In the span of 2 years, the Supreme Court's overturning of Roe v. Wade set off a series of events.
The 2024 election spotlight is on abortion, as reproductive freedom activists are pushing for ballot measures to preserve reproductive rights, due to access restrictions in numerous states.
Abortion numbers hit a decade-long high in the United States
Two years after the overturning of Roe v. Wade, 14 states have implemented total or near-total abortion bans, such as Alabama, Texas, Idaho, and Tennessee.
In spite of the increased restriction on abortion, the number and rate of abortions in 2023 reached a peak exceeding a decade, according to a report from the Guttmacher Institute, a research and policy organization advocating for sexual and reproductive health rights.
The report estimates there were over 1 million abortions in the formal United States healthcare system last year, marking a 11% increase from 2020. States without total abortion bans saw a 26% increase from 2020, the report adds.
The report points out that the loss of abortion access in states with bans was compensated by the "efforts of clinics, abortion funds, and logistical support organizations to help individuals access care."
Nearly two-thirds of all abortions in 2023, approximately 642,700, were medication abortions – not counting self-managed medication abortions outside of the healthcare setting, the report mentions. There's been a steady increase in medication abortions since 2001, when they accounted for less than 10% of all procedures.
Over the years, the US Food and Drug Administration has eased some restrictions on the use of the abortion pill, which has led to increased access. In 2016, the agency established the abortion pill as safe to use up to 10 weeks into pregnancy, as opposed to seven, and expanded the pool of providers who could prescribe it. During the Covid-19 pandemic, the FDA permitted the pill to be dispensed by certified pharmacies and through the mail, rather than just in healthcare settings.
States implement increasingly restrictive abortion policies
The landscape of abortion policies has shifted significantly in many states since the Supreme Court’s decision to overturn Roe. California, Michigan, Vermont, and Ohio have enshrined the right to reproductive freedom in their constitutions, while lawmakers in New York and other states have adopted policies to protect abortion patients and providers from legal repercussions.
More than a dozen states have enacted abortion "trigger laws" ahead of the court's decision, which took effect immediately upon the overturning of Roe, and at least seven states without trigger laws have implemented restrictive reproductive health policies that experts criticize for endangering patients and putting providers at risk of civil and criminal liability.
Patients and providers have found it challenging to navigate a confusing array of sometimes hastily implemented abortion policies, which include mandatory waiting periods, limits on Medicaid coverage for abortions, and vague language regarding medical emergency exceptions to abortion bans, as seen in states like Texas. Lower courts have been inundated with abortion-related legal challenges across different states.
These policies have already had tangible effects, such as a Texas woman suing the state to access an abortion for a pregnancy that threatened her fertility and another Texas woman being charged illegally with murder for using abortion medication to self-induce an abortion and spending two nights in jail before the charges were dropped. Providers have reported that patients in states with abortion bans have been coerced into carrying pregnancies against their will, potentially leading to health complications and life-threatening consequences.
Last month, Florida replaced its 15-week abortion ban with a six-week ban, which precedes many women realizing they're pregnant. This move represents a significant setback for reproductive access in the South, where Florida was a crucial access point for people seeking abortions. Providers and advocates warn that the restrictive policies have created a reproductive care desert in the region.
Patients cross state lines for reproductive care
More than 171,000 patients traveled for an abortion in 2023, according to the Guttmacher Institute.
Many people who traveled to obtain abortions before Roe was overturned were heading to states that now have total abortion bans, suggesting that people are now traveling farther distances, sometimes crossing multiple state lines, to access care.
In just the first half of 2023, nearly 1 in 5 people who had an abortion, over 92,000 people, traveled across state lines for abortion care, according to a December 2023 analysis from the institute.
As the abortion care landscape tightens, Alexandra Mandado, president of Planned Parenthood in South, East, and North Florida, foresees remaining abortion clinics struggling to accommodate the influx of out-of-state patients.
Supreme Court considers other high profile reproductive rights cases
The Supreme Court recently dismissed a challenge to access to the abortion pill, upholding widespread access to medication abortion in a decision that may pave the way for future legal battles. Abortion pill access could face additional legal challenges going forward.
The court is considering another case this summer dealing with medical emergency exceptions to abortion bans. The Biden administration is suing the state of Idaho, which limits exemptions to its abortion ban to life-threatening situations, arguing that federal law requires hospitals receiving Medicare funding to provide stabilizing care, including abortions, when a pregnant person's health is in danger.
In February, the Alabama Supreme Court made the controversial decision that frozen embryos are considered equal to human beings, and those who destroy them can face charges of wrongful death. This ruling has resulted in a halt to in vitro fertilization (IVF) treatments across the state due to fear of legal consequences.
As families grapple with the loss of this critical treatment, state lawmakers are under pressure to find a solution. In March, a new law was passed to shield IVF patients and providers from legal liability caused by the court's ruling. However, at least one IVF provider has announced plans to close shop by year's end due to legal concerns.
Medical professionals have voiced their worries that other reproductive care services, such as contraception, could also be under threat as a result of the court's decision and the spread of misinformation. Some even claim this misinformation is deliberately spread to stir up panic, like stating that emergency contraception is similar to abortion.
Advocates push for reproductive health rights on state ballots in November
Most reproductive health policies enacted after the Supreme Court's landmark decision were either a direct result of it or were imposed by lawmakers or local courts. In a bid to restore reproductive health access, organizers have been working tirelessly to get measures that protect reproductive rights written into state constitutions in November's ballot.
Colorado, Florida, Maryland, and South Dakota have already secured a spot for the measures on their ballots, with New York and Nevada expected to follow suit. Activists in at least seven additional states are working towards the same goal.
Besides making it harder for opponents to challenge abortion services, advocates hope that these measures will give voters a platform to convey their desires to politicians.
CNN's Deidre McPhillips, Annette Choi, and Tierney Sneed contributed to this report.
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