Note: This explainer is an overview on the landscape of the Dobbs v. Jackson Supreme Court decision. As this legislation shifts on a daily basis, we will make every effort to keep this as current as possible with information and resources. For more regular updates as abortion legislation changes in states that are still vulnerable across the U.S., follow this interactive map at The New York Times. For how you can help your local abortion fund, stay updated at National Network of Abortion Funds.
On June 24, 2022, in a 5-4 decision, the United States Supreme Court overturned Roe v. Wade, the 49-year-old landmark case that established that the U.S. Constitution provides the right to privacy to anyone who wants to receive an abortion. The court’s decision on the Mississippi case Dobbs v. Jackson Women’s Health Organization held that the Constitution does not guarantee the right to an abortion, which overturned both Roe and Planned Parenthood v. Casey, the 1992 case that established the “essential holding” of Roe.
Two years following that decision, 21 states had restrictions or total bans that make access to abortion illegal or incredibly limited. Thirteen of those states ban the procedure at every stage of pregnancy.
In the wake of Roe’s demise, President Biden took steps to expand protections for people who are not able to receive care in their states through executive orders. With abortion protections now left to the states, the country’s eyes turn to elections to see how abortion rights will be affected.
We learned the importance of state power in August 2022, not long after the overturn of Roe, when voters in Kansas voted overwhelmingly to preserve abortion rights in their state’s constitution. This, despite a misinformation campaign associated with the proposed "Value Them Both" amendment, which abortion advocates argued would have paved the way for a total ban on abortion in the state.
“The voters in Kansas have spoken loud and clear: We will not tolerate extreme bans on abortion,” Rachel Sweet, the campaign manager for Kansans for Constitutional Freedom, told the Times.
Following the election on Nov. 5, 2024, voters in 10 states — Montana, Arizona, Missouri, Colorado, Nevada, New York, Maryland, Florida, South Dakota, and Nebraska — followed in Kansas’s footsteps and went to the polls to vote on abortion protection restoration in their states. Seven of the 10 — Missouri, Colorado, Montana, Arizona, New York, Maryland, and Nevada — voted to enshrine abortion into their state constitutions. Missouri and Arizona’s vote overturned complete bans in their states.
Missouri, the first state to overturn abortion protections following the Dobbs decision, currently has a near-total ban, but now, thanks to Amendment 3 in the Missouri State Constitution, will allow abortion care up to fetal viability, around the 24th week of pregnancy.
Arizona, which currently has a 15-week ban on abortion, will also now allow care up to fetal viability, thanks to Proposition 139.
“What we started in the fall of 2022, we finished tonight,” Chris Love, a spokesperson for “Yes on 139,” said in a statement to NBC News. “A fundamental right to abortion is part of the Arizona Constitution once and for all. Next time the nation wonders how much government interference in reproductive healthcare is acceptable, or what type of arbitrary abortion ban is popular, they can look at Arizona and know the answer is ‘none.’”
Measures to expand abortion rights in Florida, Nebraska, and South Dakota all failed (Florida’s ballot initiative needed a 60 percent “yes” vote to pass and was three points shy at 57 percent). Nebraska voters faced two amendments: one that would enshrine a ban after 12 weeks and one that would allow care up to fetal viability. The state voted to maintain their 12-week ban and include it in their state’s constitution.
While there was progress at the state level, Donald Trump’s reelection as president of the United States has raised concerns with abortion-rights advocates after a Trump-elected Supreme Court overturned Roe. While his opponent, Vice President Kamala Harris, promised to safeguard abortion at the national level should Congress pass a bill allowing her to do so, a Trump presidency threatens to be a completely different story.
Despite voters’ success at the state level, a federal abortion ban is still very much in the conversation. Despite Trump’s distancing himself from the idea during his campaign, the Times notes that Republicans and abortion opponents are likely to pressure him to enact one. Following the election, the Republicans have a majority in Congress, making a proposed national abortion ban very possible.
"An already harmful abortion access crisis will likely get worse," Kelly Baden, the vice president of policy at the Guttmacher Institute, told ABC News. "The 13 states that currently ban abortion—there are real consequences to that, including death. Women are dying from these abortion bans," Baden said. She added that she didn’t think “people know that a federal abortion ban would preempt state constitutional protection.” They assumed that if they voted to protect the procedure in their state, it would be protected. But that isn’t necessarily the case.
Beyond this, Americans are already concerned about access to birth control and that under Trump, the Federal Drug Administration (FDA) could rescind access to the abortion pill mifepristone. Advocates are concerned that Trump’s Department of Justice could enact the Comstock Act, an 1873 law that would prohibit “obscene” materials designed to obtain an abortion from being mailed or received.
“All it takes is one person in the DOJ or some zealous U.S. attorney to threaten a clinic with criminal sanction under the Comstock Act, and that could potentially cause a tremendous chill among health care providers that are providing abortion,” Wendy Parmet, director of the Center for Health Policy and Law at Northeastern University in Boston told NBC news. This possibility is causing people to stock up on mifepristone and Plan B and to schedule appointments for IUD insertions ahead of Trump’s inauguration.
