Today marks 52 years since the Supreme Court’s landmark ruling in Roe v. Wade—and nearly three years since the Court’s decision to overturn it. With federal protections for abortion dismantled, access to reproductive health care now depends almost entirely on where a person lives. This decentralized, state-by-state approach has created a dangerous and confusing patchwork of laws, forcing millions of Americans to navigate medically unnecessary restrictions, legal uncertainty, and, in some cases, outright bans on their fundamental rights. But while some states have moved swiftly to strip away reproductive freedoms, others have stepped up to safeguard and expand access, proving that state leadership is now the frontline in the fight for reproductive freedom.

In the past two years, we’ve seen near-total bans take effect, patients being forced to travel hundreds of miles for care, and doctors threatened with prosecution for providing essential medical services. For some, these laws have meant fleeing their home states in search of medical care: Mylissa Farmer was denied emergency abortion care in Missouri and Kansas and had to leave her home state of Missouri to receive treatment. Amanda Zurawski nearly died of sepsis after being refused care in Texas when her water broke at 18 weeks, and Kate Cox, another Texas woman, was forced to leave the state for an abortion despite a fatal fetal diagnosis and serious risks to her own health.

In the most tragic cases, women have lost their lives because of these cruel laws. The deaths of Josseli Barnica and Porsha Ngumezi in Texas and Amber Nicole Thurman in Georgia were not tragic accidents—they were the foreseeable consequences of a post-Roe reality.

But since Roe was overturned, a growing coalition of governors has stepped up to protect access to critical reproductive health care within their borders. That’s why, in 2023, we launched the Reproductive Freedom Alliance—the first-ever nonpartisan coalition of governors committed to defending and expanding reproductive freedom at the state level. Through the Alliance, governors are coordinating efforts, sharing resources, and acting as the first line of defense against attacks on reproductive rights.

In the wake of the overturn of Roe, we’ve seen real progress in Alliance states, demonstrating the power of governors to take decisive action in protecting reproductive freedom through executive actions, budgetary authority, legislation, and regulation.

Since 2022, governors have enacted shield laws in 20 states, protecting patients and providers from out-of-state penalties and prosecutions. Recognizing the critical role pharmacies play in access to medication abortion, governors have also urged major U.S. pharmacy chains not to bow to political pressure and dispense mifepristone, reinforcing their commitment to maintaining access to care.

Beyond immediate protections, states are investing in the long-term sustainability of reproductive health care. Nearly all Alliance states have leveraged Medicaid expansion under the Affordable Care Act to ensure contraception is covered, expanding access for low-income individuals. Additionally, states are investing in provider training programs to ensure that reproductive health services remain available and accessible to patients, even in the face of mounting restrictions elsewhere. Meanwhile, states such as California, Connecticut, Illinois, and Washington are strengthening privacy protections to prevent sensitive health records from being accessed or weaponized by anti-abortion states, ensuring that people seeking care can do so without fear of surveillance or retaliation.

Despite these actions, the threats to reproductive freedom are only growing. Anti-abortion politicians wielding majority influence in the White House, Congress, and the Supreme Court could push for a national abortion ban, override state protections, or weaponize obscure laws to restrict care nationwide.

That’s why the work of the Reproductive Freedom Alliance is more critical than ever. While federal protections may remain uncertain, governors can act decisively to ensure Americans continue to have access to the care they need in their states. They can uphold shield laws to protect health-care providers and patients from out-of-state investigations, defend providers from politically motivated prosecutions, expand access to medication abortion and critical delivery points like telemedicine, and fight back against efforts to limit access to contraception and in vitro fertilization.

The post-Roe patchwork is chaotic, cruel, and unsustainable. But Alliance governors are proving that there is a path forward. State leaders are standing up to protect their residents and set a national example for what reproductive freedom should look like. This fight isn’t over—far from it. But with bold leadership, we can and will build a future where reproductive rights are protected and everyone, everywhere has the freedom to make the best decisions for themselves and their families.