Abstract
After Dobbs will satisfy any reader looking for a nuanced exploration of the experiences of providers and patients navigating the chaotic legal landscape of abortion restrictions in America since the Dobbs decision. The primary research for the book occurred throughout 2022, and the book was completed in mid-2024 during the tight battle for the White House. An epilogue was included just prior to publication, noting that Donald Trump was entering the executive office and speculating on what that might mean for abortion access in the coming years.
The book opens with an introduction narrating true stories about how varying state laws are impacting those seeking abortions and those providing abortion-related health care. This powerful beginning sets the tone for the book, which skillfully interweaves historical accounts of courtroom battles with qualitative narratives from providers who are living and adapting in an ever-evolving legal landscape.
Next, the authors provided a detailed timeline of the legal and political maneuverings that ultimately led to the Dobbs decision. Reading the history with 20/20 hindsight, it becomes easy to see how the overturn of Roe v. Wade was the inevitable conclusion of decades of strategic planning by anti-abortion groups; however, what was shocking was the degree to which providers and others who have been on the ground in the pro-choice movement knew the end of abortion as a federal right would occur in mid-2022 months before Dobbs came to pass.
The co-authors’ complementary backgrounds in sociology and law enable them to provide an analysis of the legal history that led up to Dobbs and to offer compelling anecdotes on the impact, reaction, and adjustments made by providers to ensure access to abortion services post-Dobbs. The methodology of the book is a qualitative study involving interviews with 24 providers and activists at three different timepoints in 2022: prior to Dobbs, immediately post-Dobbs, and six months post-decision. A strong conservative majority dominating the Supreme Court, the leaked draft of the Dobbs decision, and SB8 essentially ending abortion in Texas indicated what was to come for abortion providers and gave them time to plan prior to the announcement of the official Dobbs decision. Though some clinics closed, others were able to move across state lines to pro or uncertain abortion states, and many had started the process before Dobbs. Additionally, pro-choice states were able to begin expanding their services prior to June 2022 when the decision was released.
It should come as no surprise that a recurrent theme throughout the book is the chaos that continues to ensue as state laws are vague and ever-evolving due to legislative changes and legal challenges. As the authors so eloquently explain “while the general public watches…from afar…those who have to work on the ground…don’t have that luxury” (p. 95). The narratives from providers vividly paint the stress induced by shifting regulations. As one example of many, a provider laments over having to turn away patients who had already been through the informed consent process and were in the state's required waiting period when the state law changed overnight and no longer permitted the procedure. Such stories will resonate with social workers caught between professional ethics and legal mandates.
The first-hand accounts of the legal chaos drive home the headlines we have been reading for the past few years. More shocking to many readers may be the details involved in planning clinic relocations. For example, a provider recounts having to search for real estate for new clinic space in disguise and having to partner with local organizations and police enforcement to ensure safety and at least some local acceptance of the new clinic.
Not only were logistical changes to clinics needed, but medical protocols have been altered. Providers explained that they have been forced to change some best practices. For example, some abortion procedures that would have been done over two days pre-Dobbs are now done in one. The providers stress that these changes have been instituted to suit politicians rather than medical science.
While the book is a heavy emotional read, the positive theme encapsulated in the title resonated throughout the book: regardless of the onerous bans in many states, at least at the end of 2022, many women were still able to get the abortion care they needed or desired. The expansion of care in pro-choice states and increases in clinics across state borders are part of the reason for continued abortion access. Several providers talk about how women are procuring services more quickly because funding and logistical help are being provided through donations and organizations to help women travel for abortion care. The authors refer to the influx of money as “rage” donations, with many providers fearful these funds will dry up as the reality of the new post-Dobbs world settles in. It is also possible that services may decline due to the strain on provider organizations to maintain the morale of volunteers and staff.
The book closes with some thoughts on how the second Trump administration could limit abortion further, and how providers could use the stories in this book as paths of resistance. Nearly a year since the election, these attacks on abortion have not developed on the federal level, likely because abortion bans have proved so clearly unpopular when citizens have had the opportunity to vote on the issue in ballot initiatives. This book is evidence that “Dobbs, paradoxically, has propelled the abortion landscape to offer more options than ever existed before” (p.168).
