‘The Post-Roe Divide’ — Intimacy, Class, & The Cost Of Reproductive Care

Perhaps Americans were less unite — and far less joyful — on June 24, 2022, at Washington D.C.’s Supreme Court than the French were on March 4, 2024, when the phrase “My Body, My Choice” shimmered across the Eiffel Tower as abortion was made a constitutional right by the French Parliament¹.

While Parisians cheered beneath the glowing Eiffel Tower, the mood across the Atlantic could not have been more different around two years ago. Outside the Supreme Court, the celebratory applause and relief from anti-abortion supporters were combined with the shocked and heartbroken awe of those who were pro-choice. It was a day that not only politically split the country but also emotionally, and began .

Love In The Shadow Of Law

As the old saying goes, a bad law is still a law, and no one is above the law; abortion has been officially overturned at the federal level as of June 2022, and all, or at least all American women, must comply. American dating behavior, beyond just sexual activity, has significantly shifted ever since the overturning, though not dramatically overnight, but in meaningful ways.

Of course, the romantic decline, especially among young adults, cannot be blamed solely on the overturn, since it is just a part of a larger picture. Economic strain, career competition, inflation, and an impressive decline in happiness among young people all play significant roles. Still, to say that it has not been one of the major factors would be a lie.

According to the 2022 Match Singles in America survey, 13 %$$ of active daters said the overturning had made them “more hesitant to date” and 20 % of singles said the decision would make them “more hesitant to have sex” while a follow-up in 2023/24 noted that 87 % of singles under age 50 said the Roe reversal affected their dating or sex lives, an increase from 78 % in the prior year².

Dating Apps & The Digital Filter Of Fear

Of course, no one can exclude the hookup impact of dating platforms in the 21st century. While they are by no means entirely safe, they have undeniably redefined how young adults meet, communicate, and form relationships.

Luckily, dating app usage did not decline after the social tension brought by the overturn. For instance, Tinder recorded approximately 63.6 million downloads in 2024, up from previous years³, while tracking data shows Bumble’s paid user base increased by more than 17% between 2022 and 2024⁴. Similarly, according to the Pew Research Center’s 2022 survey, about 30 % of U.S. adults reported having ever used a dating app or website⁵. The figure was between 50 and 60% for adults aged under 30.

Since user numbers have not decreased, many have instead noticed changes within the apps themselves. Ever since the overturn, noticeable changes have been observed in dating app usage patterns and profile content.

For instance, OkCupid’s internal data reveals that the phrase pro-choice” ‘s mention rose by 18% in user bios in the first two weeks after the reversal, and users who identified as pro-choice were twice as likely to receive matches as those who did not as time passed⁶. Similarly, Bumble released a public statement reasserting its “pro-choice” stance on the day of the Supreme Court’s ruling and announced the addition of a new “Reproductive Rights” profile badge under its “Values & Allyship” section shortly after⁷.

Sexual Activity Trends

When fewer people are dating, it certainly does not take an expert to guess what has happened to a related topic: sexual activity followed the same downward slope.

Match Group’s Singles in America also reported that 11 percent of singles confessed to less casual sex frequency overall just months after Roe v. Wade overturning in 2022. Furthermore, it also noted that 13 percent of singles admitted they were more afraid of getting pregnant or of impregnating someone, and the figure was 21 percent among Gen Z singles⁸. In other words, nearly one in five young people have approached and are approaching sex with heightened caution and a stronger fear of consequence than they did before 2022.

Measuring Post-Roe Behavioral Shifts

By the same token, there is no need for a fear survey to know that the reversal had imposed a fear-driven urgency on many Americans, leading countless individuals to stockpile emergency contraception, birth-control pills, and other reproductive-health products in anticipation of uncertain consequences following sexual activity.

Immediately following the Supreme Court’s decision to overturn ROE, purchase rates for emergency contraception, birth-control pills, and condoms skyrocketed nationwide. Wisp reported a near-1000 % increase in emergency-contraception sales in a single 24-hour window in November 2024⁹, and major pharmacy chains such as CVS and Rite Aid placed purchase limits on Plan B and similar products in June 2022 amid the abrupt escalation of demand¹⁰.

Trends And Fallouts In Restrictive States

Interestingly, even that sharp purchase rate increases differ between states that imposed abortion restrictions and those that did not. To repeat, condoms, birth-control pills, and emergency contraceptives’ sales skyrocketed nationwide in the immediate weeks following the Roe v. Wade overturning. Yet the longevity of that increase’s intensity varied across states. In other words, while the skyrocket occurred in both abortion-restrictive or nearly-ban states and non-restrictive states, its statistical aftermath was like apples and oranges between the two.

Among states with strict abortion restrictions, the sharp, short-term spike in purchases and prescription fills for emergency and oral contraceptives that occurred just weeks and months after the Roe v. Wade ruling cooled down within a mere year. EC fills dropped about roughly 65% by mid-to-late 2023, while OCP fills dropped 4.1% more than they did in non-restrictive states¹¹. Among restrictive states, the most significant decline in OCPs was in Texas, a 28% drop just one year after Dobbs.

The sudden flattening of the skyrocket curve in restrictive states could be attributed to several factors. One of them is the aftermath of fear-driven temporary swelling of purchases. Supply shortages were widespread as emergency contraceptives and birth-control pills sold out rapidly in the weeks after the ruling, leaving pharmacies unable to restock them any time soon. Secondly, as demand peaked, so did their prices, as is common in a capitalist market; some were unable to afford the contraceptives and pills. Not to mention the surge in out-of-pocket medication costs due to state insurance programs such as Medicaid and private insurers refusing to cover certain reproductive health products.

Thirdly, policy barriers that straddled the line between law and healthcare compounded the matter. After the Dobbs decision, several restrictive states enforced state laws that not only restricted abortion but also blurred the line between it and contraceptives, when, by definition, contraceptives are medications used to prevent pregnancy, not to end it; in other words, contraceptives come before pregnancy, whereas abortion procedures address what occurs after. Nevertheless, healthcare providers were forced to restrict access not just to abortion-inducing drugs, but to routine contraceptives that their states had been legally prescribing for decades.

