Updated November 2019 to reflect that there were 25 abortion bans enacted in 2019.

The first six months of 2019 threw the state-level divide on abortion policy into sharp relief. Spurred by a more conservative U.S. Supreme Court, abortion rights were center stage in many state legislatures.

State legislatures across the South, Midwest and the Plains enacted 58 abortion restrictions, 25 of which would ban all, most or some abortions. This surge in abortion bans is a distinct departure from the strategy deployed by abortion opponents for decades, which was to adopt incremental abortion restrictions with the cumulative impact of denying care to patients and forcing clinics to close. This approach had led to passage of laws that were less likely to be challenged in the courts than outright bans.

The much more radical strategy of enacting abortion bans hinges on the hope that these bans will be the subject of court cases that will give the U.S. Supreme Court an opportunity to undermine or overturn long-standing constitutional protections for abortion. However, both strategies have the same goal—making abortion impossible to both provide and obtain.

Moving in the opposite direction are state legislatures primarily in the Northeast and West, along with Illinois. These legislatures have enacted legislation that protects abortion rights and advanced measures that expand access to contraceptive services and sex education. In fact, more proactive legislation, including measures on sex education and contraception access, was enacted in the first six months of 2019 than abortion restrictions and bans. So far this year, states have enacted 93 proactive provisions, including 29 that protect abortion rights, 23 to decrease maternal mortality, 11 that increase access to contraceptive services and 15 that improve sex education.

Abortion Restrictions

From January through June 2019, 58 abortion restrictions have been enacted in 19 states, including 25 abortion bans.

Abortion Bans

None of the abortion bans enacted in 12 states are currently in effect, either because they have been challenged in court or because the effective date of the legislation has not yet been reached. The only abortion ban to be vetoed this year was a Montana ban on abortion at 22 weeks of pregnancy.

Abortion Counseling

Since 2015, a handful of states have required that abortion counseling include information on the potential to stop the completion of a medication abortion after taking the first drug of the two-drug regimen—a claim that is not supported by credible scientific evidence.

This year, four states (Kentucky, Nebraska, North Dakota and Oklahoma) enacted this counseling requirement, and Arkansas amended an existing law that mandated this type of counseling. These laws will require medical providers to inform patients about the potential to reverse a medication abortion as part of preabortion counseling and require that the state-provided counseling materials include this information. The amendment to the Arkansas law requires that patients also be given written information after taking the first drug, in addition to information conveyed in the preabortion counseling and the state materials. In Kansas, the governor vetoed legislation that would have required similar counseling and a veto override attempt failed by one vote.

Abortion Protections

As legislators in other states attack abortion rights, progressive state legislators are responding to a more conservative U.S. Supreme Court by enacting protections and expanding availability. So far this year, six states protected or expanded abortion access.


Other Proactive Legislation

Beyond abortion, states have also enacted legislation that seeks to reduce maternal deaths, and protects and expands access to contraception and sex education.

Reducing Maternal Mortality

According to the Centers for Disease Control and Prevention, the maternal mortality ratio for black women was more than three times as high as the ratio for white women in 2011–2015. This large racial disparity has not decreased since at least the 1940s, when the maternal mortality ratio was 2.4 times higher for black women than white women. Racial disparities in health care provision and evidence of poor maternal health outcomes for certain populations reflect broader inequities and shed light on structural racism in the United States and how health care providers’ implicit bias may be contributing to these disparities.

In recent years, and continuing in 2019, reducing maternal mortality along racial and ethnic lines has been a focus of state legislatures across the country. The efforts take two overall approaches to improving maternal health: establishing or reviving lapsed statewide commissions that investigate maternal deaths, make recommendations to reduce maternal mortality rates, and address disparities in health outcomes based on race and ethnicity; and expanding access to health care and improving the quality of maternal health services.

Sex Education

State legislatures continue to focus on sex education, with legislation enacted in six states and the District of Columbia. State legislation passed this year primarily focuses on expanding the scope of sex education to provide information on sexual consent, include LGBT students, and promote healthy and violence-free relationships. Including these new laws, 24 states and DC require sex education.

Insurance Coverage of Contraceptives

By the beginning of July, four states that have existing guarantees for contraceptive coverage strengthened and expanded those requirements. There are currently 29 states that have a contraceptive coverage guarantee.

Other Measures

A new Washington state law bars private health insurance plans, student health plans and Medicaid from automatically denying reproductive health care services to enrollees that are usually or entirely covered based on gender. The new law also requires coverage of condoms, services related to sexual assault, well-person preventive visits, prenatal vitamins and breast pumps.