The Supreme Court overturned Roe v. Wade on June 24, 2022. Since then, 14 states have imposed total or near-total abortion bans. Four more ban abortion at six weeks, before most people know they are pregnant. Idaho has lost 35% of its OB-GYNs. Alabama ruled frozen embryos are legally children. Mothers in ban states are nearly twice as likely to die during pregnancy.
But every time voters get a direct say, abortion rights win. Every ballot measure since Dobbs has gone the same direction — even in Kansas, Kentucky, and Montana. The fight is not about public opinion. It is about who controls the decision.
Abortion access
Fourteen states enforce total or near-total bans. Four more ban abortion at six weeks. Three set gestational limits between 12 and 18 weeks. Twenty-five states plus DC protect access to varying degrees.
State-by-state abortion access after Dobbs. Sources: Center for Reproductive Rights, KFF
| Status | Count | States |
|---|---|---|
| Total or near-total ban | 14 | Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia |
| 6-week ban | 4 | Florida, Georgia, Iowa, South Carolina |
| Gestational limit | 3 | Nebraska (12 wks), North Carolina (13 wks), Utah (18 wks) |
| Protect access | 25 + DC | Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington |
Approximately 155,000 people traveled out of state for abortion care in 2024, more than double the number in 2019. Average travel time for residents of ban states increased from 2.8 hours to 11.3 hours. More than 28,000 Texas residents left the state for care.
”It kind of felt like this secret mission — like, we’ve-got-to-escape kind of feeling. I’m from Texas. I’m an eighth-generation Texan. And to be feeling like I need to escape the state was just a bizarre sensation.”
Lauren Thompson Miller, Dallas, who flew to Colorado for a selective reduction to save a healthy twin after her other twin was diagnosed with trisomy 18Ballot measures
Abortion rights are undefeated at the ballot box since Dobbs. Voters have had a direct say 17 times across 14 states. Rights won or protections held in all but two cases — Florida (where 57% voted yes but the state requires 60%) and South Dakota.
Every abortion-related ballot measure since Dobbs
| Year | State | Result | Margin |
|---|---|---|---|
| 2022 | Kansas | Rejected anti-abortion amendment | 59-41 |
| 2022 | Kentucky | Rejected anti-abortion amendment | 52-48 |
| 2022 | California | Enshrined protections | 67-33 |
| 2022 | Michigan | Enshrined protections | 57-43 |
| 2022 | Vermont | Enshrined protections | 77-23 |
| 2022 | Montana | Rejected “born alive” mandate | 53-47 |
| 2023 | Ohio | Enshrined protections | 57-43 |
| 2024 | Arizona | Enshrined protections | Approved |
| 2024 | Colorado | Enshrined protections | Approved |
| 2024 | Maryland | Enshrined protections | Approved |
| 2024 | Missouri | Enshrined protections | Approved |
| 2024 | Montana | Enshrined protections | Approved |
| 2024 | New York | Enshrined protections | Approved |
| 2024 | Nevada | First of two required votes | Approved |
| 2024 | Florida | 57% yes, failed 60% threshold | Failed |
| 2024 | South Dakota | Rejected protections | Failed |
Three more measures are confirmed for November 2026: Virginia (protect access), Nevada (second required vote), and Missouri (legislature trying to repeal the 2024 voter-approved protections). Idaho is collecting signatures for a statutory initiative.
”Kansans across the political spectrum believe in personal liberty and freedom.”
Rachel Sweet, Campaign Manager, Kansans for Constitutional Freedom, after winning 59-41 in a state Trump carried by 15 pointsThe pattern is clear: when voters decide, they protect access. When legislatures decide, they restrict it. The states trying hardest to limit ballot access — Missouri, South Dakota, North Dakota — are also the ones with the most restrictive abortion laws.
Courts
Courts are where bans get challenged, upheld, or rewritten. Since Dobbs, the most consequential rulings have come from state courts — not federal ones. That is where the fights that affect your state are being decided.
The Planned Parenthood defunding ruling is the sleeper case. The Supreme Court held that individual Medicaid patients cannot sue to enforce their right to choose a provider. Five states have already excluded Planned Parenthood from Medicaid. The federal reconciliation law blocks Medicaid payments to abortion providers through July 2026. A budget bill backed by Trump could force the closure of approximately 200 Planned Parenthood centers, most in states where abortion is legal. These centers provide cancer screenings, STI testing, and contraception — not just abortion.
Title X, the only federal program dedicated to family planning, is also under attack. 879 clinics across 23 states had funding frozen. Approximately 834,000 patients are at risk of losing access. New guidelines shift the program’s focus from contraception toward “natural family planning.”
