The number of abortions in the United States has increased each year since the Supreme Court overturned Roe v. Wade four years ago, a trend that runs counter to the expectation that state-level bans would reduce the procedure’s prevalence, according to NPR.
“Roe was egregiously wrong from the start,” Justice Samuel Alito wrote in the Dobbs v. Jackson Women’s Health Organization majority opinion on June 24, 2022, the date the court’s conservative majority ended the federal constitutional right to abortion. “And far from bringing about a national settlement of the abortion issue, Roe and [Planned Parenthood v.] Casey have enflamed debate and deepened division.”
Reversing Roe did not calm debate or heal division, according to NPR. A confusing patchwork of state laws began taking shape hours after the ruling, as states activated “trigger laws” designed to restrict abortion as soon as the high court allowed.
The post-Roe landscape has been defined by a surge in telehealth-prescribed medication abortion. State “shield laws” in jurisdictions that support abortion access allow clinicians to prescribe medication abortion via telemedicine — online or over the phone — to residents in states with bans. Pills are then mailed or made available at local pharmacies. The practice has increased the number of abortions in states with bans in recent years, according to the Society of Family Planning’s #WeCount report.
MSI previously reported that U.S. abortions nearly doubled since 2021, reaching nearly twice the pre-Dobbs level by 2025, driven by the telehealth medication abortion surge. Read more.
Alito has taken note of the trend. In a recent dissent related to abortion pills, he wrote that the telehealth system represents “the perpetration of a scheme to undermine our decision in Dobbs, which restored the right of each state to decide how to regulate abortions within its borders.”
Anti-abortion activists and politicians are pressing for more action, including revival of the Comstock Act, a law that prohibits mailing “obscene” materials including “every article or thing designed, adapted, or intended for producing abortion.” If enforced, the law could create a de facto national abortion ban without requiring Congress to pass new legislation. Last month, Justice Clarence Thomas asserted in his dissent to the abortion pill case that the Comstock Act was in force and that drug companies manufacturing and distributing FDA-approved medications were therefore engaged in a “criminal enterprise,” according to NPR.
States have also pursued their own restrictions. Texas passed a law allowing private citizens to sue out-of-state prescribers of abortion pills for $100,000. Louisiana scheduled mifepristone and misoprostol, the two medications used for medication abortion, as controlled substances. Louisiana also is suing the FDA, aiming to force the agency to roll back the rules change that allowed telemedicine access to mifepristone, a case likely headed for the Supreme Court.
Abortion rights advocates are pushing beyond the existing landscape. Researchers at the University of California San Francisco recently published a study examining the feasibility of making abortion medication available over-the-counter in the U.S., no prescription needed. A Planned Parenthood affiliate started offering abortion medication to patients who are not pregnant, for at-home emergency use. Telemedicine abortion providers have contingency plans to continue sending misoprostol alone through the mail even if access to mifepristone is restricted.
The post-Roe era has seen some closures of brick-and-mortar clinics that offer abortion, according to NPR, in part because Republicans in Congress withheld millions of dollars for Planned Parenthood and other organizations in 2025. Efforts to maintain in-person access include training more primary care physicians to offer abortion and turning to health facilities like urgent care clinics.
In the meantime, the use of medication abortion continues to grow. “Abortion pills are everywhere, they’re safe, they’re effective, and they’re pretty much unstoppable,” Elisa Wells of Plan C, a website about medication abortion, told NPR. “The genie is out of the bottle.”
Before Dobbs, abortion had been legal for nearly 50 years under a right to privacy grounded in the Constitution. Since that right was revoked, patients can fill out an online form and have pills delivered to their homes, avoiding protesters outside clinics. Some women who have shared stories of being denied medically necessary abortion and miscarriage care have become public figures, including Samantha Casiano and Kate Cox, whose cases were first reported by NPR.
The increasingly online experience of seeking abortion has also opened new privacy concerns. Just months after the Dobbs decision, police in Nebraska used Facebook messages to bring felony charges against a woman who gave her teenage daughter abortion pills. Many Americans track their periods in apps that have raised concerns among privacy experts, according to NPR.