By Ashley Kurzweil and Katherine Gallagher Robbins

Four years since the Supreme Court eliminated the federal constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, anti-abortion politicians have ramped up their attacks. Extremists in state legislatures, state attorneys general offices, federal courts, Congress, and the White House are targeting abortion access on every front to make it more difficult for pregnant people to get the reproductive care they need: banning abortion outright, defunding and shuttering reproductive health clinics, blocking telehealth abortion, and restricting medication abortion pills.

New analysis by the National Partnership for Women & Families shows that four years after Dobbs, more than 47 million women of reproductive age live in states with clinic closures in the wake of the One Big Beautiful Bill Act (OBBBA) or states that have attacked access to medication abortion. That means a staggering 62 percent of all women of reproductive age in the U.S. live in these 25 states, forced to navigate a fragmented reproductive health landscape. Furthermore, more than 23 million women of color of reproductive age – nearly two out of three – live in these states.

Anti-abortion politicians are forcing in-person clinics to close and restricting the provision of medication abortion via telehealth and mail to squeeze abortion access from both ends. Their agenda is designed to dismantle the infrastructure of abortion provision and upend major avenues of care for communities across the country. Rolling back abortion access restricts people’s reproductive freedom, undermines their economic security, and harms their health and lives.

Extremists Dismantle Nationwide Abortion Access

Restricted access to abortion care harms pregnant people’s health outcomes – endangering their physical and mental health, forcing them to endure life-threatening complications, and putting them at greater risk for maternal mortality. More than 30 million women live in the 20 states that ban abortion. But four years post-Dobbs, anti-abortion extremists have shifted their strategy beyond state-level bans to target access in states where abortion remains legal and protected.

Federal lawmakers have defunded reproductive health clinics to force closures. Last year, President Trump signed the OBBBA into law, which stripped funding from Planned Parenthood by prohibiting Medicaid reimbursements and consequently shuttered clinics across the country. Federal law already bans the use of federal funds to provide abortion care, with extremely limited exceptions, but Medicaid funding has historically been essential for keeping these clinics open and accessible. Prior to OBBBA, nearly half of all visits to Planned Parenthood health centers were from patients who relied on Medicaid.

In light of state abortion bans and clinic closures post-Dobbs, as well as a broader rise in telemedicine use since COVID-19, abortion seekers across the country increasingly rely on telehealth, mail, and pharmacy provision of medication abortion. Medication abortion is used in nearly two-thirds of abortion care in the U.S., and more than one in four abortions is provided via telehealth. The two-drug combination of mifepristone and misoprostol is the most common medication abortion regimen offered by U.S. providers. For abortion seekers in states with bans, telehealth abortion provided by out-of-state clinicians protected under shield laws has helped expand access to care. More than half of telehealth abortions are provided under shield laws. Because medication abortion pills and telehealth abortion allow patients to get the care they need without having to travel hundreds of miles, anti-abortion politicians have ramped up legislative and legal attacks against them.

Clinic Closures

Less than a year since Trump signed the OBBBA into law, more than 20 Planned Parenthood health centers have been forced to close across the country, stripping patients of essential care and putting their health at risk. The majority of clinic closures have been located in rural or medically underserved areas and disproportionately served patients with low incomes. Altogether in 2025, 51 Planned Parenthood health centers were forced to close following the OBBBA and the Trump administration’s months-long freeze of Title X family planning program funds. While the defund provision expires after one year, closures are expected to continue as clinics grapple with ongoing financial strain. And alarmingly, anti-abortion members of Congress want to make the law defunding Planned Parenthood permanent.

Clinic closures impact reproductive health patients from all communities, forcing people to travel greater distances for care and compounding obstacles like having to take often unpaid time off work to travel to a provider, transportation and child care costs, and more. These logistical and financial barriers can make seeking care more challenging or even prohibitive for women who are economically insecure, who are likely to lack access to the necessary funds to travel; rural people, who live in communities with limited local reproductive health care options; and young people, who often face financial constraints and lack access to transportation. Alarmingly, when people cannot access the abortion care they need, they face significantly higher risks of severe health complications and increased economic insecurity.

Community Impacts: Half of U.S. Women Live in States With Clinic Closures

National Partnership analysis shows that clinic closures post-OBBBA especially impact women of color, Latina women, immigrant women, multiracial women, and AANHPI women.

