State Laws and Policies
As of September 8, 2026

Refusal to Provide Health Care Services
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This fact sheet was written by Kimya Forouzan. It was edited by Ian Lague.

Under a patchwork of federal and state laws, health care providers and institutions in the United States may refuse to offer health care services to which they have religious, moral or ethical objections. Most US states have enacted some type of care refusal law, although they vary in scope and limitations. In the realm of sexual and reproductive health, these laws are often specific to abortion, contraception, sterilization or gender-affirming care. However, some states also maintain statutes that permit refusal for any form of health care.

States with refusal laws vary in the type of health care providers allowed to opt out of offering care—some states specifically list the categories of providers, while some extend refusal provisions to all clinicians. Additionally, some states limit the types of medical institutions that are permitted to refuse care. While this table covers state statutes related to care refusals, state professional organizations also commonly issue guidelines on such refusals.

In addition to refusal laws, several states also have laws inspired by the federal Religious Freedom and Restoration Act (RFRA). The federal RFRA law creates a higher standard for government actions which substantially burden the exercise of religion, and has been used by clinicians and institutions to defend their refusals to provide or participate in certain kinds of sexual and reproductive health care. Since its passage, several states have also enacted state-level RFRA laws.

Highlights

  • 45 states have a statute explicitly permitting refusal for abortion care.
  • 16 states have a statute explicitly permitting refusal for contraception care.
  • 25 states have a statute explicitly permitting refusal for sterilization.
  • 30 states have state-level Religious Freedom and Restoration Act laws.
Citations for Refusal to Provide Health Care Services Citations for Refusing to Provide Health Care Services- 9.2.26.xlsx

For more information

Topic

United States

Geography

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Refusal to Provide Health Care Services
Jurisdiction Refusal of Abortion Explicitly Permitted Refusal of Contraception Explicitly Permitted Refusal of Sterilization Explicitly Permitted State RFRA
Institution Individual provider Institution Individual provider Institution Individual provider

Alabama

  

X

      

X

X

Alaska

X

X

          

Arizona

X

X

X (applies only to emergency contraception)

X (applies only to emergency contraception)

    

X

Arkansas

X

X

X*

X*

X*

X*

X

California

X

X

X

X

      

Colorado

    

X

X

X

X

  

Connecticut

  

X

        

X

Delaware

X

X

          

Florida

X

X

X

X

X

X

X

Georgia

X

X

    

X

X

X

Hawaii

X

X

          

Idaho

X

X

  

X*

X

X*

X

Illinois

X*

X*

X*

X*

X*

X*

X

Indiana

X

X

  

X (specific to pharmacists and other pharmacy professionals)

    

X

Iowa

X

X

X*

X*

X*

X*

X

Kansas

X

X

    

X

X

X

Kentucky

X

X

      

X

X

Louisiana

X

X

        

X

Maine

X

X

X

  

X

X

  

Maryland

X

X

    

X

X

  

Massachusetts

X

X

X

  

X

X

  

Michigan

X

X

          

Minnesota

X

X

          

Mississippi

X*

X*

X*

X*

X*

X*

X

Missouri

X

X

        

X

Montana

X

X

X*

X*

X

X

X

Nebraska

X

X

        

X

Nevada

X

X

          

New Jersey

X

X

    

X

X

  

New Mexico

            

X

New York

X

X

          

North Carolina

  

X

          

North Dakota

X

X

        

X

Ohio

X

X

X*

X*

X*

X*

  

Oklahoma

X

X

        

X

Oregon

X

X

          

Pennsylvania

X

X

    

X

X

X

Rhode Island

  

X

      

X

X

South Carolina

X

X

X*

X*

X*

X*

X

South Dakota

X

X

        

X

Tennessee

X

X

X

X

X

X

X

Texas

X

X

        

X

Utah

X

X

        

X

Virginia

X

X

        

X

Washington

X

X

X*

X*

X*

X*

  

West Virginia

        

X

X

X

Wisconsin

X

X

    

X

X

  

Wyoming

X

X

X

X

X

X

X

Totals

41

45

16

16

22

25

30

*These reproductive health care refusals are covered under the state’s general health care refusal law.

 

Suggested citation: Guttmacher Institute, Refusal to provide health services, State Laws and Policies (as of September 2026), 2026, https://www.guttmacher.org/state-policy/explore/advanced-practice-clinicians-providing-abortion-care.

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