Three Years Later: No Fewer Abortions, But a Lot More Harm

The Medical Impact of Dobbs

It’s been three years since the Supreme Court overturned Roe v. Wade, splitting the country into two Americas—one where abortion is still legal, and another a worsening reproductive police state.

In that new country of second-class citizens, we’ve seen women forced to carry nonviable pregnancies to term and beg for help as they go septic. We’ve watched miscarriage patients get arrested while raped children and cancer patients are denied care. Rather than working to reduce this suffering, Republican lawmakers are floating restrictions on women’s right to travel and laws to jail abortion patients for life.

Conservatives’ punitive approach has driven up the maternal and infant mortality rate, shuttered labor and delivery wards, and forced doctors to flee to states where they can practice without fear of prosecution. What anti-abortion policies haven’t done, however, is reduce abortion.

In fact, since the end of Roe, the annual number of abortions in the U.S. has risen to over 1 million—the highest number in over a decade. That’s because no matter how hard conservatives push and punish, people who want abortions will—for the most part—get them.

It’s that disconnect that most defines the last three years: Conservatives desperate to codify a worldview that women actively oppose.

Over 80% of Americans don’t want the government involved in abortion in any way, including the majority of Republicans. Even voters in states with bans want abortion to be legal.

Abortion rights’ incredible popularity—which has only grown since the end of Roe—has conservative lawmakers and activists playing pretend: They tell Americans that they’re not really banning abortion, and that their policies help women and families. When that doesn’t work, they chip away at democracy so voters won’t have a choice regardless.

The one positive constant over the last three years, though, has been the incredible power and resilience of the abortion rights movement: Even with dwindling funds and the threat of prison hanging over their heads, abortion organizations, funds, providers, and activists have been relentless. They’re in every community in every state, there to ensure that the people who need care will be able to get it. (There’s a reason abortion numbers didn’t go down!)

I’ve been lucky enough to write about this movement—and what they’re up against—since the end of Roe. To give you all a bird’s-eye view of what America looks like under abortion bans, I’ve outlined three areas of impact: Medical, Legal, and Cultural.

I’m sharing an analysis of the Medical Impact today, Legal tomorrow, and Cultural on Thursday. At the end of the week, I’ll share a link that contains all three sections.

The hope is that this will help you all make sense of the last three years, and let us think together about what comes next.

Medical Impact

Horror stories started rolling out immediately after the end of Roe: Miscarrying women left to bleed for days at home or in hospital parking lots. Patients with life-threatening pregnancies forced into c-sections or hysterectomies rather than given abortions. Ectopic pregnancies bursting, fallopian tubes removed, women dying.

I’ve written about more stories than I could ever recount here, though there are a few that will never leave me:

The pregnant mother of five with cervical cancer who begged a hospital panel for chemotherapy, telling doctors that she wanted to live for the “kids she already had.” They said no.

Samantha Casiano, forced to carry a nonviable pregnancy in Texas, vomiting on the stand while testifying about watching her daughter’s pained last breaths.

The Louisiana doctor who recounted her patient “screaming, not from pain but from the emotional trauma” after being forced to vaginally deliver a nonviable fetus at 16 weeks, rather than being given a standard abortion procedure.

Amber Nicole-Thurman. Adriana Smith.

But it’s more than individual horror stories that make up America’s post-Roe health crisis—it’s the domino effect set off by abortion bans.

Reproductive health care providers are fleeing anti-abortion states. Idaho, for example, has lost nearly a quarter of its OBGYNs and over half of its maternal fetal medicine specialists. That exodus has forced multiple hospitals to shutter their maternity wards—expanding the state’s maternal health care desert in the process.

Now, some women have to drive hours just to reach a hospital where they can give birth.

Two million American women now live in a “double desert”: a county without abortion access or maternal health care.

Recruiting new doctors to fill that gap is increasingly difficult: The president of the Idaho Hospital Association says potential employees tell him they’re not willing to work in a state that criminalizes physicians. “Physicians are kind of scared to practice here,” one Idaho fellowship director told state legislators.

And though the demand for OBGYNs is the highest it’s been in decades, there’s been a dramatic decrease in residency applications to anti-abortion states. That’s not just because of the fear of criminalization, but because it’s illegal to teach OBGYNs how to perform abortions—training that’s necessary for accreditation. Doctors are forced to leave the state to learn the procedure, often on their own dime.

Then there are the doctors who stay in anti-abortion states. They’re not just contending with restrictive laws, but with hospital policies written by attorneys and administrators who often take the path of least legal resistance. The impact on patients can be devastating: When ProPublica compared miscarriage care in Houston and Dallas, they found sepsis was nearly 70% more common in Houston—where hospital policy requires patients to be critically ill before doctors are allowed to intervene.

