In the first 100 days after the June 2022 Supreme Court Dobbs v. Jackson Women’s Health Organization decision, which overturned Roe v. Wade, sixty-six health clinics in fifteen states stopped providing surgical abortions, and fourteen states enacted near-total bans on the procedure.
But then something unexpected happened. By 2024, twenty-one new facilities had opened in states where abortion was not completely banned, according to the Guttmacher Institute. Moreover, KFF (formerly the Kaiser Family Foundation) reports that by 2023, 226 virtual providers—including online pharmacies, feminist health centers, and help lines—had set up shop to counsel people seeking abortion services and provide abortion medication through the mail.
As a result, the total number of legal abortions obtained in the United States increased from 613,000 in 2022 to more than one million in 2024—an increase credited to the availability of telehealth services and passage of robust shield laws in eight states that legally protect providers who send pills to people in states that have banned it. Currently, one in four abortions is done through telemedicine, according to Carrie N. Baker, chair of the Program for the Study of Women, Gender, and Sexuality at Smith College and author of Abortion Pills: US History and Politics.
“It’s mindblowing, but telehealth gives people convenient, fast, private, and affordable access to abortion,” Baker tells The Progressive. “There is a strong network of community and clinical providers who are sending tens of thousands of pills to people throughout the country. These providers are mission-based. Most have sliding scale fees for patients and fundraise to make sure abortion is accessible to everyone. Nationwide, about one-third of people requesting pills pay nothing for them.”
In addition, Baker says that many of the online groups that dispense pills are staffed by doctors, midwives, nurses, and other health professionals who can “talk people through what is happening to them and provide them with emotional support.” Furthermore, these professionals can help patients decide whether to pursue a medication-induced abortion and advise them on how to ensure the efficacy of the recommended two-pill regimen (mifepristone and misoprostol). Telehealth staff also typically offer post-abortion counseling.
“Providers are U.S. and internationally based,” Baker says, “and they are creative about getting pills into people’s hands. Folks doing this work are determined and courageous. They are working incredibly hard to get the word out that medication abortion exists and is safe and effective.”
In the face of attempts on the right to ban mifepristone, she points to providers’ commitment to maintaining patient access to misoprostol, which can be used effectively by itself to end a pregnancy. “There is more cramping and pain when it’s used alone, but telehealth providers will do what’s necessary to make sure misoprostol access is maintained,” Baker says.
Providers who work in established, brick-and-mortar clinics have expressed similar determination to assist patients in every way they can. Take, for example, the recently opened Care for All Abortion Clinic in Milwaukee, Wisconsin. Clinic co-founder and executive director Ali Kliegman says that they are extremely proud to have opened a clinic in an abortion-hostile state and sees the facility as a model for others.
Kliegman had been working in reproductive healthcare for more than fifteen years when they moved to Milwaukee in 2020 and began thinking about opening an independent abortion clinic. The process, they say, began in earnest in June 2024 when they found a business partner and began raising the money necessary to rent space in a multi-tenant medical building, purchase equipment, hire staff, consult legal experts about the constantly evolving legal landscape, and publicize Care for All’s services.
The clinic opened in June 2025, and currently offers medication abortion for pregnancies (up to eleven weeks and six days) and procedural, or surgical, abortion for pregnancies (up to twenty-one weeks and six days), as well as family planning and miscarriage management. Once the clinic becomes more established, Kliegman hopes to offer additional services, including gender-affirming care.
In an effort to help as many people as possible, Care for All has established a pay-what-you-can policy for patients. It also works with five abortion funds that help people pay for pills, procedural care, a hotel, childcare, and other necessities. In addition, the clinic doesn’t ask patients for citizenship or any immigration-related documentation.
“We trust people,” Kliegman tells The Progressive. “But we’re a very lean operation. In our first months, 60 percent of our patients paid nothing out of pocket; most, 96 percent, got some funding from one of the abortion funds we work with.”
Still, Kliegman says the clinic faces a variety of barriers to providing people with access to care because of state restrictions. And while she notes that abortion is legal in Wisconsin, patients nonetheless face a mandatory twenty-four-hour waiting period after counseling and a required ultrasound, before they are able to obtain a medication or procedural abortion. In addition, abortion pills have to be dispensed by a physician on-site and people under eighteen need the permission of a parent, guardian, or judge before they can end their pregnancy.
These are not the only barriers: Kliegman says that most Care for All patients also have to contend with protesters who obstruct the sidewalk and menace people entering the building. Nonetheless, they tell The Progressive that neither anti-abortion activists nor state restrictions will deter them.
“People need abortion care,” Kliegman says. “Right now, our donors are making Care for All sustainable. When clients arrive, they are not burdened by financial worries. They appreciate the healthcare they receive. Abortion is not a complicated medical procedure; the fact that we’re able to do this relatively easy thing is fulfilling.”
