Abortion in the United States

Termination of a pregnancy in the United States

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A state map of the United States color-coded for abortion access. A number of U.S. states in the center and especially south of the country have banned abortion apart from certain medical exceptions. In contrast, abortion is available on demand without a mandated time limit in Alaska, Colorado, Minnesota, New Jersey, New Mexico, Oregon, Vermont, and Washington, D. C. Because the situation is changing rapidly, please see the article text for details.
Status of elective abortion in the United States
  • v
  • t
  • e
  Legal but no providers
  Legal before cardiac-cell activity[b]
  Legal through 12th week LMP*
  Legal through 15th week LMP* (1st trimester)
  Legal through 18th week LMP*
  Legal through 20th week LMP*
  Legal through 22nd week LMP* (5 months)
  Legal before fetal viability[c]
  Legal through 24th week LMP* (5½ months)
  Legal through second trimester[d]
  Legal at any stage
*LMP is the time since the last menstrual period began.
This color-coded map illustrates the current legal status of elective-specific abortion procedures in each of the individual states, U.S. territories, and federal district.[a] A colored border indicates a more stringent restriction or ban that is blocked by legal injunction or trigger provision (as of September 18, 2023).

Abortion is a divisive issue in the United States. The issue of abortion is prevalent in American politics and culture wars, though a majority of Americans support continued access to abortion.[1][2][3][4][5][6] There are widely different abortion laws depending on state.[7]

From the American Revolution to the mid-19th century abortion was not an issue of significant controversy; most held to the traditional Protestant Christian belief that personhood began at quickening, sometime between 18 and 21 weeks. It was legal prior to quickening in every state under the common law.[8][9][10][11] Connecticut was the first state to regulate abortion in 1821; it outlawed abortion after quickening, the moment in pregnancy when the pregnant woman starts to feel the fetus's movement in the uterus, and forbade the use of poisons to induce one post-quickening. Many states subsequently passed various laws on abortion until the Supreme Court of the United States decisions of Roe v. Wade and Doe v. Bolton decriminalized abortion nationwide in 1973. The Roe decision imposed a federally mandated uniform framework for state legislation on the subject. It also established a minimal period during which abortion is legal, with more or fewer restrictions throughout the pregnancy. Evangelical Christians were initially generally either supportive or indifferent to Roe — citing what they saw as a lack of biblical condemnation on the matter, its perceived affirmation of religious liberty, and furthering of non-intrusive government — but by the 1980s began to join anti-abortion Catholics to overturn the decision.[12][13] That basic framework, modified in Planned Parenthood v. Casey (1992), remained nominally in place, although the effective availability of abortion varied significantly from state to state, as many counties had no abortion providers.[14] Casey held that a law could not place legal restrictions imposing an undue burden for "the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus".[15] In December 2021, the FDA legalized telemedicine provision of medication abortion pills with delivery by mail, but many states have laws which restrict this option.

In 2022, Roe and Casey were overturned in Dobbs v. Jackson Women's Health Organization, ending protection of abortion rights by the United States Constitution and allowing individual states to regulate any aspect of abortion not preempted by federal law.[16] Since 1976, the Republican Party has generally sought to restrict abortion access based on the stage of pregnancy or to criminalize abortion, whereas the Democratic Party has generally defended access to abortion and has made contraception easier to obtain.[17]

The abortion-rights movement advocates for patient choice and bodily autonomy, while the anti-abortion movement maintains that the fetus has a right to live. Historically framed as a debate between the pro-choice and pro-life labels, most Americans agree with some positions of each side.[18] Support for abortion gradually increased in the U.S. beginning in the early 1970s,[19] and stabilized during the 2010s.[20][21] The abortion rate has continuously declined from a peak in 1980 of 30 per 1,000 women of childbearing age (15–44) to 11.3 by 2018.[22] In 2018, 78% of abortions were performed at 9 weeks or less gestation, and 92% of abortions were performed at 13 weeks or less gestation.[22] By 2023, medication abortions accounted for 63% of all abortions.[23] Almost 25% of women will have had an abortion by age 45, with 20% of 30 year olds having had one.[24] In 2019, 60% of women who had abortions were already mothers, and 50% already had two or more children.[25][26] Increased access to birth control has been statistically linked to reductions in the abortion rate.[27][28][29]

As of 2024, California, Michigan, Ohio, and Vermont are the only U.S. states to have explicit rights to abortion in their state constitutions. Other states have implicit rights to abortion subject to state judicial review, such as Kansas and Montana, or simply protect it via state law such as Colorado and Massachusetts. The state constitutions of Alabama, Louisiana, Tennessee, and West Virginia explicitly contain no right to an abortion.

