The State Abortion Policy Landscape One Year Post-Roe

Kelly Baden, Guttmacher Institute and Jennifer Driver, State Innovation Exchange

Updated on June 16, 2023, to correct the number of shield laws passed in 2023.


One year after the US Supreme Court’s decision in Dobbs v. Jackson Women’s Health overturned Roe v. Wade, the status of abortion rights in many states is dismal and complex legal questions continue to create chaos and confusion. There are also bright spots that can chart a pathway to more state and federal protections for abortion.

Despite consistent public opinion in support of legal abortion, abortion is banned in 13 states, leaving large regions of the country without abortion care and contributing to increased wait times at clinics in states where abortion remains legal. Some states are further testing the legal limits of the post-Roe landscape by passing extreme restrictions, such as a ban on helping a young person travel out of state to access legal abortion care. Relentless attempts to ban abortion everywhere, by any means available, place abortion rights front and center in a host of other policy issues, from questions about state ballot measure processes to legal maneuvers such as preemption and local government control.

Abortion Policies in the 12 Months Post-Roe

Dobbs Decision Led to Immediate Abortion Bans

For nearly 50 years, Roe provided a baseline of legal protection for abortion in the United States. Of course, Roe was never enough; access to abortion was always governed by a person’s state of residence, ability to pay and ability to navigate a complex web of obstacles created by state legislatures over the course of decades. When the Supreme Court reversed its precedent on June 24, 2022, nine states immediately banned abortion under “trigger” laws designed to take effect once Roe no longer applied (Alabama, Arkansas, Kentucky, Louisiana, Missouri, Oklahoma, South Dakota, Texas and Utah), although Utah’s ban is not in effect as a legal challenge continues.

Almost a year later, the landscape of abortion legality across the country is even worse.

  • Abortion is completely banned in 13 states (Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia).
  • Abortion is unavailable in Wisconsin because of ongoing legal complexities.
  • In Arizona, a court clarified that an 1864 abortion ban, pre-dating statehood, will not be repealed, but doctors will not be prosecuted for providing abortions. A ban on abortion at 15 weeks of pregnancy is in effect.
  • In Georgia, a six-week abortion ban (passed in 2019) was allowed to take effect in November 2022 while litigation continues.
  • Ohio’s six-week abortion ban (passed in 2019) is also in litigation and abortion remains legal in the state up to 22 weeks after the last menstrual period.
  • In Utah, the state’s trigger ban remains blocked and an 18-week abortion ban is in effect.
  • In Wyoming, the state’s trigger ban originally went into effect shortly after the Dobbs ruling, but has since been blocked in court.

State Abortion Bans Enacted in 2023

While many state legislatures with anti-abortion majorities spent years preparing for the end of Roe by passing trigger bans that took effect and banned abortion immediately or quickly after the Dobbs decision, the 2023 state legislative sessions were defined by state bans on abortion at various gestational limits and other attempts to double down on restricting access to abortion.

  • In Florida, a six-week abortion ban was signed into law on April 13, intended to go into effect following a ruling from the Florida Supreme Court on a case considering the legality of a 15-week abortion ban passed in 2022. That case may be decided in June; if the 15-week abortion ban is upheld, the six-week ban will go into effect 30 days later.
  • In Nebraska, a six-week abortion ban failed when one Republican legislator voted against it, earning national headlines; however, a ban on abortion at 12 weeks passed as an amendment to a ban on gender-affirming care and took effect on May 22.
  • In North Carolina, a 12-week abortion ban was ultimately enacted following a legislative override of a veto by Gov. Roy Cooper (D). The law is scheduled to go into effect on July 1.
  • In South Carolina, a six-week abortion ban advanced through the legislature, but was stopped by a bipartisan group—the “Sister Senators”—whose commitment to blocking the ban countered the legislature's Republican supermajority. After Gov. Henry McMaster (R) called a special session, the abortion ban was signed into law on May 25, only to be temporarily blocked following a legal challenge. Abortion remains legal in the state while litigation continues.
  • In Utah, Gov. Spencer Cox (R) signed a law in March that would have mandated the closure of all abortion clinics in the state once the current clinic licenses expired, ending access to virtually all abortions across the state at that time. In May, a judge temporarily blocked this law from taking effect.
  • In Wyoming, an additional abortion ban was enacted, despite the ongoing legal challenge to the state’s trigger ban, and it also faces legal challenge. Abortion remains legal while litigation continues.

Attacks and Progress on Medication Abortion

A legal case with national implications advanced in 2023 that threatens the availability of mifepristone, one of two drugs in the most common medication abortion regimen in the United States. Several states also took aim at medication abortion with new attempts to restrict its use.

