Center for American Progress

A Year After the Supreme Court Overturned Roe v. Wade, Trends in State Abortion Laws Have Emerged

A Year After the Supreme Court Overturned Roe v. Wade, Trends in State Abortion Laws Have Emerged

In the absence of federal protections, state legislatures have become arbiters of abortion access, with some states banning or severely restricting abortion and others improving and protecting it.

In this article
Image showing an empty exam table
An exam table is seen in a doctor's office. (Getty/Tammy Ljungblad/The Kansas City Star/Tribune News Service)

Introduction and summary

This report contains a correction.

On June 24, 2022, in Dobbs v. Jackson Women’s Health Organization, the U.S. Supreme Court overturned 50 years of precedent, overruling Roe v. Wade.  In the year following that decision, the pace of new legislation on abortion has been swift.

Indeed, by the 100th day after the Dobbs decision, nearly 22 million women1 of reproductive age—almost 1 in 3 women—found themselves living in states where abortion was unavailable or severely restricted. According to the Guttmacher Institute, which tracks state-level abortion legislation, in 2022 alone, state legislators introduced 563 provisions to restrict access to abortion, and 50 of those restrictions were signed into law the same year.2

As of publication, 14 states have near-total abortion bans during any point in pregnancy in effect, and six states have implemented abortions bans with other limits from 6 to 20 weeks after a person’s last menstrual period.3 These bans have some differences but, overall, contain only the narrowest exceptions, which have jeopardized patient safety in myriad ways. Most bans are enforced through criminal penalties and jail time for providers; however, some states, including Idaho and Oklahoma, have also passed “bounty hunter” abortion bans modeled after Texas’ law, known as S.B. 8,4 though the two “bounty hunter” laws in Oklahoma were struck down in May 2023.5 While there are some differences between states, S.B. 8—which passed roughly 13 months before the Dobbs decision and was allowed to go into effect by the Supreme Court—permits any individual to sue those who perform an abortion or simply help someone secure care.6

Abortion bans disproportionately affect marginalized groups

The impact of abortion restrictions is not felt equally, with many systemically marginalized groups facing disproportionate burdens and challenges to accessing abortion. These communities often already have limited access to abortion and other reproductive health services given a number of factors, including being more likely to be uninsured or underinsured, lower employment, or living long distances from a health center.7 Additionally, the federal Hyde Amendment—a congressional appropriations rider that prohibits federal funds from being used to pay for abortion care, with few exceptions—disproportionately affects low-income people and further restricts access to abortion.8 Because of this, millions of women enrolled in Medicaid do not receive coverage for their abortions, and many are forced to continue their pregnancies.

Furthermore, the interplay between geography and race cannot be understated, as states with the highest proportions of Black, Hispanic, and Indigenous women—those in the South and the Midwest—are also states that have banned or are poised to ban abortion post-Dobbs.9 Women of color experience higher risk of health complications, pregnancy-related morbidity, and even death,10 something that is heightened in states where abortion is criminalized.11 For people with multiple marginalized identities, such as race, chronic health conditions, and disability, barriers to abortion are often compounded. For example, 1 in 3 adults under age 65 on Medicaid has a disability,12 and the federal Hyde restriction disproportionately keeps low-income people with disabilities from getting the abortion care they need.13

At the same time, many states have explored ways to protect abortion access in the wake of Dobbs. In 2022, the Guttmacher Institute found that state lawmakers across the nation introduced 369 bills to protect access to abortion, and passed 77 of them across 18 states.14 These protections range from increased security for abortion providers and patients, expanded insurance coverage for abortion services, improved access to medication abortion, shield laws to keep providers from being prosecuted in states where abortion is illegal, and explicit abortion protections in state constitutions.15 Notably, even though nearly 200 more abortion restrictions were introduced in 2022 than abortion bans, states passed 27 more protections than restrictions and supported abortion rights on the ballot in six states,16 reflecting the fact that a strong majority of Americans support abortion rights.17

To underscore the extent to which Dobbs has decimated abortion access and to shed light on what states can do to improve access to abortion, this report provides an overview of the state trends related to abortion access. The first part of this report covers four common types of laws that have passed to restrict abortion access: near-total abortion bans; laws with enforcement mechanisms, including criminal penalties, bounty hunter provisions, and fear and confusion; challenges to medication abortion; and laws funding crisis pregnancy centers. The second part of this report covers five common types of laws that have passed to protect abortion access: statutory protections and executive orders, ballot initiatives, shield laws, laws that expand access to medication abortion, and laws that make abortion more affordable through health plans and insurance.