For instance, a major hospital system in Missouri briefly stopped providing Plan B emergency contraception in late June 2022 because hospital administrators feared that the state’s newly activated abortion ban could also indicate implantation and resumed providing Plan B only after the governor and attorney general issued formal clarification that the ban refers only to clinical and medical abortion, and not contraceptives¹². Likewise, some Texas pharmacies halted dispensing not only Plan B but also methotrexate, a medication used to treat autoimmune disorders but technically could also be used to terminate early pregnancies¹³.

Where Access Holds: The Stability Of Non-Restrictive States

On the other hand, things turned out quite differently in non-restrictive states like California, New York, Oregon, New Jersey, and Illinois, a natural consequence of not having to make any significant changes to state law. Unlike the sharp spike and equally sharp drop seen in restrictive states, contraceptive purchases in those states remained relatively steady after the initial drop because pharmacies and providers in those states were not burdened by the shortages, legal ambiguity, and declining purchase rates seen elsewhere¹⁴.

For instance, Californian pharmacists were legally authorized to distribute birth control and emergency contraceptives without a prescription¹⁵. At the same time, Oregon residents were allowed to pick up a year’s supply of oral contraceptives at once, and similar protections were extended in states like New York and Illinois¹⁶.

Pregnancy-Related Issues: Out-Of-State Travel, Barriers, And Costs

Who would have guessed that a ban on a healthcare service could create one of the most striking travel patterns in recent U.S. history? After the Roe v. Wade overturning, the number of women traveling out of state for abortion procedures roughly doubled compared to pre-Roe. Approximately 81000 people crossed state lines in 2020¹⁷.

That number nearly doubled by 2023, when approximately 170000 people left the state to receive abortions, contributing to almost 16% of all legal abortions carried out in legal states¹⁸. The majority of travelers, residents of states with bans or heavy abortion restrictions, such as Texas, Tennessee, Missouri, and Mississippi, often head to Illinois, Kansas, New Mexico, North Carolina, and, occasionally, Florida, where the six-week ban has not been legislated yet.

The financial toll of travelling itself can be severe. The Brigid Alliance reports that the average client travels roughly 1,300 miles round-trip and incurs around $2,300 in total costs excluding the abortion procedure itself, including transportation, lodging, meals, and childcare¹⁹. A 2023 Guttmacher Institute analysis showed that after Dobbs, women from Texas, Louisiana, and Mississippi were forced to travel distances of 400 to 600 miles to reach the nearest clinic located in the closest state that provides legal abortion²⁰. This is by no means a small amount of money and distance, though the costs vary widely depending on how close a person’s home is to a state line or to the nearest legal provider.

To make matters worse, travelling expenses may be the least of worries; many face additional barriers such as healthcare and health insurance coverage limits, rising medical and procedure costs, state-by-state policy differences, out-of-pocket payments, and disparate healthcare systems across states.

Over 30 states prohibit insurance providers from offering abortion coverage through Affordable Care Act (ACA) Marketplace plans²¹. For instance, Texas bans both private and marketplace plans from covering abortion costs except in cases of life endangerment, and Louisiana, Mississippi, and Tennessee’s laws are not significantly different from that²². And insurer-level restrictions even cause barriars in states where abortions are entirely legal.

And even if the costs are entirely or partially covered by insurance, insurer-level restrictions often compound these legislative barriers. For example, large insurers such as Anthem Blue Cross Blue Shield and Cigna limit abortion coverage in their ACA marketplace plans to cases of rape, incest, or life endangerment, despite the absence of a state-level ban²³.

Therefore, some large employers and insurers have responded to state restrictions by expanding their travel-benefit programs. For example, Amazon now reimburses up to $4,000 annually for employees needing to travel out of state for abortions and other related procedures unavailable locally²⁴.

Meanwhile, JPMorgan Chase, Starbucks, Disney, and Microsoft have introduced similar policies covering travel and lodging needed for abortion procedures. The Kaiser Family Foundation (KFF) found that by late 2023, nearly one in ten large employer-sponsored health plans explicitly offered abortion travel benefits²⁵. Yet these benefits are concentrated among corporate and tech firms, leaving low-income and hourly workers, a group that encompasses roughly 42% of the U.S. labor force, excluded²⁶.

Similarly, large health insurers such as CVS, Aetna, and UnitedHealthcare have offered travel reimbursement options through their employer health plans, but this applies only when employers opt in. For instance, UnitedHealthcare’s 2024 policy allows reimbursement for “medically necessary reproductive services not available within 100 miles,” yet this coverage depends entirely on the employer’s benefit tastes²⁷.

Then there is no question on how smaller regional insurers cover (if done adequately at all to begin with) when even the prominent companies and insurance providers fail to address the majority of demands when out-of-state abortion is needed.

For instance, Blue Cross Blue Shield of Alabama, Molina Healthcare, and Centene’s Ambetter plans in states such as Mississippi, Texas, and Georgia offer no abortion coverage or travel reimbursement at all except in narrowly defined cases, such as the pregnant woman’s life being in danger, excluding justifiable cases such as rape, incest, or severe fetal anomalies²⁸.

In other words, a woman would need a hospital sheet that proves that continuing the pregnancy would directly threaten the woman’s life, even in cases of rape, incest, or severe fetal anomalies. And all thanks to the states’ “life-of-the-mother” clauses written into post-Dobbs abortion bans that decreased not only hospitals, but insurance providers’ willingness to interfere due to penalties following unlawful practices²⁹.

The matter becomes doubly problematic for those insured under state-exclusive or regionally regulated plans, whose coverage is legally bound to their home state’s insurance rules.

Under these systems, abortion coverage bans follow the patient, not the clinic. To put it plainly, a woman in Texas insured under Blue Cross Blue Shield of Texas or Ambetter by Centene cannot use her plan to pay for an abortion that would occur outside the state of Texas. Texas Insurance Code §1218 explicitly forbids insurers from covering elective abortions except for life endangerments and thus, only allows optional “abortion riders”, a separate, optional add-on policy that theoretically allows a person to receive abortion coverage in addition to their main health insurance plan³⁰ (yet, this additioonal plan is ineffective to say the least since it does not cover travel or related care expenses, often exluded by employers, and most ridiculously, requires insurers to purchse it pre-emptively, that is,before a pregnancy, because the insurance system classifies abortion as a “foreseeable event” once someone is pregnant, resulting in people being unaware of the add-on`s existence, let alone purchase it in advance)³¹.

