Since Dobbs

Brianna knew her husband would claim the pregnancy was an act of God. Their marriage was falling apart. She was fed up with his infidelity and with managing their kids and home on her own. The couple had recently separated when she realized her period was late.

Deciding to get the abortion was easy. Beyond the trouble at home, Brianna’s doctor had warned her that because of her history of C-sections, another pregnancy could lead to fatal complications. She could not fathom leaving her three daughters without their mom.¹

But the barriers to ending her pregnancy seemed insurmountable. Her home state, Texas, had banned abortion in 2022. She couldn’t drive to the nearest clinic—an eighteen-hour round trip to New Mexico—without taking time away from her kids and work and risking her husband finding out about the pregnancy. She knew her family wouldn’t help, either; they would try to talk her into staying with her husband and having the baby.

When Brianna went online in search of options, she stumbled on a Reddit forum about medication abortion. It directed her toward an organization called Aid Access that would mail her the same medication she could get in a clinic: mifepristone, which stops the growth of a pregnancy, and misoprostol, which causes the uterus to contract and expel it. She paid $150 through an online portal and within days the pills arrived at her home in a discreet package. In the middle of a weekday, when her daughters were at school, Brianna curled up with a pillow and ended her pregnancy alone. 

Only a few years ago, she might not have found a way out of her predicament. Even after Roe v. Wade (1973) established a constitutional right to abortion, wealth and geography determined who could actually get one: women in red states like Brianna often lived nowhere near a provider; poor women often couldn’t afford a procedure even if they did. But since the Supreme Court overturned Roe in Dobbs v. Jackson Women’s Health Organization (2022), allowing more than a dozen states to ban abortion outright, a network of telemedicine providers has emerged to fill those gaps—and, in the process, has made abortion available in places where it never was before.

No one expected that revoking the constitutional right to abortion would wind up expanding access to it. Yet the spike in unwanted births that many predicted after Dobbs has been smaller than anticipated, while the number of abortions registered within the formal healthcare system in this country has risen every year since 2022. The telemedicine services behind this shift operate from Democratic-run states that have passed “shield laws” to protect providers from criminal investigations initiated by the states whose laws they are circumventing. Many of these providers have also raised enough funds to offer abortion medication for a fraction of what it costs in a clinic. Since I first reported on this network in 2024, such services have quickly multiplied, as has the number of people who know they exist. Each month nearly 15,000 people in restrictive states are accessing abortion pills via these means—roughly 15 percent of all abortions, according to the latest data. The real number of people bypassing abortion bans is even higher, since these figures exclude the informal activist-run networks that operate all over the country. Ms. magazine recently estimated that four of these networks are collectively serving about 3,500 people each month; one activist told me that she alone has circulated roughly 17,000 sets of the two-drug regimen in the past year, and hasn’t reported those numbers to anyone.

This is not to say that everyone who needs an abortion can get one. According to a 2023 survey, one in four OB-GYNs nationally and half of those practicing in states where abortion is banned said they had seen a patient who was forced by those laws to continue a pregnancy. A 2025 study found that states with abortion bans have cumulatively seen over 22,000 additional births, fifty-nine excess pregnancy-related deaths, and close to five hundred additional infant deaths, likely as a result of people being forced to deliver babies with catastrophic fetal anomalies. For women of color, the increased fertility rate was more than twice that of white women.

Medication abortion can’t reach everyone. Most clinicians will only send the pills to people in the first eleven or twelve weeks of pregnancy, when the regimen is safest and most effective; this means that access has especially narrowed for those who find themselves seeking an abortion later in their pregnancy, who are disproportionately young, low-income, and people of color. Certain rare medical conditions can also make taking the pills unsafe. And not everyone can face the potentially prolonged and uncomfortable experience of passing a pregnancy at home, an ordeal that can involve intense cramping, heavy clotting, and, in later weeks, seeing the fetus.

Taking the pills can also feel legally risky. Self-managing an abortion is not illegal in any state except Nevada (and even there it’s only banned after twenty-four weeks); in general, criminal cases related to abortion pills are exceptionally rare relative to the number of people using them. But it’s not unheard-of for prosecutors in Republican-controlled states to use a range of laws—from homicide statutes to interdictions on “abuse of a corpse”—to target people they suspect of taking the medications. A few recent, well-publicized homicide arrests—including those of two women in Kentucky, one for concealing fetal remains after an apparent miscarriage and another for an alleged abortion—have deepened the fear and anxiety among people in red states. In late 2025 the group Pregnancy Justice counted 412 cases since the Dobbs decision in which someone was criminalized after a miscarriage, birth, or abortion. As it was before Dobbs, legal risk today is highly contingent on class and related factors: more than three quarters of the defendants were poor, and nearly every case involved someone accused of using illicit drugs. (A recent investigation by The Marshall Project suggests that the criminalization rate could be far higher; it uncovered more than 70,000 cases over a period of six years in which women were referred to law enforcement over allegations of substance abuse during pregnancy, often because of false positives on drug tests.)