Bills targeting abortion access

From outright bans to bills targeting medication abortion and bolstering the ability of far-right activists to lie to those seeking care about available options (such as requiring counseling on medication abortion “reversal”), states across the country have accelerated their efforts to limit access to abortion.

Near-total bans, with few exceptions for rape and incest

After Dobbs was decided, states moved either to pass new bans on abortion or make their pre-Roe bans effective law once more. In many states, the sheer number of laws on the books has led to confusion among state officials—let alone the general public—on what law controls.18 While pre-Dobbs, many states passed 15-week or 20-week bans on abortion, the overall trend post-Dobbs is to ban abortion almost entirely. While the below describes trends in bans at any point in pregnancy, given they currently make up the bulk of bans in the United States, it is also important to note that bans later in pregnancy—such as Georgia’s six-week ban or Arizona’s 15-week ban—carry severe consequences for people as well and can often operate to foreclose care altogether.

As referenced above, as of publication, 14 states have near-total abortion bans during any point in pregnancy in effect: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin.19 Several other states have similar abortion bans that have been temporarily blocked by the courts,20 including Arizona,21 Indiana,22 Utah,23 and Wyoming.24

Of these 14 laws currently in effect, all at least ostensibly include exceptions for situations that put a patient’s life in danger, and more than half contain an exception—again, at least ostensibly—for the health of the patient. However, in many states across the country, the vague nature of the statutes’ language has caused women to receive delayed care, putting their lives in danger and resulting in near-death experiences.25

In addition, a majority of these laws do not contain exceptions for rape and incest. However, in the states where abortion is allowed in cases of rape or incest—Idaho,26 Mississippi,27 North Dakota,28 Oklahoma,29 and West Virginia30 in the case of rape, and Idaho, Oklahoma, and West Virginia in the case of incest—these exceptions are often poorly understood and administered.31 In addition, in the majority of these states, in order to qualify for these exceptions, survivors must report to law enforcement, which creates an additional burden. In fact, in Mississippi, reporting indicates that there may be no doctors willing to provide an abortion to survivors of rape because of the legal consequences and logistical burdens.32 Similarly, under North Dakota’s “rape exception,” abortion is allowed up to six weeks of pregnancy only if, “based on reasonable medical judgement,” the pregnancy “resulted from” rape or incest.33

Enforcement mechanisms include criminal penalties, bounty hunter provisions, and fear and confusion

Overwhelmingly, state bans on abortion at any point in pregnancy contain criminal penalties for those who perform or attempt to perform an abortion. The majority of these criminal penalties include jail time, which typically ranges from 1 to 20 years, although the bans in Alabama34 and Texas35 can lead to life in prison. In addition, some state bans impose fines, which typically range from $1,000 to $100,000. In several states, including Arizona,36 Idaho,37 Missouri,38 Texas,39 and West Virginia,40 an abortion provider could lose their medical or professional license. Some state bans also include civil penalties, including Arizona,41 Louisiana,42 and Texas.43 Strikingly, the civil penalty in Texas is at least $100,000 per abortion.

While most of the bans are enforced through criminal or civil penalties, a few states have also passed bounty hunter laws, which allow individuals to sue abortion providers and, in some cases, those who “aid” or “abet” an abortion.44 In fact, even before the Dobbs decision, some states embraced the extreme nature of Texas’ S.B. 8 and enacted their own bounty hunter legislation, often overlapping with other bans enforced within the state.45

For example, in 2022, Idaho passed a six-week abortion ban that allows individuals to sue medical professionals who provide abortion.46 Similarly, Oklahoma passed two pieces of legislation that create a civil cause of action under which plaintiffs can sue those who provide an abortion as well as those who “aid” or “abet” an abortion.47 Among these pieces of legislation, all three allow for statutory damages; under the Idaho law, plaintiffs can be awarded at least $20,000, and under the Oklahoma laws, the penalties are at least $10,000. In 2023, other states introduced similar bounty hunter-style abortion bans, including Missouri,48 Virginia,49 and Kansas.50

Already, lawsuits have emerged from these bounty hunter provisions. In Texas, an abortion provider purposefully violated Texas’ S.B. 8 in order to serve as a test case, which was thrown out in December 2022.51 Similarly, in May 2023, the Oklahoma Supreme Court struck down the two bounty hunter laws in Oklahoma because they did not have sufficient medical emergency exceptions.52