Nevertheless, amid a glimmer of hope, many women unable to use their state-based insurance have turned to nonprofits like the Brigid Alliance, the Lilith Fund, and the National Network of Abortion Funds (NNAF). These groups assist with travel, lodging, and childcare expenses for patients who are forced to travel out of state, which can exceed $2,000 per trip³². The Brigid Alliance alone assists an average of 125 clients per month, spending about $2,400 per person³³.

The Lilith Fund, primarily serving Texas residents traveling out of state for abortion care, reported a substantial increase in requests after the Dobbs v. Jackson Women’s Health Organization decision³⁴. Collectively, the NNAF distributed over $50 million in the 2023-24 fiscal year to more than 136,000 individuals and provided logistical support, including booking flights, hotels, and ground transportation and its practical support costs grew by 30%³⁵.

According to the Kaiser Family Foundation 2023 report, fewer than 5% of health insurance providers in states with near-total abortion bans have established formal reimbursement procedures for patients seeking care elsewhere³⁶. This lack of coverage forces numerous women to depend on personal savings, crowdfunding, or abortion funds to bridge the financial gap.

Medication Abortion And Telehealth Access

On the other hand, medical abortion has spared countless women the burden of not only traveling hundreds of miles to a clinic but also conflicts with state laws and regulations. According to Guttmacher Institute’s 2024 report, 63% of all abortions in 2023 were medication-based, an increase from 53% in 2020³⁷. Medical abortion is carried out through a two-pill regimen: mifepristone followed by misoprostol, which can be prescribed and received through telehealth platforms or mail-order pharmacies, allowing patients to have abortions privately at their homes.

Yet even though the medical abortion itself takes place privately at home, a woman cannot entirely step outside the reach of lawful regulation after the overturning of Roe v. Wade, unless she personally manufactures the abortion pills herself. As soon as Roe v. Wade was overturned, lawmakers across the nation strove to regulate multiple points in the medication-abortion supply chain — telehealth services that prescribe the pills, pharmacies that dispense them, companies that manufacture them, and similar entities involved in their distribution even though the United States may be a capitalist country where the federal reversal may have removed national protections for abortion and not the sale of medications — even those related to abortion.

Therefore, medical abortions are by no means complication-free, though they may be less intense than clinical ones. Both doctors and patients face potential criminal liability for the distribution or receipt of abortion pills in abortion banned states such as Texas, Louisiana, and Arkansas, even when the medications may have been prescribed legally in another state or at least where abortion is entirely legal. In other words, if a Texas resident receives pills mailed from a doctor in New York, Texas authorities may argue that the “abortion” itself took place in Texas, the location where the resident would absorb the pills and hence, technically, fall under Texas jurisdiction³⁸.

Not only that, the New York doctor who mailed the abortion pills can be accused of “aiding” or “abetting” an illegal abortion under the statutes of Texas³⁹. While the doctor, being a New Yorker, may be protected by the state of New York’s “shield laws”, laws passed in states such as New York, Massachusetts, Washington, Vermont, and California to protect doctors and providers from persecution, that forbid local officials from interfering with out-of-state abortion investigations and sharing patient or provider data with abortion-banned states⁴⁰.

Speaking of “shield laws”, a fair number of telehealth providers, such as Aid Access and Hey Jane, continue to provide medical care to patients living in restrictive states under the law’s protection⁴¹. Yet, the Texas patient could still face criminal charges, civil lawsuits, or an investigation under Texas law.

Sadly, even those “shield laws” do not protect all providers — or at least not those whose services or brand operations extend across multiple states. They were legislated to protect in-state doctors and telehealth providers from potential criminal investigation or extraction by abortion-banned states to begin with⁴².

Thus, naturally, they cannot extend to national pharmacy chains or corporations. This legal gap, therefore, forced CVS and Walgreens to refrain from mailing or stocking abortion pills in more than 20 states in early 2023 to avoid lawsuits, boycotts, or the termination of certain states’ pharmacy licenses, despite receiving FDA certification that allowed them to distribute Mifepristone by mail⁴³.

As a result, many women living in abortion restrictive states were unable to purchase and receive abortion medications through major pharmacy chains and were forced to turn to smaller telehealth services or nonprofit organizations.

Furthermore, legal intricacies concerning abortion pills may potentially cause more problems: mostly medical and logistical issues. Some abortion-restrictive states, such as Arizona, North Carolina, and Georgia, passed mandatory ultrasounds or in-person doctor consultations required before prescribing abortion pills, even online through telehealth services, subverting the very benefit of telehealth services⁴⁴.

A telehealth professional is legally mandated to follow the patient’s residing state’s abortion regulation, regardless of where the professional is located, and yes, that applies to even prominent nationwide providers such as Hey Jane, Choix, and Carafem⁴⁵.

For instance, Carefem’s telehealth services allow patients seeking potential abortions who are residents of Georgia or North Carolina, where abortion restrictions are partially present to this day, to request prescriptions for mifepristone or misoprostol only after they have made an in-person doctor visit or received an in-person ultrasound by their state’s licensed doctor⁴⁶.

Typically, medical abortions are legally required to be carried out within the first ten to twelve weeks of pregnancy⁴⁷. Hence, legal uncertainties, combined with additional problems such as logistical ones such as mailing restrictions and misinformation, can make women living in abortion restrictive states’ efforts come down to nothing since they may have approached or even surpassed the safe gestational stage limit for a medication abortion by the time the pills have reached their doorsteps.

To include an interesting aside, several state attorneys general even attempted to utilize ridiculous measures, to say in the very least, to block the mailing of abortion pills, such as trying to use the Comstock Act of 1873, a 150-year-old federal law⁴⁸. This 19th-century law, by historical accuracy, criminalized mailing of “obscene,’ ‘lewd,’ or ‘indecent’ materials.”⁴⁹

The meaning of the law is no less broad today than it was during the Victorian Era; not to mention that the law was drafted during times when even anatomy textbooks were considered “obscene”, let alone birth control and sex education⁵⁰. Of course, this attempt was unsuccessful as the US Department of Justice officially issued an opinion stating that mailing of FDA-approved abortion pills is not illegal when the sender believes the medication will be used lawfully in December 2022⁵¹.

