2022 State Legislative Sessions: Abortion Bans and Restrictions on Medication Abortion Dominate

Elizabeth Nash, Guttmacher Institute Lauren Cross, Guttmacher Institute Joerg Dreweke, Guttmacher Institute
Reproductive rights are under attack. Will you help us fight back with facts?

First published online:

Updated on May 26, 2022

This analysis has been updated throughout to reflect counts of state legislation as of May 25. Previous updates since first publication are archived below.

Notable changes since the last update include:

  • Oklahoma’s governor signed into law a total ban on abortion starting at fertilization with a "bounty hunter" enforcement mechanism that went into effect immediately. This makes Oklahoma the first state to completely ban abortion since the 1973 Roe v. Wade decision.

 

In 2021, state legislatures set an alarming record of 108 abortion restrictions enacted in 19 states. With the fate of Roe v. Wade hanging in the balance at the US Supreme Court, 2022 is shaping up to be even more devastating for abortion rights and access.

Among restrictions introduced and moving since the start of state legislative sessions in January, two key themes are anti-abortion policymakers’ continued pursuit of various types of abortion bans and restrictions on medication abortion.

State Policy Developments on Abortion January 1–May 25, 2022

So far this year, 2,025 total provisions related to sexual and reproductive health and rights have been introduced across 46 states and the District of Columbia. This includes both restrictions and proactive measures.

  • Abortion restrictions introduced: 541 restrictions in 42 states
  • Abortion restrictions passed at least one chamber: 38 in 11 states
  • Abortion restrictions enacted: 42 in 11 states—Arizona (2), Florida (1), Idaho (1), Indiana (2), Kansas (1), Kentucky (19), Oklahoma (4), South Dakota (7), Tennessee (3), West Virginia (1) and Wyoming (1)
  • Protective abortion measures enacted: 19 in 11 states—California (1), Colorado (1), Connecticut (2), Delaware (1), Maine (2), Maryland (5), New Hampshire (1), New Jersey (1), New York (1), Oregon (1) and Washington (3)

Abortion Bans January 1–May 25, 2022

The May release of a leaked Supreme Court draft opinion on Mississippi’s 15-week abortion ban indicates that a majority of justices are preparing to overturn Roe outright, which could further bolster efforts by anti-abortion policymakers at the state level. Their preemptive actions to flood statehouses with restrictive bills so far this year may accelerate in anticipation that federal protections for abortion rights will soon be gone.

As part of this strategy, anti-abortion policymakers are attempting to pass abortion bans that blatantly violate the core holding of the Roe decision and that would devastate access to abortion care in their state if allowed to be enforced.

  • Bans introduced: 88 bans in 31 states
  • Bans passed at least one chamber: 4 in 4 states—Kentucky (1), Louisiana (1), Oklahoma (1) and West Virginia (1)
  • Bans enacted: 9 in 6 states—Arizona (1), Florida (1), Idaho (1), Kentucky (1), Oklahoma (4) and Wyoming (1)

Out of all the proposed bans, anti-abortion policymakers have been focusing primarily on four types: 15-week bans, "Texas-style" bans, total abortion bans and bans designed to be triggered if Roe is overturned.

  • Bans at 15 weeks of pregnancy
    • Introduced: 6 in 4 states
    • Passed at least one chamber: 1 in 1 state—West Virginia (1)
    • Enacted: 3 in 3 states—Arizona (1), Florida (1) and Kentucky (1)
  • "Texas-style" bans that rely on a bounty-hunter enforcement mechanism (with a total, six-week or other gestational age ban)
    • Introduced: 19 in 13 states
    • Passed at least one chamber: None
    • Enacted: 3 in 2 states—Idaho (1) and Oklahoma (2)
  • Total abortion bans
    • Introduced: 26 in 15 states
    • Passed at least one chamber: None
    • Enacted: 1 in 1 state—Oklahoma
  • "Trigger" bans to quickly prohibit abortion in the state
    • Introduced: 14 in 9 states
    • Passed at least one chamber: Louisiana (1)
    • Enacted: 2 in 2 states—Oklahoma (1) and Wyoming (1)

Medication Abortion Restrictions January 1–May 25, 2022

With the US Supreme Court primed to severely weaken or overturn Roe, medication abortion is likely to become even more critical in the delivery of care to many people. Guttmacher research shows that following two decades of safe and effective use, medication abortion accounted for 54% of all US abortions in 2020—powerfully illustrating that the method has gained broad acceptance from both abortion patients and providers.

However, medication abortion has become a primary target of anti-abortion politicians and activists seeking to restrict care in and out of clinical settings. Anti-abortion state policymakers have shown they are focused on further restricting access to medication abortion this year.

