It’s been just over three years since the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision upended nearly half a century of federal abortion rights, returning the contentious issue to the states. Since then, the nation has witnessed a dramatic reshaping of abortion access, a surge in telemedicine prescriptions, and a fierce legal and political tug-of-war over medication abortion—especially in states with strict bans.
According to a study published on August 14, 2025, by researchers at the University of Texas at Austin, the vast majority—an eye-opening 84%—of more than 118,000 online abortion medication prescriptions from Aid Access over a 15-month period went to patients living in abortion-ban states. As reported by Stateline, the South and Midwest led the country in telemedicine abortion access, particularly in high-poverty areas or where women would have to travel more than 100 miles to reach a clinic. The study’s findings offer a stark look at the new geography of abortion in America: as in-person options dwindle, virtual ones fill the gap.
“We now overrule those decisions [Roe and Casey] and return that authority to the people and their elected representatives,” wrote Justice Samuel Alito for the Supreme Court majority in Dobbs. In the wake of that ruling, 41 states enacted some form of abortion protection, with 12 states banning nearly all abortions from conception and 28 establishing gestational limits, as Newsmax noted. Yet, paradoxically, the number of abortions has not declined. Instead, abortions have risen more than 10% since Dobbs, climbing from roughly 930,000 to over one million annually—over 2,800 each day, according to the Guttmacher Institute.
How is this possible? The answer, experts say, lies in the rise of chemical abortion—specifically, the abortion pill mifepristone, which now accounts for nearly two-thirds of all abortions. This trend is especially pronounced in states where abortion is banned or heavily restricted. Aid Access, one of the largest telemedicine providers, continues to ship abortion medications to all 50 states, including those with bans, thanks to so-called “shield laws.” These laws, enacted in 22 states and Washington, D.C., are designed to protect providers and patients from legal risks when accessing or providing abortion care across state lines. Eight states—California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington—go even further, specifically protecting telehealth abortion providers regardless of where their patient lives.
Shield laws have become a political flashpoint. According to Stateline, their passage has fueled a rise in telehealth and medication abortions since 2022, as women in restrictive states seek alternatives. The Guttmacher Institute reported that, in states without bans, medication abortion accounted for nearly two-thirds of all clinician-provided abortions in 2023. But as telemedicine abortion use rises, so do efforts by conservative lawmakers to clamp down. In 2025 alone, more than a dozen states introduced bills that would criminalize the sale, purchase, or distribution of abortion medications. Texas, for example, considered a bill that would have allowed private citizens to sue anyone providing abortion pills in-state for at least $100,000—a measure that passed the Texas Senate but died in the House this past May.
The legal battles are far from hypothetical. Earlier this year, Louisiana criminally charged a New York physician for providing abortion pills via telehealth to a Louisiana teen. New York, relying on its 2023 shield law, refused Louisiana’s extradition request. In July, a Texas man sued a California doctor for allegedly mailing abortion pills to his partner, marking the first federal test of these shield laws. And just this month, a Texas woman filed a federal lawsuit against Aid Access and others, alleging illegal mailing of abortion-inducing drugs and personal harm.
The surge in medication abortions coincides with a broader shift in how and where abortions are performed. According to the Charlotte Lozier Institute, nearly 1.1 million abortions were performed in the U.S. in 2024—a 20% increase from 2017 to 2023, reversing a three-decade decline. The Institute attributes the rise in part to the proliferation of abortion drugs and Planned Parenthood’s focus on abortion services. In Maryland alone, there were about 38,600 abortions in 2023, with more than 8,100 performed on out-of-state residents. Maryland, one of nine states plus Washington, D.C., that allow abortions at any point in pregnancy, has become a destination for late-term procedures. Two facilities in the state performed over 800 abortions at 21 weeks gestation or later last year, but even that demand outpaced capacity.
In Maryland, 67% of abortions in 2023 were chemical, and some providers prescribed abortion drugs over webcam without ever meeting the patient in person, according to the Guttmacher Institute. Nationally, there were 777 abortion centers as of February 2025, with Planned Parenthood remaining the largest chain. At the same time, approximately 2,700 pregnancy help centers operate across the U.S., including more than 50 in Maryland, offering free resources to mothers and children.
The debate over abortion extends far beyond access and numbers. According to a 2024 CareNet survey, 43% of women who underwent abortions regularly attended Christian churches, but fewer than half believed churches were prepared to help them with unexpected pregnancies. Meanwhile, 8% of U.S. abortions occur in teenagers aged 19 or younger. Maryland, notably, lacks sufficient parental involvement laws to protect minors—a point of contention for many advocates. A 2023 Tarrance Group survey found that 70% of Americans support parental notification before a minor’s abortion, including a majority of pro-choice voters.
There’s also a human dimension to the numbers. The CDC estimates that 60-90% of pregnancies diagnosed with Down syndrome end in abortion, often due to misconceptions and lack of counseling. Adoption, touted by many as an alternative, faces its own challenges: between one and two million U.S. families are seeking to adopt at any given time, but adoption rates have declined in recent years.
For opponents of abortion, the rise in medication abortions and the spread of shield laws are deeply troubling. Tony Perkins, president of Family Research Council, argued in Newsmax that “the Biden administration enabled this surge by eliminating critical FDA safety protocols and refusing to enforce longstanding federal laws, including the Comstock Act, which prohibits the mailing of abortion drugs.” Perkins and other conservative leaders have called on former President Trump to reverse these policies, contending that they undermine the very state protections Dobbs was meant to empower. Sixteen state attorneys general have urged Congress to act against shield laws and restore what they call the rule of law.
Yet, for many abortion-rights advocates, shield laws and telemedicine represent a lifeline for women in states where abortion is otherwise out of reach. Research has shown that telehealth medication abortion is effective and safe, comparable to in-person procedures. The legal and political battles are likely far from over, as both sides dig in for what promises to be a defining struggle in the post-Dobbs era.
In the end, the numbers tell a story of a nation divided, but also of ingenuity, resilience, and fierce debate over one of America’s most enduring issues. As the legal landscape continues to shift, the choices—and consequences—facing women, providers, and lawmakers remain as complex and consequential as ever.