The Post-Dobbs Paradox: Why Abortion Rates Have Risen Since Dobbs v. Jackson Women's Health Organization.

By Reagan Keener

Introduction

On June 24, 2022, the Supreme Court in Dobbs v. Jackson Women’s Health Organization declared that the Constitution “does not confer a right to abortion,” returning the issue to “the people and their elected representatives.”^[1]For nearly half a century, abortion jurisprudence had been structured around judicially enforced constitutional limits. Dobbs promised a different settlement in democratic control and, according to many of the decision’s supporters, a substantial reduction in abortion itself.^[2] Rather than clarity or uniformity, the decision has produced a regulatory paradox.

Regulatory authority had returned to the states, and many exercised it decisively. In the two years predating Dobbs, numerous states enacted near-total prohibitions.^[3] This was done either by activating previous “trigger” statutes or by enforcing pre-Roe v. Wade bans that had lain dormant for decades. Yet national abortion incidence did not decline: It rose.^[4] This divergence between state-level prohibition and national-level incidence has exposed a structural tension at the core of contemporary American federalism. Dobbs restored to the states the authority to regulate or prohibit abortion within their borders. The reallocation of authority occurred in a regulatory environment reshaped by telehealth and interstate networks, fundamentally distinct from the pre-Roe framework.

This article argues that the modest rise in abortion since Dobbs is not accidental. It is the predictable consequence of three converging dynamics: the maturation of medication abortion as a decentralized technology, the rapid mobilization of protective-state countermeasures, and a prohibition strategy that pursued maximal statutory bans without accounting for market adaptation, interstate mobility, and political backlash. The result is a fragmented but resilient abortion access regime.

I. The Legal Shock Surrounding Dobbs

The Court in Dobbs held there is no constitutional right to abortion, returning regulatory authority to the states.^[5]Prior to Dobbs, the prevailing law was that the Fourteenth Amendments right to privacy protects a person’s qualified right to terminate a pregnancy.^[6] Under Roe, the states could not prohibit any abortions before fetal viability, which came at the start of the third trimester. States were mostly prevented even from regulating abortion. Planned Parenthood v. Caseyin 1992 retained some parts of Roe while changing others.  Casey retained abortion as a fundamental right and elective abortion until viability but acknowledged that advances in medical technology had moved viability earlier in pregnancy. Under Casey states had more scope to regulate, without prohibiting, abortion under the undue burden standard.^[7] Over nearly fifty years, Roe, and then Roe as modified by Casey, remained the controlling law.^[8]

However, in the years that followed, several states sought to probe the limits of the Court’s framework by enacting progressively stricter abortion regulations. These states focused on testing the limits of abortion regulation under Casey’s undue burden standard, and proposing prohibitions that operate prior to fetal viability.^[9] Through successive legislative measures, such as shortening permissible gestational periods, expanding procedural requirements, and redefining medical standards, state legislatures incrementally narrowed the practical scope of the right in two ways: testing the limits of regulating, without prohibiting, abortion throughout pregnancy, and eventually testing the viability standard by proposing pre-viability prohibitions.^[10]

These events culminated in the landmark Dobbs case, which overturned the precedent that was established in Roe^[11]and refined in Planned Parenthood v. Casey.^[12] Within months, more than a dozen states implemented near-total bans, while others enacted gestational limits or revived pre-1973 criminal statutes.^[13] In the immediate aftermath of Dobbs, many proponents of abortion restrictions anticipated that national abortion incidence would decline substantially.^[14] That expectation rested on several assumptions: that the rapid implementation of near-total bans in thirteen states, coupled with early gestational restrictions in at least six others, would significantly constrain access; that clinic closures across large regions of the South and Midwest would deter patients; and that heightened legal risk would reduce both provision and demand. In short, abortion opponents’ prevailing prediction was that the combined force of territorial prohibitions and criminal enforcement would produce a measurable national contraction in abortion rates.^[15]

