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The State-by-State Battle Over Abortion in the US

Anti-abortion rights demonstrators protest during a Women’s March in Austin, Texas, US, on Saturday, Oct. 8, 2022. On October 8th, exactly one month before Election Day, women and their allies marched across the country for a massive nationwide “Women’s Wave” day of action meant to rally supporters of reproductive rights ahead of the 2022 midterms. (Bloomberg)

In overturning Roe v. Wade, the US Supreme Court didn’t so much address America’s long-running fight over abortion as spread it to statehouses across the country. The court’s June 2022 ruling in Dobbs v. Jackson Women’s Health Organization repealed constitutional protections for abortions that had been in place since 1973. That gave conservative governors and legislatures the power they had long sought to limit the medical procedure in their states, in some cases severely. Advocates on both sides are pushing for federal legislation to establish nationwide rules. For now, access largely depends on where you live — a principle that could eventually apply to other long-held American rights as well.

1. What have states done?

In around a dozen states, the Dobbs decision activated so-called trigger laws — which had been passed months or years earlier in case Roe were ever overturned — that imposed new limitations on abortion. Other states led by conservatives enacted fresh restrictions. Alabama, Texas and Tennessee are among eight states that now prohibit almost all abortions, even in cases of rape and incest, with the only exception being if there’s serious medical risk to the mother. Medical providers could face felony charges, carrying fines and jail sentences, for violating these laws. Some laws go beyond criminalizing abortion to give legal rights to fetuses. In some states, new restrictions on abortion have faced court challenges. 

2. What has that meant for abortions?

In the first two months after the Dobbs ruling, legal abortions fell in states that restricted the practice and increased in states where it remained broadly legal, for a net decline of 10,000, or about 6%, according to the Society of Family Planning, an abortion and contraceptive advocacy and research group. That number includes medication-induced abortions performed under clinical care but not “self-managed abortions,” those achieved by obtaining and taking abortion-inducing pills outside traditional US medical channels. Another study, published by the medical journal JAMA, found a nearly 120% increase in online abortion pill sales in July and August, placed through Aid Access, a nonprofit that helps prescribe and ship the medication from overseas.

3. How common is the use of abortion pills?

They became easier to receive by mail as a result of rule changes during the pandemic and were thus already the most common way to end a pregnancy in the US when Roe was overturned. One catch: Abortion pills are most effective in the first trimester of pregnancy and are recommended for use only up to 10 or 11 weeks of pregnancy. More than half of the 50 US states stipulate that the pill must be prescribed by doctors, a stricter standard than that of the US Food and Drug Administration, which also permits prescriptions by certified nurse practitioners. Even states with near-total bans on abortion face logistical hurdles in stopping people from ordering the pills from overseas manufacturers and taking them at home. 

4. What’s happening with abortion clinics?

Of 65 clinics in 14 mostly southern states that provided abortion care as of June, not a single one was still doing so as of Oct. 2, and more than two dozen of them had shut down entirely, according to the Guttmacher Institute, a research group that supports abortion rights. For women in states with no abortion services, the nearest clinic can be hundreds of miles and multiple states away, and the cost of transportation, lodging and care can be prohibitive. Groups that help finance abortions and related expenses received an influx of donations following the Dobbs decision. Since most Americans receive health insurance through work, some companies got involved too.

5. What are companies doing?

After the Dobbs decision, US corporations including JPMorgan Chase & Co., Walt Disney Co. and Meta Platforms Inc. said they would cover travel costs for employees going out-of-state for abortions.

6. What’s being proposed on the national level?

The Democrat-controlled House of Representatives passed a bill that would basically re-establish the abortion protections that existed under Roe, making it legal to terminate pregnancies until what’s known as fetal viability. But it’s highly unlikely to pass the Senate, where a 60% supermajority is needed for most major legislation. On the Republican side, Senator Lindsey Graham proposed a nationwide abortion ban after 15 weeks of pregnancy, but even some in his party oppose the idea as politically perilous in a nation that generally supports abortion rights. 

7. Why is there concern about other long-held rights?

In his concurring opinion in the Dobbs decision, Justice Clarence Thomas suggested that the court should reconsider other decisions that, like Roe, rely on the assertion that an unwritten right to privacy is contained in the US Constitution. He cited rulings that legalized contraception, same-sex intercourse and same-sex marriage.

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