In addition, novel legal arguments have been used to criminalize abortion and enforce various abortion bans. For example, a Texas man named Marcus Silva is suing three Texas women for wrongful death after they allegedly helped his ex-wife obtain a medication abortion.53 But rather than sue under S.B. 8, the man is suing under Texas’ wrongful death statute, which allows a plaintiff to sue anyone who causes the death of “an individual” through any “wrongful act.”54 Notably, these women have filed a countersuit, alleging that Silva found the medication and text messages explaining the plans before his ex-wife had the abortion, and “rather than talking with [his ex-wife] about what he found or disposing of the pill, Silva took photos of the texts and surreptitiously put the pill back.”55

Researchers posing as pregnant women called hospitals to ask about emergency abortion care and found that “not a single hospital in Oklahoma appeared to be able to articulate clear, consistent policies for emergency obstetric care that supported their clinicians’ ability to make decisions based solely on their clinical judgment and pregnant patients’ stated preferences and needs.”

Most practically, abortion bans are being enforced through fear and confusion. The massive penalties that await doctors who provide care have resulted in most clinics—particularly in the states that enforced near-total abortion bans or six-week abortion bans post-Roe—being shuttered,56 with many doctors hesitating to provide care that is legally considered abortion even in cases of miscarriage or when the mother’s health is at risk.57 In Oklahoma, for example, researchers posing as pregnant women called hospitals to ask about emergency abortion care and found that “not a single hospital in Oklahoma appeared to be able to articulate clear, consistent policies for emergency obstetric care that supported their clinicians’ ability to make decisions based solely on their clinical judgment and pregnant patients’ stated preferences and needs.”58 Polling has also shown that nearly half of women in states with abortion bans—47 percent—didn’t know whether mifepristone was legal in their state.59


Polling has shown that nearly half of women in states with abortion bans didn't know whether mifepristone was legal in their state

Ignoring science and targeting medication abortion

Since 2022, around half of states have taken steps to restrict access to medication abortion, creating much uncertainty around its availability and hesitation for the provision of care.60 In 2022, four states—Kentucky,61 Louisiana,62 South Dakota,63 and Tennessee64—enacted restrictions specifically related to medication abortion. Most restrictions on medication abortion attempt to create medically unnecessary and scientifically unfounded barriers to access in conflict with standards set by the U.S. Food and Drug Administration (FDA).65

Medication abortion has a more than 20-year track record of safe and effective use.66 Research demonstrates that additional hurdles and delays in care can have long-lasting negative impacts that disproportionately affect historically marginalized groups.67 These restrictions can also strain health care systems because more patients must visit a provider for abortion care, placing additional capacity issues on already understaffed hospitals and clinics across the United States.68 In fact, just two months after Roe was overturned, providers at a health center in New Mexico were already at full capacity because of the influx of patients traveling from out of state.69 Many clinics reported having backlogs in care, meaning that wait times increased from two to three days to two to three weeks.70 Abortion restrictions also interfere with the provider-patient relationship and a provider’s ability to make ethical and medically necessary decisions about care.

Among the states with new laws restricting medication abortion, modes of restriction include limiting what type of medical professional can administer the medication; requiring that both doses of a medication abortion be provided/taken in person at a clinic, prohibiting telemedicine; prohibiting the mailing of medication abortion; banning the use of mifepristone at seven weeks, prior to the FDA’s approved cutoff period of 10 weeks;71 and requiring counseling on medication abortion “reversal,” which typically entails a provider reading a script with scientifically unproven and unethical information on how to “reverse” a medication abortion with progesterone.72 These types of restrictions work to severely limit or hinder access to abortion against medical best practices and under the guise of fake safety concerns.

Ongoing litigation related to medication abortion

The threat to and scrutiny of medication abortion extends beyond state-level restrictions. In April, a far-right district court judge in Texas with a demonstrated anti-abortion history73 issued a decision that undermined the FDA’s authority to approve drugs,74 including mifepristone, despite decades of evidence that mifepristone is safe and effective.75 The 5th Circuit largely upheld restrictions on the medication on appeal. On April 21, the U.S. Supreme Court issued an administrative stay in the case, meaning that access to mifepristone will remain available as litigation plays out in the lower courts.76 Eventually, the case is expected to again reach the Supreme Court. Ultimately, if severe restrictions on mifepristone were allowed to stand, this case could have devastating effects on access to medication abortion across the country, even in states where abortion is legal. This chaotic and confusing legal landscape has created a perfect storm for some states to unreservedly attack abortion access, while others are left fighting to shore up protections and do what they can to expand access.