  • In Arkansas, a new law threatens physicians with loss of their medical license if they mail medication abortion pills; abortion is already banned in the state with very limited exceptions.
  • Florida banned mailing medication abortion pills to patients. The law could go into effect if a separate 15-week abortion ban is upheld by the state supreme court.
  • Montana passed a law, effective this October, targeting medication abortion by requiring new reporting requirements for providers that are not required for other drugs and procedures.
  • Wyoming banned medication abortion with limited exceptions. The law is scheduled to take effect July 1 despite ongoing litigation. 

Other states took proactive steps to expand and protect access to medication abortion.

  • Colorado passed a law specifying protection for health care workers and providers who supply medication abortion to a patient who took the pills in another state, and also prohibited medical providers from offering the medically unsupported procedure of medication abortion “reversal.”
  • Illinois clarified that medication abortion is included in the state’s existing insurance coverage requirement for abortion care.
  • Massachusetts, New York and Vermont all took action to expand medication abortion access on college and university campuses.
  • Washington state ensured the Department of Corrections can sell, deliver, distribute and dispense medication abortion pills, following the governor’s decision to stockpile medications in light of the threat to future mifepristone access.

Post-Roe Abortion Bans Face Political Headwinds

In 2023, abortion bans proposed in Nebraska, North Carolina and South Carolina were met with disagreement among anti-abortion legislators and strong public opposition, raising questions about whether abortion opponents were overreaching in their zeal to restrict abortion. Notably, the Dobbs decision has been considered a motivating force for abortion rights election wins, from victories by abortion rights supporters in the 2022 midterm elections and in a 2023 judicial election in Wisconsin to ballot measures in Kansas, Kentucky, Michigan and other states. Public opinion polling and election outcomes are in sync: Banning abortion remains deeply unpopular.

The reality that banning abortion exacerbates existing inequities in health care and harms people—especially those already impacted by systemic racism and economic injustice—contributes to support for abortion rights. So, too, does the knowledge that abortion bans have a far-reaching impact on young people seeking health care, along with the understanding that state-level abortion bans and restrictions are sometimes advanced without majority support from the electorate.

In North Carolina, for instance, a series of actions led to the ultimate passage of a 12-week abortion ban. First, a Democratic legislator switched parties, setting up an opportunity for the legislature to override any veto from the governor, a supporter of abortion rights. Then, the Republican majority used a legislative maneuver to circumvent the usual committee process, effectively removing opportunities for debate on the bill. And, proponents of the ban intentionally included measures in the bill to minimally fund needed investments in the social safety net, but not to a sufficient extent and intended simply to provide political cover. Once the abortion ban was vetoed by the governor, his veto was overridden by the legislature.

In the post-Roe landscape, every state’s abortion policy extends far beyond that state’s borders, impacting abortion access regionally and even nationally. A state abortion ban at any gestational limit is a policy decision that prioritizes scoring political wins over the health care needs of real people and acts as a stepping stone to a complete abortion ban. North Carolina’s 12-week abortion ban may set off a chain reaction across the Southeast, as studies show that the state saw a surge in abortion provision after the Dobbs decision and providers report that patients unable to get an abortion in their own states have traveled to North Carolina for that care. North Carolina’s legislation is no compromise; it is one more barrier that people in neighboring states must overcome to find legal abortion care. The political context surrounding its passage—including secret negotiations and legislative machinations intended to restrict debate—demonstrates the centrality of the abortion rights fight in defending our democracy.

Anti-Abortion Extremism Overlaps with Other Attacks

Attacks on abortion never happen in a vacuum. Anti-abortion legislators are often driven by a worldview that seeks to exert dominance and control, and state legislatures can become a site for action on a host of undemocratic and alarming maneuvers.

Abortion Extremism Is Fueling Additional Attacks on Democracy

Anti-abortion state lawmakers have found a number of ways to further restrict abortion or increase hostility around its legality and access by infusing anti-abortion sentiment into other legislative proposals.

Restricting district attorneys. While the status of some state abortion laws post-Roe remains chaotic, the question of who enforces state criminal laws restricting abortion should be clear. District attorneys are elected or appointed county officials who represent the state in criminal proceedings. As part of their role, district attorneys have discretion in charging decisions. However, anti-abortion governors and state legislators in seven states have sought to restrict this discretionary power in the last year in an attack on democracy and the separation of powers. Georgia, Iowa, Mississippi and Texas all enacted new laws limiting prosecutorial discretion or allowing state attorneys general to directly file criminal charges rather than relying on county-level officials. For example, Georgia’s bill created a new state commission with the power to discipline or remove local prosecutors. Similar bills were proposed but failed in Indiana and Missouri. And beyond limiting district attorneys, South Carolina introduced a bill that would have allowed the state’s attorney general to directly charge individuals for violating the state’s abortion ban—a complete break from legal tradition. In response, more than 100 elected prosecutors across the country signed a public letter committing to only prosecute cases that “serve the interests of justice and the people” and reject the criminalization of health care services. Even this statement of solidarity came with risks: Florida’s anti-abortion governor, Ron DeSantis (R), used this letter as grounds to suspend a Florida prosecutor under a power granted to the governor by the state constitution.