II. National Abortion Volume Since Dobbs

Abortion national surveillance is fragmented. There are many organizations that account for abortion rate incidence. The WeCount project shows that monthly abortions increased from 79,000-80,000 per month in mid-2022 to roughly 98,000 per month by early 2024.^[16] Such an increase, approaching twenty thousand additional abortions per month, is both statistically and legally consequential. Similarly, the Guttmacher Institute reported approximately 1,037,000 clinician-provided abortions in 2023, which is a substantial growth from 2020 levels.^[17] The 2023 total not only exceeds pandemic-era lows but also surpasses several pre-2020 annual counts.^[18] The upward shift therefore appears neither episodic nor anomalous, but indicative of a broader post-Dobbs realignment in the incidence and distribution of abortion care. Moreover, the Ethics and Public Policy Center stresses that even though studies suggest that abortion rates have increased since Dobbs, it is important to note that states that took a lead in enacting laws protecting the unborn have taken tangible steps to support the children, women, and families impacted by the new ban.^[19]

This recent rise in abortion contrasts with the preceding pre-Dobbs steady decline. According to CDC surveillance data, the data indicates that abortion rates declined steadily between 2010 and 2019, reflecting a sustained downward trend prior to the pandemic.^[20] This surveillance data relies on voluntary reporting from state health departments.^[21]Further, it is important to note that abortion has historically been undercounted due to a myriad of circumstances, one being that a significant portion of abortion provision occurs outside traditional clinical reporting systems.^[22] The post-Dobbs increase therefore signals a structural shift in abortion incidence. This is due to a number of factors, such as expanded telehealth provision, interstate travel for care, and overall changes in medication abortion access, resulting a dramatically altered legal and service-delivery landscape.^[23]

III. Medication Abortion and Telehealth Expansion

Chief among these structural changes is the dramatic rise of medication abortion. By 2023, medication abortion accounted for approximately 63% of all abortions in the United States, up from roughly 53% in 2020.^[24] Moreover, telehealth provision, which was virtually nonexistent before the COVID-19 pandemic, now accounts for an estimated 20-25% of abortions nationwide.^[25] This shift alone represents hundreds of thousands of abortions annually occurring through pharmaceutical rather than procedural means.^[26] This transformation in method distribution helps to explain the apparent paradox of rising abortion volume in the wake of intensified state-level prohibitions.^[27]

Several developments have enabled this shift. In 2021, the United States’ Food and Drug Association (“FDA”) permanently lifted the in-person dispensing requirement for mifepristone, allowing it to be prescribed via telehealth and mailed directly to patients.^[28] Both mifepristone and misoprostol are approved by the FDA to end a pregnancy at up to ten weeks’ gestation.^[29] Additionally, states such as California, New York, and Massachusetts subsequently enacted laws protecting in-state providers who prescribe abortion pills to patients in ban states.^[30] At the same time, telehealth abortion generally lowers costs and eliminates travel, lodging, and childcare burdens. Because medication abortion is meant to occur early in pregnancy and can be provided discreetly by mail, it is also considerably more difficult for prohibition states to detect or police. Together, these developments have nationalized abortion access despite formal state bans.

Alabama illustrates this structural dynamic. Although the state prohibits nearly all abortions, its territorial ban cannot fully prevent residents from obtaining medication abortion prescribed remotely under federal regulatory rules. While post-Dobbs prohibitions have substantially reduced in-state clinical provision, they have not produced equivalent declines in overall abortion incidence among residents. Instead, interstate health networks have partially decoupled abortion access from state territorial control.^[31] The result is a form of regulatory displacement rather than elimination, in which prohibition states export abortion provision beyond their borders without fully suppressing demand.

IV. Interstate Travel and Redistribution of Services

While abortions overall have declined sharply within ban states,^[32] protective states saw substantial increases. The number of patients traveling across state lines for abortion care more than doubled between 2020 and 2023, from roughly 81,000 to about 170,000.^[33] This figure represents a routine cross-border mobility driven by parallel statutory frameworks among the states.^[34] States such as Illinois and New Mexico experienced particularly sharp increases because of geographic proximity to restrictive states.^[35] This redistribution effect explains the apparent paradox: bans reduce in-state abortions but do not eliminate abortions among residents. Rather, abortion bans shift where abortion occurs. Furthermore, dozens of states have added legal protections, known as abortion shield laws, for both patients and providers in states where abortion is legal in an effort to allow those who live in states where abortion is restricted an opportunity to receive an abortion.^[36]