Terminology

The abortion debate most commonly relates to the induced abortion of a pregnancy, which is also how the term "abortion" is used in a legal sense.[nb 1] The terms "elective abortion" and "voluntary abortion" refer to the interruption of pregnancy, before viability, at the request of the woman but not for medical reasons.[33]

In medical parlance, "abortion" can refer to a spontaneous miscarriage or to an induced miscarriage before the fetus is viable. After viability, doctors call an induced miscarriage a "termination of pregnancy".

History

Early history and rise of anti-abortion legislation

Abortion was a fairly common practice in the history of the United States, and was not always controversial.[10][34] At a time when society was more concerned with the more serious consequence of women becoming pregnant out of wedlock, family affairs were handled out of public view.[35][34] Abortion did not become a public controversy until the health risk of unsafe abortions by (female) unlicensed practitioners was brought to the public attention in the 19th century.[36]

James Mohr wrote that even though pre-quickening abortion was legal in the first 3 decades of the 19th century, only 1 in 25 to 1 in 30 pregnancies ended in abortion. By the 1850s and 1860s this number had increased to 1 in 5 or 1 in 6.[37][11] John Keown highlights some challenges in pinning down the common law view, noting that "evidence of quickening would clearly facilitate prosecution".[38][39]

In the mid-18th century, Benjamin Franklin included a recipe for an abortifacient in a math textbook.[40][41] In 1728, Franklin condemned publisher Samuel Keimer for publishing an article on abortion. According to biographer Walter Isaacson, Franklin did not have a strong view on the issue.[42] In The Speech of Polly Baker Franklin places the blame for abortion and infanticide on the sexual double standard against women:[43]

Forgive me Gentlemen, if I talk a little extravagantly on these Matters; I am no Divine: But if you, great Men, must be making Laws, do not turn natural and useful Actions into Crimes, by your Prohibitions. Reflect a little on the horrid Consequences of this Law in particular: What Numbers of procur'd Abortions! and how many distress'd Mothers have been driven, by the Terror of Punishment and public Shame, to imbrue, contrary to Nature, their own trembling Hands in the Blood of their helpless Offspring! Nature would have induc'd them to nurse it up with a Parent's Fondness. 'Tis the Law therefore, 'tis the Law itself that is guilty of all these Barbarities and Murders. Repeal it then, Gentlemen; let it be expung'd for ever from your Books: And on the other hand, take into your wise Consideration, the great and growing Number of Batchelors in the Country, many of whom, from the mean Fear of the Expence of a Family, have never sincerely and honourably Courted a Woman in their Lives; and by their Manner of Living, leave unproduced (which I think is little better than Murder) Hundreds of their Posterity to the Thousandth Generation. Is not theirs a greater Offence against the Public Good, than mine? Compel them then, by a Law, either to Marry, or pay double the Fine of Fornication every Year.

In 1716 New York passed an ordinance prohibiting midwives from providing abortion.[44] Founding Father and Second President of the United States John Adams praised the Spartan lawgiver Lycurgus for refusing his sister-in-law from having an abortion even though it prevented him from assuming power.[44]

Early U.S. statutes did not prohibit early-term abortions: for the most part, abortion was not a crime until quickening, and most exceptions to this in practice were penalties imposed on practitioners if a woman under their care died as a consequence of the procedure.[45] Within the context of a sex scandal,[46] Connecticut became the first state to regulate abortion by statute in 1821. Many states subsequently passed various abortion laws. In 1829, New York made post-quickening abortions a felony and pre-quickening abortions a misdemeanor.[47] This was followed by 10 of the 26 states creating similar restrictions within the next few decades,[48] in particular by the 1860s and 1870s.[36] The first laws related to abortion were made to protect women from real or perceived risks, and those more restrictive penalized only the provider.[49]