Preempting local governments. Another area of state law being weaponized against reproductive rights is preemption. Preemption is a legal doctrine that allows a higher level of government to limit, or even eliminate, the power of a lower level of government to regulate an issue. On its face, preemption is a neutral tool, but it is most commonly used by majority anti-abortion legislatures to concentrate their power and block progress at the local level to protect or expand access to abortion. Historically, state preemption has been used to prohibit county or city governments from contracting with organizations that provide abortion care to offer sex education programming or contraceptive services. Recently, states have taken preemption a step further. Tennessee banned municipalities from allocating local funds for practical support to abortion seekers and prohibited local governments from expending funds to assist a person to obtain an abortion. In Florida, both the six-week abortion ban and the ban on gender-affirming care passed by the legislature this session prohibit local governments from providing their employees and contractors with travel funds to seek such care outside the state. And, Texas passed a sweeping preemption bill that prohibits municipalities from passing policies that limit prosecutorial discretion or seek to reduce harm, including by refusing to enforce abortion bans.

Changing ballot measure rules. Statewide ballot measures have been a lever of democracy to protect and expand abortion access after the end of Roe. Ballot measures put the language of proposed laws—including state constitutional amendments—directly before voters. In the immediate months after Roe was overturned, voters in states with conservative majorities, like Kansas and Kentucky, rejected ballot initiatives to ban abortion. In direct response, anti-abortion lawmakers began seeking to move the goalposts on ballot measures. Usually, a ballot measure will pass into law if it receives majority consent. In Ohio, the state legislature is forcing a special election in August to raise the proportion needed for ballot measure approval from 51% to 60%, a direct attack on an upcoming November constitutional amendment that would prohibit the legislature from banning abortion before fetal viability. Missouri lawmakers are also seeking to increase the threshold for passage from a simple majority because of a proposed ballot initiative that would codify the right to abortion, and in Florida, lawmakers are trying to raise it to two-thirds. Mississippi legislators tried and failed to pass changes to that state’s ballot measure process, including adding an exception that abortion cannot be a topic on the ballot.

State Legislators Targeted for Championing Progressive Values

State legislatures have been sites of powerful political protests even in the face of legislative losses. Georgia Rep. Park Cannon’s protest of voting rights restrictions in 2021 led to her arrest, and this year, Nebraska Sen. Machaela Cavanaugh filibustered all bills for 11 weeks to block proposed anti-trans legislation. In 2023, state legislators already facing difficult odds to block various bills that restrict people’s rights experienced significant attempts to silence their voices as anti-abortion and transphobic lawmakers relied on “rules of decorum” to silence those who are not White, straight or cisgender.

  • In March, Rep. Mauree Turner—Oklahoma’s first openly nonbinary and Muslim state legislator—was censured while fighting against a ban on gender-affirming care for those younger than 18.
  • Tennessee Reps. Justin Pearson and Justin Jones were expelled in April for standing up against gun violence in the state House. (Notably, a third legislator who participated in the protest, Rep. Gloria Johnson, was not expelled; she is White and the other two are Black. Both legislators have since been reinstated.)
  • Montana Rep. Zooey Zephyr was censured in April for her comments opposing a ban on gender-affirming care; some of her colleagues continue to intentionally misgender her.

Attacks on Gender-Affirming Care

Legislation to restrict or prohibit gender-affirming care has increased sharply this year and is part of a multipronged effort to restrict and control people’s bodily autonomy. Twenty states so far have enacted bans on gender-affirming care for young people, generally for anyone younger than 18 (Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Missouri, Montana, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah and West Virginia); 17 of these states enacted bans this year. Of those 17 states, 10 have near-total abortion bans in place and four have gestational limits up to 18 weeks in place, making it clear that these bills are two sides of the same coin. Every credible medical organization opposes these bans on gender-affirming care, as they do abortion bans, and the majority of Americans also oppose them. The tactics of escalating rhetoric, demonizing health care decisions and the people who make them, and criminalizing providers mirror those the anti-abortion movement has spearheaded for decades.