Shifting Patterns In Reproductive Outcomes

Of course, the natural hypothesis might be that once abortion is no longer protected at the federal level, American abortion rates must have decreased — or at the very least, stopped rising. After all, how could the numbers not drop when the procedure is simply unavailable in large parts of the country? Well, surprisingly: not quite, and the reasons behind that are complicated. And no, it is not because underground “abortion black markets” suddenly decided that honest reporting is a new core value they should follow better or the like.

Abortion rates, of course, had little choice but to plummet — if not drop to zero altogether — in restrictive and total-ban states after Roe v. Wade was overturned. Guessing that much is child’s play. However, as mentioned previously, the US was split into two groups after the decision: states that imposed severe restrictions or total bans, and states that continued to protect abortion access. As a result, many women living in restrictive and total-ban states were forced to travel to states where abortion remained legal. Thus, like an inverse relationship across the two groups, abortion rates sharply decreased within the ban states but rose in the states that protected abortion, the latter of which suddenly had to serve both their own residents and a flood of out-of-state patients.

Hence, while it may sound counterintuitive, nationwide abortion rates did not decrease after the overturn⁵². Instead, they remained relatively stable — or even rose slightly — because the decrease in abortion within restrictive and total-ban states was offset by increasing numbers in states that continued to protect abortion access and began receiving patients from across state lines.

Well, this raises another question: what has happened to overall birth rates since the overturn, especially unplanned or underage births, given that most abortions are connected to unintended pregnancies? If abortion rates did not decrease even after the overturn, should it not indicate that unplanned and underage pregnancy rates rose?

And if so, might the same be true for unplanned and underage births, since a pregnancy must occur before abortion can even come into the picture? Or, just like abortion rates, are these patterns now split between states that allow abortion and those that impose severe restrictions or total bans?

Well, not always, too — and this is a very difficult question to answer. Yes, to repeat, a pregnancy must occur before abortion can even come into the picture. Yet, the two are not in an entirely deterministic relationship. First, when abortion becomes unavailable — whatever the reason may be — a pregnant woman is left with only one remaining option: to carry the pregnancy to term, whether she agrees with it or not.

Thus, while an increase in abortions might suggest fewer births, a drop in abortion rates does not necessarily signal a drop in pregnancies, nor in the outcomes that follow them — especially unintended or unplanned births.

Second, birth and pregnancy rates had already been declining long before the reversal, due to various factors such as economic uncertainty, shifting career priorities, the rising cost of living and childcare, broader changes in cultural attitudes toward marriage and family planning, and the like.

To claim that Dobbs v. Jackson was the primary driver of any changes to those rates after mid-2022 would therefore be misleading. According to the CDC’s National Vital Statistics Reports, the national birth rate dropped by nearly 22% between 2007 and 2022, one of the lowest figures in the history of modern America⁵³.

Third, the majority of births today in the twenty-first century are not unplanned — far from it. Lastly, overall birth counts include planned, unplanned, and underage births all together, making it difficult to separate out which type is which, especially given privacy concerns.

Therefore, there are relatively few large-scale published studies on post-Roe unplanned pregnancy numbers. Yet, there are real-life stories from women who were denied abortions — especially clinical procedures — because of the laws in the states where they reside that made headlines (and as the word headlines suggests, these are often the most extreme and heartbreaking cases — situations that did not end in just unwanted birth itself). Some mothers (or potential mothers-to-be) have publicly shared that they were forced to continue pregnancies that were nonviable, dangerous, or guaranteed to end in tragedy under their own state laws.

One case described in a trauma-surgery analysis involves a 31-year-old woman with placenta accreta who was not able to obtain an abortion in her state, an unidentified state with a total abortion ban in 2022. She ultimately suffered a catastrophic uterine rupture and died from massive hemorrhage during childbirth in 2022⁵⁴.

Similarly, a Texas woman named Samantha Casiano learned at 20 weeks that her pregnant baby had anencephaly, a fatal condition, but was denied an abortion due to Texas’s near-total abortion ban; she was forced to carry the pregnancy to term and delivered a daughter who lived for only four hours before dying in 2022⁵⁵.

While these tragedies represent a minority of cases, they show what can happen when laws, rather than rational medical judgment, dictate clinical care. Even if they are rare from a clinical standpoint, the consequences can ultimately endanger human life.

Furthermore, those born thankfully normally yet ‘unplanned’ may face unpleasant consequences as well, though far less fatal. While unplanned births have been disproportionately concentrated among low-income women, and children born into these circumstances were more likely to experience early childhood poverty, food insecurity, unstable housing, and lower educational outcomes, even before the reversal among all 50 American states, the reversal did nothing to pacify the situation, if not worsen it.

According to 2022 U.S. Census data analyzed by Third Way, 23% of new mothers in abortion-ban states live in poverty, compared to 21% in abortion-restricted states and just 18% in states where abortion remains protected⁵⁶. In other words, the very states forcing women to continue unintended pregnancies are also the states where unplanned newborns are most likely to enter the world under severe economic hardship

The Expansion Of Anti-Abortion Advocacy

Since the overturn, many anti-abortion organizations have grown bolder, more vocal, and more organized now that their stance has officially been legalized. Some long-standing groups expanded their local chapters and outreach efforts, while new ones emerged with fresh confidence.

For instance, Students for Life Action (SFLAction), one of the country’s most active modern pro-life and anti-abortion organizations, now supports over 1,400 student chapters at numerous high schools, college campuses, and even law schools across all 50 states⁵⁷. It hosts campus fairs, sets up information booths, and organizes debates and awareness campaigns set to define abortion as both a moral and human-rights issue⁵⁸.

In November 2024, the group released its “Make America Pro-Life Again” roadmap, a detailed plan for how to push anti-abortion policy in a post-Roe America since “the fifty years of standing at the Supreme Court’s door waiting for something to happen is over“⁵⁹. The plan consists of goals such as banning mail-order abortion pills and tightening abortion restrictions for each state to make abortion entirely unavailable and unthinkable once and for all, and directing more public funding toward pregnancy resource centers⁶⁰.

