The 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization eliminated the federal constitutional right to abortion, which had been in place for nearly five decades following Roe v. Wade (1973). This ruling did not ban abortion nationwide, but rather returned the authority to regulate or prohibit it entirely to individual states. The consequence is a complex, rapidly evolving legal landscape where state-level regulatory actions now target specific aspects of reproductive healthcare access and provision. This shift has created a patchwork system, making the legality of abortion dependent on a person’s geographic location.
The Legal Shift: Authority Transferred to States
The Dobbs ruling fundamentally changed the legal mechanism governing abortion access by concluding that the U.S. Constitution does not confer a right to abortion. This decision overturned the precedents established by Roe v. Wade and Planned Parenthood v. Casey. Previously, states could not ban abortion before fetal viability, generally considered to be around 24 weeks of pregnancy.
The authority to regulate abortion is now explicitly “returned to the people and their elected representatives” at the state level. This change means that state-level laws regulating abortion are subject to a strong presumption of validity in the face of constitutional challenges. The legal environment across the country is now sharply divided, with some states offering expansive protection for abortion access and others enacting near-total bans.
Specific State Regulatory Measures
States immediately began enforcing or enacting various measures that specifically target the timing and circumstances under which an abortion can be legally performed. A primary target was the implementation of “trigger laws,” which were pre-existing bans designed to take effect automatically or by quick state action immediately upon the overturning of Roe v. Wade. These laws often resulted in near-total bans on abortion with few exceptions.
Another common regulatory measure is the imposition of strict gestational limits, banning abortion based on specific weeks of pregnancy. These limits often fall at 6 weeks of gestation, a point where many people are unaware they are pregnant, or at 12 or 15 weeks. States have also enacted near-total bans, which prohibit abortion except in extremely narrow circumstances, such as to save the life of the pregnant person. The penalties for violating these bans often target the medical provider, sometimes classifying the act as a felony.
Impact on Healthcare and Interstate Access
The new legal landscape also targets the logistical means of accessing abortion, particularly by focusing on medication abortion. This method, which uses a two-drug regimen of mifepristone and misoprostol, accounts for the majority of abortions in the U.S. State laws are now working to restrict access to these pills by banning telehealth prescriptions or prohibiting the mailing of abortion medications to residents, even when prescribed by out-of-state providers.
These regulations create significant barriers for healthcare workers, who now face new criminal and civil penalties for providing care that violates state bans. This heightened provider liability has caused confusion, especially regarding the interpretation of exceptions for medical emergencies and the treatment of miscarriages. Some states have responded by enacting “shield laws” to protect their own providers who offer telehealth medication abortion to patients in restrictive states.
Another target of restrictive legislation is interstate travel for abortion access and the support networks that facilitate it. While states cannot legally prevent a resident from crossing state lines to obtain an abortion, some are attempting to create civil and criminal liability for those who “aid or abet” such travel. This includes efforts to target out-of-state prescribers, manufacturers, and distributors of abortion pills. The goal of these measures is to eliminate the remaining avenues of access for residents of states with bans.