Criminalization did not end the practice of abortion; unlicensed doctors and midwives continued to perform them. Most of the women receiving abortions from unlicensed practitioners were poor. Women's safety continued to be a concern, especially after the highly publicized death of Mary Rogers. Wealthier women could pay willing physicians to broadly interpret health exceptions in their favor. Euphemistic advertisements for abortifacients offered an assortment of herbal remedies.[45] Abortions increased during World War II as the need for female labor outweighed other concerns and bribes were often accepted in exchange for lax enforcement. Regulations were tightened after the war to encourage a return to traditional family life, until a reform movement started in the 1950s drawing attention to the public health issue of illegal abortions, and a consensus grew in the medical community that physicians should make decisions about when health exceptions apply.[50]

A number of other factors likely played a role in the rise of anti-abortion laws. As in Europe, abortion techniques advanced starting in the 17th century, and the conservatism of most in the medical profession with regards to sexual matters prevented the wide expansion of abortion techniques.[36][51]

Physicians, who were the leading advocates of abortion criminalization laws, appear to have been motivated at least in part by advances in medical knowledge. Science had discovered that fertilization inaugurated a more or less continuous process of development, which produced a new human being. Quickening was found to be not more or less crucial in the process of gestation than any other step. Many physicians concluded that if society considered it unjustifiable to terminate pregnancy after the fetus had quickened, and if quickening was a relatively unimportant step in the gestation process, then it was just as wrong to terminate a pregnancy before quickening as after quickening.[52] Patricia Cline Cohen, a professor emeritus at the University of California, Santa Barbara, said that these laws had come about not because society saw abortion as a crime, but from a small group of white male doctors from Boston who had taken it upon themselves to prove to the rest of the county that pre-quickening abortion should be seen as a crime. The doctors used flawed math to convince the American Medical Association to accept that pre-quickening abortion should also be outlawed, leading to the raft of state laws banning abortion in the latter half of the 19th century.[53] Doctors were also influenced by practical reasons to advocate anti-abortion laws. For one, abortion providers were usually female midwives without formal training or education. In an age where the leading doctors in the nation were attempting to standardize the medical profession, these unlicensed practitioners were considered a nuisance to public health.[54][36]

Despite campaigns to end the practice of abortion, abortifacient advertising was highly effective and abortion was commonly practiced, with the help of a midwife or other women,[8] in the mid-19th century,[55][56] although they were not always safe.[57] While the precise abortion rate was not known, James Mohr's 1978 book Abortion in America documented multiple recorded estimates by 19th-century physicians,[36] which suggested that between around 15% and 35% of all pregnancies ended in abortion during that period.[58] This era also saw a marked shift in the people who were obtaining abortions. Before the start of the 19th century, most abortions were sought by unmarried women, who had become pregnant out of wedlock and for which there was much less compassion compared to married women who got an abortion; many of them were wealthy and paid well.[36] Out of 54 abortion cases published in American medical journals between 1839 and 1880, over half were sought by married women, and well over 60% of the married women already had at least one child.[59]

The sense that married women were now frequently obtaining abortions worried many conservative physicians, who were almost exclusively men. In the Reconstruction era, much of the blame was placed on the burgeoning women's rights movement. Though the medical profession expressed hostility toward feminism, many feminists of the era were also opposed to abortion.[36][60][61] In The Revolution, a newspaper operated by Elizabeth Cady Stanton and Susan B. Anthony, an 1869 opinion piece was published arguing that instead of merely attempting to pass a law against abortion, the root cause must also be addressed.[61][62] The writer stated that simply passing an anti-abortion law would be "only mowing off the top of the noxious weed, while the root remains. ... No matter what the motive, love of ease, or a desire to save from suffering the unborn innocent, the woman is awfully guilty who commits the deed. It will burden her conscience in life, it will burden her soul in death; But oh! thrice guilty is he who drove her to the desperation which impelled her to the crime."[63] To many feminists of this era, abortion was regarded as an undesirable necessity forced upon women by thoughtless men.[64] The free love wing of the feminist movement refused to advocate for abortion and treated the practice as an example of the hideous extremes to which modern marriage was driving women.[65] Marital rape and the seduction of unmarried women were societal ills, which feminists believed caused the need to abort, as men did not respect women's right to abstinence.[65] Feminist opposition to abortion was much less prevalent by the 20th century, and it was feminists and physicians who came to question anti-abortion laws and raise public interest in the 1960s.[36]

Abortion legal on request: AK, HI, NY, WA; allowed for danger to woman's health, rape or incest, or likely damaged fetus: AR, CA, CO, DE, FL, GA, KS, MD, NC, NM, OR, SC, VA; allowed for danger to woman's health: AL, MA; allowed for rape but not life: MS; allowed for danger to the woman's life: AZ, CT, IA, ID, IL, IN, KY, LA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NV, OH, OK, RI, SD, TN, TX, UT, VT, WI, WV, WY; complete ban: PA.
Abortion laws in the U.S. before Roe:[66]
  Fully illegal (1 state).
  Legal in cases of risk to woman's life (29 states).
  Legal in cases of rape (1 state).
  Legal in cases of risk to woman's health (2 states).
  Legal in cases of risk to woman's health, rape or incest, or likely damaged fetus (12 states).
  Legal on request (5 states).

