As the U.S. marks the third anniversary of Dobbs v. Jackson Women’s Health Organization, the impact of overturning abortion rights guaranteed in Roe v. Wade is still unfolding across every corner of the country. Although the decision was made on June 24, 2022, its effects were felt much earlier and more deeply in some states than others. Abortion providers and advocates across the country are spreading the word: Abortion isn’t ending, it’s shifting underground, across state lines, and into the hands of the most resilient.

The view from Texas

In Texas, the collapse of reproductive rights came even before Dobbs. On Sept. 1, 2021, the state implemented Senate Bill 8, which banned abortions after detection of fetal cardiac activity that typically occurs around six weeks of pregnancy. The Texas abortion law was designed to be enforced by private citizens rather than state officials, a tactic that made it difficult to challenge in court. According to Supreme Court Justice Sonia Sotomayor and former President Joe Biden, the bill allowed lawmakers to sidestep constitutional scrutiny and undermine the rule of law.

“[SB 8] was our breaking point,” said Anna Rupani, the executive director of Fund Texas Choice (FTC), which provides travel support for abortion care. “We went from like 40 calls a month to like 300 calls a month … and at the time, we were two full staff members and a part-time contractor.”

Dobbs further muddled the situation. The Texas attorney general cited multiple competing abortion bans—including pre-Roe and trigger-law versions—forcing FTC to pause operations and win a court injunction to continue their lifesaving work.

FTC has seen a 400% increase in support requests since 2021, according to Rupani. Yet they can only serve about 40% of callers, as costs have surged sharply: The average per-client support has shot up from $558 in 2021 to $1,302 in 2024.

FTC’s support includes holistic case management, coordinating all parts of travel, navigating out-of-state clinic schedules, and providing emotional and practical post-care support. But it’s fighting on two fronts: the logistical complexity of travel and hostile political terrain at home.

The emotional toll on clients and staff is immense, Rupani said, with people worrying if calling is even safe in a state with murky legal enforcement, and staff face unending threats from new legislation that could criminalize their work, in addition to funding shortages.

“The abortion movement is going to struggle to keep up with the need,” Rupani said. “We’re spending more money than ever … and yet, for the first time, this last fiscal year, abortion funds have helped fewer people since Dobbs.”

FTC also focuses on often-overlooked populations: undocumented immigrants in border regions who can’t cross state lines safely and minors whose access fell by 90% post-SB 8, forcing countless young people to endure unwanted pregnancies.

“There’s always a fear that clients have because of the murky and controversial status of abortion access in Texas,” said Sarah Lopez, also with FTC.  “We’re not always able to completely [put] clients’ minds at ease, because it’s scary, and it’s hard to have to travel out of state for your abortion.”

From the perspective of staff members, Lopez said, “The constant barrage of bad actors and legislation that we have to deal with is rough, because it’s hard to plan out your own life when every other year there could be a law passed that really negatively affects the organization.”

Out-of-state patients in protective states

Dr. Liz Solger, a New York-based OB-GYN and reproductive health advocate with Physicians for Reproductive Health, has witnessed firsthand how the ruling has reshaped the landscape—not by eliminating abortion, but by complicating and delaying it for many.

“We’ve actually seen a slight increase in the number of abortions across the country,” Solger said in an interview. “But people are traveling farther, potentially across multiple states, having to spend more for travel, for child care, having to take time off of work.”

Though abortion remains legal in New York, it hasn’t been untouched by the ripple effects of Dobbs. Clinics like Solger’s are now treating an increasing number of patients from out of state, particularly those fleeing restrictions in the South and Midwest.

“It’s just been a large strain on all of the facets of care, whether it’s reproductive health care or the whole system,” Solger said

One of the most troubling trends, Solger noted, is the fear and misinformation that patients are bringing with them, often fueled by social media and unclear state laws.

“People are afraid to seek care for a miscarriage or for bleeding in pregnancy because they’re afraid that they might be criminalized or arrested or something like that,” Solger said.

The impact, she added, is uneven. Low-income patients, immigrants, and people of color often face compounding challenges.

The strain on resources is evident in Illinois, now considered a central national access point. The Chicago Abortion Fund (CAF), one of the largest independent abortion funds in the U.S., has experienced an unprecedented spike in demand since the Dobbs ruling.

“We are now the largest and really most relied upon independent abortion fund in the country,” said Qudsiyyah Shariyf, interim executive director at CAF. “[Since Dobbs] we fielded over 40,000 support requests from people that are seeking abortion care, and we’ve been able to support everyone who’s relying on Illinois for care.”

Shariyf said the top states from which abortion-seekers are traveling to Illinois are Indiana, Wisconsin, Texas, and Kentucky. 

“And then, of course, there’s also people in Illinois that are still needing support, whether it’s navigation support to find the best clinic for them, figuring out insurance coverage, or providing travel support, maybe for folks that need to travel within the state of Illinois,” Shariyf said. 

CAF scaled from a two-person operation in 2019 to a team of 26 full-time staffers and a robust volunteer base, Shariyf said. Case managers coordinate care before, during, and after patients travel, hustling logistics from flights and lodging to child care and weather gear—unseen but vital support.

Building sustained support

According to CAF’s 2024 Impact Report, they fielded support requests from over 15,000 callers and pushed out over $4.5 million for abortion care and related wraparound services. The average cost of support is over $1,000 per person, including the procedure costs, travel, and logistics support. 

Shariyf said sustained funding and coordinated policy investment across states are critical to maintain Illinois’s role as an access hub. She noted that CAF received a wave of “rage donations” immediately after Dobbs, but sustaining that support remains a challenge.

“We have a rapid response list as well for people based in Illinois that can show up immediately,” Shariyf said, for efforts such as submitting witness slips for legislation to shore up protections in the state. CAF now offers a monthly donor program, volunteer opportunities, and rapid response initiatives in Illinois, encouraging people to stay involved even if they live outside the state. 

Shariyf suggested people visit the CAF website to find other ways to support and fundraise.

“Everyone can do something—whether it’s donating, volunteering, or just being someone in your community who others can turn to for help,” she said.

Both Solger and Shariyf stressed that while states like New York and Illinois are doing their part, the burden shouldn’t fall on just a few access points.

“We can’t do it alone, we need more states and people across the country to really shore up the legal protections that they can and invest in abortion access infrastructure,” said Shariyf. “Illinois has really built a model that we’re hoping that other people will look at to think about ways that they can be innovative and combine public policy as an approach.”

For Solger, reproductive freedom means more than legality—it’s about dignity, trust, and autonomy.

“I think one important part of of reproductive freedom is just having universal access to safe and dignified reproductive health care that’s free of things like fear and stigma, just having it be part of a healthy society, and letting people choose what their personal reproductive goals are,” said Solger, rather than “siloing” reproductive health care on its own. “Once we’re able to acknowledge how we’re all interconnected and how it’s all working together, then we can hopefully move forward together to make that freedom available for everyone.”

Editorial Team:
Sahar Fatima, Lead Editor
Carolyn Copeland, Top Editor
Stephanie Harris, Copy Editor