The focus on medication abortion continues to grow. In 2023 alone, at least 16 states have introduced some type of bill that restricts medication abortion.77 Of those, five have been enacted.

Most notably, in March, Wyoming Gov. Mark Gordon (R) signed a bill making it a felony to prescribe, sell, or use “any drug for the purpose of procuring or performing an abortion,”78 which takes effect July 1.79 While bans on medication abortion are subsumed under all blanket abortion bans, Wyoming’s is the first ban to explicitly ban medication abortion pills. The law criminalizes people seeking medication abortion care and any physician or person who helps procure or perform an abortion. In April, Florida Gov. Ron DeSantis signed into law a six-week abortion ban, S.B. 300, which will only go into effect if the state’s current 15-week ban is upheld in court. 80 The six-week ban includes several provisions to severely restrict the availability of medication abortion, including requiring medication abortion to be dispensed by a physician in person and prohibiting the medications from being mailed. In March 2023, Utah Gov. Spencer Cox (R) signed into law H.B. 467,81 which limits the type of medical professional who can prescribe medication abortion. In early May, a district court blocked the implementation of this law.82 Additionally, in Kansas, the legislature voted to override the governor’s decision to veto H.B. 2264,83 meaning that abortion clinics now have to counsel patients on a scientifically inaccurate medication abortion “reversal” regimen. This law goes into effect on July 1, 2023.

Funding crisis pregnancy centers

Crisis pregnancy centers (CPCs) are organizations that represent themselves as comprehensive reproductive health care facilities, when they actually aim to dissuade people from accessing abortion and do not provide referrals to abortions clinics or offer abortion. Typically, CPCs disseminate medically inaccurate information about abortion care in order to convince patients not to have an abortion;84 for example, in 2022, CPC counselors in Texas reinforced the myth that abortions can cause mental illness85 and incorrectly suggested that abortions can cause cancer86 and infertility.87

According to the Guttmacher Institute,88 in 2022, 11 states passed legislation that funds crisis pregnancy centers: Arkansas, Florida, Kansas, Louisiana, Michigan, Missouri, Mississippi, North Carolina, Ohio, Oklahoma, and Pennsylvania. As of May 15, 2023, 20 states had introduced 54 pieces of legislation that would fund CPCs.89 So far, several have been enacted: These include a budget bill in Ohio that allocates $3 million to CPCs and $2 million in Kansas for an “alternatives to abortion” program, which was approved after the state legislature overrode the governor’s line-item veto.90

In states where abortion is legal, CPCs are often located near abortion clinics in an effort to confuse patients who are seeking abortion care.91 As a result, patients seeking abortion in states where abortion is legal and where CPC funding has been increased could be at a higher risk of visiting a CPC when they mean to go to an abortion provider. According to the National Committee for Responsive Philanthropy, that risk is further amplified given that CPCs are already “funded at five times the rate of those dedicated to ensuring abortion access, pulling in $278M in foundation support compared to $56M for legitimate clinics and abortion funds.”92 More funding allocated to CPCs is likely to generate additional misinformation and confusion around abortion access.

Bills to improve abortion access

As some politicians work against the will of the American people to limit reproductive rights, other states are ensuring care remains available within their borders. These efforts to create new legal rights include statutory and state constitutional protections, as well as laws to protect providers and those who travel for care. Some states are also expanding the use of medication abortion while making abortion care more affordable overall.

Protecting state-level abortion rights through statutory protections and executive orders

Both before and after Dobbs was decided, states codified statutory protections to ensure access to abortion and other forms of reproductive health care. In 2022 and 2023, states such as Colorado,93 New Jersey,94 and Minnesota95 passed laws with affirmative language to protect reproductive rights, including abortion access. For example, New Jersey’s Bill S49/A6260, the Freedom of Reproductive Choice Act,96 specifically covers contraception, including emergency contraception, access to public benefits, the choice to terminate a pregnancy, and the choice to carry a pregnancy to term.