Certain jurisdictions provide prime examples of this redistribution effect. For example, Illinois experienced one of the largest numeric increases in abortion volume in the country.^[37] This is largely because it borders multiple states, such as Kentucky, who have enacted near-total bans or severe gestational limits.^[38] Similarly, New Mexico saw substantial growth in abortion provision due to its proximity to Texas and Oklahoma, both of which implemented sweeping prohibitions following Dobbs.^[39]

This cross-border mitigation reflects the regulatory bifurcation. Demand has not disappeared in jurisdictions where the procedure is prohibited. It has simply reallocated.^[40] The redistribution of abortion provision can help to explain the apparent paradox in Dobbs data trends. Bans substantially reduce the number of abortions performed within a prohibitory state’s borders, often to near zero in the case of total bans.^[41] However, they do not eliminate abortions among the state’s residents. Instead, they externalization provision to neighboring jurisdictions and, increasingly, to telehealth providers operating across state lines.^[42] Thus, the national scheme is one of spatial displacement and not aggregate suppression.

For decades following the Court’s decision in Roe, pro-life lawmakers and advocacy organizations recognized that sweeping federal prohibitions on abortion were unlikely to succeed under prevailing constitutional doctrine. Consequently, much of the movement’s legal and political strategy focused on incremental regulation at the state level. State legislatures enacted a wide range of measures, including parental involvement requirements, informed-consent laws, waiting periods, clinic regulations, and restrictions on the use of public funds for abortion, that were designed both to limit abortion access and to test the doctrinal boundaries established by Roe and later cases.^[43] This incremental regulatory approach became a central strategic feature of the pro-life movement in the decades following Roe.^[44]

During this same period, abortion-access advocates frequently relied on the federal constitutional protections articulated in Roe and reaffirmed in Casey, which preserved Roe’s core holding while, under Casey, allowing certain regulations that did not impose an “undue burden.”^[45] Because these decisions provided a nationwide constitutional safeguard, much of the abortion-rights movement’s legal strategy centered on defending federal constitutional precedent rather than pursuing widespread state constitutional amendments prior to 2022.^[46]

The legal landscape shifted dramatically when the Court decided Dobbs and overturned Roe, returning primary regulatory authority over abortion to the states.^[47] In the immediate aftermath of Dobbs, pro-abortion organizations rapidly pursued a different strategy: entrenching abortion protections in state constitutions through ballot initiatives and referendums. Constitutional amendment campaigns emerged quickly in multiple states, including Kansas, Michigan, Ohio, and Kentucky.^[48] Scholars examining the post-Dobbs environment note that abortion policy has increasingly shifted from federal courts to state political processes, including mechanisms of direct democracy such as statewide ballot initiatives.^[49]

These referendum contests have also been characterized by significant financial investment and the growing nationalization of abortion-policy campaigns. Ballot-measure campaigns concerning abortion have attracted tens of millions of dollars in spending, often involving national advocacy groups and donors funding initiatives across multiple states.^[50] In several post-Dobbs ballot initiatives, abortion-rights campaigns substantially out-spent pro-life campaigns, allowing them to dominate statewide messaging and voter outreach efforts.^[51] The rapid emergence of constitutional amendment campaigns, combined with substantial campaign spending and highly mobilized national advocacy networks, has therefore reshaped the political dynamics of abortion policymaking in the post-Dobbs era.

V. States with Near-Total Bans: The Case of Alabama

The impact of this transformation is especially evident in states with near-total bans. For instance, Alabama has instituted a near-total ban on abortion with the Human Life Protection Act, a statute that prohibits abortion at all stages of pregnancy except to “prevent a serious health risk to the unborn child’s mother.”^[52] However, despite this near-total ban, a substantial number of Alabama residents still obtain abortions through interstate travel to states where the procedure remains lawful.^[53] Or, more significantly, Alabama residents obtain abortions through telehealth providers operating outside of the state.^[54]

Furthermore, in-state clinical abortions have decreased drastically.^[55] However, residents continue to obtain abortions in a myriad of ways. One instance is traveling to neighboring or protective states. Another is obtaining telehealth prescriptions from shield-law states. Some residents also engage in self-managed abortion, which is more difficult to measure.^[56] Additionally, legal disputes have continued as to whether a physician in a state such as California may prescribe medication abortion to a resident of Alabama.^[57] These conflicts raise complex questions of extraterritorial jurisdiction, federal preemption, and interstate comity that are yet to be answered.

