Updated on June 9, 2022:

This resource has been updated to include:

  • A reference to the leaked Supreme Court draft decision in Dobbs v. Jackson Women’s Health Organization.
  • An updated count on the number of states with one or no abortion clinics.
  • New sections on self-managed abortion, transgender-inclusive language, rape and incest exceptions to abortion bans, birth control not being a substitute for abortion, and a debunking of the false claim that abortion providers “target” Black and Hispanic communities.

Lauren Cross, an original co-author, left the Institute before the June update.

Updated on December 10, 2021:

This resource has been adjusted to indicate that the United States Supreme Court heard oral arguments on the constitutionality of Mississippi's 15-week abortion ban.

First published on November 22, 2021:

In January 1973, the US Supreme Court ruling in Roe v. Wade affirmed the constitutional right to abortion. Since then, Roe has been used as shorthand for federal protections of abortion rights.

Today, the abortion policy landscape in the United States is shifting in major ways.

Whether you’ve been covering abortion policy for years or are new to the issue, here are 15 key ideas to consider as you write about the future of abortion rights in the United States.

 

1. At the end of 2021, the Supreme Court heard oral arguments in a case that could roll back generations of abortion rights in the United States.
  • On December 1, 2021, the US Supreme Court heard oral arguments in Dobbs v. Jackson Women’s Health Organization, a case on the constitutionality of Mississippi’s 15-week abortion ban.
  • A leaked draft of the Supreme Court majority opinion in Dobbs made public on May 2 would explicitly overturn Roe v. Wade, the 1973 case that affirmed a constitutional right to abortion. While the draft opinion is not yet final and abortion remains legal in all states, except Oklahoma, a similar final verdict would mean that an additional 25 states are certain or likely to ban abortion.
  • These developments are the result of a recent shift to a much more conservative federal judiciary and Supreme Court majority.
    • In just four years, then-President Trump appointed more than 200 federal judges—nearly three in 10 of all active federal judges in the United States—and three of the nine justices on the Supreme Court, creating a strong 6-3 anti-abortion majority.
    • State policymakers have been testing the limits of what the new Supreme Court majority might allow and laying the groundwork for a day when federal constitutional protections for abortion are weakened or eliminated.

 

2. Abortion is a widely shared experience in the United States.

  • People of all different ages, races and religions have abortions in the United States.
  • In 2017, about 860,000 abortions were provided in clinical settings in the United States.
  • Even as the overall number of abortions nationally has declined, use of medication abortion via pills has been rapidly increasing.
    • In 2020, medication abortion accounted for 54% of abortions. This was the first year medication abortion crossed the threshold to become the majority of all abortions and is a significant jump from 39% In 2017.
    • Beyond its exceptionally safe and effective track record, what makes the abortion pill particularly significant is how convenient and private it can be—and how radically it could expand access to abortion care if freed from politically motivated restrictions.
    • Self-managing an abortion is not a new phenomenon. While fears around the grim state of abortion access in a post-Roe country are valid, phrases such as “coat hanger” or “back alley” abortion do not accurately reflect the models for self-managed abortion that have existed outside the medical system for a long time. Many providers, researchers and advocates stress that people seeking to self-manage an abortion primary face legal rather than health risks.

 

3. Even with Roe v. Wade in place, many people are already unable to obtain abortion care.

  • People currently face a number of barriers to obtaining abortions, from insurance coverage bans like the Hyde Amendment to forced waiting periods. Overcoming these restrictions, especially when they are layered on top of each other, can be impossible for many people, especially those with the fewest resources.
  • In addition, if there are few abortion providers in a state, if abortions are unaffordable or if various logistical barriers make it too difficult to reach a provider or schedule an appointment, then the fact that abortion is “legal” means it is a right in theory but not in practice for many people.
  • Access to abortion also varies by geographic region. Many of the most hostile states are clustered in the Midwest, the South and the Plains, so a person may not be able to get the care they need even if they travel to a neighboring state.
  • There are six states with only one remaining abortion provider: Mississippi, Missouri, North Dakota, South Dakota, West Virginia and Wyoming. Because of a near-total abortion ban, Oklahoma has no clinics that are currently able to provide abortion care.

 

4. Not everyone who needs an abortion may identify as a woman. Some trans and nonbinary individuals also need abortion care, and their experiences are underrepresented in abortion data and media accounts.

