Four years after the Dobbs decision, abortion access looks very different

The Dobbs decision returned abortion policy to the states. Four years later, NPR's Selena Simmons-Duffin examines how that promise has played out in practice.

Transcript

ADRIAN FLORIDO, HOST:

It's been nearly four years since the Supreme Court decided what is known as the Dobbs case, overturning the constitutional right to abortion. On that day in June of 2022, ALL THINGS CONSIDERED host Ailsa Chang spoke with NPR health policy correspondent Selena Simmons-Duffin.

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AILSA CHANG: Well, already today, we have seen several states - Missouri, Alabama, just to name a couple - these states are announcing laws on their books banning abortions are now in effect. So what does that mean for the doctors in those states?

SELENA SIMMONS-DUFFIN, BYLINE: Well, it means there's a whole new legal regime that could very well affect how they practice medicine.

FLORIDO: As Selena has reported over the years, that new legal regime has changed abortion laws and practices in many ways, and she has covered every turn in the story. Like this report from 2023, about the health impact of the Dobbs decision.

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SIMMONS-DUFFIN: A survey of OB-GYNs came out this week from the health policy group KFF, and a large majority - 68% - said the Supreme Court ruling allowing states to ban abortion has worsened their ability to manage pregnancy-related emergencies.

FLORIDO: And this report from 2024 on the unexpected increase in abortions after Dobbs.

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SIMMONS-DUFFIN: So an important piece of context is that the number of abortions in 2023 actually went up, and that fact surprised researchers and has galvanized anti-abortion activists.

FLORIDO: Most recently, she's been reporting on the ongoing legal battle over access to the abortion pill mifepristone. Here she is last month.

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SIMMONS-DUFFIN: The justices issued a stay pending appeal, so telemedicine access can continue as it has been while the case plays out in the lower courts.

FLORIDO: Reporting the story has not been easy. She has to get up to speed on medical science, politics, and dive into legal cases.

SIMMONS-DUFFIN: My editor and I were - we were watching the Supreme Court a couple weeks ago, and she was like, it's just, like, every once in a while that we have to become Supreme Court experts. The medical side is almost, like, the simplest part. The court side can get confusing.

FLORIDO: And there's the question of getting people to open up about their very personal experiences with abortion. So for this week's Reporter's Notebook, I started by asking Selena how she does that.

SIMMONS-DUFFIN: I realized pretty quickly that the only way to find patients to talk about this was to have them come to you. You know, as a health reporter, sometimes you can - if you're interested in a topic, you can find a provider and say, like, hey, are there any patients? Can you give them my number? You can kind of go that route. That's really not appropriate (laughter) in this context. You need to find people who want to talk to a reporter and have something to say.

So we - at NPR, we sometimes do callouts where we put online a story that says, like, hey, we want to hear from you, and we have a form for people to fill out. And they say, you know, you can reach me. Here's what I have to say. Here's where I am. So we did one right after the Dobbs decision, and I heard from a lot of people that I connected with and ended up doing feature stories on. And we've done subsequent ones about mifepristone use because the story has kind of moved in that direction...

FLORIDO: Yeah.

SIMMONS-DUFFIN: ...Because medication abortion has become such an important part of how abortion happens in the U.S. It's now, I think, two-thirds of abortions happen using these medications.

FLORIDO: Selena, a lot of your reporting since the Dobbs decision has focused on how reproductive healthcare has been affected by abortion bans. Is there any story that you've reported that sort of, you know, encapsulated for you the unintended health consequences that bans or severe restrictions are having?

SIMMONS-DUFFIN: So the story that comes to mind is Jaci Staton. She is - lives in Oklahoma, and she already had a couple of kids, got pregnant, was excited about it - started bleeding in her kitchen. And it turned out that she had a molar pregnancy. There was no embryo. There was no baby. And a molar pregnancy can be dangerous because you can bleed and bleed and bleed. And she went to the hospital, and they, you know, understood the situation. But they understood Oklahoma's law to say that only if she were really close to death could they act. So, you know, she was - there was no baby. Like, she was never going to give birth to a baby. She...

FLORIDO: Yeah.

SIMMONS-DUFFIN: ...Was clearly in danger of getting really sick. And she was terrified. Her husband was terrified. I mean, he really thought that she was going to die. And he was at her bedside saying, you know, what am I going to do? And she was told by the hospital staff to go wait in the parking lot until she got sicker.

And I feel like that story really hit people. She ended up driving to Kansas and having an abortion. And she - I mean, she was clearly still processing it when she was talking to me, but she was also really mad. And she, you know, identified as pro-life and was like, what just happened? Like - and in the end, she decided to have a tubal ligation so she couldn't get pregnant again 'cause she was afraid of something happening to her again.

FLORIDO: How are you noticing that the needle has moved or is moving on the stigma associated with abortion?

SIMMONS-DUFFIN: Yeah, I definitely think it has changed. There is an element, especially with some of the early reporting that we did right after the Dobbs decision, where people were just baring their - these horrible brutal stories about miscarriages and waiting for care or people. I spoke to a woman named Samantha Casiano who - I spoke to her days after she had given birth to a baby who lived for a few hours, and she was pregnant for months knowing that the baby wasn't going to survive.

And there's something just so wrenching - and there is a moment where my editor and I were saying, like, why do people have to share these things with the world? Like, these are some of the hardest things that you can live through, and it almost feels like in order to make it clear why this matters, why these policy issues matter, you have to ask people to just really bare their souls. I think that as more and more people have shared their stories, that's had this kind of - a snowball effect where it empowers the next person to be willing to share.

FLORIDO: You know, if you had to summarize where access to abortion currently stands the - in the United States, how would you do that? How would you summarize that?

SIMMONS-DUFFIN: Yeah. I mean, I would say that it's an inflection point. I mean, the current kind of delicate balance of the patchwork where you have, you know, over a dozen states with complete bans and some places with gestational limits at six weeks or blah, blah, blah, and then you have other places that are setting themselves up as safe havens for abortion access that create these shield laws.

I mean, this is - we've lived with this for on - coming up on four years now, some version of this patchwork. And I just - it doesn't quite feel sustainable. Like, it feels a little combustible, I would say. And there's this pending court case out of Louisiana that, depending on how the Supreme Court rules, could really blow it up and create a whole different universe of policy context for what abortion access looks like.

FLORIDO: I've been speaking with Selena Simmons-Duffin, health policy correspondent here at NPR. Selena, thanks.

SIMMONS-DUFFIN: You're welcome. Transcript provided by NPR, Copyright NPR.