Moreover, SFLAction’s efforts also did not stop at the courthouse steps and campuses but extended to pharmacy aisles⁶¹. Against abortion pill’s wider distribution, it put on student-led street demonstration protests at Walgreens and CVS over their decision to sell over-the-counter mifepristone, a medication used to end an early pregnancy typically within the first ten weeks that they described as “sale of life-ending abortion drugs”, in early 2023⁶².

Likewise, Susan B. Anthony Pro-Life America (SBA), one of the most influential modern anti-abortion organizations alongside SFLAction that also carries the goal of making abortion unthinkable and illegal, has played a leading role in shaping post-Roe strategy.

By early 2023, SBA increased its state-affairs teams in about thirty states, placing staff and advocates directly within local legislatures⁶³. In other words, SBA’s teams had helped draft and support anti-abortion bills such as heartbeat laws, parental notification requirements, and restrictions on abortion pills or public funding for abortion providers⁶⁴.

In the same year, SBA also launched the Her Pregnancy and Life Assistance Network (Her PLAN) program, which connects pregnant women with financial, medical, and housing resources⁶⁵. This network currently operates in Georgia, Mississippi, Virginia, and West Virginia and plans to expand nationwide over the next few years.

Furthermore, alongside its policy work, SBA has also intensified on training and election mobilization, partnering with strategy groups to prepare members in campaign messaging, voter outreach, and legislative advocacy throughout 2023 and 2024, shifting from a mere campaign-driven organization into a renowned political and legislative entrenched one⁶⁶.

The Pro-Choice Response: Mobilization And Resilience

Ironically, the pro-choice front has not quieted down either, even though things have turned out quite disadvantageously to them. In fact, the reversal has stimulated activism, fundraising, and public support in unexpected ways.

For example, NARAL Pro‑Choice America (renamed Reproductive Freedom for All in 2023) reported an astounding 1,403% surge in donations through their official website and affiliated fundraising platforms⁶⁷ within just 24 hours after Politico, a well-known Washington, D.C.–based political publication founded in 2007, published a 98-page draft majority agreeing opinion in Dobbs v. Jackson Women’s Health Organization, which stated that the Supreme Court had voted to overturn Roe v. Wade after verifying the leaked court draft’s authenticity and releasing it online with deeply comprehensive analysis in early May of 2022.⁶⁸

The sudden overnight nationwide outpouring of financial support for NARAL Pro‑Choice America was not just an overwhelming flood of online donations typical of following a single landmark incident. These generous contributions were directed toward one goal: the pro-choice cause. More specifically, the donations were aimed at supporting pro-choice campaigns at both the state and federal levels to sustain abortion access, organizing rallies and awareness events to mobilize people, and creating media and educational content to challenge anti-abortion messages.

In similar fashion, Mayday Health, a nonprofit organization founded in 2022 shortly after the Dobbs decision, has become one of the more visible new advocacies in the pro-choice movement⁶⁹. While initially not as established as organizations like Planned Parenthood or NARAL, Mayday quickly gained national attention for its creative and aggressive information-campaigning methods.

Most notable examples are bold billboards in Jackson, Mississippi, reading “Pregnant? You still have a choice”, backed up by mobile ads and digital campaigns, edycating people living in abortion restrictive states about safe medical abortion⁷⁰, and high-profile stunts such as presenting airplane banners and truck ads carrying the message “Abortion pills by mail” during major public events, including the Indianapolis 500, one of the most famous car races in the world held in Indiana annually⁷¹.

As a result, by 2023, Mayday saw a sharp rise in its online traffic, as thousands residing in abortion-restrictive states searched for information about medication abortion and how to access abortion pills safely⁷².

The Disappearing Middle

Interestingly, last but not least, a fair number of individuals who once stood neutral primarily and stayed entirely out of the abortion debate shifted towards the pro-choice direction. Surveys showed that support for legal abortion rose from 59 percent to 63 percent from 2021 to 2024, and the most significant increase⁷³, 76 percent, came from the age segment of women under 30⁷⁴.

Correspondingly, a 2025 political-behavior study found that the majority of Americans who changed their minds on abortion after Dobbs moved toward supporting abortion access rather than restricting it, and that some of those stats descend from deeply human experiences⁷⁵.

For instance, Rob Schenck, a former prominent evangelical activist, Operation Rescue organizer, and most importantly, anti-abortion advocate, wrote in The New York Times that after decades of campaigning to overturn Roe, he could no longer call his efforts pro-life, arguing that abortion bans would only punish poor women and minorities by making them “risk pregnancy without proper medical, social, and emotional support”⁷⁶.

Paradoxically, writer Robin Marty, a pro-choicer, stated in Politico Magazine that ending Roe v. Wade could serve as an essential wake-up call for progressives who had become too passive⁷⁷. What she means is that the shock of the overturn might finally push liberals to take constructive action after years of quietly allowing more and more abortion limits to be passed without much resistance.

More ambiguously, Sam Sawyer, a pro-life Jesuit writer for America Magazine, agreed with ending Roe v. Wade but criticized America’s pro-life movement for failing to show more understanding and empathy toward women’s economic hardship and inequality and alienating political behavior — actions that may have pushed away people who might otherwise support them⁷⁸.

A Divided Health Academic Curriculum In A Divided America

Perhaps the classrooms, or at least the health classes, are no less divided. Whether a state has an abortion ban or not, the legal requirements to provide medically accurate, mandatory sex education in the U.S. are still surprisingly weak, let alone the requirements to teach accurately about abortion⁷⁹.

A recent analysis by Guttmacher Institute and SIECUS shows that most states, both abortion restrictive ones and those not, are not mandated to provide medically accurate sex education at all, with 68% of abortion-ban states and 64% of non-ban states⁸⁰.

Therefore, it is difficult to fully measure how abortion-related education has changed since the reversal across restrictive and non-restrictive states, because “health education” itself is so broad, and abortion often makes up only a tiny part of it, if it appears in the curriculum at all. In many states, the absence of any academic requirement for medically accurate health education effectively becomes a way to avoid addressing abortion altogether, allowing schools to bypass the topic since they won`t be breaking any laws.

