State Policy Trends Midyear Analysis: Five Key Issues to Watch in 2026

As people across the United States continue to face profound gaps in access to sexual and reproductive health care, many states are compounding these inequities with new restrictions and barriers to care. Currently, 13 states enforce total bans on the provision of abortion care, and 28 other states ban abortion somewhere between six weeks and viability. While state-level fights over abortion bans continue (such as those over bans based on gestational duration), many states have shifted their focus towards cutting off access to the remaining points of care and further criminalizing pregnant people.

While this list is not comprehensive of all 2026 state policy trends, it includes major trends in the first half of this year.

1. Lawmakers want to make getting an abortion a crime.

Since the overturning of Roe v. Wade, some anti-abortion lawmakers and organizations have claimed that they do not want to criminalize pregnant people for seeking or obtaining abortion care. However, states have continued to introduce bills that would do just that—demonstrating that criminalization is directly intertwined with the push to restrict reproductive rights.

Some bills explicitly attach criminal penalties to receiving abortion care, while others seek to grant fetuses or embryos rights through the concept of legal “personhood.” These measures set the stage for criminalizing patients for accessing a range of reproductive health services or experiencing common reproductive health outcomes—based on the legal rights granted to embryos and fetuses.

As of June 3, 2026, at least 17 states and one territory have introduced 36 bills that would embed personhood language in the state code. (Of these, none have been enacted.) Also this year, eight states have introduced 14 bills that would explicitly criminalize a pregnant person for getting an abortion.

For example, in Tennessee, a bill was introduced that would have allowed the state to charge pregnant people who access abortion care with homicide. While none of the bills that would explicitly criminalize a pregnant person for getting an abortion have been enacted, they are part of accelerating efforts to criminalize the provision and receipt of sexual and reproductive health care.

2. States are trying to falsely separate abortion care from pregnancy loss care

As the life-threatening harms of abortion bans have become increasingly clear and well-documented, some lawmakers have sought to distance abortion care from pregnancy loss care, such as miscarriage management. Lawmakers have increasingly introduced bills that define care for pregnancy loss as separate from abortion care, despite the fact that the two types of care involve the same procedures and medications.

As of June 3, 2026, eight states have introduced 10 bills that would define pregnancy loss care as separate from abortion care. One has been enacted thus far in 2026.

The newly enacted law in South Dakota amended the definition of abortion to exclude care provided for pregnancy loss. Furthermore, when first introduced, the bill contained references to embryonic and fetal personhood, language that has the potential to restrict access to a broad range of reproductive health care services. Another bill, introduced in Utah, sought to establish a differentiation in medical records between so-called “elective” abortions and those that are considered “not elective,” further entrenching this false distinction between abortion care and pregnancy loss care within patients’ individual medical records.

Ultimately, such bills disregard the realities of medical practice and fail to address the harms generated by abortion bans.

3. State legislatures are escalating attacks on shield laws and access to medication abortion.

In recent years, individuals living in states with total abortion bans or other restrictions have increasingly accessed care via telehealth from providers in states with shield laws—statutes and executive orders that protect clinicians, patients and helpers from out-of-state investigations and prosecutions. For example, an abortion seeker in Texas could access care via telehealth from a provider based in New York, under the protection of New York’s shield law. Recent data from Guttmacher’s Monthly Abortion Provision Study found an increase in telehealth provision by US clinicians to states with total bans: from 72,000 abortions in 2024 to 91,000 abortions in 2025.

Access to telehealth abortion care under shield laws has been a lifeline for many people in states with total abortion bans and other restrictions on care. However, telehealth access to medication abortion has faced relentless attacks at both the federal and state levels. Some states are attacking this type of care with bills that could impose legal liabilities on health care providers operating under shield laws.

Some of these bills would criminalize various acts related to the distribution of medication abortion pills. As of June 3, 2026, 21 states have introduced 58 bills that would criminalize the sale, purchase or distribution of medication abortion pills. Thus far, four of these bills have been enacted (in Iowa, Mississippi, Oklahoma and South Dakota).

