After spending more than four decades studying abortion in American social, medical, and political culture, Carole Joffe was fully prepared for the Supreme Court to overturn Roe v. Wade in 2022. “Dobbs itself wasn’t that scary to me,” she says. “It was upsetting and politically outrageous, but because of our work, we knew abortion wasn’t going to go away.”

What she did find frightening was a Louisiana lawsuit last month challenging the Food and Drug Administration’s rules allowing the abortion pill mifepristone to be prescribed via telemedicine and sent through the mail. In the end, the justices kicked the case back to the lower courts, but abortion advocates were reminded of how much patients around the country still have to lose. “Things since Dobbs have gone better than many of us thought, but so much of that access has been dependent on telehealth,” says Joffe, a sociologist and professor at the University of California, San Francisco. “So yes, the case felt scary, but then I got back to business as usual. ‘Abortion is still happening. Who do I want to interview?’”

Joffe’s mission is to try to understand the American abortion ecosystem through the people who populate it, including patients, providers, and fellow advocates. Her most recent book, After Dobbs: How the Supreme Court Ended Roe But Not Abortion, co-written with Drexel University legal scholar David S. Cohen, tracked how that ecosystem adapted in the aftermath of the landmark ruling: the surge in abortion protections in blue states, the mobilization of activists to help patients in red states, the rage donations—and just rage—fueling it all.

Four years post-Dobbs, the right-wing legal and legislative attacks have been relentless, and the risks from the courts and the Trump administration are dire, but the abortion-access movement has proven to be more resilient than even Joffe foresaw. She points to new data from the #WeCount project showing that clinician-managed abortions approached 1.13 million in 2025, with the monthly average up 14 percent from April 2022. By the end of last year, almost 9,000 women a month were accessing care in states where abortion is banned. “David and I knew that there would still be abortions happening in the blue states, but we did not anticipate the [nationwide] numbers going up to the degree they have,” she says. “That has been astonishing.”

“Things since Dobbs have gone better than many of us thought, but so much of that access has been dependent on telehealth.”

Much of the movement’s strength is due to legal and medical innovations that have made abortion pills more accessible than ever before, including telemedicine and blue-state shield laws that protect providers in those states who care for patients from places where abortion is illegal. Cohen is one of the masterminds behind shield laws, which have been embraced by Democratic-run states. But when he and Joffe were working on their book, the laws had barely taken hold. Now, she says, “their impact can’t be emphasized enough.”

Still, those innovations have largely benefited women seeking what one recent law review article calls “everyday abortions”—those occurring for non-medical reasons, usually in the first trimester. For other segments of the population—women suffering from life-threatening pregnancy emergencies, those seeking abortions later........

© Mother Jones