In the wake of the Dobbs decision, state governors in several states signed executive orders to protect and support abortion access,97 including Colorado, Hawaii, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Pennsylvania, and Rhode Island. The executive orders range in scope, but many are shield laws that prohibit state agencies and departments from participating in investigations by other states who seek to punish patients or providers who receive or perform an abortion. Other executive orders include the release of $3.5 million in Maryland to train new abortion providers and the designation of $10 million in New Mexico to build a reproductive health care clinic in an underserved area of the state.98

In the past decade, several states enacted legislation to repeal outdated and pre-Roe or post-Roe bans, including Colorado99 in 2013, Delaware100 in 2017 and 2021, Massachusetts in 2018,101 Nevada in 2019,102 New Mexico in 2021,103 Rhode Island in 2019,104 and Vermont in 2014.105 Most recently, in April 2023, Michigan Gov. Gretchen Whitmer (D) signed a law to repeal the state’s 1931 abortion ban,106 which did not contain exceptions for pregnancies resulting from rape or incest.

Ballot initiatives to protect abortion

A strong majority, 64 percent, ­of Americans believe that abortion should be legal in most or all cases, and this has been reflected through ballot initiatives across the country.107 In November 2022, three states enshrined abortion rights into their state constitutions: California, Michigan, and Vermont.108 In California, nearly 67 percent of voters approved a constitutional provision to protect an individual’s reproductive freedom, including abortion and contraception.109 This amendment was adopted alongside California’s existing abortion protections, serving to underscore the state’s commitment to reproductive rights.

In Michigan, almost 57 percent of voters approved a constitutional provision “to establish a new individual right to reproductive freedom,” which includes the right to make decisions about abortion and prohibits prosecution of a person who helps someone obtain an abortion.*110

In Vermont, almost 77 percent of voters approved a constitutional provision to protect “an individual’s right to personal reproductive autonomy” and prohibit that right from being “denied or infringed unless justified by a compelling State interest achieved by the least restrictive means.”111 Abortion has been legal in Vermont since 2019, but this provision prevents future state legislatures from impeding the right to reproductive autonomy, including abortion.112

Alongside these three states, in 2022, Kansas and Kentucky voters rejected an amendment that would have explicitly excluded abortion rights from their state constitutions.113 In addition, Montana voters rejected a measure designed to confuse the public on abortion and disrupt medical professionals’ care of their patients.114

Already, advocates in several states are working to introduce ballot initiatives to protect abortion rights,115 including Arizona, Arkansas, Florida, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, and South Dakota. Other states considering language as of publication include Nevada,116 Maryland,117 and Oregon.118 Recently, there has been significant movement in Ohio, as the Ohio Ballot Board has approved a proposed ballot measure to protect abortion.119 Advocates now have until July 5 to gather more than 413,000 valid signatures in order to appear on the ballot, although anti-abortion activists in Ohio have sued,120 and if they are successful, pro-choice advocates would need twice as many signatures.121

Shield laws to protect abortion providers and patients

According to the Guttmacher Institute, in 2020, nearly 1 in 10 people seeking abortion care traveled outside their home state to access abortion.122 Now that abortion is banned in 14 states and restricted in many more, interstate travel for abortion is likely more common. In fact, recent data show that in 2022, 28 percent of abortion care in Colorado was provided to out-of-state patients.123 In addition, in the first four months that Texas S.B. 8 was in effect, Planned Parenthood health centers in states surrounding Texas saw an 800 percent increase in abortion patients.124

Extremist politicians in states with bans have taken note of these trends and now openly discuss criminalizing travel or attempts to enforce their bans past state borders.125 As a result, in 2022, 14 states adopted so-called shield laws—either through executive order or the legislative process—to prohibit abortion providers and patients from being prosecuted by states that criminalize abortion.126 Typically, these laws include provisions to protect medical professionals that provide abortion care to out-of-state patients who are traveling from states where abortion is banned. Others explicitly protect patients from prosecution if they travel from a state where abortion is illegal.

Most of these laws exclusively focus on abortion care, though some, including in Massachusetts127 and New York,128 also apply to gender-affirming care. So far in 2023, shield laws have been passed in nine states: Colorado,129 Hawaii,130 Illinois,131 Maryland,132 Minnesota,133 Nevada,134 New Mexico,135 Vermont,136 and Washington,137 as well as the District of Columbia.138 In the majority of these states, these laws also contain protections related to gender-affirming care. In total, 15 states and the District of Columbia have passed “shield laws” through the legislative process to protect abortion rights.