A newly enacted law in Mississippi, for example, amends the state code regarding illegal drugs and controlled substances, adding a new section criminalizing the sale, purchase or distribution of medication abortion pills. Like many states that have introduced this type of legislation, Mississippi already bans all abortion care. By focusing on the distribution of medication abortion pills, such legislation could provide legal groundwork for prosecuting the clinicians and support organizations who provide access to care under shield laws; in some instances, these bills may also lead to the criminalization of pregnant people seeking care.

At the same time, 13 states have introduced 33 bills that would improve or establish shield laws, and two of these have been enacted as of June 3, 2026 (in Hawaii and Oregon). Oregon’s HB 4088 adds key protections to the state’s existing shield law, including protections against extradition and a prohibition on state law enforcement providing information to federal officials regarding protected health care provision.

4. State constitutions remain critical to fights for abortion access and against abortion bans.

In addition to the state legislative trends prevalent in 2026, litigation stemming from state constitutional claims has had significant impacts on abortion bans and restrictions. Since the Dobbs decision, several states have passed ballot initiatives that have established a right to abortion, or more broadly, reproductive health care, within their state constitutions. Thus far in 2026, Virginia and Nevada have initiatives to constitutionally protect abortion rights, and in the case of Virginia, reproductive rights more broadly, that will appear on their ballots in November; meanwhile Missouri has an initiative on the ballot that would repeal the reproductive rights amendment the state previously enacted.

As in previous years, ballot initiatives are forming the basis for state constitutional challenges to abortion bans and restrictions. For example, in February, an Arizona court held that several state abortion restrictions were unconstitutional, based on the state's successful 2024 ballot measure recognizing a constitutional right to abortion. The unconstitutional restrictions included a ban on telehealth abortion care, a ban on the mailing of abortion pills, and mandates that required biased abortion counseling, medically unnecessary ultrasounds, and waiting periods prior to care provision.

Additionally, in April, the Pennsylvania Supreme Court issued a ruling that affirmed a right to abortion and struck down a ban on state Medicaid coverage of abortion, citing the state’s Equal Rights Amendment. While the state Attorney General has appealed the ruling, thus delaying and challenging implementation of coverage, the legal fight surrounding the state Medicaid ban demonstrates the importance of state constitutional fights.

While these developments have helped codify abortion rights in many states, they have also been met with pushback, as anti-abortion lawmakers seek to curtail the impact of these citizen-led ballot initiatives. For example, Wyoming’s Supreme Court struck down two abortion bans early this year—one a total ban and one ban specific to medication abortion—on the basis of their state constitution. Less than two months after that decision, Wyoming enacted a 6-week abortion ban. While the 6-week ban has since been blocked, state officials’ relentless focus on shutting down Wyoming's last procedural abortion clinic illustrates the potential challenges of defending a constitutional right to abortion.

5. States continue to shore up protections for contraception

Over the past year, federal Medicaid cuts and the US Supreme Court’s decision in Medina v. Planned Parenthood of South Atlantic have already had a devastating impact on people's access to contraception, due to both financial constraints and restrictions on access to providers. State bills have also been introduced in recent years that are designed to facilitate new restrictions on contraception, while misinformation surrounding contraception continues to proliferate.

In response, states have taken steps to protect or expand access to contraception. As of June 3 of this year, 29 states have introduced 122 bills that would protect contraceptive access. Of these, nine have been enacted across four states (Georgia, Maryland, South Carolina and Virginia).

In some states, protections for contraception have taken the form of bills that establish a legal right to contraception, providing a bulwark against future attacks on contraceptive care. Virginia enacted a right to contraception bill this year, after advocates rallied around the issue.

Other states have sought to expand access to contraception. For example, Georgia lawmakers enacted a bill that would allow pharmacists to dispense contraception to patients without a prescription, taking a vital step to remove access barriers.

Conclusion

During the second half of 2026, those opposed to sexual and reproductive health and rights will likely expand their efforts to eliminate the remaining abortion access points and to escalate the criminalization of pregnant people. Despite such attacks, patients, providers, and helpers have remained resilient, with 142,000 people traveling across state lines to access care and 91,000 people in states with total bans receiving care via telehealth in 2025.

Abortion and contraception care have always been deeply stigmatized in the United States. This year's state-level trends reflect adaptation to the shifting ways that people access and provide care in a hostile legal environment. To counter these attacks, innovative approaches will be required to secure and defend access to the full spectrum of sexual and reproductive health care.