But the Roe reversal, or at least the sex-education measures that followed, has perhaps brought these long-standing gaps into sharper focus. A CNN review of 2024 data reveals a record number of sex-education bills, and most of the restrictive bills came from states that also restrict abortion⁸¹. Some of the content of those restrictive bills includes removing contraception lessons, focusing only on abstinence, banning discussions of gender or sexuality, or requiring anti-abortion materials.

Texas is a key example: according to a July 2022 report from The 19th News, Texas’s sex-education curriculum does not require medically accurate information, emphasizes abstinence, excludes consent education, and even goes as far as to frame homosexuality negatively⁸². After Roe’s reversal, Texas lawmakers even pushed educational proposals that closely complied with the state GOP platform, such as mandating ultrasounds and teaching that life begins at fertilization, further attempts to tie education policy to the state’s abortion ban⁸³.

In contrast, states that protect abortion access are generally moving toward a more comprehensive approach with medically accurate sex education. National data cited in The 19th News report shows that while sex-education policies vary widely by state, fewer political restrictions are present in non-restrictive states that tend to support a broader, more inclusive sexual-health curriculum⁸⁴.

For example, Washington D.C. and 20 states require schools to teach contraception, and 17 states mandate medically accurate sex-education materials that carry comprehensive educational programs that emphasize human development, sexual health, and healthy relationships alongside LGBTQ+-inclusive and age-appropriate content⁸⁵.

The Post-Roe Divide — What It All Means

Perhaps Roe v. Wade was never the main driver, but rather an amplifying force. It may have functioned less like a central protagonist and more like a deuteragonist in a novel — supporting the main characters and shaping the arc, yet ultimately standing as a kind of bridesmaid to the larger plot since as previously mentioned, romantic and sexual activity rates, birth rates, and pregnancy rates had already been declining due to a range of social and economic factors long before the Supreme Court decision.

Furthermore, the United States — despite its “superpower” status — has never been known for efficient or affordable healthcare, let alone abortion-related services, even long before the fall of Roe.

Nevertheless, the reversal did nothing to pacify the already-declining situation, bringing far more problems than benefits, whether it is a Texan pharmacist afraid to prescribe routine birth control or a Mississippi woman forced to travel 600 miles for a procedure she once could have accessed at home through medical deliveries.

The reversal was — and still is — a truly black-and-white issue, with no single perspective coloring over the other. No, humans are not chickens or livestock, and bodily autonomy cannot be managed like an agricultural system. Even a fair number of vegans, people who possess some of the strictest ethical views on life and harm, are pro-choice.

In a post-Roe America, abortion policies now shape daily life far beyond the clinic. The consequences of those policies have at least partially extended into dating behavior, healthcare access, education policy, economic mobility, and some of the most intimate decisions a person can make-all on the divide over who (or what) should control the future of reproduction.