Moreover, the longstanding Hyde Amendment adds additional complexities. The Hyde Amendment prohibits federal Medicaid funding for most abortions, except in limited circumstances.^[58] However, several protective states use state funds to cover abortion services for Medicaid recipients.^[59] Thus, while Hyde limits federal financing, it has not prevented certain states from subsidizing abortion access, further contributing to interstate disparities.^[60]

The post-Dobbs experience suggests that abortion incidence is shaped by more than legality alone. Key variables include technological access to medication abortion, regulatory design via FDA rules and shield laws, interstate mobility, financial assistance networks, and public opinion backlash. These factors have demonstrated that the demand for abortion has not disappeared. Instead, the supply mechanism has evolved.

VI. Conclusion

Contrary to expectations, national abortion numbers have risen modestly since Dobbs. The increase has been driven primarily by medication abortion and telehealth and reinforced by interstate travel and protective state policies. The post-Dobbs landscape demonstrates that decentralized prohibition in a technologically connected society produces redistribution rather than elimination. Whether future strategies will alter this dynamic remains an open question.

^[1] 597 U.S. 215, 215 (2022).

^[2] Abortion in the United States Dashboard, KFF (Feb. 2012), https://www.kff.org/womens-health-policy/abortion-in-the-u-s-dashboard/ (last visited Mar. 9, 2026). Many observers predicted that abortion incidence would decline sharply as trigger bans and pre-Roe prohibitions went into effect across much of the South and Midwest.

^[3] See Ala. Code §§ 26-23A-1 to -10 (2019) (enacting a near-total ban on abortion that went into effect after the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization); Sharon Perley Masling & Megan L. Lipsky, Evolving Laws and Litigation Post-Dobbs: The State of Reproductive Rights as of May 2023, MORGAN LEWIS (May 3, 2023), https://www.morganlewis.com/pubs/2023/05/evolving-laws-and-litigation-post-dobbs-the-state-of-reproductive-rights-as-of-may-2023 (identifying a network of post-Dobbs or triggered near-total abortion bans in multiple states including Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin). 

^[4] Soc’y for Fam. Planning, #WeCount Report April 2022 Through December 2024 – No. 23 (2025), https://societyfp.org/research/wecount/wecount-december-2024-data/. (referencing 2024 update).

^[5] Dobbs, 597 U.S. at 215.

^[6] Roe v. Wade, 410 U.S. 113 (1973).

^[7] Id. The Court created a trimester framework, to structure the constitutional limits on state abortion regulation. Id. During the first trimester, the decision to terminate a pregnancy was left to the pregnant person and their physician, and the state could not regulate abortion beyond requiring that it be performed by a licensed medical professional. In the second trimester, the state could regulate abortion in ways reasonably related to maternal health, reflecting the increasing medical risks associated with later procedures. In the third trimester, once the fetus reached viability, i.e. the point at which it could survive outside the womb, the state could prohibit abortion altogether, except where necessary to preserve the life or health of the pregnant person. Thus, this framework treated viability as the critical constitutional boundary between protected choice and permissible prohibition, a structure later abandoned in Planned Parenthood v. Casey, 505 U.S. 833 (1992), but central to abortion jurisprudence for nearly two decades.

^[8] Id. Roe was upheld by Casey, which allowed for state restrictions on abortion after fetus viability was reached, scrapping the trimester framework Roe provided. Casey, 505 U.S. at 846 (reaffirming the “essential holding” of Roe v. Wade, 410 U.S. 113 (1973)).