  • Restrictions on medication abortion introduced: 117 restrictions in 22 states, including 7 measures that would ban medication abortion outright
  • Restrictions on medication abortion passed at least one chamber: 10 in 6 states—Georgia (4), Louisiana (2), Missouri (1), South Carolina (1), South Dakota (1) and Wyoming (1)
  • Restrictions on medication abortion enacted: 18 in 3 states—Kentucky (8), South Dakota (7) and Tennessee (3)

Among the total count of medication abortion restrictions that have been introduced are bills that seek to ban medication abortion entirely. Others would make it much harder to administer and access care, including by prohibiting the mailing of pills, limiting provision to physicians (leaving out other qualified medical professionals) and limiting the gestational age for use.

  • Bans use of medication abortion
    • Introduced: 7 in 8 states
    • Passed at least one chamber: 2 in 2 states—South Dakota (1) and Wyoming (1)
    • Enacted: None
  • Prohibits mailing of abortion pills
    • Introduced: 12 in 9 states
    • Passed at least one chamber: 3 in 3 states—Georgia (1), Louisiana (1) and Missouri (1)
    • Enacted: 2 in 2 states—Kentucky (1) and South Dakota (1)
  • Restricts administration to physicians
    • Introduced: 14 in 10 states
    • Passed at least one chamber: 1 in 1 state—Georgia (1)
    • Enacted: 3 in 3 states—Kentucky (1), South Dakota (1) and Tennessee (1)
  • Limits provision at a specific gestational age
    • Introduced: 3 in 3 states
    • Passed at least one chamber: None
    • Enacted: 1 in 1 state—South Dakota

Protections and Expansions of Abortion Rights and Access January 1—May 25

State legislatures across the country have taken steps to protect abortion rights by introducing a range of legislation to repeal existing restrictions, protect the right to abortion and shore up access to abortion care. In states with progressive legislatures, these efforts are designed not only to expand access for their own residents, but also to support people from other states who might be forced to cross state borders because of new restrictions or bans in their home state.

  • Protective measures introduced: 263 in 29 states and DC
  • Protective measures passed at least one chamber: 14 in 6 states and DC—California (1), Connecticut (1), District of Columbia (2), Hawaii (1), Maine (1), Maryland (6) and New Hampshire (2)
  • Protective measures enacted: 19 in 11 states—California (1), Colorado (1), Connecticut (2), Delaware (1), Maine (2), Maryland (5), New Hampshire (1), New Jersey (1), New York (1), Oregon (1) and Washington (3)
  • Protective constitutional amendment on November ballot: 1 in 1 state—Vermont

Efforts to protect abortion access include provisions to establish or expand the right to abortion in statute. Other provisions expand the types of health care professionals who can provide abortion care to include advanced practice clinicians, such as physician assistants, advanced practice nurses and certified nurse midwives. In addition, some states have focused on legislation to assist patients with paying for an abortion, either by requiring coverage of abortion in public and private health insurance plans or earmarking state funds for abortion services.

  • Establishes or expands statutory protections for the right to abortion
    • Introduced: 61 in 20 states and DC
    • Passed at least one chamber: 2 in 2 states— Hawaii (1) and Maryland (1)
    • Enacted: 5 in 5 states—Colorado (1), Connecticut (1), Maine (1), New Jersey (1) and Washington (1)
    • On the ballot: 1 in 1 state—Vermont
  • Authorizes advanced practice clinicians to provide abortion care
    • Introduced: 15 in 11 states
    • Passed at least one chamber: 2 in 2 states—Connecticut (1) and Maryland (1)
    • Enacted: 4 in 4 states—Connecticut (1), Delaware (1), Maryland (1) and Washington (1)
  • Requires health plans to cover abortion or establishes a state fund to assist with abortion costs
    • Introduced: 40 in 10 states
    • Passed at least one chamber: 2 in 2 states—California (1) and Maryland (1)
    • Enacted: 6 in 4 states—California (1), Maryland (3), New York (1) and Oregon (1)

Previous Updates

May 6 update

This analysis has been updated throughout to reflect counts of state legislation as of May 5. Previous updates since first publication are archived below.

Notable changes since the last update include:

  • A draft US Supreme Court opinion on Mississippi’s 15-week abortion ban was leaked and published online; if the final decision is similar, it would overturn Roe v. Wade outright and end the federal constitutional right to abortion.
  • Oklahoma’s governor signed into law a six-week abortion ban with a "bounty hunter" enforcement mechanism that went into effect immediately.

State Policy Developments on Abortion January 1–May 5, 2022

So far this year, 1,991 total provisions related to sexual and reproductive health and rights have been introduced across 46 states and the District of Columbia. This includes both restrictions and proactive measures.