All of this amounts to a complex picture in which abortion access is expanding and contracting at the same time. Never in modern history have wealth and location been less decisive in whether someone can get an abortion in the US. And yet these longstanding factors still shape how most people confront an entirely new set of considerations—notably how willing they are to tolerate the legal risk, isolation, and uncertainty that come with having an abortion in a state where it is banned.

*

Pro-choice advocates had hoped that Roe v. Wade would make it possible for anyone who needed an abortion to get one. Before legalization, wealthy patients could persuade a doctor to offer them a “therapeutic” procedure in a hospital, or travel to a country where abortion was safe and legal. Poor patients could take their chances with a back-alley provider or induce an abortion themselves with a knitting needle or the infamous coat hanger; many were maimed this way, and many more died slow, excruciating deaths in septic wards set up for victims of unsterile abortions.

After Roe, many insurance plans throughout the country, including state Medicaid programs, began covering abortions. But opponents of the procedure had started devising ways to restrict public funding even before the decision came down. In 1976 Congress passed the Hyde Amendment, which bans federal funding of abortion in most circumstances. Its proponents knew that they lacked the political support to ban abortion altogether—a few short years after Roe, public opinion was already tilted in favor of keeping the ruling in place. They saw, however, that they could prevent Medicaid recipients from accessing this new constitutional right. “We cannot save the unborn of the rich,” Illinois Congressman Henry Hyde conceded in 1993 during a debate over the annual renewal of the ban. “Thank God we can save some of the children of the poor, and that is what I want to do.”²

The ban has been renewed by every subsequent Congress regardless of which party is in power. As a result, most Medicaid patients have been unable to get their procedures covered. (A minority of states today cover Medicaid abortions with their own funds.) This has condemned an untold number of the poor to die. The first and most publicized case was that of twenty-seven-year-old Rosie Jimenez, who sought an abortion from a lay midwife in Texas shortly after the state cut off Medicaid coverage. The midwife inserted a tube into Jimenez’s cervix; she died of sepsis eight days later, blood leaking from her eyes as a result of the infection as she pleaded with the doctors to stop berating her about the abortion and leave her to die in peace.³

A far more common outcome of the Hyde Amendment has been to compel people to remain pregnant. As many as one in four Medicaid patients who seek an abortion is stymied by an inability to pay. By 2010 it was estimated that the Hyde Amendment had resulted in more than one million people giving birth because they couldn’t afford an abortion.

Geography was the other major factor that shaped access before Dobbs. Clinics are concentrated in urban areas, and incremental restrictions on abortion in red states have driven many facilities out of business across the South and Midwest. By 2020, 89 percent of counties nationwide lacked an abortion provider, and six states had only one clinic. After Dobbs, the travel time to a clinic for people from states with bans increased from 2.8 to 11.3 hours; more than half of respondents in a 2025 study reported needing to spend at least one night away from home in order to reach a facility. Despite these hurdles, most abortions registered in the formal system today still involve in-person care.

Yet now Brianna and women like her—even when they can’t afford an abortion in a clinic or,  stranded in access deserts like the state of Texas, can’t reach one—can go online and with a few clicks find no fewer than ten verified providers of medication abortion who send pills by mail cheaply or for free. This requires access to accurate information, but such information is becoming much easier to find via websites like PlanCPills.org, INeedAnA.com, and AbortionFinder.org, which are publicized everywhere from social media ads to stickers plastered on lampposts and public bathroom stalls. (The founders of PlanCPills.org told me that they have circulated close to five million stickers.) Beyond formal telehealth providers like Aid Access, women can find volunteer-run organizations that will mail pills in an ordinary envelope, or activists who will bring them to the door in a dime-bag.

