In 1973, the landmark Supreme Court case Roe v Wade legalized abortion nationwide by establishing a person’s constitutional right to choose to terminate a pregnancy [1]. In 2022, the landscape of reproductive rights faced a seismic shift with the case of Dobbs v Jackson Women’s Health Organization, where the Supreme Court ruled that a person’s right to choose is now determined at the state level [2]. In the case’s turbulent aftermath, states rapidly enacted laws that lowered the legal gestational age limit to obtain an abortion. However, the battleground for reproductive rights has expanded beyond the confines of those age limitations. The erosion of reproductive care accessibility encompasses a more aggressive assault on reproductive rights that goes beyond the scope of conventional debates. 

Several states have restricted access to reproductive care through funding, including limitations on private insurance and public aid. Twenty-three states banned private insurance coverage and thirty-three have limited public Medicaid funding for abortions [3]. With an average of 35% of the most restrictive states’ female residents living 200% below the federal poverty level, these policies are especially concerning [4].

In addition to funding limitations, an increase in pre-procedure mandatory counseling policies has led to further challenges in reproductive care accessibility. Thirty-three states enforce this mandate, requiring either one or two sessions [5]. Alabama [6] and Tennessee require a forty-eight hour waiting period in between counseling and the procedure [7], six states require a seventy-two hour waiting period, and sixteen states mandate a twenty-four hour waiting period [8]. Mandatory counseling increases the financial challenge for patients as they necessitate additional time and funds for gas, travel, housing, and food, especially when traveling away from home to undergo the procedure [9]. 

These policies also deviate from the standard informed consent procedure for medical interventions [10]. Twenty-nine states identify specific information that providers are required to relay to their patients [11]. Some emphasize informing patients about the ability of the fetus to feel pain. Five states insist that providers disclose the belief that personhood begins at conception. Emotional manipulation tactics regarding inaccurate mental health risks are employed by providers in counseling sessions, along with misinformation about the reversibility of medication abortion [12]. Research shows that counseling rarely reverses a person’s decision to obtain an abortion [13]. The decision to seek an abortion is not an easy one. Policies and tactics such as these shame patients and waste time, money, and healthcare resources. They not only restrict reproductive rights but compromise the integrity of medical care by promoting ideological agendas over factual, patient-centered healthcare.

Policy changes also target the use of telehealth services where providers can mail abortion medication to patients. A study concerning the relationship between reproductive care accessibility and the role of telehealth found that telehealth addresses geographical and economic challenges by reducing travel time, costs, and distances [14]. After Dobbs, lawmakers banned telehealth abortions in twenty-three states. As of December 2022, there has been a 137% increase in telehealth abortions, with one in ten medication abortions obtained through telehealth [15]. The fluctuating landscape surrounding abortions continues to leave providers and patients uncertain about the legality of telehealth and medication abortions. In light of the impending Supreme Court judgment on pregnancy termination drugs like mifepristone and misoprostol, medication abortions may soon be inaccessible for patients across the country [16]. Despite a decrease in abortions nationwide since 2021, the number of telehealth abortions has risen, indicating that access to these virtual appointments is an even greater concern than it has been in the past [17]. Therefore, limitations on telehealth are a pressing issue for people trying to preserve women’s access to abortions. 

Following the overruling of Roe v Wade, thirty-six states require parental consent or notification for minors seeking abortions [18]. Parental involvement increases the obstacles faced by minors, who now face barriers in obtaining consent, with many turning towards unsafe abortions. A study conducted in 1992 showed that many minors facing this mandate refrained from involving their parents out of fear of disownment or physical abuse, which was especially prevalent in households stung by domestic violence or substance abuse [19]. Confronting parents with such a vulnerable issue can delay obtaining that consent, which may result in later abortions [20]. The World Health Organization found that minors are at a higher risk of pregnancy-related complications than their adult counterparts, including trauma to organs, which further emphasizes the need for minors to be able to access abortions in a timely manner [21]. A 2023 Health Affairs Scholar study [22] and a study showing the rise in second-trimester procedures following Missouri’s 1981 parental consent law show that parental consent and notification laws have historically correlated with late-term abortions for minors [23]. The influx of parental consent laws after the Dobbs decision not only exacerbates the barriers minors seeking abortions face but also exposes them to increased health risks, and they suggest a concerning trajectory for reproductive care access and health outcomes. 