Expanding access to medication abortion

Since Dobbs, a few states have introduced legislation that explicitly protects and expands access to medication abortion. Further, a number of states have couched medication abortion protections in other types of laws, such as expanding, protecting, and funding the abortion provider workforce and the introduction of shield laws.

For example, in 2022, Delaware and Massachusetts enacted laws to expand access to medication abortion.139 These laws included provisions to expand the scope and types of medical providers who can provide medication abortion, including providing additional funding to train staff in the provision of medication abortion; requiring public universities to provide medication abortion to students; and protecting people who may self-induce an abortion with medication abortion, also known as a “self-managed abortion” (SMA). Additionally, some states have expanded access to telehealth overall, and these laws have the potential to improve access to medication abortion in states where it is legal.140

In 2023, at least 11 states and the District of Columbia have introduced some type of legislation that would protect or expand access to medication abortion.141 Of those states, seven have enacted legislation. Washington, D.C., enacted B. 24-0726142 in March, which protects people who self-manage their abortion and those who support them.143 In early April, Washington state purchased a three-year stockpile of mifepristone, in preparation of if the drug were to become inaccessible because of pending legal challenges.144 In late April, it signed into law S.B. 5768,145 which creates a mechanism that allows the state Department of Corrections to obtain, distribute, and provide the medication. Additionally, in April, Massachusetts purchased a one-year supply of mifepristone,146 and Gov. Maura Healey (D) issued an executive order explaining that the state’s 2022 shield law applies to medication abortion and that both providers and patients are protected.147

In order to protect medication abortion, some states have taken the approach of protecting providers who prescribe or send medication as well as people who may travel from out of state to get abortion care. These protections are also known as shield laws. For example, the New York Legislature recently passed a shield law that would allow providers to provide telemedicine abortion services to out-of-state patients.148

Making abortion more affordable

In 2022, five states enacted legislation to make abortion more affordable through both private health insurance plans and state Medicaid coverage. However, many more states introduced legislation in 2022 to make abortion more affordable.149

Continuing that momentum in 2023, nine states introduced legislation to expand coverage for abortion under Medicaid,150 and 18 states introduced legislation to expand coverage under private health plans.151 So far in 2023, only Illinois, Washington, Vermont, and Rhode Island have signed coverage-related bills into law. Illinois enacted H.B. 4664, which clarifies that medication abortion is included in the abortion coverage requirement for health plans without cost sharing, restrictions, or delays, in addition to requiring other types of care such as HIV care and gender-affirming care.152 Washington state signed S.B. 5242 (and companion bill H.B. 1115) into law, which requires state-regulated health plans to cover abortion without cost-sharing charges to an enrollee; it encompasses all plans that are renewed on or after January 1, 2024.153 Most recently, Rhode Island Gov. Daniel McKee (D) signed the Equality in Abortion Coverage Act, which allows state employee insurance and state Medicaid funds to pay for abortion care.154 Laws that make abortion more affordable are crucial to improving health equity and ensuring people get the essential health care they need without delay.

Additionally, some states are considering ways to allocate funding for abortion and abortion-related costs, particularly those states where people may be traveling to receive care. For example, at the end of 2022, Massachusetts confirmed that it would allocate approximately $2 million in its fiscal year 2023 state budget155 and another $2 million from its governor’s spending plan to 11 organizations156 that offer abortion services, which includes providing assistance with transportation and lodging, childcare payments, translation services, and abortion doulas. This funding could help remove financial barriers for low-income families and uninsured or underinsured patients.

Another example is Connecticut’s work to establish a fund for out-of-state abortion patients. The state’s Reproductive Rights Caucus and advocates have been collaborating to establish a Safe Harbor Fund, which, if enacted, would provide financial assistance to people who travel to the state for an abortion.157 This funding has the potential to make a significant difference in affordability, especially considering that people who must travel for abortion typically pay out of pocket for those services and all associated travel expenses.


The legislative trends that have emerged in the year since the Supreme Court overturned Roe v. Wade illustrate a few things: The fight for abortion access and rights is far from over; abortion access continues to be piecemeal and patchwork across the United States, as well as dependent on where a person lives; and people’s lives are heavily affected every day by the decisions of elected representatives and other policymakers. These trends demonstrate that states must protect abortion access and rights within their borders, but some also have to fight to counter the reprehensible restrictions and bans in states hostile to abortion access and rights. The effects of abortion restrictions are multifaceted, affecting public health outcomes and economic security, and state policymakers must contend with this as they make decisions to advance reproductive health and well-being.

