Comment: Assault on abortion access quieter; just as dangerous

By Lisa Jarvis / Bloomberg Opinion

In the three years since the landmark Supreme Court decision overturning Roe v. Wade, the number of abortions in the U.S. has steadily increased, according to new data from the Society of Family Planning. Those data reflect the monumental effort to maintain care; and the increasingly vital role of medication abortion and telehealth in the U.S.

But make no mistake: Abortion access under the Trump administration is increasingly fragile.

Abortion providers and funders are competing for dwindling donations. Republicans are trying to bar Planned Parenthood from receiving Medicaid funding. States with bans are introducing disturbing laws intended to criminalize women seeking care. And anti-choice activists are pushing for new restrictions on prescribing and dispensing mifepristone, one of two pills that comprise medication abortion.

These threats won’t just affect women in states with the most restrictive laws. Those in places where abortion is legal could face longer waits for appointments, fewer options for care, and less financial support to cover it. Women in states where the procedure is banned may have to travel further for care; and many may end up going without, either because they can’t afford the trip or are afraid to.

The threat to mifepristone poses one of the most profound challenges to reproductive freedom in the U.S. The Society for Family Planning’s #WeCount initiative underscores the indispensable role medication abortion plays in maintaining access regardless of where a woman might live. Since the Food and Drug Administration eased restrictions on prescribing and dispensing abortion pills in 2021, the method has become the most widely used form of abortion care, accounting for 63 percent of all abortions nationwide in 2023.

That shift has been facilitated by telehealth, which has allowed women living in states with — and without — bans to more easily access timely care. According to #WeCount, by the end of 2024, 25 percent of all abortions were provided by a virtual clinic, compared to just 5 percent in early 2022.

However, all that progress could be undone by the FDA, which has been ordered to review the data on mifepristone by Health and Human Services Secretary Robert F. Kennedy Jr.

Reams of data affirm the safety of the drug; including when it is prescribed via telehealth. The worry, though, is that instead of following the science, the FDA will consider anti-abortion activists’ questionable analyses. That fear was reinforced last month during an exchange between Kennedy and Republican Sen. Josh Hawley of Missouri, who brought up a new “study” from abortion opponents that claims 11 percent of women who use mifepristone experience an adverse event. “It’s alarming, and it indicates that at the very least, the label should be changed,” Kennedy said.

The problems with the report are almost too many to list, but for starters it wasn’t published in a peer-reviewed journal and the authors failed to disclose the source of the data or the methods used in their analysis, says Ushma Upadhyay, a professor at the University of California, San Francisco. They also grossly overstate the safety issues associated with mifepristone. For example, they count routine medical visits — such as a woman visiting an emergency room with a question or to get an ultrasound to confirm the abortion is complete — as a “serious adverse event.” (The FDA’s label for the drug puts the rate of serious side effects at around 0.5 percent.)

However, if a politically motivated FDA finds these questionable reports compelling, the agency could decide to reinstate restrictions, such as those on in-person prescribing and dispensing. Forcing women back into brick-and-mortar clinics would mean many, especially the most vulnerable, would lose access to care altogether. Those who can travel may find appointments harder to come by, which could delay care until later in a pregnancy, leaving fewer options for providers and procedures. “These are all things the anti-choice movement is counting on,” Upadhyay says.

Republicans’ plan to defund Planned Parenthood by stripping its Medicaid funding would also limit women’s options. The nonprofit organization is a vital provider of reproductive health care for low-income women. In 2021, 1 in 10 women of childbearing age and covered by Medicaid accessed a routine service, such as birth control, Pap smears and breast exams, from a Planned Parenthood clinic, according to an analysis by KFF.

Yet Republicans would bar any clinic that offers abortions from receiving Medicaid funding for any service. That would gut the budgets of the organization’s affiliates. For example, about 40 percent of Planned Parenthood of Illinois’ patients use Medicaid, accounting for about 30 percent of its revenue, interim President and Chief Executive Officer Tonya Tucker says. The loss of Medicaid would leave a $16 million hole. “We would have to take a step back and look at our operations and determine whether or not we could sustain ourselves with our current footprint,” Tucker says.

That would put a tremendous strain on access to abortion care for women who live in Illinois and neighboring states, many of which have strict bans. Planned Parenthood of Illinois has already closed four health centers this year, part of the 20 or more affiliate clinics to shutter around the country amid funding struggles. The Medicaid change could add another 200 clinics to that list nationwide, the organization says.

And then there is the fear factor. Every abortion funder and provider I spoke with told me their patients are more afraid to access health care, whether because of the specter of laws that seek to criminalize patients or because their immigration status makes them terrified of leaving the house, let alone crossing state lines.

A monumental effort has allowed many American women to maintain bodily autonomy despite restrictive abortion laws in their state. But three years after the Supreme Court’s decision, the threat to reproductive freedom feels even more urgent than ever; and is evolving in ways that jeopardize access for everyone.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News. ©2025 Bloomberg L.P., bloomberg.com/opinion.