“It is a great equalizer—the fact that anybody can go on Plan C Pills and find a provider,” one such activist in the South told me. Crucially, unlike the methods that killed Rosie Jimenez and countless other women, medication abortion is overwhelmingly safe: a 2022 FDA report found that of the roughly 5.9 million people who have taken mifepristone since it became available in the US more than two decades ago, thirty-two died afterward; about half those deaths were seemingly unrelated to the abortion itself. When women first started using misoprostol to induce abortions after it went on the market in Brazil as an ulcer drug, the country saw a precipitous decline in abortion-related deaths, as the gender studies scholar Carrie N. Baker found.⁴ Even before abortion pills, when self-managed abortions were understood to be dangerous, “folks still went that route because they didn’t want to be pregnant,” the activist said. “So you’re definitely going to have a harder time stopping folks now.”

*

When mifepristone was first approved by the Food and Drug Administration in 2000, news coverage heralded its potential to transform abortion access. No longer would women need to find their way to a clinic or face protesters outside, since any doctor could prescribe the medication in their office. The imagery of abortion would change, too; now that it could be administered by a simple set of pills rather than requiring procedures that had been demonized, advocates theorized that it would become more acceptable.⁵

But experts like the sociologist Carole Joffe cautioned that the revolution was likely to happen “gradually, not overnight.” Sure enough, until recently the FDA required people seeking a medication abortion to make three separate in-person visits to a clinic. Along with the out-of-pocket costs that the Hyde Amendment imposed on the poorest abortion seekers, this protocol—which reflected politics rather than medical necessity—meant that mifepristone became just as difficult to obtain as an in-clinic procedure.

Then came the Covid-19 pandemic. The risk of Covid exposure prompted a federal court to suspend the in-person dispensing requirement, which in turn allowed domestic providers to start mailing the drugs. (International services and pharmaceutical websites had already begun shipping the pills to the US, but this could take weeks, which put some people past the early stage of pregnancy when the protocol is recommended.) While the Supreme Court later reinstated the in-person requirement, the Biden administration declined to enforce it during the pandemic, and in 2023 eliminated it altogether. At first domestic providers mainly operated in states where telehealth abortion was legal—but now anyone in the country could order the pills if they were willing to get creative, for example by having their mail forwarded from a P.O. box in a blue state.

After Dobbs, a group of pro-choice legal strategists, looking for ways to counteract the devastation of abortion bans, devised the idea of shield laws. Officials in blue states would agree not to cooperate with investigations into abortion providers initiated by states where abortion was illegal, functionally immunizing providers as long as they didn’t travel to places where state officials might try to arrest them. A total of eight states—California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington—have now passed such laws.  

The resulting telehealth services are reaching enough people to provoke profound consternation among anti-abortion activists, who are flailing for ways to diminish what one called the “huge flood of the abortion pill being mailed to women.” At a recent anti-abortion gathering, the National Pro-Life Summit, Mark Cavaliere of the group Southwest Coalition for Life lamented that it is getting harder for activists like him to intercept abortion seekers outside clinics; the people who do make it to in-person appointments these days have often traveled hours to get there and are too “invested” in their decision to be engaged. His organization’s solution was to peddle what he called “chemical abortion recovery and evaluation kits,” which include graphic photos of fetuses and a plastic container that women can use to collect their blood and tissue for burial. The clear intention of the kit is to present women with anti-abortion propaganda even if activists can’t buttonhole them on the sidewalk. 

The new telehealth network has been so revolutionary in part because it has nearly eliminated the costs associated with having an abortion. The proliferation of generic versions of mifepristone has made the pills themselves more affordable: one clinician I spoke to estimated that the cost to her organization of shipping a medication abortion package is about seventy-five dollars. Philanthropic support has enabled services such as hers to offer the pills at a reduced rate or for free to people who need it.

The savings for abortion seekers include not only the costs of the procedure but also incidental expenses, which can prove much more prohibitive. Since the passage of the Hyde Amendment, local abortion funds have raised and spent millions of dollars each year to get people the care they need. For decades most of this money went to pay clinic fees (which can be thousands of dollars later in pregnancy). But since Dobbs the funding has increasingly gone to the cost of planes, buses, hotels, and other “practical support” for those who must travel from red states to blue ones. In 2024 alone the fifty-nine organizations that make up the National Network of Abortion Funds spent more than $63 million, with an average per-person pledge of $475. But the funds didn’t have the money to save everyone; that year they could help only 54 percent of callers.