Footnotes

1. Aurelien Breeden and Catherine Porter, “France Enshrines Abortion Rights in Its Constitution,” The New York Times, March 4, 2024. ↩︎
2. Match Group, “Singles in America: Match Releases Largest Study on U.S. Single Population for 13th Year,” press release, January 24, 2024. ↩︎
3. Tinder Statistics and Facts (2024),” DemandSage, accessed March 2025. ↩︎
4. “Bumble Usage and Revenue Statistics (2024),” Backlinko, accessed March 2025. ↩︎
5. Aaron Smith and Monica Anderson, “Key Findings About Online Dating in the U.S.,” Pew Research Center, February 2, 2023. ↩︎
6. Urooba Jamal, “OkCupid’s popular ‘pro-choice’ profile badge is helping singles weed out people they will likely clash with as the U.S. overturns Roe v. Wade,” Business Insider, June 25, 2022. ↩︎
7. Bumble Inc., “Statement on Leaked Supreme Court Opinion on Abortion Rights,” Bumble blog, May 3, 2022 (approx.). ↩︎
8. Match Group, “Singles in America: Match Releases Largest Study on U.S. Single Population for 13th Year,” press release, January 24, 2024.. ↩︎
9. Mary Hanbury, “Plan B and birth control sales skyrocketed by nearly 1,000% after Election Day, telehealth provider says,” Business Insider, November 10, 2024. ↩︎
10. “U.S. pharmacies reportedly set purchase limit on emergency contraception pills,” The Guardian, June 28, 2022. ↩︎
11. Alice Chen et al., “Prescription Fills for Birth Control and Emergency Contraceptives After Roe v. Wade Was Overturned,” USC Schaeffer Center for Health Policy & Economics, August 1, 2024. ↩︎
12. NPR Staff, “After Roe, Confusion Over Missouri’s Abortion Ban Led a Hospital to Stop Dispensing Emergency Contraception,” NPR, July 13, 2022. ↩︎
13. Marin Wolf, “Pharmacists Are in Limbo Under Texas Abortion Laws,” Dallas Morning News, July 18, 2022. ↩︎
14. Dima M. Qato et al., “Prescription Fills for Birth Control and Emergency Contraceptives After Dobbs v. Jackson Women’s Health Organization,” JAMA Network Open 7, no. 6 (2024): e2418620. ↩︎
15. California Business and Professions Code § 4052.3(a)(1); “Self-Administered Hormonal Contraception Protocol for Pharmacists,” California State Board of Pharmacy, accessed March, 2026. ↩︎
16. Oregon Health & Science University, “Oregon’s 12-Month Contraception Supply Law,” accessed March 2025. ↩︎
17. KFF, “Abortion Trends Before and After Dobbs,” July 15, 2025. ↩︎
18. Isaac Maddow-Zimet et al., “Interstate Travel for Abortion Care After the Overturning of Roe v. Wade,” Guttmacher Institute (news release), June 24, 2025. ↩︎
19. The Brigid Alliance, “How the Cost of Accessing Abortion Care Is Increasing for The Brigid Alliance Clients,” (2023), accessed September 13, 2025. ↩︎
20. Guttmacher Institute, “High Toll of U.S. Abortion Bans: Nearly One in Five Patients Now Traveling Out-of-State for Abortion Care,” December 7, 2023. ↩︎
21. Kaiser Family Foundation, “State Policies on Abortion Coverage in Medicaid, Private Insurance, and ACA Marketplace Plans,” accessed October 2025. ↩︎
22. National Women’s Law Center, “State Laws Regulating Insurance Coverage of Abortion Have Harmed Women’s Health and Economic Security,” accessed 2025. ↩︎
23. National Health Law Program, “Beyond the Law: The Challenges of Marketplace Coverage of Abortion in 2024,” December 12, 2024. ↩︎
24. Jeffrey Dastin, “Amazon to reimburse U.S. employees who travel for abortions, other treatments,” Reuters, May 2, 2022. ↩︎
25. Michelle Long et al., “Coverage of Abortion in Large Employer-Sponsored Plans in 2023,” Kaiser Family Foundation, February 29, 2024. ↩︎
26. Christine Vestal, “Privacy, Stigma May Keep Workers from Using Abortion Travel Benefits,” Stateline, October 3, 2022. ↩︎
27. Aetna, “Travel and Lodging Reimbursement Request,” form published 2021–2022. ↩︎
28. Kaiser Family Foundation, “State Policies on Abortion Coverage in Medicaid, Private Insurance, and ACA Marketplace Plans,” last modified March 5, 2024. ↩︎
29. Ambetter from Magnolia Health, Written Plan Description (Mississippi), June 3, 2015, 38 (abortion excluded “unless the life of the mother would be endangered if the fetus were carried to term”). ↩︎
30. Texas Insurance Code § 1218.002–1218.003 (prohibiting health-insurance policies from covering “elective abortion” except when the woman’s life is endangered and authorizing coverage only through optional supplement plans), Texas Statutes Online. ↩︎
31. National Women’s Law Center, “State Bans on Insurance Coverage of Abortion Endanger Women’s Health and Take Benefits Away from Women,” December 1, 2017. ↩︎
32. National Network of Abortion Funds, “How Abortion Funds Work,” accessed May 2024. ↩︎
33. The Brigid Alliance, “How the Cost of Accessing Abortion Care Is Increasing for Brigid Alliance Clients,” 2023. ↩︎
34. Lilith Fund, “Funding Requests Surge in the Wake of Dobbs: Report on Texas Abortion Fund Trends,” Texas Observer, August 13, 2025. ↩︎
35. National Network of Abortion Funds, “2024 Membership Enrollment Survey,” June 18, 2025. ↩︎
36. Kaiser Family Foundation, “Coverage of Abortion in Employer-Sponsored Health Plans in 2023,” February 29, 2024. ↩︎
37. Guttmacher Institute, “Medication Abortion Now Accounts for More Than 60% of All US Abortions,” Guttmacher Data Center, March 2024. ↩︎
38. Elizabeth Nash et al., “Post-Roe State Abortion Bans and Restrictions: Criminal, Civil and Professional Penalties,” Guttmacher Institute, updated December 2023; see also Caroline Kitchener, “States Seek to Police Out-of-State Abortion Pills,” The Washington Post, July 13, 2022. ↩︎
39. Elizabeth Nash et al., “Post-Roe State Abortion Bans: Criminal, Civil and Professional Penalties,” Guttmacher Institute, updated December 2023. ↩︎
40. New York State Senate, Reproductive Health Care Provider Shield Law (S.9079A/A.10372A), enacted June 2022; see also David S. Cohen et al., “The Rise of Abortion Shield Laws,” Columbia Law Review Forum 124 (2023): 1–22. ↩︎
41. Caroline Kitchener, “Telemedicine Abortion Providers Rely on Shield Laws to Reach Patients in Ban States,” The Washington Post, July 13, 2023. ↩︎
42. David S. Cohen, Greer Donley, and Rachel Rebouché, “The Rise of Abortion Shield Laws,” Columbia Law Review Forum 124 (2023): 1–22. ↩︎
43. Pam Belluck and Adam Liptak, “Walgreens and CVS Will Seek to Offer Abortion Pills Where Allowed,” The New York Times, March 3, 2023; see also Daniel Wirls, “Walgreens Won’t Sell Abortion Pills in 20 States, Even Some Where It’s Legal,” Politico, March 2, 2023. ↩︎
44. Arizona Revised Statutes § 36-2153 and § 36-2154 (requiring in-person counseling and a mandatory ultrasound before any abortion, including medication abortion), Arizona State Legislature; North Carolina General Statutes § 90-21.82 and § 90-21.83A (requiring an in-person consultation, a 72-hour waiting period, and ultrasound requirements prior to prescribing abortion medication), North Carolina General Assembly; and Georgia Code § 31-9A-3 and § 31-9A-16 (requiring an ultrasound and in-person physician examination before abortion, including medication abortion), Justia. ↩︎
