Ending Roe v. Wade May Have Had the Opposite Effect That Conservatives Had Hoped For

On Tuesday, Ohio voters passed a ballot measure enshrining the right to an abortion in the state constitution, joining several states where voters have responded to the end of Roe v. Wade by protecting reproductive rights via popular referendum. We recently learned, however, that even without these votes, reproductive rights might be safer than many expected following the end of Roe in 2022.

When the Supreme Court overturned Roe v. Wade in Dobbs v. Jackson Women’s Health Organization, the conventional wisdom was that there would be a steep drop in the number of abortions in the United States. As it turns out, though, conventional wisdom was wrong. To many observers’ surprise, two recent studies reveal that national abortion numbers have actually slightly increased since the Supreme Court ended Roe. Based on everything we know about abortion seekers and providers, however, that abortion numbers would go up in the face of Supreme Court retrenchment should have been exactly what was predicted.

Abortion seekers, both in this country before Roe and around the world in countries where abortion is illegal, have shown again and again that they will do what they need to do to get the care they need. In this country, before abortion was legal, women went to both reputable doctors and back-alley quacks to get care. Some estimates even indicate that abortion numbers immediately before Roe were comparable to those after legalization. In other countries where abortion remains illegal or severely restricted, people who need abortions obtain pills outside the established medical system or find covert abortion providers. They do this in the face of sometimes unsafe conditions and legal systems that could punish them.

We also know that abortion providers, and those who support their efforts, will do whatever they can to care for their patients despite systems that are designed to make abortion care difficult, if not impossible. We know this because even before Roe was overturned, abortion providers in many states in this country had to jump through medically unnecessary hoops in order to deliver safe care for their patients. These restrictions and regulations—from imposed waiting periods to parental consent for minors’ abortions to bans on insurance coverage to excessive, expensive requirements for clinic spaces—were unique in the medical field. Rather than throw up their hands and give in to the legislative roadblocks, abortion providers and their supporters developed practices and workarounds that made abortion as accessible as possible in hostile environments.

Now, with abortion illegal or seriously restricted in 17 states, we’re seeing the same ingenuity and resilience from abortion providers and their supporters. The two of us spent 2022 interviewing various abortion providers and supporters around the country about how they were planning for and responding to the Supreme Court overruling Roe. What we learned from these providers and supporters was that they were determined to take every measure possible to continue to care for people in states that were expected to ban abortion.

What this has meant is that providers have been creative, resourceful, and nimble in continuing to provide care post-Dobbs. In states like Tennessee and North Dakota, we’ve seen clinic owners quickly relocate clinics across state lines so their patients have minimal disruption in their care. In states like New Mexico, Illinois, and Colorado, we’ve seen clinics prepare for an influx of patients by increasing staffing and opening new facilities. And once Dobbs allowed neighboring states to make abortion illegal, clinics in these “surge” states rose to the occasion by increasing hours, coordinating care with each other, and experimenting with new delivery models, such as telehealth. In states like Georgia and Utah, we’ve seen providers pingpong back and forth following ever-changing restrictions and legal rulings from their state courts while focusing on providing as much care as legally possible to their patients at every turn. And in states like Connecticut, Minnesota, and Maine, we’ve seen abortion-supportive legislators get rid of long-unnecessary restrictions that had made abortion access difficult even in these blue states.

We’ve seen people take extraordinary steps nationally, as well. “Patient navigators” connected to national organizations and abortion funds have helped patients in red states arrange abortion appointments and obtain payment for travel as well as the procedure itself. We’ve seen virtual clinics and online pharmacies proliferate to provide even more access for people in states where abortion remains legal. A small number of providers have taken advantage of some pro-choice states’ shield laws to mail abortion pills to patients in states with abortion bans. And informal networks now operate under the radar to get abortion pills into the hands of people who need them, no matter where the patient is.

To be sure, the post-Dobbs landscape is not one of uniform good news. Abortion clinics have closed in many states, leaving communities without local reproductive health care of all types. Abortion bans have also driven many OB/GYNs out of their states, worsening an already existing crisis in maternity care. Women experiencing pregnancy complications in banned states have been subjected to shockingly cruel treatment by being denied abortions that are necessary to address emergency medical situations, with some even having to be driven by ambulance to other states in order to receive the care they need. People who are forced to now travel for an abortion have to endure many life disruptions, often for several days. And many women—the poorest without internet access, the undocumented, those in abusive relationships—who want an abortion have been unable to travel or access care otherwise, leaving them vulnerable to increased risks associated with carrying pregnancies to term. The losses these people have suffered are devastating and the direct consequence of a Supreme Court removing people’s basic human rights.

But as important as the story of the losses from Dobbs is, the story of what abortion patients and providers have done to continue accessing and providing care is equally important. They, along with an American electorate that is proving again and again that it supports abortion’s legality, have resoundingly responded to the Supreme Court by saying, as one provider in an embattled state put it to us, “we’re definitely not down for the count.”

Whether this uptick in abortions will continue into the future is, of course, unknown. More states could soon ban abortion. And the financial resources and the very long hours put in by clinic staff and supporters in surge states that have been essential to all of these developments post-Dobbs may not be infinite. Republican victories in future elections, including the 2024 presidential election, could also change things dramatically.

But for now, what we see from the latest reports of abortion numbers is clear: The Supreme Court may have ended Roe v. Wade, but thanks to the will and determination of abortion seekers and providers, it did not end abortion. In fact, it may have accomplished the exact opposite by prodding people on the ground to make abortion, on the whole, more accessible than ever before.