Portrait of René Kladzyk
René Kladzyk

For people seeking abortions, geography matters. United States laws that shape access to abortion vary widely depending on where you’re located. While some states have passed laws enshrining the right to an abortion regardless of Supreme Court rulings, others have extensive measures in place designed to halt all abortions now that Roe v. Wade has been overturned.

The 6-3 Supreme Court decision announced Friday upended nearly fifty years of precedent, since the landmark 1973 Roe v. Wade decision established a constitutional right to an abortion. The majority opinion, penned by Justice Samuel Alito, argues that abortion access should be decided by the states; and now that Roe has been overturned, 26 states are either certain or likely to ban abortion, according to the Guttmacher Institute. Other Supreme Court decisions in recent months had suggested Roe would fall, and many conservative state legislatures have been preparing and advancing legislation with that in mind.

More than a dozen states have advanced copycat laws that eviscerate access to abortion after the U.S. Supreme Court decided to not stop a Texas abortion ban in fall 2021. Thirteen states have passed “trigger laws” that ban abortion upon the overturning of Roe v. Wade, while seven more states have existing abortion bans on the books that will go back into effect. Amid increased demand for abortion medication by mail, state legislation has also emerged restricting it. Meanwhile, sixteen states and the District of Columbia have passed laws that protect and uphold the right to abortion, regardless of federal law.

Here, we break down what you need to know about the different state laws shaping abortion access throughout the country.

The inventive fallacy of “heartbeat bills”

Many states have proposed what are termed “heartbeat bills,” banning abortion as early as six weeks into pregnancy after detection of what their proponents say is a “fetal heartbeat.” Medical experts have disputed this framing as “clinically inaccurate”, because embryos do not yet have a heart at six weeks, nor are they considered a fetus at that stage in gestation. An inventive Texas law passed in May 2021, Senate Bill 8, was the first of such laws to be enforced – it possesses an unusual enforcement mechanism where any person can bring a civil suit against someone who ‘aids and abets’ the provision of an abortion, and can collect a $10,000 bounty. This facet of the bill has made judicial challenges more difficult, and in September 2021 the Supreme Court ruled 5-4 to leave the measure in place – a decision some abortion advocates said portended the downfall of Roe v. Wade.

The impacts of the law have been sweeping and profound. Neighboring states experienced an 800% increase in abortion patients from Texas in the first six months after SB8 went into effect, according to data compiled by Planned Parenthood. Requests for abortion medication by mail spiked dramatically, and researchers predict that total abortion bans, now permitted in the wake of Roe v. Wade being overturned, will increase pregnancy-related deaths by 21%, with the greatest impact on non-Hispanic Black people where deaths are expected to rise 33%.

A wave of copycat legislation has followed in other states, with conservative lawmakers emboldened by the Supreme Court’s failure to halt SB8. In recent months, lawmakers have passed abortion bans in Arizona, Oklahoma, and Florida, while other states have introduced similar legislation that has not yet passed.


Trigger laws

Thirteen states have passed what are known as “trigger laws” – measures designed to immediately ban abortion following the overturning of Roe v. Wade. In seven states, abortion bans that predate Roe v. Wade are still on the books, and would become enforceable again following it being overturned. In total, 26 states are expected to rapidly ban abortion if Roe is overturned, according to the Guttmacher Institute.

Map from Guttmacher Institute. Accessed June 24, 2022.

The specifics of state trigger laws vary. Some offer exceptions for rape and incest (Idaho, North Dakota, Utah, and Wyoming), and others do not (Arkansas, Kentucky, Louisiana, Missouri, Oklahoma, South Dakota, Tennessee, and Texas). Some states would make performing an abortion a felony offense for doctors, with fines as high as $100,000 and prison sentences ranging from two to 20 years.

Abortion medication by mail

Medication abortions account for more than half of all abortions performed in the United States, according to the Guttmacher Institute. But as more states have passed abortion restrictions and bans, the accessibility of abortion medication by mail has become a key battleground. A December decision by the Food and Drug Administration established a federal standard permitting abortion by mail, permanently lifting in-person requirements for obtaining abortion-inducing medications, while varying state restrictions on abortion medication constrain access depending on where you’re located.

Thirty-two states require abortion medication to be provided by a physician according to the Kaiser Family Foundation, while 18 states and the District of Columbia permit abortion medication to be provided by nurse practitioners, physician assistants and nurse-midwives. Eighteen states require heightened standards for clinics that provide abortion care, effectively limiting the number of such clinics that can operate. Six states – Arizona, Arkansas, Missouri, Louisiana, Texas, and West Virginia – have passed laws banning the use of telehealth for dispensing abortion medication.

Abortion protection laws

Despite the wave of laws restricting and banning abortions, many lawmakers are working to improve access to abortion and mitigate the harms caused by abortion bans in other states. Sixteen states and the District of Columbia have laws in place that protect the right to an abortion, with some amending their state constitutions to enshrine abortion access. “The right to reproductive liberty is central to the exercise of personal autonomy,” read an amendment to the Vermont state constitution that was passed in February. The California legislature introduced a proposed amendment along similar lines to be decided by voters in November 2022. “This measure will ensure … an inviolable right to a safe and legal abortion that is protected in our constitution,” said California Governor Gavin Newsom in a June 8 statement.

States have also introduced measures to address the affordability of abortion in order to improve access. Maryland passed the Abortion Care Access Act in 2022, requiring that insurance providers cover abortion costs without cost-sharing, and California passed a similar law. Illinois, New York, and Oregon have similar laws already on the books for coverage of abortion care by state health plans. Connecticut recently passed a law protecting all people within the state –including visitors from other states –from prosecution related to providing or receiving abortion care.

At adyn, we believe all people should have access to safe and humane reproductive healthcare, and will update this piece to reflect changes to abortion access throughout the country in the weeks and months to come.