Four years ago, the Supreme Court overturned Roe v. Wade and handed anti-abortion America its biggest victory in half a century. Here is what happened next: abortions went up. Every single year since Dobbs, the national abortion number has increased, and the justices who torched the constitutional right to the procedure are apparently not thrilled about it.
The Plan Didn't Exactly Work
When the court handed down Dobbs v. Jackson Women's Health Organization on June 24, 2022, more than a dozen states had trigger laws ready to go. Abortion bans snapped into place within hours. The logic was pretty straightforward: ban the procedure, fewer people get the procedure.
That logic was wrong. As NPR reports, the national abortion count has risen each year since Dobbs. Not stayed flat. Not dipped slightly. Gone up. Whatever the architects of the post-Roe world thought they were building, this was not it.
The reason is a combination of factors that the ban-everything crowd genuinely did not anticipate. States that support abortion access rolled back waiting periods, eliminated parental consent requirements, and made it dramatically easier for out-of-state patients to travel for care. The barriers that had always suppressed abortion numbers in blue states came down, and the totals climbed.
The Mail Is Doing What the Court Could Not Undo
Here is the part that has Justice Samuel Alito in an absolute spiral. Shield laws. States that support abortion rights have passed legislation protecting clinicians who prescribe medication abortion via telemedicine to patients living inside states with full bans. A patient in Texas can get on a video call with a provider in a shield-law state, get a prescription, and receive pills by mail or pick them up at a local pharmacy. No travel required.
According to NPR, this has produced the genuinely stunning outcome that abortion numbers in ban states have actually increased in recent years as telemedicine access expanded. The bans are in place. The numbers are going up anyway.
Alito addressed this directly in a recent dissent, writing that what is at stake is "the perpetration of a scheme to undermine our decision in Dobbs." A scheme. He used the word scheme. The man wrote an opinion reversing fifty years of constitutional precedent and is now upset that people found a workaround. The audacity of sick people to keep seeking medical care.
The Anti-Abortion Coalition Is Fracturing Under Its Own Weight
The political situation for abortion opponents has gotten genuinely messy, and NPR's reporting lays it out clearly. Trump is stuck. His three Supreme Court appointees gave the movement its biggest legislative win in generations, but he has gone conspicuously quiet on abortion heading into the midterms because the independent voters who put him back in the White House in 2024 broadly support abortion rights. He can't celebrate too loudly without reminding those voters exactly what they helped cause.
Meanwhile, the activist wing of the anti-abortion movement is not interested in quiet. They want the Comstock Act, the 19th century obscenity law that bans mailing materials related to abortion, dusted off and weaponized to create a de facto national ban without needing Congress to actually pass anything. Last month, Justice Clarence Thomas used a dissent in the abortion pill case to declare that drug companies manufacturing and distributing FDA-approved abortion medications were engaged in a "criminal enterprise" under Comstock. Criminal enterprise. Federally approved medications prescribed by licensed doctors.
States are moving too. Texas passed a law allowing private citizens to sue out-of-state abortion pill prescribers for $100,000 a pop. Louisiana classified mifepristone and misoprostol as controlled substances. Louisiana is also suing the FDA to roll back the telemedicine rules that have kept abortion access alive in ban states, and per NPR, that case is likely headed for the Supreme Court. If Louisiana wins, mifepristone disappears from telemedicine nationally.
Abortion Rights Advocates Are Not Waiting Around
The other side has been busy too. Researchers at the University of California San Francisco published a study examining whether abortion medication could be made available over-the-counter in the United States, no prescription needed. A Planned Parenthood affiliate started offering abortion medication to patients who are not currently pregnant, to keep at home in case they need it later. Providers have contingency plans to keep mailing misoprostol alone even if mifepristone gets locked down.
The phrase abortion rights advocates are using, according to NPR, is that abortion pills are "unstoppable." That is not spin. That is an accurate description of what the last four years have demonstrated. You can ban the procedure in half the country and the numbers still go up. The pills move through the mail. The telemedicine calls happen across state lines. The shield laws hold.
Brick-and-mortar abortion clinics have seen some closures since Dobbs, partly from the restrictive state laws and partly from other pressures. But the overall infrastructure of abortion access in America has adapted faster than the people trying to dismantle it anticipated.
The Ballot Box Has Not Been Kind to the Bans Either
Voters have not been cooperative with the anti-abortion project either. This year, states across the country are considering ballot measures to protect or restrict abortion access, and the track record since Dobbs is not a winning one for the restriction side. State after state, including deeply red ones, has seen abortion-related measures go against the ban-everything position when voters get a direct say.
That is the context for Trump's silence. That is the context for the GOP's sudden coyness about one of the central promises that animated the conservative legal movement for five decades. They got what they wanted. The public responded. Now everyone is recalibrating.
The human cost of all this recalibrating remains brutally real. NPR notes that dramatic stories of medical care denied to pregnant patients continue to unfold across the country. That is the part that does not fit neatly into either the "abortions are up, therefore access is fine" story or the "bans are failing, therefore nothing to worry about" story. People are being turned away from emergency rooms. Miscarriages are being mismanaged because doctors are terrified of prosecution. The legal chaos has real bodies behind it.
The Dingo Take
Samuel Alito wrote in his Dobbs majority that Roe had "enflamed debate and deepened division," and that overturning it would fix all that. Four years later, he is writing dissents calling the adaptation of medical technology to serve patients a "scheme" and the political coalition that celebrated his opinion is quietly hoping voters forget it exists before November. If this is what a settled debate looks like, the other kind must be genuinely unpleasant.
The story of the last four years is really a story about what happens when a legal ruling tries to stop something that a large portion of the population is going to do regardless. The bans are real. The prosecutions are real. The denied care is real and people have been seriously hurt by it. And yet the number of abortions keeps climbing because mailing pills across state lines is not particularly complicated and a lot of doctors in blue states are willing to write prescriptions. You can build a legal wall around a medical procedure. You cannot build one around the internet.
None of this means everything is fine. Louisiana is one Supreme Court case away from gutting telemedicine abortion nationally. Clarence Thomas is out here calling FDA-approved medications a criminal enterprise and he gets to vote on things. The Comstock Act is sitting there like a loaded gun that the right has not quite decided to fire yet. The people celebrating rising abortion numbers as a clean victory are skipping past the part where pregnant patients are being turned away from emergency rooms in states where doctors are afraid to treat them. This fight is not over. It has barely started.
