Rebecca Hart Holder

“What are you going to do to protect me, because I am not going to stop providing care,” she said. That’s the call I received from an abortion provider on the fateful night that the Dobbs decision was leaked in 2022. Her words became my rallying cry from that moment on. Up until the Supreme Court ruled to overturn fifty years of judicial precedent and upend abortion rights, I had structured my worldview around a faulty premise—that the courts would ultimately, despite setbacks, protect reproductive freedom. That painful night made clear what had long been true for many: relying on the courts or elected officials to vindicate our human right to bodily autonomy is a losing strategy.

Rebecca Grant’s Access: Inside the Abortion Underground and the Sixty-Year Battle for Reproductive Freedom reminds us that abortion access has always been precarious—and that the most enduring and courageous work has often happened in defiance of the law, not because of it. Access traces a lineage of care from the Jane Collective to Women on Waves to modern-day telehealth providers operating in legal gray zones. It insists that legality is not the same as justice, and that access is not the same as rights. The formal systems may shift—and with Dobbs, they collapsed—but abortion seekers and their helpers have never waited for permission.

Dobbs didn’t end abortion; it forced radical innovation. The decision created profound suffering, especially for Black and Brown communities in states with bans. It accelerated the criminalization of pregnancy and worsened maternal health. And yet, by forcing the fight to the states, Dobbs also reignited the underground. As Grant documents, a new generation of activists, providers, and accompaniers has stepped up to meet the need—mailing pills, building cross-border care networks, and declaring boldly, “we refuse to comply.”

Eight states have passed telehealth shield laws protecting providers who mail abortion pills into states with abortion bans. These shield laws are not just policy wins; they are power shifts. They declare that care will not be confined by geography or ideology. They devalue traditional gatekeeping in favor of community-based harm reduction. As Access shows, this is the feminist promise of medication abortion finally realized: safe, effective, and radically distributed. And the work is having an impact. Despite the Supreme Court’s ruling in Dobbs, the overall number of abortions in the US has not gone down. Many people, though not all, are getting the care they need—just through new, defiant, and decentralized systems.

This moment tells us much about the state of feminist resistance in the US. Historian Ruth Ben-Ghiat writes that authoritarian regimes rely on the “discipline, demeaning, and criminalization” of women to preserve white Christian male dominance. In that context, the work of abortion providers protected by shield laws is more than medical; it is political resistance. It is a refusal to cede the terrain of bodies and futures to courts and politicians. As Grant writes, activists today operate not in the shadows but “inside, outside, and along the margins of the law,” forging what she calls “transformative illegality”—resistance so widespread it renders the law incoherent.

Mailing pills is not just public health; it is feminist praxis. It is over-the-counter defiance of a corrupt Court and a crumbling system. In doing this work, these providers have become the standard bearers of a post-Dobbs feminist movement in the US, one defined by pragmatism, solidarity, and a fierce unwillingness to wait.

Abortion access in this country is not static. It is not granted from above or secured once and for all. It is created—day by day, pill by pill, act by act—by people who refuse to surrender their power. Access reminds us that the struggle for abortion is not just a fight over policy; it is a fight over who gets to live freely and on their own terms. And it is far from over.

Katrina Kimport

Access, by Rebecca Grant, is a well researched, original examination of abortion activists. Not abortion seekers, not clinical providers: activists. And not your usual suspects, either. The activists Grant catalogs aren’t leading marches or lobbying legislators. They don’t exclusively target the political system. In fact, some are not interested in politics at all. Rather, the activists profiled in Access work to make abortion possible and obtainable for individuals who need it. They cultivate practices, leverage technologies, and innovate outside of and in opposition to unjust laws. Much of the history, research, and journalism on abortion rights activism has focused on politically targeted activism by name-brand US-based organizations, glossing over the movement’s legacy of direct action and the transnational collaborations that undergird it. Access is thus a welcome addition—and partial historical corrective. As Grant writes, it puts these activists’ stories “on the record.”