Provider Julie Burkhart agrees. Burkhart owns Wellspring Health Access in Casper, Wyoming (the only full-service abortion clinic in the state), and co-owns Hope Clinic, which has locations in Granite City and Chicago, Illinois. She tells The Progressive she has seen firsthand how state laws can help or hinder the delivery of reproductive care.
The Illinois state government, she says, has been supportive of clinicians, while the Wyoming state government has not. In early 2025, according to Burkhart, Wellspring had to pause abortion services for seven weeks while the legislature passed two bills: one requiring the clinic’s eight rotating physicians to have hospital admitting privileges in the only hospital in the area, and another requiring patients to have a sonogram and wait forty-eight hours before being prescribed abortion medication. Both measures have been enjoined into one case. Wellspring will argue against them in court sometime this spring.
Despite roadblocks, Burkhart says she knows abortion clinics provide essential health care, which is why she is working to raise the estimated $2.2 million to $2.7 million in funding needed to open a fourth clinic in Grand Junction, Colorado. She hopes to open the facility in late 2026 to meet the need. For those residing in Grand Junction, she says, the closest place to obtain a procedural abortion is more than 200 miles away. Similarly, the nearest in-person location to acquire abortion pills is nearly a ninety-mile trip each way. “The need is enormous,” Burkhart says, adding that there is also a need for gender-affirming care in the area. “We’ll provide it and will also offer people access to contraception and general gynecological care. Colorado does not ban abortion, but even with Constitutional protections, much of the state lacks access to reproductive healthcare.”
Despite this momentum, abortion clinics in states with abortion bans have had to face an ultimatum: change the services they offer or close their doors. Robin Marty, executive director of WAWC Healthcare (formerly the West Alabama Women’s Center) in Tuscaloosa, Alabama, tells The Progressive that after the state enforced its 2019 Alabama Human Life Protection Act in 2022, following Dobbs v. Jackson Women’s Health Organization, procedural and medication abortion became illegal unless the pregnancy posed an imminent danger to the life of the pregnant person. This forced the clinic to shift gears and stop providing abortions. WAWC now provides gender affirming care, prenatal and post-partum exams, facilitates births onsite and in people’s homes, and has expanded its mental health services.
Earlier this month, the clinic was awarded a grant of more than $1 million from Melissa French Gates’s Action for Women’s Healthcare.
“It is life-changing for this clinic and will allow us to move into a larger building in Tuscaloosa and bring in more providers,” Marty says. “We also plan to open another clinic in Birmingham to deliver healthcare to the LGBTQIA+ community. Both facilities will ensure that people have access to the services they need.”
Like Kliegman, Marty says that she is optimistic, even as she mourns the clinic’s inability to provide abortion care.
At the same time, she knows that reproductive justice requires adequate medical personnel for the full spectrum of services to be readily available in other parts of the country. According to the American College of Obstetricians and Gynecologists, 48 percent of today’s medical students are being trained in states where abortion is banned and have to travel out of state to learn how to perform them. Equally distressing, they say, is the fact that learning to deliver abortion care is not required for medical school accreditation.
This has spurred Merle Hoffman, founder of Choices Women’s Medical Center in New York City, to offer medical students and others pursuing careers in health care the opportunity to spend two to three weeks at the Choices facility, observing practitioners in action. “Without providers, there is no choice,” Hoffman tells The Progressive. “Students can come here several times a year, see abortions up to twenty-four weeks, and see how we treat menopause, perimenopause, dispense birth control, and counsel patients.”
She adds, “We’re giving students a chance to sit in and see what a full reproductive health service should encompass. We hope that this will be a revelation and will push these students to go back to their schools and demand better, more comprehensive training.”
Others are paying attention to the spiritual dimension of reproductive health care.
The need for compassionate care is front and center of the work done by the Religious Community for Reproductive Choice, says Reverend Katey Zeh, the group’s CEO. Zeh says that she wants everyone to understand their reproductive and sexual health options, but recognizes that abortion is about more than hard facts. Many people have questions about the morality of abortion, she tells The Progressive, and want to speak with someone who will listen to their concerns without judgment. Moreover, she says she’s seen an increasing number of pastors and seminary students who want to protect abortion access.
“In the three years since Dobbs,” Zeh says, “there has been a resurgence of a moral compulsion to get involved. People who had quietly supported reproductive justice saw Dobbs as a call to become engaged and visible. More people are expressing an interest in doing reproductive chaplaincy, and being present for people who may be experiencing pain and trauma.”
Everyone, Zeh adds, “needs a combination of the right information and caring support. We at the Religious Community for Reproductive Choice are focused on people’s spiritual well-being. We center the people who are most impacted by abortion. It is holy, sacred, and necessary work.”