Healthcare providers face significant concerns regarding the future of their practice as a result of these policy changes in the wake of Dobbs [24]. In West Virginia, the sole abortion clinic halted its abortion services despite the state’s pre-existing abortion ban not being fully enforced [25]. Similarly, in Arizona, where legislative efforts to restrict abortion faced legal challenges, nine out of ten clinics ceased offering abortion services. One provider in Arizona cited the fear of potential criminalization as the reason for suspending abortion services [26]. This apprehension among providers exacerbates existing shortages of skilled healthcare professionals in reproductive care, as many are hesitant to relocate or continue practicing in states with increasing restrictions or legal disability. 

These policy changes have led to a large rise in the number of those traveling out-of-state for reproductive care. For example, New Mexico, Colorado, and Illinois have each seen a substantial increase in interstate travel for abortion care between 2020 and 2023, with New Mexico’s number of abortions given to out-of-state patients increasing by 36% [27]. While the number of patients seeking abortions has increased with interstate travel, the number of providers is the same. This has led to fewer available appointments, which hinders residents’ ability to obtain this healthcare. Interstate travel for abortion care requires increased costs such as travel, gas, hotel accommodations, and food. The National Network of Abortion Funds [28] and the Baltimore Abortion Fund [29]—two organizations that aim to diminish these constraints—have reported surges in requests for financial aid for reproductive care since the Dobbs decision, which reflects how intense the restrictive policies’ financial burden is. These policy developments hinder individuals’ ability to afford this essential healthcare. 

Many argue that there is a simple fix to the abortion issue: be responsible and have protected sex. However, it is not as simple as that. In a Senate hearing on abortion on February 28, 2024,  Senator John Kennedy (R-La.) questioned Allie Phillips, a mother who traveled to New York to terminate a 20-week pregnancy. While showing an image of a 21-week fetus, he aggressively described the procedure, saying that doctors use “a pair of pliers with sharp teeth on the end… [and] start tearing the baby apart.” Phillips responded with her story, where her fetus was diagnosed with multiple conditions, such as non-functioning organs, that would result in immediate hospice after birth and threaten Phillips’s health. Tennessee’s strict abortion policies forced her to start a GoFundMe to fund her travel to New York, where she learned her fetus had died and underwent the procedure with no friends or family by her side [30]. Situations like Phillips’s show that these new policies are not in place to protect mothers; they make the difficult decision to obtain an abortion more dangerous, traumatizing, and emotionally painful. 

Following the significant shift in abortion policies across the nation, it is crucial to recognize the proactive steps being taken to protect reproductive rights. Eleven states have introduced shield laws, safeguarding the privacy of individuals seeking abortions by prohibiting law enforcement agencies from divulging such information across state lines [31]. Additionally, there is a promising trend emerging as several states gear up to include reproductive care protections within their state constitutions, slated for the 2024 ballot. Pharmacy chains, like Walgreens and CVS, are set to begin selling abortion pills in states where abortion is legal, increasing the attainability of reproductive care [32]. Furthermore, the FDA recently approved the contraceptive pill “Opill” for over-the counter-sales [33]. These initiatives signify a concerted effort to uphold abortion rights and ensure the continued accessibility of reproductive healthcare services, even in the face of restrictive legislative changes. 

In the aftermath of the Dobbs decision, it becomes increasingly evident that the assault on reproductive rights extends far beyond the confines of temporal restrictions. The subtle yet impactful policy changes, ranging from insurance coverage limitations to mandatory counseling sessions, serve as serious barriers to accessing essential reproductive care. By imposing restrictions on insurance coverage, mandating counseling sessions, parental consent, and increasing travel barriers, legislators not only exacerbate existing inequalities but also undermine the fundamental trust in individuals to make informed choices about their own bodies.