As the title suggests, the activists profiled in the book aren’t focused on what is legal; they are focused on what is accessible. More pointedly, they are focused on what they can do to make safe abortion more accessible to more people. Access is an account of people who prioritized the needs of abortion seekers over fears of personal risk. It is the story of people who declined to comply in advance and sometimes even invited arrest and the opportunity to make their case in the proverbial public square. By centering these activists’ work, Grant returns agency to abortion advocates and potentially to readers feeling disheartened about the prospects for abortion rights and reproductive justice in the contemporary US.

Some readers will take away not just a richer understanding of abortion activism but also hope and perhaps some lessons in creativity and perseverance in activism. This is important at a moment when the Right’s shock-and-awe approach has overwhelmed social-justice activists in the US. Access charts the stories of people who continued their work—innovating, leveraging new technologies, and taking personal risks—against very long odds.

What’s missing from Access is an exploration of how these activists built power. Especially in the first and second sections, Access assembles a “great woman” version of the history of abortion activists. Charismatic visionaries are important—and inspiring—but true feminist gains come through collective organizing. I don’t mean this as a knock against Grant’s meticulous work. Rather, I think of it as an invitation to ask more questions about past and present abortion activism—questions that emerge thanks to Grant’s book.

For me, Access is the latest example of a long-awaited shift in the legitimacy of journalistic coverage of abortion. Grant writes that in 2015 she decided to create her own beat focused on reproductive rights. She was met with skepticism but persisted nevertheless. That commitment yielded deep understanding of the landscape of abortion and enabled her to tell stories that haven’t been publicly told. Access educates audiences about abortion beyond the legal debate, political slogans, and out-of-touch claims of a post-Dobbs return to the “back alley” and “coat hangers.”  In a way, Grant did exactly what the activists she profiles did: create the work you find meaningful and trust that the world will catch up.

Kelly S. O’Donnell

When I wrote about the historical memory of the 1960s-70s underground abortion collective Jane for Signs in 2017, examining why abortion-rights supporters kept returning to that story in moments of political crisis, I thought that while abortion rights were a threadbare patchwork, at least things were stable and predictable (if deeply unequal). How naïve I was. Less than a decade later, Roe is gone, and legal chaos continues to reign. There is some small comfort, at least, in the predictability of Jane histories returning in full force, in both academic and popular discourse.

Reviewing journalist Rebecca Grant’s Access: Inside the Abortion Underground and the Sixty-Year Battle for Reproductive Freedom almost feels like writing an epilogue to that article. The book is not exclusively about Jane, of course, though the group makes a lengthy appearance. But the deeper point still stands: here we are yet again, looking to the past and reaching for stories of community-centered, patient-controlled, outside-any-unreliable-systems approaches to fertility management in troubled times.

Access is “a book about efforts to provide reproductive freedom in the face of oppressive political, social, and religious headwinds,” Grant gives us Jane, again, but also Madame Restell’s booming nineteenth-century business, Patricia Maginnis’s defiant 1960s leaflets and classes, the 1970s menstrual-extraction device of feminist bookstore fame, Verónica Cruz Sánchez’s cross-border abortion aid, the boats and boundless creativity of Women on Waves, today’s digital operations that ship abortion pills around the world, and much more in between. Grant’s slate of examples across time are all gripping stories, and they remind us that when systems (legal, medical, or otherwise) fail, people don’t stop needing care. And sometimes, others step up to provide it.

As shown in the more recent and present-day stories, some health activists are no longer merely trying to fix the system. They are building other systems entirely, ones that prioritize intimacy and care over policy and compliance. The very concept of “access” has been upended. And yet, as Access shows, this tension has been with us for a very long time, regardless of abortion’s technical legal status. After New York’s legalization of the procedure, Grant writes, Jane’s members realized that “lawful did not automatically translate to good care and… illegal care didn’t have to be inferior.”

If the post-Roe years have made anything clear, it is that no federal protection, no court ruling, and no institutional framework can be relied upon entirely to safeguard reproductive autonomy for the long haul. Trust in the Supreme Court, in state governments, in pharmacy chains and hospital systems, and in the FDA’s basic regulatory authority has all eroded. What remains is what has always remained: community.