Of course, abortion and contraception are not the only things within the reproductive sphere that are vulnerable at this time. Invitro fertilization (IVF) was a topic of discussion throughout the presidential race. On the campaign trail in August, Trump said his administration would protect IVF. But considering that Senate Republicans—including Sen. J.D. Vance, the incoming vice president—voted against a bill that would have required insurance companies to cover IVF, those advocating for the procedure are uneasy.
Another red flag is what’s already happening on the state level, namely the previous attack on IVF in Alabama in February of 2024, in which embryos were declared to have personhood by the state’s Supreme Court.
It’s also important to note that gender-affirming care, which has been a specific target of Trump and the GOP, is intertwined within reproductive care. A good first step: Familiarize yourself with and start using inclusive language, because women are not the only people who receive abortions, and the transgender and LGBTQ+ rights movements are very much entwined with the reproductive justice movement.
After the Supreme Court’s Dobbs decision, the effects were immediate across more than a dozen states with “trigger bans,” or laws that immediately outlawed abortion upon Roe’s demise. Here are just a couple of stories from people in those states.
On June 26, 2022, two days after the Dobbs decision, a nurse named Ashley shared a text, via X, from her friend Lex, a fellow nurse, who shared her story of how pregnant people in states where abortion is banned were already in danger.
Lex shared that, after the trigger law went into effect in her state, a pregnant woman came in with an ectopic pregnancy, which means that the fertilized egg implants and grows outside the uterus, often in the fallopian tubes. A fetus does not survive this kind of pregnancy. Lex said that, before her team could take action, they had to call legal counsel and make sure providing care would not cost them their medical licenses. By the time they could treat the woman, her fallopian tube had ruptured, she had dangerous amounts of blood in her abdomen, and almost died.
OBGYN Colleague in Missouri “We are now observing patients with ectopic pregnancy and hemoperitoneum until they have a documented falling hemoglobin or unstable vital signs”
— Jane van Dis MD (@janevandis) June 28, 2022
1:50 pregnancies is ectopic pic.twitter.com/HwYEMz67su
In June of 2022, a 10-year-old abuse survivor in Ohio had to travel to Indiana to receive an abortion because she was six weeks and three days pregnant. Following the Supreme Court’s decision on June 24, Ohio’s law banning abortion after six weeks took effect immediately.
The 10-year-old was referred by a child-abuse doctor in Ohio to Dr. Caitlin Bernard, who was able to provide her with care in Indiana. Bernard told the Cincinnati Enquirer that she knew her window to help was closing; she has since faced harassment, and the Indiana attorney general is asking that she face discipline for her actions.
“It’s hard to imagine that in just a few short weeks we will have no ability to provide that care,” she said, referring to the Indiana legislature’s plan to call a special session in late July to further restrict abortion beyond its current 22-week ban.
And these were just the first few weeks since Roe fell. In December of 2023, The 19th reported the health risks of pregnancy loss in a country with limited abortion access. They told the stories of people like Ann Carver (whose name was modified for privacy reasons), who experienced devastating pregnancy losses and who was afraid to get pregnant again for fear of not being able to receive the emergency care she might need in her home state of Georgia, which bans abortion after six weeks with limited exceptions.
As The 19th reported, one in three pregnancies results in miscarriages, but there are other forms of nonviable pregnancies, such as ectopic pregnancies, that can require intervention. There are other complications that occur in the second trimester, or stillbirth, which can occur after 20 weeks. And, as The 19th noted, “the standard medical treatment for any of these conditions often relies on access to abortion.”
As mentioned earlier, Missouri was the first state to ban abortion under a trigger law, with only the medical exception that there is “serious risk of substantial and irreversible physical impairment of a major bodily function.” Dr. Jeannie Kelly, a Washington University OB-GYN, told St. Louis on the Air at the time that the state’s definition is not clear enough and could cause real problems for providers who are trying to save their patients’ lives.
“Medicine, in general, is not really black and white in many circumstances,” she said. “There are many clinical situations that we are concerned [about]. The law is vague, and the law is not well defined [regarding] these trickier situations where we're not sure: ‘Is this a medical emergency? Does it qualify as an exception to this abortion ban? Or would we be risking our licenses and we'd be risking jail time if we perform the abortion in this circumstance?’”
Dr. Kelly’s concerns have, unfortunately, been proven true across states that have abortion bans. Amber Thurman, a 28-year-old Black woman, died of septic shock after being denied critical abortion care. Doctors waited 20 hours to finally perform a dilation and curettage, or D&C, to remove fetal tissue that was causing an infection in Thurman’s body. By then, it was too late. During a Harris campaign event this fall, Thurman’s mother, Shanette Williams, said, “People around the world need to know that this was preventable.” Williams added that after initially feeling resistant to going public about her daughter’s story, she wanted voters to understand that her daughter “was not a statistic. She was loved.”