^[9] Maria F. Gallo et. al., Passage of abortion ban and women’s accurate understanding of abortion legality, National Library of Medicine (June 10, 2025), https://pmc.ncbi.nlm.nih.gov/articles/PMC9723984/ (noting that specifically Ohio passed bans on abortion after six weeks of gestation while Roe was still in effect).

^[10] B. Jessie Hill, Legislative Restrictions on Abortion, AMA Journal of Ethics (Feb. 2012), https://journalofethics.ama-assn.org/article/legislative-restrictions-abortion/2012-02.

^[11] 410 U.S. at 113.

^[12] 505 U.S. at 833.

^[13] Elizabeth Nash & Isabel Guarnieri, 13 States Have Abortion Trigger Bans— Here’s What Happens When Roe Is Overturned, Guttmacher Inst. (June 6, 2022), https://www.guttmacher.org/article/2022/06/13-states-have-abortion-trigger-bans-heres-what-happens-when-roe-overturned.

^[14] Cong. Rsch. Serv., R47228, Abortion Law After Dobbs v. Jackson Women’s Health Organization (2023).

^[15] See Soumya Karlamangla et. al., Three Years After Dobbs, “the Reality is People Are Getting Abortions,” NY Times (Dec. 9, 2025), https://www.nytimes.com/2025/12/09/us/states-new-abortion-laws.html (stating that David Cohen, a law professor at Drexel University, sums this up by stating that “[t]he reality is people are getting abortions, people are providing abortions, and the post-Dobbs environment is not stopping them.”; David S. Cohen & Carole Joffe, After Dobbs: How the Supreme Court Ended Roe But Not Abortion, Beacon Press (2025).

^[16] Marlene M. Maheu, Telehealth Abortions and Abortion Access: Insights From the #WeCount Report (April 2022- December 2024), Telehealth (Sep. 11, 2025, 4:00 AM), https://telehealth.org/news/telehealth-abortions-and-abortion-access-insights-from-the-wecount-report-april-2022-december-2024/.

^[17] Monthly Abortion Provision Study (2024), Guttmacher Inst., https://www.guttmacher.org/monthly-abortion-provision-study (last visited Feb. 27, 2026) [hereinafter Monthly Abortion Provision Study (2024)]. The Guttmacher Institute notes that the total number of abortions is likely an undercount because it does not reflect self-administered medication abortion in states where that practice is banned. Further, because Guttmacher collects data directly from providers rather than relying solely on state reporting systems, its figures are widely regarded as one of the most complete annual censuses of abortion incidence in the United States. Id.

^[18] Id.

^[19] Patrick T. Brown, Two Years After Dobbs Ethics & Public Policy Center (June 18, 2024), https://eppc.org/publication/two-years-after-dobbs/. Specifically, states who have enacted laws protecting life in the womb have taken measures to expand Medicaid coverage for postpartum women up to a year after childbirth, expand options for childcare, increased availability of health services for women, and increased the eligibility for safety-net programs for pregnant and new moms.

^[20] Katherine Kortsmit et al., Abortion Surveillance— United States, 2019, 70 Morbidity & Mortality Wkly. Rep. (Surveill. Summ.), no. SS-9, at 1 (Nov. 26, 2021). More specifically, the CDC’s surveillance system primarily captures clinician-reported abortions performed within formal health care settings. Id.

^[21] Id.

^[22] Stephanie Sy & Ian Couzens, Why Abortions Are Rising in the U.S. Despite More Restrictions, PBS News (Apr. 15, 2025, 6:30 PM), https://www.pbs.org/newshour/show/why-abortions-are-rising-in-the-u-s-despite-more-restrictions.

^[23] Id.

^[24] Rachel K. Jones & Amy Friedrich-Karnik, Medication Abortion Accounted for 63% of All U.S. Abortions in 2023—An Increase from 53% in 2020, Guttmacher Inst. (Mar., 2024), https://www.guttmacher.org/2024/03/medication-abortion-accounted-63-all-us-abortions-2023-increase-53-2020.

^[25] Soc’y for Fam. Planning, #WeCount Report April 2022 Through December 2024– No. 23 (2025), https://societyfp.org/research/wecount/wecount-december-2024-data/. [hereinafter Soc’y for Fam. Planning, April 2022].