45. Elizabeth Nash et al., “Post-Roe State Abortion Bans and Restrictions,” Guttmacher Institute, updated December 2023. ↩︎
46. Carafem, “Medication Abortion Telehealth Service Information: State Requirements,” accessed May 2024. ↩︎
47. American College of Obstetricians and Gynecologists, “Medication Abortion Up to 70 Days of Gestation,” Practice Bulletin No. 225 (2020). ↩︎
48. Pam Belluck, “Attorneys General Try to Revive 1873 Law to Halt Abortion Pill Access,” The New York Times, February 24, 2023. ↩︎
49. U.S. Code, 18 U.S.C. §§ 1461–1462 (Comstock Act), originally enacted 1873 (prohibiting mailing of “obscene, lewd, lascivious, indecent” materials, including abortion-related items). ↩︎
50. U.S. Code, 18 U.S.C. §§ 1461–1462 (Comstock Act), originally enacted 1873 (criminalizing the mailing of “obscene, lewd, lascivious, indecent” materials, including contraceptives and abortion-related information). ↩︎
51. U.S. Department of Justice, Office of Legal Counsel, “Application of the Comstock Act to the Mailing of Prescription Drugs That Can Be Used for Abortions,” December 23, 2022. ↩︎
52. Isaac Maddow-Zimet and Candace Gibson, “Despite Bans, Number of Abortions in the United States Increased in 2023,” Guttmacher Institute, March 19, 2024. ↩︎
53. Brady E. Hamilton et al., Births: Provisional Data for 2022 National Center for Health Statistics, National Vital Statistics Reports 72, no. 3 (June 2023): 1–20. ↩︎
54. Andrea V. Ciaranello et al., “Trajectory of Maternal Deaths in the United States After Abortion Bans,” Obstetrics & Gynecology 141, no. 2 (2023): 343–352. (This case is frequently referenced in trauma-surgery and maternal-mortality analyses discussing the impacts of restrictive state bans.) ↩︎
55. Selena Simmons-Duffin (NPR), “In Post-Roe Texas, Two Mothers with Traumatic Pregnancies Walk Very Different Paths,” NPR, July 4, 2023. ↩︎
56. Michelle Burrows and Sloane Alexandro, “New Mothers in Post-Roe America Face Stark Inequities,” Third Way, October 4, 2023. ↩︎
57. Students for Life Action, “Students for Life Action Details Ways to Address Federal Spending on Abortion in Letter to Capitol Hill on Appropriations Priorities for 2025,” May 21, 2024. ↩︎
58. Students for Life Action, “Students for Life Action Releases the Students for Life Action Scorecard for the 118th Congress,” February 27, 2024. ↩︎
59. Students for Life Action, “Students for Life Action Releases the Make America Pro-Life Again Roadmap,” November 8, 2024. ↩︎
60. Students for Life Action, Make America Pro-Life Again: A Post-Roe Policy Roadmap (Washington, DC: Students for Life Action, 2024). ↩︎
61. Students for Life Action, “Pro-Life Students Protest Walgreens & CVS Over Chemical Abortion Pills,” January 17, 2023. ↩︎
62. Pam Belluck, “Walgreens and CVS Will Seek to Offer Abortion Pills Where Allowed,” The New York Times, March 3, 2023. ↩︎
63. Susan B. Anthony Pro-Life America, “SBA Pro-Life America Builds Largest-Ever State Affairs Team in 30 States Heading Into 2023 Legislative Sessions,” press release, January 5, 2023. ↩︎
64. Susan B. Anthony Pro-Life America, “2023 Legislative Achievements Report: Protecting Life in the States,” June 2023 (summarizing SBA’s support for heartbeat laws, parental-involvement statutes, abortion-pill restrictions, and limits on taxpayer funding for abortion providers). ↩︎
65. Her PLAN (Her Pregnancy and Life Assistance Network), “About Her PLAN,” Susan B. Anthony Pro-Life America, accessed February 2025 (listing current operational states and expansion goals). ↩︎
66. Susan B. Anthony Pro-Life America, “SBA Pro-Life America Announces 2023–2024 Leadership Training & Election Mobilization Strategy,” press release, June 15, 2023. ↩︎
67. NARAL Pro-Choice America, “NARAL Sees 1,403% Increase in Online Donations Following Supreme Court Draft Opinion Leak,” press release, May 3, 2022. ↩︎
68. Josh Gerstein and Alexander Ward, “Supreme Court Has Voted to Overturn Abortion Rights, Draft Opinion Shows,” Politico, May 2, 2022. ↩︎
69. Amy Littlefield, “The New Abortion Access Activists Using Billboards, Bus Ads, and Guerrilla Tactics,” The Nation, January 11, 2023. ↩︎
70. Mayday Health, “Our Campaigns,” accessed February 2025 (archiving Mississippi billboards and state-specific outreach materials) ↩︎
71. Lauren Goode, “The Abortion Pill Fight Has Gone Totally Guerilla,” Wired, June 8, 2023 (detailing airplane banners at the Indianapolis 500 and national truck-ad campaigns). ↩︎
72. Mayday Health, “2023 Annual Update: Expanding Access in a Post-Dobbs America,” press release, December 2023 (reporting increased website traffic and inquiries from restrictive states). ↩︎
73. Pew Research Center, “Public Opinion on Abortion,” trend data updated April 2024 (showing an increase in support for legal abortion from 59% in 2021 to 63% in 2024). ↩︎
74. Public Religion Research Institute, 2023 American Values Survey: Women Under 30 and Reproductive Rights published November 2023 (reporting that 76% of women under age 30 support legal abortion in all or most cases). ↩︎
75. Daniel A. Cox and Jacqueline Clemence, “Post-Dobbs Opinion Change: How Personal Experience and Proximity Shape Abortion Attitudes,” Survey Center on American Life, American Enterprise Institute, January 2025. ↩︎
76. Rob Schenck, “I Was an Anti-Abortion Crusader. Now I Support Roe v. Wade,” The New York Times, June 1, 2019. ↩︎
77. Robin Marty, “Roe’s End Could Finally Awaken the Left,” Politico Magazine, May 3, 2022.  ↩︎
78. Sam Sawyer, “Pro-Lifers Must See More Than the Life of the Child—They Must See the Life of the Mother,” America Magazine, May 20, 2022. ↩︎
79. Guttmacher Institute, “Sex and HIV Education,” State Laws and Policies, updated January 2, 2025. ↩︎
80. Guttmacher Institute, “Sex and HIV Education,” State Laws and Policies, updated January 2, 2025; SIECUS: Sex Ed for Social Change, 2023 State Profiles: A New Vision for Sexuality Education in the U.S. released June 2024. ↩︎
81. Sarah Kaplan and Andrew Choi, “States Introduced a Record Number of Sex-Education Bills in 2024—Here’s What They Would Change,” CNN, March 7, 2024. ↩︎
82. Kate Sosin and Marisa Fernandez, “How Sex Education in Texas Leaves Students Unprepared for a Post-Roe World,” The 19th, July 21, 2022 (detailing Texas GOP platform–aligned proposals, including teaching that life begins at fertilization and incorporating ultrasound-related content in curriculum proposals). ↩︎
83. Kate Sosin and Marisa Fernandez, “How Sex Education in Texas Leaves Students Unprepared for a Post-Roe World,” The 19th, July 21, 2022 ↩︎
84. Melinda Lemke et al., “Gender-Based Violence and the Politics of Sex Education in the United States: Expanding Medically Accurate and Comprehensive Policy and Programming,” Youth 5, no. 4 (2025): 127. ↩︎
85. Guttmacher Institute, “Sex and HIV Education,” State Laws and Policies, updated January 2, 2025. ↩︎