• Women of color have more limited financial resources and transportation options than white women, making it more difficult for them to travel greater distances for abortion care. Women of color are more likely to experience economic insecurity due to wage gaps, racial inequality, and gender discrimination, among other factors.
• The need to travel for abortion care because of clinic closures can put the health, safety, and freedom of Latina women and immigrant women at risk. While these are distinct populations, one-third of Latina women in the U.S. are immigrants and the Trump administration’s mass deportation campaign and policing of immigrant communities have targeted Latino communities. This has made traveling particularly precarious or even impossible for many immigrant women and Latina women, especially those at risk of deportation, detention, and family separation. The climate of fear and surveillance can impose significant barriers to travel and lead patients to forgo care, regardless of their immigration status. For Latina women, discrimination in health care systems, lower rates of insurance coverage, and a lack of access to culturally and linguistically competent care layer onto these fears. Additionally, clinic closures may particularly impact immigrant women who are forcibly displaced or otherwise marginalized and have fewer resources to support their ability to access abortion care.
• Abortion is already challenging to access for many AANHPI women for myriad reasons, including limited access to culturally and linguistically appropriate care and lack of insurance coverage, especially among certain AANHPI communities. Access is particularly difficult for AANHPI women who are immigrants due to economic insecurity and precarious immigration status.
• Living at the intersection of multiple racial and ethnic identities creates unique obstacles to abortion access for multiracial women – ranging from language barriers to racial discrimination to economic insecurity. Clinic closures only exacerbate these structural issues.

Attacks on Access to Medication Abortion

State attacks on access to medication abortion include bans on telehealth abortion, bans on mailing or distributing medication abortion, laws that classify medication abortion pills as controlled substances, and lawsuits targeting mifepristone and telehealth abortion. Six states have explicit bans on telehealth abortion, and a dozen more enforce restrictions, including numerous in-person visitation requirements, that effectively prohibit the use of telehealth for abortion care. The vast majority of states that have prohibitions on telehealth abortion also enforce abortion bans, including 6-, 12-, and 18-week bans. That means people in states with gestational bans and telehealth prohibitions who seek in-state abortion care face countless obstacles. Patients must travel during narrow timeframes to a clinic – sometimes hundreds of miles because closer options have already closed – for an initial exam, to receive the pills, or to take the medication, regardless of a provider’s medical recommendation. Moreover, several states prohibit the mailing or distribution of abortion pills to target telehealth abortion under shield laws, online platforms, community health networks, and international clinics. The use of online platforms outside the formal health care system to obtain medication abortion and self-manage care has become increasingly prevalent for people in states with abortion bans.

Not stopping there, anti-abortion state officials are endeavoring to cut their residents off from out-of-state care by attempting to impose their state prohibitions on telehealth abortion and mailing abortion pills onto shield law providers. For example, Texas and Louisiana have taken legal action against out-of-state clinicians for allegedly violating prohibitions on telehealth abortion and mail distribution. What’s more, six anti-abortion state attorneys general have brought three federal lawsuits seeking to restrict access to mifepristone – challenging the Food and Drug Administration’s initial approval and subsequent decision in 2023 to remove medically unnecessary in-person dispensing requirements. Their strategy is intended to upend abortion access for their state residents and reproductive health patients nationwide. Federal courts could limit telehealth abortion and prevent pregnant people from being able to fill mifepristone prescriptions at a pharmacy or through the mail.

Community Impacts: More than One-Third of U.S. Women Live in States with Attacks on Medication Abortion Access

Telehealth, mail, and pharmacy provision of medication abortion are crucial for many communities facing the complex and ever-shifting landscape of abortion care post-Dobbs. National Partnership analysis shows that rural women, Black women, women who are economically insecure, and veteran women are especially likely to live in states that have attacked access to medication abortion.

• Telehealth, mail, and pharmacy provision have been a lifeline for people in rural areas, people with low incomes, and Black people – for whom the nearest provider could be hours away and costly to travel to. Attacks on such avenues for care harm these groups because they can be more likely to live in areas with reproductive health care provider shortages and experience economic insecurity, complicating travel for abortion care.
• Attacks on telehealth, mail, and pharmacy provision hit veteran women hard in light of the ban on abortion at Department of Veterans Affairs (VA) health care facilities. Given the prevalence of military sexual assault, these provision options are also critical to maintaining safety and privacy for veterans who are survivors.