^[26] Id.

^[27] Id.

^[28] U.S. Food & Drug Administration, Mifepristone REMS Modification (Dec. 2021).

^[29] Questions and Answers on Mifepristone for Medical Termination of Pregnancy

Through Ten Weeks Gestation, FDA, https://www.fda.gov/drugs/postmarket-drug-safety-

information-patients-and-providers/questions-and-answers-mifeprex, (last visited Mar. 6, 2026).

^[30] KFF, State Shield Laws Protecting Abortion Providers (2024).

^[31] Geoff Mulvihill, More People Are Obtaining Abortions But Fewer Are Crossing State Lines, Study Finds, PBS News (Apr. 15, 2025, 3:02 PM), https://www.pbs.org/newshour/health/more-people-are-obtaining-abortions-but-fewer-are-crossing-state-lines-study-finds. In a report provided by Guttmacher Institute, the number of clinical provided abortions in states where it is legal rose less than 1% from 2023 to 2024. Yet, the number of people crossing state lines for abortions dropped by about 9%. See, e.g., Sooumya Karlamangla, Three Years After Dobbs,’The Reality Is People Are Getting Abortions’, NY Times (Dec. 9, 2025), https://www.nytimes.com/2025/12/09/us/states-new-abortion-laws.html; Paul Batura, The Telephone Used to Save Lives. Now It Takes Them, Daily Citizen (Dec. 12, 2025), https://dailycitizen.focusonthefamily.com/tag/chemical-abortion/ (noting multiple pro-life organizations and actors who claim that the FDA is “slow-walking” the review of mifepristone and its generic counterpart).

^[32] See Soc’y for Fam. Planning, April 2022, supra note 19 (finding substantial declines in abortions provided within the fourteen states enforcing total bans and estimating approximately 144,690 abortions foregone or displaced during the first eighteen months post-Dobbs); see also Medication Abortion Accounted for 63% of All U.S. Abortions in 2023—An Increase from 53% in 2020 (2024), supra note 24 (documenting steep declines in abortions performed within states implementing total bans).

^[33] Karen Diep et. al., Abortion Trends Before and After Dobbs, KFF (Jan. 7, 2026), https://www.kff.org/womens-health-policy/abortion-trends-before-and-after-dobbs/.

^[34] See Soc’y for Fam. Planning, April 2022, supra note 25 (documenting geographic redistribution of abortion services following state bans).

^[35] Id.

^[36] See Mitch Smith & Ava Sasani, Michigan, California and Vermont Affirm Abortion Rights in Ballot Proposals, NY Times (Nov. 10, 2022), https://www.nytimes.com/2022/11/09/us/abortion-rights-ballot-proposals.html (noting that abortion has “appeared to shape results in some candidate races.”); see also Emily Cochrane & Pam Belluck, Louisiana Indicts Another Out-of-State Doctor Over Abortion Pills, NY Times (Jan. 13, 2026), https://www.nytimes.com/2026/01/13/us/louisiana-abortion-pills-california-indictment.html (noting that Governor Gavin Newsome of California has refused to extradite a doctor to Louisiana where they have been charged with providing abortion pills to a resident of that state).

^[37] Eleanor Grano, Three Years Post-Dobbs, Illinois Is Holding the Line on Abortion Access, Chicago Abortion Fund (June 24, 2025), https://www.chicagoabortionfund.org/press-releases/three-years-post-dobbs-illinois-is-holding-the-line-on-abortion-access.

^[38] See Medication Abortion Accounted for 63% of All U.S. Abortions in 2023—An Increase from 53% in 2020, supra note 24 (identifying Illinois as a major destination state for out-of-state patients).

^[39] Id.; see also Dobbs, 597 U.S. at 215.

^[40] Karen Diep et. al., Abortion Trends Before and After Dobbs, supra note 33.

^[41] Medication Abortion Accounted for 63% of All U.S. Abortions in 2023—An Increase from 53% in 2020, supra note 24.