Healthcare workforce
Idaho lost 35% of its OB-GYN workforce — 94 of 268 doctors — in the two years after its ban took effect. Six of nine maternal-fetal medicine specialists left. Only 23 OB-GYNs serve 37 rural counties with nearly a quarter of the state’s population. Three maternity wards have closed.
This is not just an Idaho problem. OB-GYN residency applications declined 10.5% in states with total bans. States with legal abortion saw a 0.4% increase. Since 2018, approximately 300 maternity wards have closed nationwide. Two million people now live in maternity care deserts.
”When it came time to be like, ‘Am I willing to go to jail for that, or lose my license?’ That’s when the rubber hit the road for me.”
Dr. Leilah Zahedi-Spung, OB-GYN, who left Tennessee for Colorado. She was one of eight abortion providers in the state. Five remain.Mothers in ban states are nearly twice as likely to die during pregnancy, childbirth, or postpartum compared to states that protect access. Maternal mortality fell 21% in protective states after Dobbs. In Texas, maternal mortality rose 56% in the first full year of the ban. Black mothers in ban states are 3.3 times as likely to die as white mothers.
18.6 deaths per 100,000 The U.S. maternal mortality rate — more than 3 times the rate in Norway, the Netherlands, and New Zealand. The U.S. rate is comparable to Palestine and Chile.
Who This Affects
A pregnant woman in rural Idaho, Lemhi County
Her county's nearest OB-GYN is 90 miles away. The maternity ward at her local hospital closed after the ban. If she develops complications during labor, the ambulance ride to Boise takes over two hours. Before the ban, she would have had a doctor 15 minutes from her home.
Based on documented cases and public data.
IVF and personhood
In February 2024, the Alabama Supreme Court ruled that frozen embryos are legally children under the state’s Wrongful Death of a Minor Act. IVF treatments halted across the state. Nineteen days later, the legislature passed emergency immunity for providers — but did not change the underlying legal status of embryos. That immunity has been described as “tenuous at best.”
The threat is spreading. Seventeen states have established fetal personhood by law or judicial decision. At least 38 personhood bills were introduced across 24 states in a recent session — 9 of them broad enough to threaten IVF.
At the federal level, Republican senators voted against a bill establishing a federal right to IVF care. Trump signed an executive order defining life as beginning at conception.
If personhood laws spread
- IVF providers in more states face wrongful death liability for embryos that don't survive
- Clinics pause or leave states rather than risk prosecution
- Patients who can afford it travel; patients who can't lose access to fertility treatment entirely
If federal IVF protections pass
- IVF providers operate without criminal risk regardless of state personhood laws
- Patients retain the ability to make decisions about embryo storage and disposition
- The Alabama model stays isolated instead of spreading
Medication abortion
63% of all abortions in the United States are now medication-based — mifepristone plus misoprostol. More than 25% are managed via telehealth. The FDA approved mifepristone in 2000. Decades of studies confirm it is safe, with a serious complication rate below 0.4%.
Medication abortion is now the top target for anti-abortion groups. South Dakota criminalized dispensing, distributing, selling, or advertising abortion pills as a felony (HB 1274). Multiple ban states have enacted specific prohibitions on medication abortion by mail.
The federal threat: the Comstock Act of 1873 prohibits mailing anything “intended for producing abortion.” If the DOJ enforced a broad reading, it could function as a de facto nationwide ban — even in states that protect access — by blocking the mailing of pills and surgical instruments. The DOJ has not enforced Comstock against abortion medication, but anti-abortion groups delivered nearly 13,000 petitions demanding enforcement. The Stop Comstock Act has been introduced but has no realistic path to passage.
Protect yourself right now
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Know your state’s law. The Center for Reproductive Rights maintains the definitive state-by-state map. Laws change fast. Check before you need to.
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Find a provider. The National Abortion Federation Hotline at 1-800-772-9100 connects patients with verified providers. INeedAnA.com helps locate the nearest clinic and estimates costs and travel.
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Know your rights if you travel for care. You cannot be prosecuted in a state where abortion is legal for obtaining care there. But digital evidence (search history, texts, location data) has been used in investigations. The Digital Defense Fund has security guides.
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Contact your state legislators. If your state is considering a personhood bill, a medication abortion ban, or a ballot initiative restriction, your call matters. Use Resist Bot to send a letter: text RESIST to 50409.
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Support the ballot initiative in your state. If you are in Idaho, Virginia, Nevada, or any state with a pending reproductive rights measure, volunteer with the campaign. Ballot measures have won every time voters have had a say.
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Talk to people who don’t think this affects them. IVF patients, people with high-risk pregnancies, and rural residents who depend on local maternity wards are all affected by abortion bans, whether or not they would seek an abortion. The healthcare workforce collapse does not discriminate.
Last updated May 24, 2026