Conclusion

In the four years since the overturning of Roe v. Wade, the anti-abortion movement has chipped away at access to abortion to strip people of reproductive health care options and control their decisions. Anti-abortion extremists are trying to ban abortion nationwide, and policies that shutter clinics and limit telehealth abortion function as backdoor abortion bans. The impacts are felt by millions across different communities, even in states where abortion is legal and protected. Ultimately, everyone deserves the freedom to make reproductive health decisions that are best for them and their families as well as access to abortion care in their communities, no matter who they are, where they live, or how much money they make.

Methodological Note

In our analysis, a state in which abortion is banned meets at least one of the following criteria: (1) it has a “trigger” ban or total abortion ban in effect, or (2) it has gestational limits in effect banning abortion between six and twenty weeks. As of the publication date of this analysis, these states are Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Nebraska, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, and West Virginia. See After Roe Fell: Abortion Laws by State. Additionally, in our analysis, states in which clinics have closed since the One Big Beautiful Bill Act are California, Colorado, Florida, Indiana, Iowa, Louisiana, Michigan, Missouri, New York, Ohio, Tennessee, and Texas. See The “Defund” Disaster: How The Republican Attack on Planned Parenthood Is Hurting Patients and Raising Americans’ Health Care Costs. Finally, in our analysis, states that have attacked access to medication abortion include states that have enacted prohibitions on telehealth abortion, bans on mailing or distributing medication abortion, or laws that classify medication abortion pills as controlled substances, or states that have brought lawsuits targeting mifepristone and telehealth abortion. As of the publication date of this analysis, these states are Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin. State of Telehealth Medication Abortion, Mifepristone Related Litigation, and independent National Partnership for Women & Families legislative and legal research informed this analysis.

This impact analysis uses the 2020-2024 American Community Survey accessed via IPUMS USA, University of Minnesota. While people of many ages can become pregnant, in this analysis we use ages 15-49 through this analysis to align with the Guttmacher Institute, the World Health Organization, and others. Women who are “Gen Z” in this analysis are ages 15 through 29. How race and ethnicity data are gathered and reported is foundational to understanding health and health care disparities. These categories have a problematic history, having been imposed on communities by government entities, often in direct conflict with how those communities identified themselves. Such categories have also evolved over time, both in how communities self-identify and in how governments standardize data collection. Racial categories in this analysis include women who identify as Latina and/or Hispanic and Latina women may be of any race. Immigrant women are foreign-born women who are not the children of U.S. parents. People born in U.S. territories and possessions are born in the U.S. People are identified as having a disability in this analysis if they responded that they have difficulty in one or more of the following six realms: vision, hearing, cognitive, ambulatory, self-care, and independent living. People may have multiple disabilities. This is a limited definition of disability that excludes a portion of disabled people. For more information on how disability is measured in the American Community Survey please see the U.S. Census Bureau’s report How Disability Data are Collected from The American Community Survey. While people across the income spectrum may have difficulty making ends meet, in this analysis we define “economically insecure” as living in a family below 200 percent of the federal poverty line. Women are defined as living in “rural” areas if they live outside of metropolitan areas. This analysis defines “mother” as having at least one own child (including step, adopted, or biological) under the age of 18 in the household. Due to data limitations, there are mothers who are not included in this definition, including those who have non-resident or older children or those whose children have passed away. Not all women of reproductive age have the potential to become pregnant – many of them may not be able to for medical reasons or they may not participate in sexual activities that could result in pregnancy.

Due to data limitations, this analysis does not include people who do not identify as women but may become pregnant, including transgender men and nonbinary people. The 2.8 million transgender people 13 and older and 1.2 million LGBTQ nonbinary people age 18-60 in the U.S. are deeply impacted by Dobbs. Many transgender and nonbinary people can become pregnant and are directly impacted by Dobbs. The harms are more severe for transgender and nonbinary people of color, those who are disabled, and others who are members of multiply marginalized communities. The transgender and nonbinary communities are not mutually exclusive.

The authors are grateful to Lorena Bonet Velazquez, Mettabel Law, Rosann Mariappuram, and Nima Sheth for their review and thoughtful contributions.

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