  • Guttmacher’s survey of all known health care facilities that provided abortions in 2017 found that between 462 and 530 transgender and nonbinary individuals obtained abortions that year.
  • Many abortion facilities do not document their patients’ gender identity, thus the actual number is likely higher.
  • Like other patients from marginalized backgrounds seeking abortions, trans and nonbinary people often have fewer resources to overcome restrictions on abortion care.
  • Trans and nonbinary individuals may also face discrimination and stigma in the health care system, compounded by recent state laws banning or restricting gender-affirming health care for adolescents that has led to the closure of trans health care clinics.
  • It is important to use gender-inclusive language when possible. However, there are contexts when the use of “women” to refer to the population of people impacted by abortion restrictions is necessary to accurately reflect data collected by the US Census Bureau and other sources.

 

5. Nearly 50 years of escalating anti-abortion campaigns and policies set the stage for the situation we are in today.

  • Between 1973 and May 2022, 1,380 abortion restrictions were enacted in states.
  • More than 630 restrictions have been enacted since 2011, showing how the pace of attacks has picked up. In other words, it took nearly 40 years to accrue 54% of the restrictions and only about a decade for the other 46%.
  • In fact, over 100 abortion restrictions were enacted in 2021 alone. This surpasses the count from 2011, previously the worst year on record, when 89 restrictions were enacted.
  • This worrying trend has continued in 2022, with more than 500 abortion restrictions introduced and more than 35 enacted through May.

 

6. The people most affected by abortion restrictions are those already facing overlapping systems of oppression.

  • Restrictions disproportionately impact those who have limited resources to overcome financial and logistic barriers. This includes young people, people with disabilities, LGBTQ people, people with low incomes and those in rural areas, as well as Black, Indigenous and other people of color.
  • It is critical to remember that the majority of people who get an abortion are already struggling to make ends meet: Some 75% of abortion patients have low incomes and the majority are already parents.
  • In 2014, Black patients accounted for 28% of all abortion patients, Hispanic patients for 25%, White patients accounted for 39%, and patients of other races and ethnicities accounted for 9%. This means the majority of people who have abortions are also facing structural racism that is exacerbated by every logistic hurdle.
  • Anti-abortion activists falsely claim that abortion providers “target” Black and Hispanic communities to explain the racial disparities among abortion patients and that most abortion clinics are located in predominantly Black or Hispanic neighborhoods.

 

7. Abortion restrictions are political tools designed to make abortion harder to access and are not focused on helping people or improving medical standards of care.

  • Any one restriction on abortion can pose an undue burden and require patients to jump through hoops and navigate barriers to receive care. Many states layer restrictions on top of one another, creating a labyrinth of obstacles that research shows has negative consequences for pregnant people seeking care.
    •  In 2021, 90% of the enacted restrictions were adopted in states already considered to be hostile toward abortion rights because of their many types of restrictive policies.
  • Abortion restrictions typically block people from getting care by intentionally targeting people where they are most vulnerable: finances and logistics. Other restrictions override providers’ medical judgment or intentionally make the experience demeaning or harmful to patients.
  • The average cost of an abortion at 10 weeks is around $550, and the cost goes up significantly later in pregnancy. This creates a vicious cycle in which someone might have to delay getting an abortion to raise the needed funds, only to have the cost increase.
    • The Hyde Amendment prohibits federal funding for abortion, preventing people enrolled in Medicaid and other public programs in most states from using their health insurance to cover abortion care.
    • 11 states have restrictions that keep people from using their private health insurance to pay for an abortion, and 25 states restrict abortion coverage in plans offered through the Affordable Care Act’s health insurance exchanges.
  • If a person has to travel a long way to get an abortion, they may have to arrange for time off work, find and pay for transportation and child care, and pay for food and lodging.
    • In 14 states, the combination of in-person counseling requirements and a waiting period means patients have to make two separate trips to a clinic.

 

8. Exceptions for rape and incest in abortion bans rarely help survivors and are a thinly veiled attempt to make draconian laws look less cruel.

  • Exceptions for rape and incest are not common among abortion restrictions. They appear most often in bans on abortion coverage in public and private health plans. When an abortion restriction or ban includes exceptions for people who have experienced rape or incest, it means patients must jump through additional hoops to get care, such as reporting the assault to law enforcement.
    • These hurdles are designed to be insurmountable and are often retraumatizing if not dangerous for the patient.
    • Focusing on exceptions also pits “good” versus “bad” reasons for obtaining an abortion against each other. This stigmatizes all abortions and ignores the most effective support for survivors of rape and incest—removing abortion bans and restrictions entirely.
  • A lack of rape and incest exceptions in many abortion bans highlights anti-abortion lawmakers’ determination to stop everyone from obtaining an abortion.
    • 12 states do not include exceptions for rape and incest in their bans that would be triggered if Roe were overturned or bans on abortions up to eight weeks of pregnancy: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Ohio, Oklahoma, South Dakota, Tennessee and Texas.

 

9. Many states supportive of reproductive rights have laws on the books that maintain or expand the right to abortion with or without Roe.

