State Policy Trends Midyear Analysis

States that ban abortion based on gestational duration often include exceptions to these bans in their laws. Typically, these exceptions purport to allow access to abortion care in circumstances involving risk to the life or health of the pregnant person or when the pregnancy is the result of sexual violence. However, these exceptions are unworkable for many people and many jurisdictions withhold care unless patients meet onerous requirements for medical documentation, law enforcement reporting, and other processes. While these narrow exceptions may allow some people to access the care they need, such changes to the law have little impact on the care denials and other harms that abortion bans cause. 

So far in 2025, 12 states have introduced 42 bills that would add exceptions to existing gestational duration bans on abortion. Two of those bills have been enacted into law. While many of these bills were genuinely designed to mitigate the harms associated with abortion bans, they often attempt to do so by defining the care provided in certain medical emergencies as distinct from abortion care, as designated in the state code. For example, miscarriage management care or care performed to save the life of the pregnant person is often defined as something other than abortion, even though the service provided is abortion care. As a result, providers are only able to offer care in narrow circumstances, even though the best interventions for their patients’ health are often complex and cannot be captured in an enumerated list.

This problem is exemplified by a law enacted in Kentucky this year, which redefined exceptions to the state’s abortion ban from abortion care if deemed necessary by a physician’s clinical judgment to a list of specific medical situations in which a physician can provide such care. The law also stripped the word “abortion” from the state code’s description of these exceptions, instead using terms such as “medical procedure” or “medical treatment” and further stigmatizing abortion care.

Other legislation purporting to reform abortion ban exceptions was actually a trojan horse for anti-abortion goals. In Texas, Senate Bill 31/House Bill 44 were presented as bills to clarify exceptions to the state’s abortion ban, but the amendments would re-open the state’s 100-year-old abortion ban, which imposes criminal penalties not just on abortion providers but also on those who support abortion patients and (potentially) on patients themselves. The threat of this legislation—which passed the state legislature and is awaiting action by the governor—is not hypothetical, as the state’s Attorney General previously argued that the century-old abortion ban could be enforced after Dobbs. While the state legislature amended the bill to insist that it not be construed to “affirm or reject the validity” of the 100-year-old abortion ban, this language does nothing to assure abortion providers, supporters, and patients that they will be safe from liability.

Such tactics suggest that anti-abortion policymakers are primarily concerned with imposing barriers and penalties on anyone providing, aiding, or accessing abortion care, rather than with protecting the lives and health of patients.

Access to medication abortion continues to be a primary target of state-level anti-abortion legislation. So far in 2025, 14 states have introduced bills that attempt to criminalize the sale, purchase or distribution of medication abortion pills. Some bills aim to ban medication abortion entirely, while others target online resources and logistical support organizations that facilitate access to medication abortion. 

This year, 10 bills were also introduced that would reclassify the abortion medications mifepristone and misoprostol as Schedule IV controlled substances, and six bills were introduced that would require wastewater to be tested for traces of these medications. Such legislation specifically targets providers of medication abortion, limiting their ability to prescribe and threatening their physical provision of the medications. A related bill in Texas goes so far as to require fresh drinking water to be tested for traces of mifepristone, in an attempt to generate fear and misinformation regarding medication abortion and its well-established safety record.

In January, Louisiana issued the first criminal indictment of an abortion provider since Roe v. Wade was overturned. The state charged a New York physician with criminal abortion under its total abortion ban, for allegedly providing abortion pills via telehealth to a Louisiana teenager. (The governor of New York refused to comply with Louisiana’s request to extradite the physician.) In February, the same New York doctor was fined by a judge in Texas for mailing abortion pills to a patient there.

New York is among the 22 states (plus the District of Columbia) with shield laws designed to protect abortion patients, providers, and support organizations from prosecution and extradition by states with abortion bans. Eight of these shield law states (including New York) have provisions that protect abortion providers who use telehealth, regardless of the patient’s location. Colorado, Maine and New York have also strengthened their shield protections in 2025 by allowing providers’ names to be removed from prescription labels and replaced with the names of their health care facilities.

At least 38 bills have been introduced across 24 states this year that include embryonic or fetal personhood language. These bills seek to grant an embryo or fetus the full legal rights of a person. The bills are part of a broader strategy to prevent the reestablishment of a constitutional right to abortion. Personhood language also directly targets legal protections for abortion providers and patients, such as the shield laws discussed above. These bills seek to implicate pregnancy outcomes such as abortion, miscarriage, and stillbirth under criminal and civil laws such as child abuse, homicide, and wrongful death claims.

Ten of these bills explicitly include language that could be used to criminally charge people for their pregnancy outcomes. For example, Montana introduced a bill creating the crime of “abortion trafficking” that could be used to prosecute anyone who helps a pregnant person travel for abortion care, and specifically names that a pregnant person could be charged under the new crime.