This state of affairs was at the front of Angel Foster’s mind when she launched her shield law provider, the Massachusetts Medication Abortion Project (known as the MAP), with other doctors and advocates in 2023. In its first year, the MAP raised enough money to set the price of a medication abortion at $250 in all fifty states—and to offer a sliding scale if people couldn’t afford that much. (This work is subsidized by free labor as well as philanthropy; Foster, a medical professor, does not draw a paycheck from the MAP for her administrative work, for example, although the clinicians who work for the service are paid.) The organization reached almost five thousand patients that year, about a third of whom paid five dollars or less. But after hearing feedback from those patients, Foster realized just how many had struggled to come up with $250. The MAP has since changed the way it asks for money, requesting five dollars and suggesting that people pay more if they can afford to. (The service will send the pills for free to anyone who emails them.) The number of patients quintupled, although the proportion paying five dollars or less stayed the same.

As a result of the shield laws, Foster began to notice changes not just in how many people were accessing abortions but in who was doing so. Among patients in the Southeastern US, she saw a particular increase in people who already had five or more children. Many seemed to come from conservative, evangelical communities in rural areas. Prior to Dobbs, Foster suspected, these women had been unable to drive to one of a dwindling number of clinics. “How difficult was it for a white woman in rural Oklahoma to get to an urban area?” she asked, by way of example. If the woman was coming from a conservative evangelical community, “how do you get there without telling anybody about it, especially when you’ve got multiple visits and waiting periods?” Researchers also found that shield laws have expanded access for young people. According to a recent paper, the rise in demand for telehealth abortions after Dobbs was highest among young adults and adolescents, who seem to be using online providers to get around not only abortion bans but also longstanding laws—on the books in most states, including blue ones—that require parental involvement in a minor’s decision to end a pregnancy.

All of these developments mean that, a quarter of a century after mifepristone was approved in the US, the drug has at last fulfilled its proponents’ hopes. Joffe, the sociologist who cautioned that the pill’s much-anticipated revolution would be slow, told me that not even the most optimistic predictions foresaw how telehealth would transform access. “Not only has the revolution arrived,” she said, “it’s exceeded expectations.”

*

Even as shield laws have given people new choices, however, they have also created new forms of anxiety and uncertainty. The providers are so inexpensive and so easy to access that many people assume they are scams. The first “frequently asked question” on the MAP’s website is: “Is this a legitimate service?” The r/abortion forum on Reddit is filled with feverish posts from people seeking reassurance that once they enter their payment information, the pills will indeed arrive. Deepening this sense of illegitimacy is the hesitation among some mainstream abortion providers to refer directly to these services due to fear of legal repercussions.

There are medical factors to take into account too: while medication abortion has an impressive safety record, in about five percent of cases it doesn’t work. Retained tissue can cause an infection or hemorrhage, side effects that are easily treatable but can quickly turn life-threatening if hospitals fail to act quickly because of anti-abortion laws. That’s what happened in the tragic case of Amber Nicole Thurman. As ProPublica reported, Thurman sought follow-up care after a medication abortion in Georgia—but doctors who feared prosecution under the state’s abortion ban waited until it was too late. Her heart stopped during surgery. People who use telehealth services to have abortions in red states are often afraid to seek follow-up care, and those fears may be valid; in about half of the cases where people have been criminalized for allegedly self-managing abortions, it was health care workers who called the police. In another case in Georgia reported by ProPublica, a woman named Candi Miller was afraid to seek care for retained tissue after a medication abortion. Her husband found her dead in her bed with her three-year-old daughter beside her.

The fear that people experience in states with abortion bans is by design. Unable to stop the flow of pills, abortion opponents and their allies in Republican state legislatures have attempted to isolate the people who take them. Among the most extreme measures is a new law in Texas, HB 7, which allows any private citizen to sue anyone who manufactures, distributes, or mails abortion pills in or to Texas for at least $100,000. Lawsuits that invoke HB 7 can effectively out women for having abortions; this is what happened when the anti-abortion strategist and attorney Jonathan Mitchell represented a man with a history of violent domestic abuse allegations who sued the doctor who provided his girlfriend with abortion pills.

These kinds of risks were front-of-mind for Julia, a woman in Southern Texas who realized she was pregnant earlier this year. “Though some websites are said to be safe to order even to red states,” she told me, “I didn’t want to take that risk and be caught somehow.” She was worried about using a service that could turn out to be a scam, and about taking the pills without having an exam to determine how far along she was; she liked the idea of being evaluated and having the procedure explained to her in person, even if most clinics still give patients like her pills to take at home. She ultimately decided to drive to Mexico and pay $350 to get mifepristone and misoprostol dispensed to her in a clinic. In her case the old rules of abortion access still applied: money and the ability to travel brought her choices and peace of mind.