Physicians, one of the most famous and consequential being Horatio Storer, remained the loudest voice in the anti-abortion debate, and they carried their agenda to state legislatures around the country, advocating not only anti-abortion laws but also laws against birth control on racist and pseudoscientific grounds;[67] religious groups were not particularly active within this movement,[68] which presaged the modern debate over women's body rights.[69] Though many of these laws indicated the woman as a co-criminal, she was rarely prosecuted.[36] A campaign was launched against the movement and the use and availability of contraceptives. Criminalization of abortion accelerated from the late 1860s through the efforts of concerned legislators, doctors, and the American Medical Association influenced by Storer,[70][71] and were facilitated by the press.[36] In 1873, Anthony Comstock created the New York Society for the Suppression of Vice, an institution dedicated to supervising the morality of the public. Later that year, Comstock successfully influenced the United States Congress to pass the Comstock Law, which made it illegal to deliver through the U.S. mail any "obscene, lewd, or lascivious" material. It also prohibited producing or publishing information pertaining to the procurement of abortion, birth control, and venereal disease, including to medical students.[72] The production, publication, importation, and distribution of such materials was suppressed under the Comstock Law as being obscene, and similar prohibitions were passed by 24 of the 37 states.[73]

In 1900, abortion was normally a felony in every state. Some states included provisions allowing for abortion in limited circumstances, generally to protect the woman's health or to terminate pregnancies arising from rape or incest.[74] Most Americans did not view abortion as a crime, and abortions continued to occur and became increasingly available.[75] The American Birth Control League was founded by Margaret Sanger in 1921; it would become Planned Parenthood Federation of America in 1942.[76][77] By the 1930s, licensed physicians performed an estimated 800,000 abortions a year.[78]

Sherri Finkbine

In the early 1960s, a controversy centered around children's television host Sherri Finkbine that helped bring abortion and abortion law more directly into the American public eye. Living in the area of Phoenix, Arizona, Finkbine had had four healthy children; during her pregnancy with her fifth child, she discovered the child might have severe deformities when born.[79] This was likely because Finkbine had been taking sleeping pills that she was unaware contained thalidomide, a drug that increases the risk of fetal deformities during pregnancy.[80] Though Finkbine wanted an abortion, the abortion laws of Arizona only allowed abortions if a pregnancy posed a threat to the woman's life. The situation gained public attention after Finkbine shared the story with a reporter from The Arizona Republic, who disclosed her identity in spite of her requests for anonymity. On August 18, 1962, Finkbine traveled to Sweden to obtain a legal abortion, where it was confirmed that the fetus had severe deformities.[81]

Finkbine's story marked a turning point for women's reproductive rights and abortion law in the United States. Still, Finkbine was only able to get an abortion because she could afford to travel overseas for it,[82] highlighting an inequality in abortion rights persisting to this day whereby many women cannot afford or otherwise do not have the resources to obtain a legal abortion; in such cases, women may turn to illegal abortion.[83][84]

Pre-Roe precedents

In 1964, Gerri Santoro of Connecticut died trying to obtain an illegal abortion, and her photo became the symbol of an abortion-rights movement. Some women's rights activist groups developed their own skills to provide abortions to women who could not obtain them elsewhere. As an example, in Chicago, a group known as "Jane" operated a floating abortion clinic throughout much of the 1960s. Women seeking the procedure would call a designated number and be given instructions on how to find "Jane".[85]

In 1965, the U.S. Supreme Court case Griswold v. Connecticut struck down one of the remaining contraception Comstock laws in Connecticut and Massachusetts.[86] However, Griswold only applied to marital relationships, allowing married couples to buy and use contraceptives without government restriction. It took until 1972, with Eisenstadt v. Baird, to extend the precedent of Griswold to unmarried persons as well.[87] Following the Griswold case, the American College of Obstetricians and Gynecologists (ACOG) issued a medical bulletin accepting a recommendation from six years earlier that clarified that "conception is the implantation of a fertilized ovum",[88] and consequently birth control methods that prevented implantation became classified as contraceptives, not abortifacients.

