In May, the US Supreme Court ruled that doctors could continue to prescribe the abortion pill mifepristone. The ruling allows women seeking abortions to obtain the pill at pharmacies or via the mail, without an in-person visit to a doctor, in the 13 US states where the procedure is banned. But the case has now returned to a lower Louisiana court, where litigation aimed at limiting access to the drug continues.

The case is illustrative of how the landscape for abortion access has changed in the few years since the 2022 Supreme Court judgment in Dobbs v Jackson Women’s Health Organization. The Dobbs ruling overturned a nearly 50-year-old precedent protecting the right to abortion under the US Constitution. Since then, virtual clinics have emerged as a key means of accessing abortion in states with bans.

Anti-abortion groups are aware that the Dobbs ruling ‘did not have the immediate impact they wanted in reducing abortion figures, but they’ve played the long game for 50-some years,’ says Kim Ricardo, a professor of law at the University of Illinois Chicago (UIC) School of Law. ‘They are skilled and strategic in trying to find all of the different ways to try to reduce access to abortion.’

In 2024, Ricardo and UIC sociology professor Claire Laurier Decoteau received a grant from the Society of Family Planning to investigate the barriers that pregnant people face in seeking abortion care. Over an 18-month period, the two interviewed over 120 women living in states with abortion bans who travelled out-of-state to undergo a procedure or used medication sent to their homes to terminate a pregnancy.

Abortion is legal in Illinois, but it’s surrounded by states with total bans or severe restrictions, such as Indiana, Kentucky and Iowa. It’s therefore emerged as a key state for abortion care since Dobbs. ‘Our study contains lots of stories from women who are just confused about what type of access rights they have and so have relied on organisations and cooperatives to help them filter through the large, vast amounts of information out there,’ says Ricardo.

According to a report from the Center for Reproductive Rights published in June, the make-up of state courts has been a key factor in determining abortion access. Ten states have amended their state constitutions to protect reproductive freedom since Dobbs. ‘Much of the legal conflict has moved from the federal courts to the state courts, with courts deciding for the first time whether there are protections in their state constitutions,’ says Myrick. ‘Every state court is able to decide whether their constitution protects abortion rights separate from the Supreme Court. State courts don’t have to follow the politics of the state, and a state constitution should be insulated from politics. So, state courts have a lot of potential to advance reproductive autonomy, including abortion.’

In spite of the increase in procedures, the ruling in Dobbs has nevertheless had a significant impact on women seeking abortions, on medical practitioners now operating under a criminal and potentially civil risk in states with bans and on people seeking to access reproductive healthcare more generally. ‘Four years after Dobbs, abortion hasn’t disappeared, but equal access to it has. What was once a constitutional right is now a postcode lottery shaped by geography, money, fear and legal uncertainty,’ says Mark Stephens CBE, Co-Chair of the IBA’s Human Rights Institute.

Highlighting that state-level abortion bans have exacerbated discriminations related to race, gender, socioeconomic status and class, he says that ‘access now depends much more on mobility, knowledge, financial and economic ability and legality to cross borders.’ In respect of the latter criteria, it’s notable that officials in some US states have threatened to prosecute individuals who assist others in travelling across state borders to undergo abortion procedures. In Louisiana, for instance, those providing abortion care face penalties of up to 15 years in prison and $200,000 in fines.

Meanwhile, there have been reports of patients with severe pregnancy complications being denied medically necessary care in states that have abortion bans in place, despite those bans allowing exceptions for healthcare reasons. ‘Rather than doing preventive medicine or prophylactic medicine, [doctors] wait to treat until the risk becomes extreme and their judgement couldn’t be second-guessed – which is not in the best interests of the mother, or anyone else,’ says Stephens, a consultant at law firm Howard Kennedy. ‘And it really challenges the Hippocratic oath of do no harm.’

Even though federal law prohibits Medicaid health insurance funding for abortion except in rare circumstances, states with abortion bans have barred the non-profit Planned Parenthood – which provides sexual healthcare services across the US – from receiving Medicaid reimbursements for services such as cancer screenings and contraception.

Meanwhile, in 2025, the Trump administration also made cuts to a federal programme that offers family planning and related preventative health services to low-income individuals, alleging violations of federal civil rights law and executive orders that target diversity, equity and inclusion programmes by some of the organisations receiving the funding. Although funding was restored following a court ruling in January, these cuts led to the closure of at least 20 Planned Parenthood health centres and local affiliates across the nation, according to the organisation.

As a result, care for those who need to see doctors in obstetrics and gynaecology has become more limited. Ricardo highlights that such doctors don’t only deal with reproductive healthcare, meaning there have been a number of ‘secondary and tertiary effects.’

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