In June 2022, the US Supreme Court issued a ruling in the case Dobbs v. Jackson Women's Health Organization that ended the legal right to abortion nationwide.
CNN —
Two years ago, the US Supreme Court overturned Roe v. Wade, ending the constitutional right to an abortion and setting off a fierce fight for reproductive rights at the state level.
Abortion has emerged as a key issue in the 2024 election, and as access narrowsin many states, reproductive freedom advocates are working to get measures preserving reproductive rights on the November ballot to let voters weigh in.
Abortion rates reach a decade-long high in the US
Two years after Roe v. Wade was overturned,14 states have total or near-total banson abortion, including Alabama, Texas, Idaho and Tennessee.
Despitean increase inrestrictive policies,the number and rate ofabortionsin 2023 hit their highest point in over a decade, according toa report fromtheGuttmacher Institute, aresearch and policy non-profit that advocates for sexual and reproductive health rights.
The organization estimatesthere were more than 1 million abortions in theformalUShealthcare systemlast year, a11% increase from 2020. States withouttotalabortion bans saw a26% increase from 2020, according to the report.
The loss ofabortionaccess in states with bans, the authors noted, was countered by“efforts on the part of clinics, abortion funds and logistical support organizations to help people…access care.”
Nearly two-thirds of all abortions in 2023, about 642,700, were medication abortions – not including self-managed medication abortions outside of the healthcare setting, the report says. The authors note a steady increase since 2001, when medication abortionsaccounted for less than 10% of all procedures.
Over the years, the US Food and Drug Administration relaxed some of the restrictions for use of the abortion pill, and access to the medication increased. In 2016, the agency deemed the abortion pill safe to use up to 10 weeks into pregnancy, rather than seven, and expanded the pool of providers who could prescribe it. After the onset of the Covid-19 pandemic, the FDA allowed for the pill to be dispensed by certified pharmacies and through the mail, rather than just in healthcare settings.
States implement increasingly restrictive abortion policies
Abortion policies have changed rapidlyin manystates since the Supreme Court’s decisionto overturn Roe. Four states, California, Michigan, Vermont and Ohio, have sinceenshrined rights to reproductive freedom in their constitutions, while lawmakers inNew Yorkand other states implemented policies to protect abortion patients and providers.
More than a dozen states passedabortion “triggerlaws” ahead ofthe court’s decision,meant to take effect almost immediately in the event that Roe was overturned,and at least sevenstates without trigger laws have followed suit with restrictive reproductive health policies that critics say put patients in danger and leave providers at risk of civil and criminal liability.
Patients and providers have struggled to navigate a patchwork of sometimes hastily implemented abortion policies that includemandatory waiting periodsto obtain an abortion in statesincludingArizona and Georgia, limits onMedicaid coveragefor abortion, in states including South Dakota, and vague language aroundmedical emergency exceptionsto abortion bans in states including Texas. Lower courts have been asked to take abortion issues up in multiple legal challenges across states.
These policies have already had real-worldeffects. For example,one woman in Texassued the state to access an abortion for a pregnancy that was threatening her future fertility. Another Texas woman wasunlawfully chargedwith murder forusing abortion medication to self-induce an abortion and spent two nights in jail before the charges were dropped.Providers saythat patients in states with abortion bans have been forced to carry pregnancies against their will, leading to compromised fertility and other life-threatening consequences.
Last month, Florida replaced its 15-week abortion ban with asix-week ban, which falls before many women know they’re pregnant. The move was a major blow to reproductive access in the South, where Florida was a critical access point for people seeking abortions. Providersand advocatessay the restrictive policies have created areproductive care“desert” in the region.
Some reproductive care providers say the South has become an abortion services desert.
Patients cross state lines to access reproductive care
More than 171,000 patients travelled for an abortion in 2023, according to the Guttmacher Institute.
Many people who traveled to obtain abortions before Roe was overturned were going to states that now have total abortion bans, meaning people are now traveling farther distances – sometimes crossing multiple state lines – to access care, theorganization noted recently.
In just the first half of 2023,nearly 1 in 5 peoplewho had an abortion –more than 92,000 people – traveled across state lines for abortion care, according to aDecember2023analysisfrom theinstitute.
As the abortion care landscape becomes more and more restrictive, Alexandra Mandado, president of Planned Parenthood in South, East and North Florida,says that remaining abortion clinicswill struggle to absorb the increase in out-of-state patients.
Supreme Court takes up other high profile reproductive rights cases
The Supreme Court recentlyrejected a challengeto accessto the abortion pill, mifepristone, maintaining widespread access to medication abortion in a ruling that will allow for continued mailing of the pillsto patients without an in-person doctor’s visit. Experts say abortion pill access could face additional legal challenges in the future.
The court is considering another case this summer dealing withmedical emergency exceptionsto abortion bans. In the case, the Biden administration sued the state of Idaho,where exemptions to its abortion ban are limited to life-threatening situations,arguing that federal law requires hospitals receiving Medicare funding to provide stabilizing care, including abortions, when a pregnant person’s health isin danger.
The abortion pill has emerged as a major access point for abortion amid increasing restrictions since the fall of Roe v. Wade.
Access to other reproductive care services is challenged
In February,theAlabama Supreme Courtruled that frozen embryos are considered human beings and those who destroy them can be held liable for wrongful death, causing fertility clinics throughout the state to pause in vitro fertilization (IVF) treatments out of fear of legal prosecution.
As families across the state lost access to IVF treatments, lawmakers scrambled to meet the widespread demand for a fix. In March,the state passed a lawaimed at protecting IVF patients and providers from the legal liability imposed on them by the state court’s ruling. While some services resumed,at least oneof the state’s limited pool of IVF providers says it will halt services altogetherby the end of the year, citing litigation concerns.
Experts haveexpressed concernthat other reproductive care services, like contraception, are also on the line amid a swell of misinformation that some say is sown intentionally to create panic,like lawmakers conflating emergency contraceptionwith abortion, for example.
Advocates work to get abortion on state ballots in November
Most abortion policies implemented after the Supreme Court overturned Roe were directly triggered by that decision or handed down by lawmakers or state courts. In an effort torestore the issue of reproductive health access, organizers across the country have been working to get measures to enshrine reproductive health rights in state constitutionson ballots in November.
Colorado, Florida, Maryland and South Dakota have secured the measures on their state ballots, with New York and Nevada likely to follow suit. Organizers in at least seven other states are working to do the same.
In addition to making it more difficult to challenge access to abortion services, organizers hope that the measures will allow voters tosend a message to politicians about what they want.
CNN’s Deidre McPhillips, Annette Choi and Tierney Sneed contributed to this report.