A Blueprint for Action

The post-Roe reality requires increased interstate travel for many people to obtain an abortion, and abortion opponents are doubling down on their coercive agenda by considering attempts to restrict travel across state lines for abortion care. Numerous states have moved to protect providers and patients with “shield laws.” These policies differ but generally protect abortion providers and patients, and in some cases practical support volunteers, from punishments or investigations in states that have banned abortion care. Twenty states plus the District of Columbia have enacted such protections (California, Colorado, Connecticut, DC, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, Rhode Island, Vermont and Washington), with 10 states and DC enacting 16 shield laws in 2023 (Colorado, DC, Hawaii, Illinois, Maryland, Minnesota, Nevada, New Mexico, New York, Vermont and Washington).

In 2023, multiple states took additional actions to protect and expand abortion rights and access; some examples include:

  • Colorado enacted a law aiming to mitigate the harmful effects of anti-abortion centers by banning deceptive advertising. The state also enacted a shield law to protect providers and patients of abortion or gender-affirming care from potential legal action originating in another state that bans such care.
  • Michigan repealed its pre-Roe abortion ban—a direct result of voters changing the partisan control of their state legislature in 2022 and also approving a state constitutional amendment guaranteeing the right to abortion and other reproductive health services.
  • Minnesota enacted protections for people seeking gender-affirming care and people seeking abortion care in the state after the anti-abortion majority was voted out of the legislature in 2022.
  • New York required medication abortion access on all public college, community college and university campuses.
  • Rhode Island passed a law ensuring state funds for abortion coverage to those who qualify for public health insurance, including state employees.
  • Washington state enacted the My Health, My Data Act, the first law in the country to regulate companies that collect and share consumers’ health-related data, among other provisions.

A Path Forward for Abortion Rights

As we mark one year since the Supreme Court’s Dobbs decision, which upended nearly 50 years of federal legal precedent, the state-by-state landscape of abortion rights and access is more dismal than ever and the devastating consequences of banning abortion in a number of states are becoming clear.

Inequities in abortion access existed long before Dobbs, but the loss of Roe and the result so far—abortion being completely banned or unavailable in 14 states—has made a bad situation worse. People and communities already harmed by structural racism in the US health care system were most impacted by the patchwork abortion landscape before Dobbs and will be at even higher risk of harm in the post-Roe reality. Many people will be forced to travel long distances to obtain abortion care if they are able to, or seek other methods of abortion beyond their method of choice or continue a pregnancy against their will with potentially harmful health-related or financial consequences. Research shows that states that have banned or restricted abortion have worse maternal health outcomes than those where abortion is legal, with fewer maternity care providers and higher maternal and infant mortality rates; Black, American Indian and Alaska Native women experience the greatest inequities.

Meanwhile, legislators in states that have banned abortion are also seeking to secure their structural power through undemocratic means in service of their extremist views, often in opposition to the majority of the public. With abortion attacks percolating at all levels of government and courts, the response must be equally multifaceted and long-term. Policymakers at all levels can take action to respect and protect abortion rights and block efforts to criminalize health care services. Cities and counties can explore what is possible, while states can enact laws to protect and expand abortion rights and access. Lawmakers in states that have restricted abortion can shed light on undemocratic, racist and misogynistic tactics and be visible champions for the bodily autonomy of their constituents. Congress can enact the Women’s Health Protection Act and the EACH Act, and the Biden administration can continue to explore and advance additional options to protect abortion patients and providers. The unraveling of Roe did not occur overnight and our solutions to achieve abortion access for all must be expansive: This is a generational fight.

State Abortion Legislation by the Numbers

Counts in 2022 (June 24–December 31)

From the date of the Dobbs decision through the end of 2022, 83 measures related to abortion were introduced and more than half of these were restrictive.

Protecting and Expanding Access to Abortion

  • 17 measures enacted, including 1 state constitutional protection for reproductive autonomy

Restricting Access to Abortion

  • 5 measures enacted
  • 19 court cases resulted in abortion bans taking effect; 2 additional near-total bans were blocked in court and 1 near-total ban remains in litigation

Counts in 2023 (as of June 13)

Nearly 700 abortion bills have been introduced so far this year, about half of which would expand access and about half would restrict access.

Protecting and Expanding Access to Abortion

  • 30 measures enacted, including:
    • 16 shield laws
    • 5 laws that protect the legal right to reproductive health care
    • 1 constitutional amendment to appear on the 2024 ballot
    • 1 requirement for Medicaid to cover abortion
    • 1 repeal of a total abortion ban

Restricting Access to Abortion

  • 25 measures enacted
    • 7 temporarily blocked from taking effect during ongoing lawsuits
    • 1 awaiting a separate state supreme court decision in order to take effect

Information on legislation and enactments on specific topics can be found in our State Policy Update, which is updated twice a month.

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