Abortion as a Lens on Health Governance in the Post-Dobbs United States

Health governance refers to the systems and institutions that structure access to healthcare, shaping who receives care and through which pathways. Abortion provides a particularly revealing lens for examining health governance because it operates at the intersection of law, ideology, and structural conditions, making visible how governance acts on bodies to produce unequal outcomes. In recent years, two key modalities of reproductive care, Crisis Pregnancy Centers (CPCs) and telehealth abortion services, have emerged as key mechanisms within this governance system, operating as distinct forms of healthcare. CPCs are predominantly Christian organizations that oppose abortion and contraception and typically operate without medical licensure. They target individuals seeking reproductive healthcare, disseminate misinformation, and receive public funding, effectively functioning as pseudo-medical institutions. In contrast, telehealth abortion services have become integral to abortion access post-Dobbs, operating across state lines within fragmented and shifting legal environments, while remaining contingent on digital infrastructure and financial access. I argue that abortion governance in the United States operates through three intertwined mechanisms: legal restrictions that define the boundaries of lawful care; ideological infrastructures, including CPCs, that normalize these restrictions and redirect patients away from clinical services; and structural conditions, such as geographic access, insurance coverage, and digital connectivity, that determine whether legal rights translate into material access. I conceptualize this framework as the Pronatalist Political Economy. Using this framework, this study examines how post-Dobbs health governance produces a fragmented and uneven geography of abortion access across states. As no existing dataset captures the layered and modality-specific nature of abortion governance, I construct the Abortion Governance Dataset (AGD), which integrates legal, ideological, and structural indicators across abortion care modalities in the United States. The AGD links abortion provision outcomes with state policy environments, reproductive health infrastructure, and sociodemographic conditions. Using Ordinary Least Squares regression, I analyze variation in total and telehealth abortion provision rates in 2024. Findings demonstrate that governance mechanisms operate differently across modalities: total abortion provision is shaped primarily by legal restrictions and CPC density, whereas telehealth provision is influenced by telehealth-specific regulations and financial access conditions. These results show that aggregated abortion rates obscure distinct governance dynamics and underscore the need for modality-specific analysis in reproductive health governance research.