June 24, 2022, was a watershed moment in US legal and medical history. The Supreme Court ruled in favor of upholding the state of Mississippi’s ban on abortion after 15 weeks, in a case known as Dobbs v Jackson Women’s Health Organization. By so doing, the court effectively ended the constitutional right to abortion in the country by reversing its own legal precedent – an extremely rare event – set by the 50-year-old landmark judgment, Roe v Wade.
Now, a year on from that event, a reported 25 million women of reproductive age live in states where abortion has either been banned or is more difficult to access than before. We’ve looked back over the past 12 months to see how we got here, and what the future might hold.
Where have restrictions been tightened?
It makes sense to start with the state of Mississippi, whose efforts to tighten restrictions on abortion underlie this whole event.
In the original Roe v Wade case, the judges ruled that the right to access abortion was protected under the Constitution and that state governments could therefore not ban the practice outright. The system that came out of the ruling allowed absolute access to abortion during the first trimester of pregnancy. Second-trimester abortions would be subject to some government regulation, and states could ban or restrict abortions in the final trimester (often called “late-term abortions”) as they saw fit – although abortions later in pregnancy would remain accessible where doctors deemed them necessary to save the mother's life.
The case of Dobbs v Jackson Women’s Health Organization was a challenge to a law passed in Mississippi in 2018, which prohibited abortions after 15 weeks, except where deemed medically necessary. The Supreme Court ruled, by a majority of 6-3, in favor of the state.
The decision was leaked beforehand, but that did little to dampen the seismic impact of the ruling when it came.
Other Republican-led states either already had laws on the books that would take effect in the event that Roe v Wade was overturned, or else scrambled to quickly pass new restrictions.
Texas had, in fact, already brought in a law that was even more strict than the one in Mississippi. It was the first of the so-called “heartbeat bills”, based on the scientifically questionable notion that a fetus’s "heartbeat" can be detected from 6 weeks of pregnancy – the heart is not yet present at this stage, so what is being detected is really a flutter from the cells that will become part of the heart, if left to continue developing. It was hugely controversial, not least because in the best possible scenario it gave someone discovering they were pregnant a window of only about 10 days to access an abortion, and in reality for most people a lot less time.
According to the New York Times, since last year Texas, Mississippi, and 12 other states have now banned almost all access to abortion: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, West Virginia, and Wisconsin. Georgia also has a ban in place after six weeks of pregnancy.
There is legal wrangling currently ongoing in Iowa, as the state Supreme Court is in deadlock over a blocked ban on abortion after six weeks; abortion remains legal in the state up to 20 weeks. Stricter limits on abortion have also been imposed in Arizona, Florida, Nebraska, North Carolina, and Utah.
One of the major controversies has centered around the exceptions made for pregnancies resulting from rape or incest. While a number of states with bans in place do allow for abortions under these circumstances, this is not universal. For example, Arkansas has enacted a total ban with no exception for rape or incest. In North Dakota, the exceptions for rape and incest can only be made up to the sixth week of pregnancy.
In Texas, a well-publicized addition to the legislation not only makes no exceptions for rape or incest, but allows private citizens to bring lawsuits against abortion providers or those assisting patients to access abortion after six weeks.
Where are abortion rights protected?
Even as many state governments moved to fulfill long-held ambitions of restricting abortion rights, others have rapidly sought to protect the right to abortion access.
California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington have all placed varying new legal protections around the right to abortion, some of which also protect people traveling to seek abortion from neighboring states.
Abortion remains legal in Alaska, Kansas, New Hampshire, Virginia, and Washington D.C., although specific gestational limits and legal protections do vary.
There are also five states where moves to ban or restrict abortion have so far been blocked: Indiana, Montana, Ohio, South Carolina, and Wyoming.
What does the future look like?
There’s no doubt that, despite efforts to ban or restrict the practice, there will always be people who seek terminations, for many varied – often painful and difficult – reasons. It’s a medical procedure that no one enters into lightly. Scientific studies have demonstrated the risks of restricting access to reproductive healthcare, with a recent paper modeling a substantive increase in maternal morbidity and mortality as a direct result of the overturning of Roe v Wade.
It’s difficult to know exactly how many abortions are currently being provided across the US, but the most recent report from #WeCount, a project coordinated by the Society of Family Planning, shows that the average number of abortions has decreased since Roe v Wade was overturned. What’s less clear – and more concerning – is how many people are turning, in desperation, to unsafe termination procedures carried out without medical supervision.
Beyond restricting access to abortion, there are newer battlegrounds emerging. The majority of abortions in high-income countries aren't surgical, involving the use of a combination of oral medicines. Recently, one of these drugs, called mifepristone, hit the headlines after a federal judge in Texas ruled to put an end to its Food and Drug Administration (FDA) approval, which had been in place for over two decades.
For now, mifepristone remains available, and in the event of a ban there are ways to carry out a termination without this specific drug, but the case has still raised important questions about the implications of a ruling that could threaten the entire landscape of regulatory approval in the country.
In states where new legal protections have been introduced around abortion access, it’s likely that a year from now, abortion rights will remain. Equally, it’s difficult to envisage any major changes in the states that already have bans in place. Legal challenges in specific states will continue, and attention will likely focus on those areas where bans and enforcement are currently on hold; meanwhile, others will worry about the wider ramifications of this historic decision.
Voters have consistently expressed their support for abortion rights, and the outcry around Roe v Wade has been cited as one of the reasons behind the better-than-anticipated performance of the Democrats at the 2022 midterms. Abortion is a medical issue – but it’s also a political issue. And it hasn’t gone away.