These were things Brianna did not have. Before taking the pills, she began to worry about the gastrointestinal side effects sometimes experienced by people who take the medication orally, which she’d read about online. She texted the medical support line listed in the pamphlet that came with her pills. “I am trying to decide whether taking misoprostol vaginally or orally will be best for me,” she wrote.

The problem is I’m in a ban state. I am a single mom and need to take care of my kids which is why I’d like to avoid the vomiting and nausea. I want to take the pills vaginally but am worried…in case I need hospital care. If that were to happen and they did see white residue would they really ask me if it were abortion pills? Would they then refuse treatment?

In response, however, she received only an automated message telling her that the organization’s medical support line was permanently closed. Unbeknownst to Brianna, the founder of Aid Access, Rebecca Gomperts, had recently shut down that part of the service amid staffing changes related to the tightening legal climate. Doctors at Aid Access have faced legal action from attorney generals and private citizens; Gomperts herself was named in two such lawsuits in Texas. Now some of the doctors who were publicly named in litigation and the press, who were among the most prominent people affiliated with Aid Access, no longer work there. (To protect providers, six states—California, Maine, Massachusetts, New York, Washington, and Vermont—have passed laws allowing them to keep their names off the prescription bottles they send to patients.)

Gomperts told me that the staffing changes “had to do with higher protections and security.” The number Brianna called was out of date and should not have been included in her mailing, Gomperts said; Aid Access now refers callers with medical questions to the independently run Miscarriage and Abortion Hotline. Gomperts added that patients can still get a timely response by emailing Aid Access.

After Brianna had passed the pregnancy, she tried the Aid Access medical line again, this time calling instead of texting. She hadn’t experienced some of the more intense side effects that she’d seen described online, and she was seeking reassurance that the medication had worked. She got an automated voicemail telling her to leave a message; no one ever called her back. “I’m always like, what a beautiful program,” Brianna said of Aid Access. “I just rave about it. But then it’s like, okay, but y’all have to answer the phone.”

Brianna was left wishing she could have gone to a clinic, as she had done when she needed two abortions years earlier. She craved certainty that she hadn’t retained tissue—and that she wasn’t unknowingly advancing in her pregnancy. She wanted to seek follow-up care, but she was afraid to be honest about her reasons for doing so. Brianna ultimately sent Aid Access an email expressing her frustration at not being able to get ahold of someone. “I thought y’all were in the business of helping women,” she wrote. Via email, Aid Access referred her to the Miscarriage and Abortion Hotline, which instructed her to take a pregnancy test. It was negative. “I would have preferred a clinic, because I know it’s done, it’s quick, I don’t have to think about it after,” she said. “But obviously, I didn’t have that choice.”

That choice is vanishing for more people as clinics close at an alarming rate—forced to shutter by financial strain as well as abortion bans. At least twenty-three independent clinics closed last year alone; one hundred have closed since the Dobbs decision, according to the Abortion Care Network, the national association for independent clinics. Planned Parenthood closed about fifty centers last year. The low cost of telehealth abortions risks further undermining the clinics’ bottom lines. (Many advocates privately believe this is one of the reasons that many mainstream reproductive healthcare groups were hesitant to embrace the idea of shield laws.)

As people seek abortions by means both new and familiar, the factors of race, class, and geography—especially the happenstance of finding oneself in a red state or a blue one—continue to determine the paths their lives take. Before Dobbs, the legal scholar Michele Goodwin told me, Black women were far more likely than white women to have law enforcement or child protective services called on them by their medical providers, and there’s no reason to assume that things have changed. “It’s not as if Dobbs opened up a more empathetic society in these various states and communities,” Goodwin said.

The shifts that have occurred are sources of both help and harm, as Joffe, who investigated the present landscape for her book with David S. Cohen, After Dobbs (2025), told me. “To me, the story of Dobbs is these conflicting narratives,” she said. “Improved abortion access for some, and a horrible situation for others.”

*

It’s unclear whether the Trump administration and the Supreme Court will allow shield law providers to continue operating indefinitely. Thus far, however, the administration has frustrated abortion opponents by declining to take action that could stop the flow of pills. Project 2025, the Heritage Foundation’s notorious blueprint for Trump’s second term, outlined how the Justice Department could forbid the mailing of abortion pills using the Comstock Act, an anti-obscenity law from 1873; the fact that the administration hasn’t done so may reflect their understanding that, particularly post-Dobbs, restricting abortion has proven to be a major electoral liability for Republicans.

