Since the Supreme Court overturned federally-mandated nationwide abortion access in the 2022 Dobbs decision, states have been enacting ever-tightening restrictions on access to reproductive healthcare.
Thirteen states have banned abortions; across the rest of the country is a complicated patchwork of restrictions and access barriers that have reduced access to healthcare, and have created confusion about what even is legal or where.
“What these types of legislation and proposals do is continue to create a chilling effect, and also create fear in an environment that already has so much misinformation,” said Candace Gibson, Director of State Policy at the Guttmacher Institute, which advocates for evidence-based, human-rights based sexual and reproductive healthcare.
Finding funding for the procedure itself is also a challenge, which includes hidden costs like travel and childcare, as well as other barriers like provider referrals or late pregnancy recognition.
Access is likely to decrease in Trump’s second term; many of his appointees have strong anti-abortion backgrounds and have pledged to cut off funding from organizations that support abortion access, like Planned Parenthood.
Some have even expressed intent to bring back the Comstock Act, an 1873 law against the mailing of obscene matter, to attack access to doctor-prescribed abortion medication received through the United States Postal Service. Medical abortions can be performed at home around loved ones and are effective for terminating pregnancies up to ten to twelve weeks, according to experts. This type of abortion is safer and more effective, as well as more private, making it the preferred choice by many doctors. Although medical abortions constituted 63% of all abortions performed in the U.S. in 2023, access to them would be severely limited by the Comstock Act.
Because of that, Giwa says, “We might start to see a reversal in the trends we’ve been seeing since 2020, and procedural abortions might start to rise proportionally again. And that won’t be because that’s what patients want. That’ll be because that’s all patients can get.”
“Project 2025,” a conservative policy agenda created and pushed by Trump’s first-term allies and a right-wing think tank, outlines planned attacks on many elements of reproductive health, including denial of access to life-saving emergency abortion care.
With possible impending retirements of Supreme Court judges, Trump could also have further opportunities to appoint anti-choice judges, according to Alison Dreith, Director of Strategic Partnership at Midwest Access Coalition, an abortion fund that funds logistical elements surrounding abortion access, such as transportation, accommodation and childcare.
“Another piece of this puzzle is that when restrictions increase, patients end up getting later and later care,” said Latona Giwa, Executive Director of Midwest Access Project, an organization which helps clinicians access training and education for abortion care, miscarriage care, pregnancy emergency care and more. “So if they have to travel farther to get care, if the procedure is going to cost more, they’re delaying [the procedure] trying to save money. They also have to go through a longer chain of referrals. So patient need is going to shift towards later gestation care.”
And, according to Giwa, these delays in access will come up against a set of stricter laws on gestational limits, as well as fewer healthcare providers who have access to training opportunities in later gestation care. Dreith and Giwa both anticipate the pathwork of restrictions–including financial and legal barriers–becoming all the more complicated and difficult to navigate over the next four years.
“There’s going to be a whole new era of abortion restriction that we haven’t seen before,” Dreith said.
Giwa says organizations and individuals advocating for abortion care are also likely to face other attacks under Trump’s second term, such as hacking, doxxing, legal threats and targeted auditing.
“Things like that will take capacity, time and money from organizations like ours that are crucial to maintaining this abortion care ecosystem,” Giwa said.
Illinois and other safe haven states – those that are dedicated to protecting abortion access despite changes federally or in other states –will face the brunt of these burdens. These states are likely to see a huge influx of incoming travelers seeking abortion care. Access is already stretched incredibly thin, as Illinois has seen a nearly 50% increase in out-of-state residents seeking reproductive care since the Dobbs decision; Giwa says that statistic is rising.
Before Roe v. Wade was overturned, abortion access was already sparse in many areas, according to Dreith. In Missouri, there was only one clinic for the entire state.
Not only does that reduce access on the patient side – for individuals who need abortion care – but also on the clinician side, for providers seeking to learn how to provide abortion care. With fewer states able to offer clinical training opportunities, increasing abortion bans and restrictions, Giwa says that the educational burden also increases in safe harbor states like Illinois, further reducing patient access.
“We already have a situation where we’re only able to meet about 20 percent to 40 percent of training demand right now, and that is the result of a dramatic increase in demand,” Giwa said. “Even if a patient has the [legal] right, the funds and the childcare, if there are not trained providers anywhere near them, or if the strain on providers where they’re traveling to is so great, they’re still not going to have access to care.”
It’s also even more difficult for clinicians to access training for later gestation care, according to Giwa.
“The sites around the country that train in second trimester or third trimester procedures are already very few, and the more pressures we put on clinics, the fewer of those learning opportunities there will be,” she said.
Expanding who can provide reproductive healthcare is one potential solution to reduce the burden on providers, says Giwa, noting that some states now allow nurse practitioners and certified midwives to provide abortion care.
“Welcoming into the fold more provider types is a protective measure, because it does expand access,” Giwa said. “It expands the workforce in harbor states that are inevitably going to be receiving more and more patients, especially states with shield laws.”
Illinois is one of the harbor states which has enacted shield laws, which guard the state against investigations, prosecutions, provider disciplines, extraditions and civil liabilities enacted or requested by out-of-state entities.
Shield laws, which function at a state level, have yet to be tested in the face of a situation such as a federal ban. Gibson notes that this is uncharted territory for the next four years.
Bolstering shield laws would offer another layer of protection by safeguarding access to abortion care, particularly in the face of new restrictions such as laws that criminalize helping – in nearly any way – a minor obtain an abortion.
According to Giwa, whose organization offers clinical training opportunities for medical professionals, applications to participate in abortion care training surged during their November cycle. “I think that demonstrates that providers are worried that they’re not going to have access to training in abortion care soon, and so they’re looking for it now,” Giwa said.
Advocates like Dreith and Giwa advise individuals to stockpile abortion pills and contraceptives, and contribute to funding access networks both at the state level and at the independent, grassroot level.
“While I am devastated and disappointed about the results of this election,” Giwa said, “I am inspired and hopeful about the ways in which this moment is politicizing and empowering advocates.”