Reproductive-justice work has often flourished at the edges. We see it most clearly enacted in things like the anonymous leaflet, the whispered referral, or the smuggled pill. These are also emblematic of alternative infrastructures of care. Grant does not romanticize abortion undergrounds, nor does she offer them as scalable solutions to a massive public health crisis. But she does, quite powerfully, remind us that scale isn’t always the right metric. The ethos on display in the histories presented in this book—“rooted in principles of mutual aid and … abortion as a community responsibility”—is the real story here.

Rebecca Grant

In April 2022, I received a Signal message from a source who was willing to talk to me about her intention to distribute abortion pills outside of FDA-approved channels. She started this work during COVID, when clinics across the country suddenly closed, and with the Supreme Court’s decision in Dobbs v. Jackson Women’s Health looming, she was preparing to scale up her operation. As a journalist who had been on the “repro” beat since 2015, this felt like a pivotal moment. I thought it highly likely that Roe v. Wade would be overturned and that a modern underground with pills at the center would emerge in the US, as had long been the case in countries with abortion bans. I just hadn’t known who would spearhead the effort or how it would happen, and now here was a source, calmly telling me her plans.

In some ways, this was a seed I would go on to build Access around. I was inspired by the stories of activists who were unwilling to let politicians, judges, or even doctors dictate who could access abortion. They saw self-managed abortion both as a form of direct action and a tool of resistance, and in doing so, they joined a global feminist lineage. In the book, I wanted to trace that lineage in all the directions it took me: through the underground networks of midcentury America; the voyages of Women on Waves with the Dutch doctor Rebecca Gomperts; the streets of Guanajuato, Mexico, where Verónica Cruz Sánchez founded Las Libres; and to contemporary America, where those legacies laid the groundwork for a new crop of activists who are building a self-managed abortion ecosystem for a post-Dobbs world.

In her commentary, I was interested to learn about Rebecca Hart Holder’s own experience of disillusionment with institutions after the Dobbs decision leaked and about how, like many of the sources in the book, Dobbs served as a moment of reckoning. I wanted Access to have a tone of defiance, and appreciated her moving words about how she sees abortion access now: “It is created ‘day by day, pill by pill, act by act—by people who refuse to surrender their power.’”

Katrina Kimport also noted the spirit of defiance that runs through the book, and writes that while Access serves as a “welcome addition” and “partial historical corrective,” it is also missing an exploration of how these activists built power, focusing instead on a “great woman” version of history. I think that’s fair. In choosing the activists to center, I aimed to highlight their roles as charismatic visionaries in part because I wanted the book to feel character and narrative driven, but also because I saw these figures as driving paradigm shifts in what abortion access could look like. Their innovations catalyzed collective organizing, but the nitty-gritty, hard work of building coalitions and grassroots power did not receive the same attention, and I agree that that’s how true feminist gains are made.

Finally, I think Kelly O’Donnell raises an interesting question about why abortion supporters return, again and again, to the story of the Janes in moments of political crisis. Since there has been so much discourse about the group, I was unsure about dedicating an entire chapter to them in Access, but as I reported on the underground networks active today, I kept picking up on points of resonance. The ex-pats who formed the American wing of Las Libres in 2022 referred to themselves as “the Juanas,” for instance, and I saw parallels between my anonymous source Stephanie’s insistence on decentralization and compartmentalization and how the Janes structured their organization. Perhaps because of their role in popular culture, the Janes were an inspiration to many of the activists working in the 2020s, and those connections felt important to draw.

In all three of these thoughtful commentaries, the writers emphasize the crumbling faith in institutions that the Dobbs decision triggered and highlight the power of activists and ordinary women who stepped up to ensure abortion remains accessible, regardless of the law. Kimport writes, “In a way, Grant did exactly what the activists she profiles did: create the work you find meaningful and trust that the world will catch up.” I wasn’t sure how such a radical book would be received, but my hope was that it would help move the conversation forward. Reading these commentaries, I’m heartened to think it might have.