Advocates also fear that Trump’s FDA may reimpose the requirement that mifepristone be dispensed in person. Republican attorney generals have filed three lawsuits asking the agency to do so. A federal judge in Louisiana heard arguments in one of those cases in February, a legal showdown that the abortion rights attorney Julie F. Kaye described to me as “King Kong versus Godzilla” because it involved two entities that want to restrict medication abortion by different means. Louisiana asked the judge to immediately reinstate the in-person requirement for mifepristone, while the Trump administration asked him to wait until the FDA conducts a new safety review. Bloomberg News reported in December that the administration is slow-walking the review until after the 2026 midterms. Frustrated with this delay, Missouri Senator Josh Hawley has introduced legislation to revoke federal approval of mifepristone. 

Republican-led states, meanwhile, have moved far more quickly in both their efforts to legislate against abortion pills and their attempts to target providers who mail them. Texas Attorney General Ken Paxton has been particularly prolific, suing doctors in New York, California, and Delaware. So far the shield laws have fended off these efforts. But the cases illustrate that, when the Supreme Court purported to send the issue of abortion back to the states with its Dobbs decision, it inaugurated an era in which “interstate conflict is a defining feature of the legal landscape,” as Rachel Rebouché, a law professor and one of the architects of the shield laws, acknowledged in a piece for The Nation last year. Legal experts believe it’s only a matter of time before these questions about how far a state can go to enforce its laws—or interfere with those of another—come before a Court that has proven hostile to abortion access.

While a Supreme Court decision or a rule change by the Trump administration could disrupt the work of shield law providers like the MAP and Aid Access, it would not reverse the increase in medication abortions altogether. Community activists across the US would continue handing out pills, which can be obtained cheaply from manufacturers in India. International websites would still ship medications to the US, and Aid Access—which used to ship pills from abroad before it began operating domestically—could return to its former approach. Even domestic services like the MAP could keep offering medication abortion with misoprostol alone (though this method can take longer, cause more discomfort, and be less effective than the two-drug regimen).

Whatever shifts do occur will be captured in real time by Plan C Pills, the best-known clearinghouse for abortion pill information. “We know that these community networks, these telehealth providers, will continue to serve people even as things change,” Amy Merrill, a cofounder of the organization, told me. Abortion restrictions are harmful, Merrill noted, but they are also, ultimately, ineffective. “We expect that abortion will be unstoppable,” she said.  

A future in which abortion is largely divorced from formal medical settings would constitute a kind of return to the past. People have always self-managed abortion: as Renee Bracey Sherman and Regina Mahone have written, enslaved women would end their pregnancies using plants, a quiet rebellion against a system that separated their families and commodified their children.⁶ Until the Comstock Act cracked down on access in the 1870s, pills and potions for ending pregnancies were routinely advertised in newspapers.

Today, in the Rio Grande Valley, residents often cross the border for more affordable medical care, including to buy misoprostol, which is readily available in Mexican pharmacies. Amelia Bonow, an abortion rights activist and cofounder of the Shout Your Abortion campaign, envisions a world in which abortion pills are as ubiquitous as the opioid overdose medication Narcan; anyone could carry them in their purse to help out a friend in an emergency. Many telehealth providers will already offer the pills to whoever asks for them—which could make this vision a reality.

“Self-managed abortion isn’t for everyone,” Nancy Cárdenas Peña, the director of the campaign Abortion on Our Own Terms, told me. But Cárdenas Peña herself decided to have an abortion at home using misoprostol several years ago. As an advocate, she had all the resources she needed to make an informed choice, and abortion was still legal in her home state, Texas. But state-mandated waiting periods would have delayed her access to a clinic, where she also would have had to contend with the protesters pacing the sidewalks outside. “My priority was getting unpregnant as fast as possible,” she told me. What’s more, “I wanted to lean into the things that were most important for me, which were privacy and autonomy. I wanted to be able to end my pregnancy with my own hands.”

All the advocates I spoke to agreed that every person who needs an abortion should be able to get one, and on the terms they choose. More people than anyone expected have been able to access an abortion in post-Dobbs America, yet they have often been forced to do so in ways they would not have chosen, in circumstances marked by fear and uncertainty. The task, then, for abortion rights advocates is to try to restore the legal protections of the past while preserving the expansive access of the present—and to keep reaching toward a future in which abortion is even more available than it was before Dobbs. To Cárdenas Peña, the importance of medication abortion in the current landscape illustrates the need for contingency plans. No matter what happens, she said, “we cannot put ourselves back in a position of having to rely on just one method of care.”