Four years after Dobbs, the next battle over abortion access is centered on protecting the clinicians who provide medication abortion through telemedicine. Demonstrators gather outside the Supreme Court on March 26, 2024, as justices hear arguments in a challenge to the FDA’s approval of mifepristone, one of the medications most commonly used for abortion in the United States. In a unanimous decision issued that June, the Court ruled the plaintiffs lacked standing to sue, preserving existing FDA regulations governing the drug. (Anna Rose Layden / Getty Images)

A bottle in your medicine cabinet containing a few small pills may be the key to your reproductive freedom. 

Four years after Dobbs, the next battlefield in reproductive rights is abortion medication sent by mail.

And while the federal government has failed to ensure reproductive healthcare access, states have become the unsung heroes.

• For the past four years, 25 abortion-friendly states have protected abortion access, including 18 states and D.C. that enacted shield laws for patients who travel to these states and those who provide care there.
• Eight states have shown up even more strongly, by passing telemedicine abortion shield laws. These laws enable licensed clinicians in abortion-protective states to prescribe and mail medication to patients anywhere in the country, regardless of where those patients live or what they can afford to pay. 

Shield laws have been battle-tested, halting extradition attempts against doctors from New York to California.

Recently, the state of Louisiana sued to require all women nationwide to go in person to pick up a key abortion medication rather than receive it by mail. However, the Supreme Court blocked this action, requiring more evidence at the trial court level. We will see next year if the Court will uphold the key rights issue here.

Meanwhile, more than 30 percent of all abortions in the United States now occur via telemedicine. That is not an accident. It is the direct result of deliberate legal work done in the shadow of Dobbs, building laws and practices to withstand abortion challenges.

Telemedicine’s reach matters—because the need is staggering: Between 17 and 53 percent of a given state’s population lives in a contraceptive desert, with little or no access to nearby reproductive healthcare. Telemedicine can provide the same abortion medication without requiring a patient to miss work, school or caregiving to travel to pick up the pills.

Four years after Dobbs, telemedicine is not just a convenience. For thousands of women, it is the best or only option.

Telemedicine’s success means that antiabortion threats have grown more sophisticated and intense. Pregnancy is statistically the most dangerous time in a violent relationship. Patients seeking abortion care also risk harassment and violence from hostile partners, as well as abortion opponents, and in the worst cases, life-threatening violence. A pill bottle with your name on it is evidence that can be used with threats to expose you to your employer, your family, immigration authorities or a stranger on social media.

We have developed legislation that would better safeguard the privacy of people seeking abortion care by allowing patients and providers to choose not to have their names appear on pill packaging. Our organization is currently working to pass this legislation in several states.

As Dr. Mary Applegate, a public health physician who testified in favor of such a bill in New York, spelled out: Allowing the use of a pseudonym on prescription labels can be a matter of life and death.

The next post-Dobbs battle centers not just on whether abortion care is legal, but on whether patients can access it safely. After decades of loud and often violent protests in front of clinics, telemedicine also provides a much greater level of privacy for patients and healthcare workers too.

Antiabortion officials are not just trying to restrict access in their own states; they are trying to reach into abortion friendly states like New York, California and others, posing a serious threat to providers across the nation. We have seen extradition requests. We have seen subpoenas. We have seen lawsuits filed against clinicians in New York and California for providing legally protected care.

Before Dobbs, a woman’s access to abortion depended on her constitutional rights. Today it depends on her zip code, her income and her ability to take time off work to travel. Telemedicine was built to make those accidents of circumstance irrelevant. Opponents are trying to make those accidents of circumstance matter again—and indeed to put reproductive healthcare out of reach nationwide.

Four years after Dobbs, we know what works. Shield laws have expanded access. Telemedicine has reached patients who would otherwise go without care. Now, more states must enact laws and practices that make access meaningful.

Reproductive freedom is not just the right to obtain care, it is the ability to seek that care safely, privately and without fear.

Look to these trusted groups if you or a loved one needs to know more about reliable abortion care:

• A one-stop-shop for abortion seekers: I Need An A
• Other websites to explore all your options for abortion care: Plan C Pills, Abortion Finder
• Safe websites to buy abortion medication: Aid Access, Massachusetts Medication Abortion Access Project, Hey Jane
• If you need help affording abortion care, tell your telemedicine provider or contact an abortion fund near you.
• To protect your digital privacy when planning your abortion, click here.
• For free legal help as a patient or doctor, call If/When/How’s Repro Helpline—844-868-2812—or contact Pregnancy Justice.
• For medical advice, contact the Miscarriage & Abortion Hotline: 833-246-2632.
• If you need to know the abortion law in your state, look to the Center for Reproductive Rights. or Guttmacher Institute.

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A note from Ms. editors: We want to hear from you for The Majority, a new campaign collecting stories about how reproductive freedom has enabled readers to build the lives they want and need. Poll after poll shows a majority of Americans support reproductive healthcare access. Yet public debate overlooks the lives shaped by abortion access, contraception, IVF, miscarriage care, maternal healthcare or comprehensive sex education—countless women who chose to pursue an education, have children, not have children, protect their health and chart their own future. Add your voice and complete the sentence: “Access to reproductive choices gave me the freedom to….” Together, these stories will help show not only why reproductive freedom remains a majority value, but also what it makes possible.