In the two years since Roe was overturned, it’s become difficult to keep up with the number of cases in which pregnant people’s lives have been put at risk—or they were forced to carry pregnancies to term—because they couldn’t access necessary healthcare. In January, a study published in the journal JAMA Internal Medicine found that, after the fall of Roe, there were an estimated 520,000 rapes that led to 64,565 pregnancies in the 14 states with total abortion bans. The timeline on this data ranged from four to 18 months prior to the study’s publication.
Research published by the Society of Family Planning also found that between April 2022 to June 2023, there were fewer than 10 abortions in these total-ban states. This included states where there are exceptions to the bans for rape.
“Restricting abortion access to survivors of rape can have particularly devastating consequences,” JAMA’s editors wrote in a note about the new research. “Whether these survivors of rape had illegal abortions, received medication abortion through the mail, traveled to other states, or carried the child to birth is unknown.”
Per research published in the Times and gathered by the Guttmacher Institute, an estimated 170,000 people traveled to other states to receive abortions in 2023. This data also shows that out-of-state travel in 2023 was more than double compared to 2019. The Times notes that most people traveled to the nearest state where abortion is legal (like someone from Missouri traveling to Illinois or Kansas). In fact, per Guttmacher, 37,300 people traveled to Illinois from surrounding states and states in the South in 2023.
In the South, though, it isn’t as easy to find a bordering state with access. As of right now, 13 Southern states have restrictions or total-abortion bans, which means there are people who have to travel even farther. Sixteen-thousand patients from the South sought care in Illinois, and nearly 12,000 traveled to Northern states from South Carolina and North Carolina. Texas, the largest state with a complete ban on abortion (with very limited exceptions), saw 35,000 patients traveling to other states to receive care. Fourteen-thousand of them were able to travel to the New Mexico border; 21,000 went farther.
Because of these bans and restrictions, states have begun to prosecute their residents who receive life-saving care. Last September, Brittany Watts, a 34-year-old woman from Warren, Ohio, became the focus of international attention when, at 21 weeks and five days pregnant, her water broke prematurely. At the time, abortion was illegal in Ohio after 21 weeks, six days, but in the time in which Watts had to wait to be seen by a doctor, her pregnancy officially reached 22 weeks. A fetal heartbeat was present, but her doctor told her that her fetus would not survive and she’d need an abortion to induce labor and save her life.
She ended up miscarrying in her bathroom toilet, which became clogged with the fetus, and she was charged with the felony of abuse of a corpse as a result. This is a fifth-degree felony and means a year in prison and a $2,500 fine. In January, a grand jury decided not to indict Watts, but this case further highlighted the extreme danger that pregnant people—especially Black and brown pregnant people—are in if they live in non-access states.
Michele Goodwin, a law professor at the University of California, Irvine, and author of Policing The Womb, told VOA news that Black women are “canaries in the coal mine" for the “hyper-vigilant type of policing.” She continues: “Post-Dobbs, what we see is kind of a wild, wild West,” she said. “You see this kind of muscle-flexing by district attorneys and prosecutors wanting to show that they are going to be vigilant, they’re going to take down women who violate the ethos coming out of the state’s Legislature.”
Per the Texas Tribune, about 40 percent of women who get abortions in the U.S. are Black, and according to the CDC, Black women are three times more likely to die from a pregnancy-related cause than white women.
Soon after the Supreme Court’s decision in June of 2022,, lawmakers used the momentum to pass restrictive legislation in their states. On August 5, 2022, Indiana became the first state to pass a ban on abortion that was not triggered by the overturn of Roe v. Wade.
The Indiana law, Senate Enroll Act (S.E.A. 1), initially took effect on September 15, 2022, with limited exceptions: serious risk to the health or life of a pregnant person; diagnosis of a “lethal fetal anomaly”; and rape or incest before 12 weeks of pregnancy. But as providers have pointed out, language in laws like this can prove to be too vague and puts them in a vulnerable position during emergencies. It was blocked five days later, but in 2023, the Indiana Supreme Court allowed the ban to take effect. In April, the Indiana Court of Appeals affirmed a preliminary injunction that will allow Indiana residents to receive an abortion if it is their sincere religious belief that they must be able to obtain one.
To help people in Indiana who need abortions, you can support the Hoosier Abortion Fund, which is open to all residents of Indiana, “regardless of age, income, insurance, or immigration status.”
In addition to voting and advocating for pro-choice candidates in your state and at your local level, you can:
Regularly read websites that have state-by-state legislation information, including:
Hilary Weaver is a writer and editor based in New England. Her work has been published in The Cut, ELLE, Vanity Fair, Refinery29, Esquire, Cosmopolitan, The Nation, and more. She has covered reproductive rights both as a writer and as a fact-checker and researcher since 2015.