In 1967, Colorado became the first state to decriminalize abortion in cases of rape, incest, or in which pregnancy would lead to permanent physical disability of the woman. Similar laws were passed in California, Oregon, and North Carolina. In 1970, Hawaii became the first state to legalize abortions on the request of the woman,[89] and New York repealed its 1830 law and allowed abortions up to the 24th week of pregnancy. Similar laws were soon passed in Alaska and Washington. In 1970, Washington held a referendum on legalizing early pregnancy abortions, becoming the first state to legalize abortion through a vote of the people.[90] A law in Washington, D.C., which allowed abortion to protect the life or health of the woman, was challenged in the Supreme Court in 1971 in United States v. Vuitch. The court upheld the law, deeming that "health" meant "psychological and physical well-being", essentially allowing abortion in Washington, D.C. By the end of 1972, 13 states had a law similar to that of Colorado, while Mississippi allowed abortion in cases of rape or incest only and Alabama and Massachusetts allowed abortions only in cases where the woman's physical health was endangered. In order to obtain abortions during this period, women would often travel from a state where abortion was illegal to one where it was legal. The legal position prior to Roe v. Wade was that abortion was illegal in 30 states and legal under certain circumstances in 20 states.[91]

In the late 1960s, a number of organizations were formed to mobilize opinion both against and for the legalization of abortion. In 1966, the National Conference of Catholic Bishops assigned Monsignor James T. McHugh to document efforts to reform abortion laws, and anti-abortion groups began forming in various states in 1967. In 1968, McHugh led an advisory group which became the National Right to Life Committee.[92][93] The forerunner of the NARAL Pro-Choice America was formed in 1969 to oppose restrictions on abortion and expand access to abortion.[94] Following Roe v. Wade, in late 1973, NARAL became the National Abortion Rights Action League.

Roe v. Wade

The United States Supreme Court membership in 1973
F.l.t.r. seated Potter Stewart, William O. Douglas, Warren E. Burger (chief justice), William Brennan, and Byron White.
Standing Lewis F. Powell, Thurgood Marshall, Harry Blackmun, and William Rehnquist.

Prior to Roe v. Wade, 30 states prohibited abortion without exception, 16 states banned abortion except in certain special circumstances (e.g. rape, incest, and health threat to mother), 3 states allowed residents to obtain abortions, and New York allowed abortions generally.[95] Early that year, on January 22, 1973, the U.S. Supreme Court in Roe v. Wade invalidated all of these laws, and set guidelines for the availability of abortion. The decision returned abortion to its liberalized pre-1820 status.[36] Roe established that the right of privacy of a woman to obtain an abortion "must be considered against important state interests in regulation".[96] Roe also established a trimester framework, defined as the end of the first pregnancy trimester (12 weeks), as the threshold for state interest, such that states were prohibited from banning abortion in the first trimester but allowed to impose increasing restrictions or outright bans later in pregnancy.[96]

In deciding Roe v. Wade, the Court ruled that a Texas statute forbidding abortion except when necessary to save the life of the mother was unconstitutional. The Court arrived at its decision by concluding that the issue of abortion and abortion rights falls under the right of privacy in the United States (e.g. federal constitutionally-protected right), in the sense of the right of a person not to be encroached by the state. In its opinion, it listed several landmark cases where the court had previously found a right to privacy implied by the Constitution. The Court did not recognize a right to abortion in all cases, saying: "State regulation protective of fetal life after viability thus has both logical and biological justifications. If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother."[97]

The Court held that a right to privacy existed and included the right to have an abortion. The court found that a mother had a right to abortion until viability, a point to be determined by the abortion doctor. After viability a woman can obtain an abortion for health reasons, which the Court defined broadly to include psychological well-being. A central issue in the Roe case and in the wider abortion debate in general is whether human life or personhood begins at conception, birth, or at some point in between. The Court declined to make an attempt at resolving this issue, writing: "We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man's knowledge, is not in a position to speculate as to the answer." Instead, it chose to point out that historically, under English and American common law and statutes, "the unborn have never been recognized ... as persons in the whole sense", and thus the fetuses are not legally entitled to the protection afforded by the right to life specifically enumerated in the Fourteenth Amendment. Rather than asserting that human life begins at any specific point, the Court declared that the state has a "compelling interest" in protecting "potential life" at the point of viability.[97]