Along with legislation likely to criminalize pregnant people, some states have taken steps in 2025 to penalize individuals and organizations that provide support and funding to abortion seekers and other pregnant people. Continuing earlier legislative efforts to preemptively undermine abortion funds and practical support organizations, Texas passed legislation prohibiting municipalities from giving grants to or contracting with organizations that support abortion seekers. Such legislation is part of a concerted effort to push back against the millions of dollars that cities and counties have pledged to support abortion funds and practical support organizations post-Dobbs. And Louisiana passed a law expanding civil liability against out-of-state providers who mail medication abortion pills into the state, with the intent to target abortion shield providers.

From 2019 to 2023, maternal mortality fell by 21% in the 24 states where abortion care remained legal and accessible post-Dobbs. However, birthing people living in the 13 states with abortion bans were nearly two times as likely as those in protective states to die during pregnancy or childbirth, or soon after giving birth. Black birthing people living in ban states were more than three times as likely to die in pregnancy or childbirth compared to white birthing people in these states. This disproportionate loss of Black mothers is one of the reasons that the United States has one of the highest maternal mortality rates of affluent countries. 

In 2025, states continue to grapple with documenting the impact of these acute inequities in maternal health care and health outcomes, exacerbated by post-Dobbs restrictions. For example, Maternal Mortality Review Committees (MMRCs) are multidisciplinary groups that convene at the state and local level to comprehensively review deaths that occur during or within one year from the end of pregnancy. After a 2024 ProPublica report on preventable maternal deaths in Georgia, the state’s Department of Public Health disbanded its MMRC. To revive this vital working group, Georgia lawmakers proposed legislation to establish a multidisciplinary committee to review maternal deaths, mandate compliance with privacy laws, list conditions for removal of committee members, and require annual reporting to address the state's high maternal mortality rate. Texas has also wrestled with maternal mortality data surveillance post-Dobbs. In 2022, the first full year of Texas’s abortion ban, there was a 56% increase in Texas’s maternal mortality rate. Concerningly, at the end of 2024, Texas’s MMRC announced it would not review maternal death data from 2021 to 2024. In 2025, in an effort to protect health care providers and collect accurate information, Texas lawmakers introduced a bill to exempt providers from certain reporting requirements during case reviews by the Texas MMRC.      

Moreover, nearly 41.5 million women in the United States live in areas in which they have significantly limited or no access to necessary reproductive health care. Meanwhile, the maternal, reproductive and perinatal workforce faces numerous legal and structural barriers including extremely low reimbursement rates; scope of practice limitations; inconsistent licensure requirements from state to state; and inequitable access to education, funding and resources. Therefore, states have attempted to mitigate the devastation of maternal mortality by increasing access to doula and midwifery care, both of which have long been associated with improved maternal health outcomes and lower rates of medical intervention at birth.

In the first half of 2025, over 20 states introduced bills that would expand access to doula care. These reforms include requiring insurance coverage for doula care with no-cost sharing, allowing for prepartum and postpartum care, establishing Doula Advisory Committees and credentialing processes for doulas to become Medicaid providers, setting reimbursement rates and creating patient education programs. States like Arkansas, Maryland, Missouri, Montana, Vermont and Virginia passed legislation that would expand access to midwifery care. This includes expanding licensure opportunities and removing barriers through such initiatives as collaborative practice agreements to allow midwives to provide care more independently.

As in previous years, many policymakers in 2025 have sought to restrict youth access to sex education, SRH care and gender-affirming care, and to prevent LGBTQ youth from accessing sports activities, restrooms and other public accommodations. 

In 2025, 21 states (nearly twice as many as in 2024) have attempted to mandate harmful misinformation as part of sex education—through so-called “Baby Olivia” bills. These bills require school instructors to show students a fake ultrasound video purporting to illustrate fetal development throughout pregnancy. Some bills mandate use of the original “Meet Baby Olivia” video produced by the anti-abortion group Live Action, while others require the use of substantively similar videos—but all are medically inaccurate and designed to stigmatize abortion. Six states enacted these bills this session, further jeopardizing the quality of sex education that young people receive. Currently, fewer than half the states require sex education to be medically accurate, and only 29 states and DC require sex education at all.

Young people are also facing attacks on their access to sexual and reproductive health care. In 2025, six states have introduced eight bills known as “abortion support bans,” which target people who help a minor travel to access legal abortion care without their parents’ knowledge or consent. Actions such as transporting a minor across state lines for an abortion or providing a minor with financial or logistical support could lead to civil or criminal penalties, and in some cases substantial fines and jail time. Young people already face significant barriers in accessing abortion care and such bills deter both young people from seeking abortion care and others from assisting them. As discussed above, Montana took this type of travel restriction even further by attempting to make it a crime to travel for abortion care or assist someone in this travel, regardless of the patient’s age. As in previous years, restrictions on abortion access are often paralleled by restrictions on gender-affirming care, especially when it comes to young people. Thus far in 2025, 21 states introduced 35 bills seeking to ban gender-affirming care for minors, and three states enacted them. These efforts are a stark reminder that young people serve as a test group and many anti-abortion politicians explicitly seek to ban all travel for abortion care and other SRH services.

