Three years after Dobbs, the antiabortion movement is escalating efforts to block access to medication abortion, criminalize interstate travel, and impose a nationwide ban—threatening reproductive freedom across all 50 states.

It has been three years since Roe v. Wade was overturned, unleashing legal chaos and confusion for patients and providers across the United States. But even though abortion is banned in many U.S. states, the antiabortion movement is only intensifying its campaign to restrict abortion access nationwide. Overturning Roe is just the beginning; since then, the movement has pursued a range of strategies to make abortion completely inaccessible no matter where you live. 

Abortion access in the U.S. is a patchwork. Thirteen states are currently enforcing total abortion bans, and others ban abortion as early as six weeks. Yet, despite these restrictions, the number of U.S. abortions increased in both 2023 and 2024. Two primary factors that have helped mitigate some of the impacts of abortion restrictions are the greater availability of medication abortion and more people traveling out of state for care. These two options are imperfect, as everyone deserves access to their preferred method of abortion care in their own community. But they have been lifelines for patients—and are now the antiabortion movement’s next targets. 

Data from the Guttmacher Institute reveals major shifts since Roe fell. From 2020 to 2023, the share of abortions that were medication abortions rose from 53 percent to 63 percent. And we know these numbers are almost certainly an undercount because of provision under shield laws and people who self-manage their abortions. Meanwhile, the number of people who traveled out of state for abortion care has doubled since 2020. These trends reflect the determination of people to access care against all odds—and the dynamic network of clinicians, abortion funds, practical support volunteers and online resources that helped make it possible. 

But the antiabortion movement has a multi-pronged strategy to undercut these shifts. Just this year, 25 states have introduced at least 68 bills to restrict medication abortion. A Wyoming law that is currently blocked in court would require patients to obtain an ultrasound 48 hours before a medication abortion, forcing patients to make several trips to a clinic when clinical evidence shows that telehealth is a safe option for this care. Other lawmakers have floated baseless claims that medication abortion and even hormonal birth control contaminate the water supply as another avenue of attack.  

These state-level moves, reliant on junk science and debunked claims, are buttressed by a national strategy to use the courts and the Trump administration to restrict or revoke the FDA’s approval of mifepristone, one of the two drugs used in medication abortion—a move which would impact everyone regardless of what state they live in. 

There is also a growing push to restrict travel for abortion care, a flagrant violation of the constitutional right to interstate travel. Minors are the current focus of such restrictions, but we know from experience that the antiabortion movement will not stop there. So far this year, five states have introduced eight bills to criminalize people or organizations who help a minor leave their state to access legal abortion elsewhere. Two states, Idaho and Tennessee, have already enacted these laws, though some components are tied up in the courts. Other state legislators and local officials are on record threatening to bar adults from leaving their state for health care; this year in Montana legislators introduced (but failed to pass) a bill that would have criminalized travel in or out of state for an abortion that is illegal under Montana law.  

What would it take to enforce a ban on abortion-related travel? The infrastructure already exists, including routine state and local traffic enforcement as well as immigration checkpoints. Imagine, for example, a Texas abortion seeker trying to get care in New Mexico who is pulled over by police or stopped at a checkpoint and questioned about the purpose of their trip and their pregnancy status. Such a scenario may sound dystopian, but it’s a distinct possibility. In 2023, more than 14,000 people made that very journey, despite steep financial and logistical barriers. We already know immigration checkpoints delay or prevent people from accessing care and that abortion bans risk the health and well-being of immigrants. Adding another layer of surveillance would disproportionately harm immigrants, people of color, and anyone already navigating a hostile system. 

Despite these bans and restrictions, abortion care will persist, as it has throughout recorded history. But it is important to recognize that the increase in out-of-state travel and the rise of medication abortion are responses that depend on state policy innovations, an empowered network of abortion funds and support organizations, and of course, the tenacity of abortion patients and providers. Such efforts to mitigate the harms of the Dobbs decision face an increasingly aggressive “abortion abolitionist” movement that seeks to investigate and criminalize pregnancy outcomes including abortion, stillbirth and miscarriage, as well as those who provide or assist with care.  

Once we recognize the escalation of antiabortion strategies and goals, our next steps are clear. We must expand state protections wherever possible and support the people and infrastructure that have helped protect abortion care in the post-Dobbs landscape. Together, we can plant the seeds for our long-term vision—going beyond what Roe promised and finally guarantee abortion access for all.