The authors would like to thank Isabela Salas-Betsch, Amina Khalique, Maggie Jo Buchanan, and Emily Gee for their contributions to and reviews of this report.

* Correction, July 31, 2023: This report has been corrected to clarify that 57 percent of Michigan voters approved a constitutional provision to protect abortion access.


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  29. Abortion; prohibiting performance of abortion except under certain conditions; requiring test to meet specified criteria; physician records; civil action; prohibiting certain transfer of venue; emergency, OK H.B. 4327, 58th Legislature, 2022 sess. (May 26, 2022), available at
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  89. Ibid.
  90. Jason Tidd, “Kansas lawmakers override anti-abortion vetoes months after voters spurned Value Them Both,” The Topeka Capital-Journal, April 27, 2023, available at
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  94. Freedom of Reproductive Choice Act (s49/a6260), New Jersey Legislature sess. 2020-2021 (2022), available at
  95. Steve Karnowski, “Minnesota governor signs broad abortion rights bill into law,” AP News, January 31, 2023, available at
  96. Freedom of Reproductive Choice Act (s49/a6260).
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  121. Jessie Balmert, “Lawsuit: Ohio Ballot Board should have split abortion amendment into multiple issues,” The Cincinnati Enquirer, March 20, 2023, available at
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  131., “Gov. Pritzker Signs Sweeping Reproductive Rights Protections Into Law,” Press release, January 13, 2023, available at
  132. Senate Bill 0859, Chapter 246, Maryland General Assembly (June 1, 2023), available at
  133. Lisa Baumann and Steve Karnowski, “Washington, Minnesota become trans refuges, shield abortion,” ABC News, April 27, 2023, available at
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  137. Baumann and Karnowski, “Washington, Minnesota become trans refuges, shield abortion.”
  138. D.C. Law 24-257: Human Rights Sanctuary Amendment Act of 2022, available at
  139. Delaware General Assembly, H.B. 455, 151st General Assembly (2022–2022), available at; General Court of the Commonwealth of Massachusetts, H.5090, 192nd court (2021–2022), available at
  140. Guttmacher Institute, “State Legislation Tracker”; Reproductive Health Initiative For Telehealth Equity and Solutions, “State Telehealth Policies At-A-Glance,” available at (last accessed June 2023).
  141. Guttmacher Institute, “State Legislation Tracker.”
  142. Council of the District of Columbia, B24-0726 – Enhancing Reproductive Health Protections Amendment Act of 2022, available at (last accessed June 2023).
  143. Ibid.
  144. Sarah McCammon, “Washington state stockpiles thousands of abortion pills,” NPR, April 4, 2023, available at
  145. Washington State Legislature, S.B. 5768, 68th Legislature, 2023 Regular sess. (2023), available at
  146. Steph Solis, “Massachusetts stockpiles mifepristone, adds abortion medication to shield law,” Axios, April 10, 2023, available at
  147., “Executive Order No. 609: Protecting Access to Medication Abortion Services in the Commonwealth,” April 10, 2023, available at
  148. Carrie N. Baker, “New York Shield Law Would Protect Clinicians Mailing Abortion Pills to Patients in Red States,” Ms. Magazine, January 19, 2023, available at
  149. Guttmacher Institute, “State Legislation Tracker.”
  150. Ibid.
  151. Ibid.
  152. Illinois General Assembly, “Bill Status of HB4664,” 102nd General Assembly, available at (last accessed June 2023).
  153. Washington Legislature, S.B. 5242, 68th Legislature, 2023 Regular sess., available at
  154. State of Rhode Island, “Gov. McKee, Lt. Gov. Matos Statements on Signing Equality in Abortion Coverage Act Into Law,” Press release, May 18, 2023, available at
  155. General Court of the Commonwealth of Massachusetts, “FY 2023 Final Budget,” available at (last accessed June 2023).
  156. Heather Alterisio, “Baker administration awards $4.1 million in grants to boost reproductive health access,”, December 19, 2022, available at
  157. Democrat Erick Russell, “State Treasurer Candidate Erick Russell Announces Plan To Launch The Connecticut Safe Harbor Fund And Connect Women Seeking An Abortion To The Health Care They Choose For Themselves,” Press release, July 27, 2022, available at

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Senior Policy Analyst


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