Many states have also sought to roll back young people’s right to consent to sexual and reproductive health services. This session, 39 bills were introduced in 19 states that would restrict or eliminate entirely young people’s ability to access abortion, contraception, prenatal care, and testing and treatment for sexually transmitted infections without forced parental involvement. (Of these, one proposed constitutional amendment was passed in Missouri, although it will require further approval by the voters.) Other states are taking steps toward eliminating judicial bypass exceptions to parental notice and consent requirements for abortion care. (While the judicial waiver process can be extremely difficult and burdensome, it is often the only option for young people who cannot safely involve their parents in their abortion or other health care decisions.) In May, Florida’s Fifth District Court of Appeals issued an alarming ruling that the state’s judicial waiver statutes were invalid and requested that the Florida Supreme Court confirm that these statutes violate parents’ Fourteenth Amendment rights. If the state supreme court agrees with the Fifth District, Florida would become the first state to require parental notice and consent for a young person’s abortion—without any alternative or exceptions. Legislators in South Carolina also attempted to eliminate young people’s ability to access abortion care without parental consent by introducing bills that would repeal their judicial bypass process. Forcing parental involvement often deters young people from accessing these services, and when it comes to abortion, most young people who can safely involve a parent in their decision already choose to do so. Young people deserve autonomy and confidentiality in accessing health care services—without them, fewer young people will seek the care they need and many will face worse health outcomes. 

These restrictions on care have been accompanied by a series of policy measures that exclude LGBTQ young people from full participation in public life. So far in 2025, over 80 bills have been introduced across the United States that restrict transgender youth access to sports activities, restrooms and other public accommodations. For example, North Dakota and Montana imposed sweeping restrictions on restroom access while Indiana enacted a bill to prohibit transgender people from participating in athletic teams. Meanwhile, Tennessee enacted a measure that gives educational and other employees license to misgender and harass students and coworkers using their sex and names assigned at birth—protecting these employees from disciplinary actions and giving them a right to sue employers with transgender-affirming policies. Finally, in a devastating attack on gender-expansive and trans people, Iowa passed a law removing gender identity as a protected class in the state’s civil rights act, making it the first state to rescind civil rights protections for a previously recognized group.

As states grapple with ongoing efforts to restrict contraception access at the state level and renewed attacks on contraception access at the federal level, many are responding with new measures designed to protect their residents’ access to contraception. 

Proactive, protective bills related to contraception vary in scope. Some states have introduced and passed legislation that increases access points for contraception. For example, five states and Guam have introduced bills expanding access to emergency contraception on college campuses and in emergency rooms. Other states have expanded contraception access through pharmacists. For example, laws enacted in Michigan allow pharmacists to prescribe and dispense contraception and require insurance coverage of pharmacist-prescribed contraception. Thus far in 2025, nine states have introduced 19 other bills expanding contraceptive access through pharmacists.

In addition to increasing contraceptive access points, states have also focused on decreasing the financial burden of contraception by improving insurance coverage. So far in 2025, 17 states proposed (and DC enacted) legislation that expands insurance coverage of contraception, including sterilization services and over-the-counter contraceptives that are available without a prescription. Other states have sought to improve coverage for an extended supply of contraception, reducing gaps in coverage and ensuring continuous access. Twelve bills introduced in seven states would cover an extended supply of up to 12 or 6 months of contraceptives, and Virginia and Oklahoma enacted these measures—however, Virginia’s governor vetoed their bill. 

Additionally, states continue efforts around codifying the right to contraception, an important step toward protecting future contraceptive access. To date this year, 47 bills to establish a right to contraception were introduced from 21 states; Tennessee’s law was enacted in April and will take effect in July.

Notably, some states that otherwise have restrictive laws related to sexual and reproductive health and rights have taken steps to protect contraceptive access. Tennessee and Oklahoma, two states with complete abortion bans and restrictive sexual and reproductive rights policies, took significant steps to improve contraceptive access. This is the direct result of advocates in the state continuing to fight for proactive policies that the public supports, despite opposition from anti-abortion legislators.

As with contraception access, several states moved to mandate insurance coverage of fertility care over the last decade, especially in the years following the Dobbs decision. In 2025, several states with severe abortion restrictions have, for the first time, moved to protect fertility treatments, including in vitro fertilization. Tennessee passed a law protecting the right to seek access to fertility treatment and contraception. Utah expanded its state employee benefits program to cover some fertility treatments but requires beneficiaries to meet certain infertility criteria. And Florida now requires coverage for fertility preservation services for cancer patients under the state’s insurance system.

The theme of these developments is that states may be willing to create a statutory right to seek fertility care, but few states with abortion bans are mandating broad insurance coverage or protecting patients from the burden of cost-sharing. So, while infertility care may now be legally protected, it remains inaccessible to patients who cannot pay tens of thousands of dollars out of pocket. Additionally, anti-abortion advocates have begun adding moral and religious objections exceptions into legislation related to fertility care, as happened in Arkansas this year, allowing providers to refuse care to patients seeking these services