  • Abortion restrictions introduced: 546 restrictions in 42 states
  • Abortion restrictions passed at least one chamber: 32 in 12 states
  • Abortion restrictions enacted: 37 in 10 states—Arizona (2), Florida (1), Idaho (1), Indiana (2), Kansas (1), Kentucky (18), Oklahoma (3), South Dakota (7), West Virginia (1) and Wyoming (1)
  • Protective abortion measures enacted: 14 in 8 states—California (1), Colorado (1), Maine (1), Maryland (5), New Jersey (1), New York (1), Oregon (1) and Washington (3)

April 15 update

Notable changes since the last update include:

  • New section "Protections and Expansions of Abortion Rights and Access" added.
  • Oklahoma’s governor signed into law a total abortion ban that will go into effect in August unless it is blocked in court.
  • Maryland’s legislature overrode the governor’s veto to enact several measures to protect and expand abortion access.
  • Kentucky’s legislature overrode the governor’s veto to enact a number of abortion restrictions, including a 15-week ban and limits on medication abortion.
  • Florida’s governor signed into law a 15-week abortion ban that will go into effect in July unless it is blocked in court.

The total number of sexual and reproductive health and rights provisions that have been introduced through April 14 stands at 1,989 across 46 states and the District of Columbia. This includes both restrictions and proactive measures.

  • Abortion restrictions introduced: 536 restrictions in 42 states
  • Abortion restrictions passed at least one chamber: 28 in 11 states
  • Abortion restrictions enacted: 33 in 9 states—Arizona (2), Florida (1), Idaho (1), Indiana (2), Kentucky (19), Oklahoma (1), South Dakota (5), West Virginia (1) and Wyoming (1)
  • Protective abortion measures enacted: 11 in 7 states—California (1), Colorado (1), Maryland (4), New Jersey (1), New York (1), Oregon (1) and Washington (2)

April 4 update

Notable changes since the last update include:

  • Arizona’s governor signed into law a 15-week abortion ban on March 30; it has an effective date of 90 days after the legislative session ends.

The total number of sexual and reproductive health and rights provisions that have been introduced through March 31 stands at 1,884 across 46 states and the District of Columbia. This includes both restrictions and proactive measures.

  • Abortion restrictions introduced: 529 restrictions in 41 states
  • Abortion restrictions passed at least one chamber: 48 in 13 states
  • Abortion restrictions enacted: 9 in 5 states—Arizona (1), Idaho (1), Indiana (2), South Dakota (4) and Wyoming (1)

March 25 update

Notable changes since the last update include:

  • Idaho’s governor signed into law a six-week abortion ban on March 23; it will take effect 30 days after signing.
  • South Dakota’s governor signed into law four provisions to restrict access to medication abortion on March 23; they only go into effect if similar regulations are upheld in an ongoing court case.

The total number of sexual and reproductive health and rights provisions that have been introduced through March 24 stands at 1,885 across 46 states and the District of Columbia. This includes both restrictions and proactive measures.

  • Abortion restrictions introduced: 525 restrictions in 41 states
  • Abortion restrictions passed at least one chamber: 48 in 13 states
  • Abortion restrictions enacted: 8 in 4 states—Idaho (1), Indiana (2), South Dakota (4) and Wyoming (1)

First published on March 16:

In 2021, state legislatures set an alarming record of 108 abortion restrictions enacted in 19 states. With the fate of Roe v. Wade hanging in the balance at the US Supreme Court, 2022 is shaping up to be even more devastating for abortion rights and access.

Already, a number of state bills have grabbed headlines for proposing outrageous and shocking abortion restrictions. Efforts from banning treatment for ectopic pregnancies to prohibiting people seeking abortions from leaving their home state show just how radical the anti-abortion agenda truly is. While these measures are attracting media coverage, often they are not the main focus of anti-abortion policymakers, but pull attention away from other abortion restrictions and bans that are moving quickly through some state legislatures. Moreover, these types of headline-baiting restrictions can make other devastating provisions, such as Texas-style bans or gestational age bans, seem less radical and harmful than they really are.

In addition, court cases continue to compound the harm of restrictions enacted in previous years, chief among them Texas’ ban on abortions at six weeks of pregnancy. The state’s top court recently rejected a challenge by abortion providers, ruling that there are no public officials who can be sued to stop the law. That decision exhausts the legal options to stop this immensely harmful law that has been in effect for more than six months and may embolden other states to adopt their own Texas-style bans this year.

Among restrictions introduced and moving since the start of state legislative sessions in January, two key themes emerging are anti-abortion policymakers’ continued pursuit of various types of abortion bans and restrictions on medication abortion.

So far this year, 1,844 total provisions related to sexual and reproductive health and rights have been introduced across 46 states and the District of Columbia. This includes both restrictions and proactive measures.

  • Abortion restrictions introduced: 519 restrictions in 41 states
  • Abortion restrictions passed at least one chamber: 46 in 13 states
  • Abortion restrictions enacted: None