 

10. Expanding access to birth control and improving maternal health outcomes is vital, but not a substitute for access to abortion.

  • Abortion rates have been declining since 1990, and one of the factors behind this decrease is improvements in contraceptive use, with more adolescents and young people relying on long-acting reversible methods and condom use increasing.
    • However, contraceptive use is not a fail-safe way to prevent pregnancy. In 2014, 51% of abortion patients reported they had used a contraceptive method in the month they became pregnant.
  • Additionally, advocating for increased access to birth control in the absence of abortion care ignores the long history of anti-abortion advocates asserting that certain methods of contraception are methods of abortion.
  • There is also reason to doubt that contraceptive access will remain protected under the US constitution.
    • The constitutional right to privacy used to support the legality of abortion in Roe v. Wade had been established in the 1965 Griswold v. Connecticut and 1972 Eisenstadt v. Baird Supreme Court decisions that guaranteed the right to use birth control. If Roe is overturned, there is significant reason to be concerned that those protections will be overturned next, along with other rights that rely on a similar privacy argument, like same-sex marriage.
11. A recent Guttmacher analysis shows that if Roe v. Wade is weakened or overturned, there are 26 states that are certain or likely to quickly ban abortion to the fullest possible extent.
12. For years, anti-abortion activists have been teeing up blatantly unconstitutional state laws to lie in wait for a day when Roe is gone or drastically undermined.
  • With the potential for the Supreme Court to severely roll back abortion rights, anti-abortion policymakers have been enacting a wide range of restrictions in the hopes that these laws will be allowed to go into effect.
  • Thirteen states have provisions to ban all or nearly all abortions that would be triggered if Roe were overturned: Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah and Wyoming.
  • In addition, four states have passed a constitutional amendment explicitly declaring that their state constitution does not secure or protect the right to abortion or allow use of public funds for abortion: Alabama, Louisiana, Tennessee and West Virginia.
13. Research shows that pregnant people are harmed in many different ways when they do not have access to abortion care.
  • A significant body of scientific literature shows that the adverse consequences of withholding abortion coverage are serious and long-lasting.
    • Forcing someone who wants an abortion to continue a pregnancy is tantamount to requiring them, against their wishes, to accept the risks of pregnancy- and labor-related complications, including preeclampsia, infections and death.
    • These risks fall much heavier on some communities than others. The United States has the highest maternal mortality rate among developed countries, with dramatic but preventable racial inequities caused by systemic racism and provider bias. Black and Indigenous women’s maternal mortality rates are 2–3 times the rate for White women, and 4–5 times as high among women aged 30–39 than among younger women.
  • The risks of serious consequences do not end with a safe delivery. The Turnaway Study by researchers at UCSF found that denying wanted abortion care can have adverse consequences for people’s health, safety and economic well-being.
    • For example, among women experiencing intimate partner violence, being forced to carry an unwanted pregnancy to term can delay separation from the partner, resulting in ongoing exposure to violence. In addition, compared with women who get the abortion they seek, women who do not obtain a wanted abortion have four times greater odds of subsequently living in poverty.
    • People who are unable to get the abortion they want also have three times greater odds of being unemployed, and they are less likely to be able to have the financial resources for basic needs such as food and housing.
14. Abortion funds and practical support networks already exist and are incredibly important.
  • Each time an egregious anti-abortion law makes national news, people who are less involved in the abortion rights movement are quick to propose new support networks (often on social media) for pregnant people who may need an abortion.
  • But in doing so, they can actually cause harm and confusion by diverting funds from more than 80 organizations called abortion funds that already serve at least 50,000 patients annually who need assistance obtaining an abortion.
  • If Roe is weakened or overturned, the abortion funds already supporting their communities are best positioned to help patients navigate local and regional barriers to accessing care.
  • Also, philanthropists of every stripe have a critical role in protecting access to abortion care, and there are plenty of established but underresourced organizations on the front lines of abortion-related work that need financial support, including abortion funds, reproductive justice organizations and legal defense groups.
15. Congress has the tools to put an end to discriminatory state restrictions and let people get the abortion care they need.
  • The Women’s Health Protection Act would protect pregnant people’s access to abortion—whether someone lives in California, Texas, Indiana or Maine—by establishing federal statutory rights for providers to offer, and patients to receive, abortion care free from medically unnecessary restrictions and bans.
  • The Equal Access to Abortion Coverage in Health Insurance (EACH) Act would lift the discriminatory Hyde Amendment and restore insurance coverage of abortion for people enrolled in Medicaid and other federal programs. This bill is the result of long-standing efforts led by women of color to counter the injustice and discrimination of the Hyde Amendment.