetus can survive outside the womb, generally considered to be between 23 and 24 weeks.

Broward is a Democratic bastion in a state that turned sharply Republican in last fall’s gubernatorial election. But the volunteers are confident that Florida voters support abortion as a fundamental right, as expressed in the name of the coalition working to pass the amendment: Floridians Protecting Freedom.

“We don’t want politicians telling us what to do,” says Marsha E., a volunteer who declines to give her last name, but suggests she be photographed in her “I’m With the Banned” T-shirt depicting controversial books.

About half the people she and her fellow volunteers approach agree to sign the abortion amendment petition, Marsha says.

Florida is consequential in many ways: It’s the third most populous state in the country, with 29 electoral votes. It’s the home state of the GOP’s top polling presidential candidates – former President Donald Trump and Gov. Ron DeSantis. And it’s a destination, for now, for people in nearby anti-abortion Southern states seeking abortions.

The Sunshine State highlights how the battle over abortion rights has evolved in the last year. In anticipation of Dobbs, Florida at first enacted legislation that bans most abortions after 15 weeks of pregnancy. Then in April, with new GOP supermajorities in both houses, the state Legislature limited abortion to six weeks, effectively an outright ban, as many women don’t know they’re pregnant at that point. Mr. DeSantis signed the bill late at night, without fanfare; with a majority of Americans opposing the overturning of Roe, he doesn’t bring up the subject much on the campaign trail.

Florida’s original 15-week ban is currently before the state Supreme Court, but even if it’s upheld, the new six-week ban would go into effect. And that would mean women and girls from nearby states with abortion bans – Mississippi, Alabama, and Louisiana – would effectively no longer be able to use Florida clinics as an option for services.

Abortion’s potency in 2024

Democrats are counting on the potency of abortion as an issue in the 2024 election, as it was in 2022. Kansas, a red state, upheld abortion rights in a stand-alone ballot measure last August. And in the November midterms, Michigan – a major battleground state – enshrined abortion rights in the state constitution. That set up the state as a regional hub for abortion services, given near-bans in nearby states. 

The latest Gallup poll found a record-high 69% of Americans say abortion should be generally legal in the first three months of pregnancy, and 61% called the overturning of Roe a “bad thing.” 

But one expert on abortion warns that Democrats can’t rely on the issue as the savior of 2024. As always, most Americans – including suburban women – will prioritize the economy in their voting behavior, says David Garrow, author of the book “Liberty and Sexuality.” 

“Abortion isn’t something people go around thinking about, other than activists,” Mr. Garrow says. 

Still, the Biden administration went big on reproductive rights Friday, announcing President Joe Biden’s plan to sign an executive order aimed at protecting birth control access. In addition, the president and Vice President Kamala Harris were endorsed for a second term by three major abortion-rights groups – EMILY’s list, NARAL Pro-Choice America, and Planned Parenthood Action Fund. 

Impact of Dobbs

Since the Dobbs ruling, experts on abortion rights have been crunching numbers on its impact. A study from the University of California, San Francisco (UCSF) finds that in the first five months post-Dobbs, a third of American women of reproductive age faced “excessive travel times” to access abortion. Two-thirds of women were more than an hour away from an abortion provider, and the jump in travel time was biggest in Southern states. In Texas and Louisiana, travel time went from 15 minutes before Dobbs to more than six hours after the ruling.

Increasingly restricted access affects Black women the most, with 40% living at least a one-hour drive from abortion services after Dobbs, compared with 15% before the ruling. Before Dobbs, the figure was 40% among American Indians and Alaska Natives, who together with Black women face significantly higher maternal health risks than women of other races and ethnicities. Following the ruling, more than half of American Indian and Alaskan Native women found themselves at least an hour from care. 

Now, one year post-Dobbs, “we see an impact on anybody who can become pregnant,” says Katrina Kimport, a medical sociologist with the Advancing New Standards in Reproductive Health program at UCSF.

Today, some 25 million women of childbearing age live in states with strict limits on access to abortion or outright bans. And for a woman whose pregnancy runs into problems, the ability to receive care can become exponentially more complicated. 

“There are cases where patients report being turned away from multiple institutions because the hospitals are fearful that they would then have to provide what they are worried is banned care,” says Professor Kimport. “So they just refused to take a patient or they discharged the patients.”

A new report known as #WeCount, from the Society of Family Planning, provides the latest data gathered from abortion providers on state-by-state increases and decreases in abortion: In the nine months after the Dobbs decision, states that limit abortion to six weeks’ gestation or ban the procedure altogether saw a decline of about 81,000 abortions, while states where abortion remains broadly legal increased by about 56,000, for a net decrease of about 25,000 abortions. 

States that are geographically close to states with bans are seeing surges, including North Carolina, South Carolina, Florida, Kansas, and Illinois, the report notes. 

“People don’t realize how difficult it is to navigate a whole new health care system, to leave one’s home state to get health care,” says Ushma Upadhyay, co-chair of the #WeCount Steering Committee. 

Margaret Johnson, a feminist law professor at the University of Baltimore, calls the post-Roe reality highly destabilizing, as abortion laws have devolved to the states. 

Even though there have been no criminal prosecutions thus far, she notes, “these laws create risk aversion and fear, and that alone is very powerful in eroding people’s rights.”

Some activists who favor abortion rights see cause for hope. Jeanné Lewis, executive director of the national advocacy group Faith in Public Life, sees an uptick in engagement since Roe was overturned. 

“People are responding more and engaging more in our democracy at the state level,” Ms. Lewis says. “I’ve seen individuals who were silent on this issue [reproductive rights], for a variety of reasons, now feeling very compelled to speak out.”