The Future of Reproductive Freedom in America: A Conversation with Brigitte Amiri

Listen now on Apple Podcasts, Spotify, and YouTube.

Key Takeaways

• State constitutional amendments protecting reproductive freedom represent one of the most powerful tools available to litigators in the post-Dobbs era, and ballot measures have consistently demonstrated that abortion is more popular than any political party.

• The battles over medication abortion — including mifepristone, telehealth access, and Shield laws — are active, unresolved, and among the most consequential legal fights in reproductive health right now.

• Abortion stigma is not a side issue. Amiri argues that shame and stigmatization made it easier for the Supreme Court to treat abortion as something other — and that dismantling stigma is part of the legal and cultural fight.

• Durable reproductive rights will require a long-term strategy. Amiri's vision includes a federal constitutional amendment modeled on the state-level protections that have proven resilient to political whims.

• Everyone has a role. From normalizing conversations about abortion to volunteering with clinic escort programs to supporting abortion funds, Amiri encouraged listeners — especially young people — to start locally and stay engaged.

A Landscape Transformed

Roughly one in four women in the United States will have an abortion by the age of 45. That statistic, grounding and often overlooked, opened a conversation that refused to traffic in abstractions. Four years after the Supreme Court's Dobbs decision overturned Roe v. Wade and ended the federal constitutional right to abortion, Dr. Thoại Ngô sat down with Brigitte Amiri to make sense of where things stand — and where they are headed.

Amiri has spent more than two decades litigating reproductive rights cases at the ACLU, from challenges to state abortion bans to lawsuits protecting Title X, the nation's only dedicated federal family planning program. She is clear-eyed about the weight of this moment. "It's been a very rough several years," she said. "But I see my work as what I'm called to do, and I don't really know how to do anything else."

What followed was one of the most substantive public conversations about abortion rights in recent memory: part legal primer, part historical reckoning, part call to action.

Two Stories at Once

Amiri described the current landscape as a tale of two parallel realities. In one, the news is genuinely encouraging. Following Dobbs, grassroots organizers in state after state mounted ballot initiatives to enshrine reproductive freedom in their state constitutions — and won, often in places that defied political expectations. Missouri voters passed a reproductive freedom amendment in the same election they voted for Donald Trump. Ohio voters passed five cases' worth of new constitutional protections that have since transformed the state into a regional haven for abortion access, surrounded as it is by states with near-total bans.

"We as litigators can use those constitutions to strike down abortion restrictions that have been on the books for a very long time," Amiri explained. These state-level wins represent, in her words, one of the most significant forms of progress the movement has made since Dobbs.

The other story is harder. Twelve states now have near-total abortion bans. Federal threats loom — over medication abortion in particular, and potentially over contraception. Amiri is watching closely for restrictions on mifepristone, one half of the two-drug medication abortion regimen that today accounts for nearly two-thirds of all abortions in the United States. Telehealth prescribing, Shield laws allowing providers in legal states to mail pills across state lines, and the broader FDA approval of mifepristone are all currently subjects of active litigation.

Dr. Ngô, who completed his doctoral research on improving access to medication abortion in low- and middle-income countries, pressed Amiri on the whiplash that has come to define this terrain. "One day I wake up and hear that mifepristone is being restricted. A couple hours later, I hear it's back." Amiri's answer was honest: the legal battles are unresolved, the outcomes uncertain, and the landscape is shifting faster than most people can track.

The Human Cost Behind the Numbers

Since Dobbs, the national number of abortions has actually increased — a fact that supporters of the decision did not anticipate. In 2024 alone, approximately 150,000 patients obtained abortions outside of their home states. For some observers, that figure is read as evidence that access has been maintained. Amiri pushed back on that reading with characteristic precision.

"The facts and figures don't tell the human story," she said. Traveling across state lines for abortion means reliable transportation, time off work, child care, and in some states, two separate trips due to mandatory waiting period laws. It means financial cost and logistical burden falling heaviest on those who can least afford it. And for some, it means not going at all.

"We know people have not been able to obtain abortion because of the bans in their home states," Amiri said, "and we know people who have suffered emergencies and people who have died."

Her vision for what access should look like is clear: "Our vision has to be ensuring access for everybody, no matter where they live, no matter their income — and with dignity, without shame, without violence."

That last phrase carries particular weight. Amiri argued that the stigmatization of abortion in American life made Dobbs easier for the Court to hand down — that treating abortion as something other, something shameful, made it possible to strip away a right that had stood for fifty years. Changing that, she suggested, is as much a part of the fight as any brief filed in any court.

What Durable Rights Require

Dr. Ngô pressed Amiri toward hope without bypassing the hard realities. What does the path back to a federal constitutional right to abortion actually look like?

Amiri was direct: it will take a very long time. She is not convinced the Supreme Court is the right venue, or that restoring Roe in its original form is the right goal. Instead, she pointed to the state constitutional amendments as a model — not just for abortion, but for a broader reproductive freedom framework that includes contraception, prenatal care, and the right to give birth. A federal constitutional amendment, she said, is ultimately what the country needs if it wants rights that do not bend with every political cycle.

In the meantime, she offered a three-part charge to listeners. First: things will get worse before they get better — be prepared, not alarmed. Second: doing nothing guarantees there is no bottom to how bad it gets. Third: keep fighting, because change — real, lasting change — is possible.

She knows this because she has seen it happen. She grew up in Michigan, a state she described as heavily restrictive on abortion when she was young. "I really couldn't see how things were going to change," she said. Then, just a few years ago, Michigan passed a sweeping reproductive freedom amendment with broad popular support. "In my lifetime, my home state has gone from a heavily restricted abortion state to a state that protects not just abortion but a whole host of reproductive freedoms in their state constitution. That to me is amazing and gives me hope."

PopTalks is a new podcast from Dr. Thoại Ngô and Columbia's Department of Population and Family Health. New episodes release every two weeks.

Subscribe on Apple Podcasts, Spotify, and YouTube.