^[42] National Academies of Sciences, Engineering, and Medicine, The Safety and Quality of Abortion Care in the United States, Washington, D.C.: The National Academies Press, page 46, (2018) https://doi.org/10.17226/24950.; Kelly Cleland, et. al., Significant adverse events and outcomes after medical abortion, National Library of Medicine (Jan. 2013), https://pubmed.ncbi.nlm.nih.gov/23262942/; Ara Aiken, et. al., Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study, National Library of Medicine (Aug. 2021), https://pubmed.ncbi.nlm.nih.gov/33605016/.

^[43] See, e.g., Bellotti v. Baird, 443 U.S. 622 (1979); Maher v. Roe, 432 U.S. 464 (1977); H. L. v. Matheson, 450 U.S. 398 (1981).

^[44] Mary Ziegler, The Possibility of Compromise: Antiabortion Moderates After Roe v. Wade, 87 Chi.-Kent L. Rev. 571, 575–80 (2012).

^[45] Casey, 505 U.S. at 846.

^[46] Mary Ziegler, Beyond Backlash: Legal History, Polarization, and Roe v. Wade, 71 Wash & Lee L. Rev. 969, 772-72 (2014).

^[47] Dobbs, 597 U.S. at 215.

^[48] The Status of Abortion-related State Ballot Initiatives Since Dobbs, KFF (Mar. 24, 2026), https://www.kff.org/womens-health-policy/the-status-of-abortion-related-state-ballot-initiatives-since-dobbs/.

^[49] Rachel Rebouche & Mary Ziegler, Fracture: Abortion Law and Politics After Dobbs, 76 SMU L. Rev. 1, 3-7 (2023).

^[50] See Elizabeth Nash & Lauren Cross, 26 States Are Certain or Likely to Ban Abortion Without Roe, Guttmacher Institute (updated analysis of post-Dobbs abortion policy and political mobilization).

^[51] Associated Press, Abortion-Rights Groups Outspend Opponents in Ballot Measure Campaigns, (Oct. 30, 2024) (reporting significant fundraising disparities in statewide ballot initiatives).

^[52] Ala. Code § 26-23H-4 (Human Life Protection Act).

^[53] See Mary Walrath-Holdrige, DOJ Argues Alabama Can’t Charge People Assisting With Out-Of-State Abortion Travel, USA Today (Nov. 10, 2023 6:19 PM), https://www.usatoday.com/story/news/nation/2023/11/10/alabama-cant-charge-people-assisting-out-state-abortion-travel-doj/71534183007/ (noting that Alabama has residents attempting to travel outside of the state in order to obtain an abortion).

^[54] Ann Clair Vollers, Women In States With Abortion Bans Are the Biggest Users of Abortion Telemedicine, Alabama Reflector (Aug. 14, 2025 12:01 PM), https://alabamareflector.com/2025/08/14/women-in-states-with-abortion-bans-are-the-biggest-users-of-abortion-telemedicine/.

^[55] Mia Steupert & Tessa Cox, Abortion Resporting: Alabama (2022), Charlotte Lozier Inst. (Nov. 6, 2023), https://lozierinstitute.org/abortion-reporting-alabama-2022/.

^[56] Abigail RA Aiken et. al., Safety and Effectiveness of Self-Managed Medication Abortion Provided Using Online Telemedicine in the United States: A Population Study, National Library of Medicine (Feb. 17, 2022), https://pmc.ncbi.nlm.nih.gov/articles/PMC9223776/.

^[57] See, e.g., Governor Newsom Rejects Louisiana’s Attempt to Extradite California Doctor for Providing Abortion Care, California State Portal (Jan. 14, 2026), https://www.gov.ca.gov/2026/01/14/governor-newsom-rejects-louisianas-attempt-to-extradite-california-doctor-for-providing-abortion-care/#:~:text=September%202025:%20Governor%20Newsom%20signed,medication%20used%20for%20abortion%20care.

^[58] Consolidated Appropriations Act, 2023, Pub. L. No. 117-328 § 506, 136 Stat. (2022) (Hyde Amendment rider).

^[59] State Funding of Abortion Under Medicaid, KFF (last updated Mar. 3, 2026), https://www.kff.org/medicaid/state-indicator/abortion-under-medicaid/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

^[60] Id.