Doe v. Bolton

Under Roe v. Wade, state governments may not prohibit late terminations of pregnancy when "necessary to preserve the life or health of the mother", even if it would cause the demise of a viable fetus.[98] This rule was clarified by the 1973 judicial decision Doe v. Bolton, which specifies "that the medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient".[99][100][101] It is by this provision for the mother's mental health that women in the U.S. legally choose abortion after viability when screenings reveal abnormalities that do not cause a baby to die shortly after birth.[102][103][104][105]

Planned Parenthood v. Casey

In the 1992 case of Planned Parenthood v. Casey, the Court abandoned Roe's strict trimester framework but maintained its central holding that women have a right to choose to have an abortion before viability.[106] Roe had held that statutes regulating abortion must be subject to "strict scrutiny"—the traditional Supreme Court test for impositions upon fundamental Constitutional rights. Casey instead adopted the lower, undue burden standard for evaluating state abortion restrictions,[106] but re-emphasized the right to abortion as grounded in the general sense of liberty and privacy protected under the constitution: "Constitutional protection of the woman's decision to terminate her pregnancy derives from the Due Process Clause of the Fourteenth Amendment to the United States Constitution. It declares that no state shall "deprive any person of life, liberty, or property, without due process of law." The controlling word in the cases before us is 'liberty'."[107]

The Supreme Court continues to make decisions on this subject. On April 18, 2007, it issued a ruling in the case of Gonzales v. Carhart, involving a federal law entitled the Partial-Birth Abortion Ban Act of 2003 which President George W. Bush had signed into law. The law banned intact dilation and extraction, which opponents of abortion rights referred to as "partial-birth abortion", and stipulated that anyone breaking the law would get a prison sentence up to 2.5 years. The United States Supreme Court upheld the 2003 ban by a narrow majority of 5–4, marking the first time the Court has allowed a ban on any type of abortion since 1973. The opinion, which came from justice Anthony Kennedy, was joined by Justices Antonin Scalia, Clarence Thomas, and the two recent appointees, Samuel Alito and Chief Justice John Roberts.

In the case of Whole Woman's Health v. Hellerstedt, the Supreme Court in a 5–3 decision on June 27, 2016, swept away forms of state restrictions on the way abortion clinics can function. The Texas legislature enacted in 2013 restrictions on the delivery of abortions services that, it was argued by its opponents, created an undue burden for women seeking an abortion by requiring abortion doctors to have difficult-to-obtain "admitting privileges" at a local hospital and by requiring clinics to have costly hospital-grade facilities. The Court supported this argument and struck down these two provisions "facially" from the law at issue—that is, the very words of the provisions were invalid, no matter how they might be applied in any practical situation. According to the Supreme Court, the task of judging whether a law puts an unconstitutional burden on a woman's right to abortion belongs with the courts, and not the legislatures.[108]

The Supreme Court ruled similarly in June Medical Services, LLC v. Russo on June 29, 2020, in a 5–4 decision that a Louisiana state law, modeled after the Texas law at the center of Whole Woman's Health, was unconstitutional.[109] Like Texas' law, the Louisiana law required certain measures for abortion clinics that, if having gone into effect, would have closed five of the six clinics in the state. The case in Louisiana was put on hold pending the result of Whole Woman's Health, and was retried based on the Supreme Court's decision. While the District Court ruled the law unconstitutional, the Fifth Circuit found that unlike the Texas law, the burden of the Louisiana law passed the tests outlined in Whole Woman's Health, and thus the law was constitutional. The Supreme Court issued an order to suspend enforcement of the law pending further review, and agreed to hear the case in full in October 2019. It was the first abortion-related case to be heard by President Donald Trump's appointees to the Court, Neil Gorsuch and Brett Kavanaugh.[110] The Supreme Court found the Louisiana law unconstitutional for the same reasons as the Texas one, reversing the Fifth Circuit. The judgment was supported by Chief Justice John Roberts who had dissented on Whole Woman's Health but joined in judgment as to upholding the court's respect for the past judgment in that case.[109]

Dobbs v. Jackson Women's Health Organization

The composition of the Supreme Court at the time of Dobbs
Front row, l.t.r.: Samuel Alito, Clarence Thomas, John G. Roberts, Jr., Justice Stephen G. Breyer, Sonia Sotomayor.
Back row, l.t.r.: Brett M. Kavanaugh, Elena Kagan, Neil M. Gorsuch, Amy Coney Barrett.