And while we’d all like hospitals to be braver on behalf of their patients, these institutions aren’t just operating under the fear of the law itself. Republican attorneys general have preemptively threatened hospitals and doctors to scare them out of providing care—like then-Louisiana Attorney General Jeff Landry did when Roe was overturned. Idaho Attorney General Raúl Labrador went all the way to the Supreme Court to fight for the right to deny patients life-saving abortions! That sends a clear message to any medical institution or provider.

Patients are hearing that message too—the threat of criminalization doesn’t just make doctors too afraid to provide care, but patients too afraid to seek it. When Candi Miller developed an infection after self-managing an abortion at home, fear of Georgia’s abortion ban stopped her from seeing a doctor. The mother-of-three was found dead by her husband and 3-year-old daughter.

Of course women are twice as likely to die during pregnancy in states with abortion bans. The two Americas created by abortion bans don’t just determine your rights—but your life. In fact, the Gender Equity Policy Institute (GEPI) found that Texas’ maternal mortality rate is now 155% higher than California’s. To no one’s surprise, Black mothers are also over three times more likely than white mothers to die in states that have banned abortion.

And while maternal mortality in pro-choice states has dropped 21%, that doesn’t mean they’re immune to the fallout from Dobbs. Doctors there are overwhelmed with out-of-state patients—many of them seriously ill.

In ban states, providers prevented from treating high-risk pregnancies without delay are sending those cases across state lines for immediate care. Illinois was seeing so many of these transfers that the state launched the Complex Abortion Regional Line for Access (CARLA)—a hospital navigation program for urgent cases.

Living in a pro-choice state also doesn’t guarantee you’ll be able to obtain care. Religious hospitals refuse to provide birth control and abortion—even in emergencies. I’ll never forget the miscarrying California woman who was discharged with a bucket and towels “in case something happens in the car.” In some pro-choice ‘havens’, like Washington, religious institutions make up over 40% of the state’s hospital beds.

That market dominance can be deadly: A report from National Nurses United (NNU) found that when the Catholic health system giant Ascension entered a community, for example, the maternal mortality rate skyrocketed.

States with so-called ‘viability’ limits also prevent the most vulnerable patients from accessing care. There are only a handful of states that allow abortion in the third trimester, and even fewer where clinics actually offer that care.

You may notice a trend: Abortion bans are most likely to impact the most marginalized Americans—patients in the most complicated and difficult circumstances.

Here’s the good news: as complicated as the medical landscape has been, the abortion rights movement has risen to the occasion. They’ve adapted along with every restriction and ban.

Abortion funds ensure patients can afford their procedures and travel, abortion navigators are on the phone and online every day, booking train tickets and hotels, and shield state providers have become that little Dutch boy with their finger in the dam—staving off total devastation by shipping pills across state lines.

That interstate access—made possible by abortion medication and telehealth—has been the saving grace of the last three years: pills account for more than 60% of abortions in the U.S., and 1 in 4 abortions are now provided via telehealth.

As important as medication abortion has been, people still need procedural care. Last year, over 150,000 people crossed state lines to get abortions—aided by activists, donors, healthcare providers, and patient support systems.

The fact that so many people have been able to access abortion post-Dobbs is an incredible accomplishment of organizing, movement building, and individual bravery.

None of that erases the harm done by bans: even patients who eventually obtain their abortions are put through hurdles that can cause lasting physical, emotional, and financial harm.

Over the past three years, I’ve spoken to a woman in South Carolina who was denied an abortion for days after she miscarried, a very young woman in Texas who couldn’t get an abortion in her home state even though her fetus was developing without a head, and dozens of others whose lives were forever changed by the laws in their states.

That’s why if I could simplify the medical impact of the last three years into one sentence, this would be it: Abortion bans aren’t reducing abortions, but they are increasing harm.

Keep an eye on your inbox tomorrow for the next section digging into the post-Dobbs Legal Impact. Here’s a snippet of what’s to come:

Legal Impact

The post-Roe health crisis hasn’t slowed Republicans down one bit. In fact, they’ve used the chaos and confusion of the past three years to their benefit—further codifying bans, restrictions, and punishments under the guise of ‘protecting’ women.

From constitutional frameworks down to local ordinances, the idea is to give anti-abortion activists the power to criminalize care, intimidate providers, surveil patients, and undermine basic civil liberties.

And let’s be clear: They’re not just barreling towards a future without abortion. Conservative lawmakers are chipping away at women’s ability to participate in the public sphere at all—attacking birth control, sex education, and workplace protections.