The Supreme Court granted certiorari to Dobbs v. Jackson Women's Health Organization in May 2021, a case that challenges the impact of Roe v. Wade in blocking enforcement of a 2018 Mississippi law (the Gestational Age Act) that had banned any abortions after the first 15 weeks.[111] Oral arguments to Dobbs were held in December 2021, and a decision was expected by the end of the 2021–22 Supreme Court term. On September 1, 2021, Texas passed the Texas Heartbeat Act, one of the most restrictive abortion laws in the nation, banning most procedures after six weeks.[112] On May 2, 2022, a leaked draft majority opinion for Dobbs, written by Samuel Alito, set to overturn Roe was reported by Politico.[113]

On June 24, 2022, the Supreme Court overruled both Roe and Planned Parenthood v. Casey in the Dobbs case on originalist grounds that a right to abortion cannot be found in the U.S. Constitution. John Roberts, the Chief Justice of the United States, concurred in the decision to uphold the law at question as constitutional, by a 6–3 vote, and did not support overruling both Roe and Casey.[114][115] This enabled trigger laws, which had been passed in 13 states,[116][117][118] to effectively ban abortions in those states.[119][120]

Abortion-related initiatives were placed on the 2022 ballot in six states, the most in a single year. 2022 California Proposition 1, 2022 Michigan Proposal 3, and Vermont Proposal 5 enshrined the right to an abortion in state constitutions, while the 2022 Kansas abortion referendum, 2022 Kentucky Amendment 2, and Montana Legislative Referendum No. 131 rejected restrictions on abortion.[121] Voters in Ohio defeated August 2023 Ohio Issue 1 intended to make changes to the state's constitution more difficult, ahead of November 2023 Ohio Issue 1, which added the right to an abortion to the Ohio constitution.[122]

Abortion-related issued remained a critical topic leading into the 2024 United States elections, including the presidential election. Several legal cases ruled after Dobbs in Republican-leaning states further drove stronger support for abortion rights. The pending Supreme Court case, FDA v. Alliance for Hippocratic Medicine, brought into question the United States Food and Drug Administration (FDA)'s approval and rules around mifepristone, after lower courts had deemed the FDA's approval unlawful.[123] In Arizona, the state Supreme Court ruled in Planned Parenthood Arizona v. Mayes that instead of a 15-week ban on abortion passed by the state in 2022, that the state should follow a 1902 law, based on a pre-ratification 1864 law, that disallowed nearly any abortion except in the case of a medical emergency.[124] Some Republicans, including allies of presidential candidate Donald Trump, have pushed Project 2025, a sweeping government reform plan that includes banning abortions at a federal level as well as access to medical abortions drugs.[125] Democrats used the pushback against these Republican and conservative anti-abortion goals as a point of campaigning for the election.[126]

Travel to Mexico

State map of Mexico. Most states are grey: technically illegal but effectively legal, as the state law is not prosecuted. As of 2022, 9 states have legalized abortion; this includes Coahuila, which borders Texas.
Availability of abortion in Mexican states.
  Illegal but providers are not prosecuted
  Legal during first 15 weeks LMP (first 12 weeks of pregnancy)
  Legal for economic reasons if mother already has 3 children

In the wake of state abortion bans and restrictions in the United States, Americans have started traveling to Mexico for abortions, and Mexico has expressed a willingness to help.[127][128]

At least partly due to a unanimous 2021 Supreme Court of Justice of the Nation decision that penalties for abortion violate women's rights, abortion-providers are not prosecuted even in states where abortion remains illegal under state law; there are also legal exemptions for rape and medical reasons, and a police report is not required for a rape exemption. Providers openly treat American travelers in several states where abortion remains technically illegal, such as Nuevo Leon, which neighbors Texas. Following the Supreme Court ruling, abortion is being gradually legalized at the state level, and as of 2022 is legal during the first trimester (before the 13th week after implantation) in eleven states and Mexico City.[129][130] In an additional two states, abortion is legal for economic reasons if a woman already has 3 children; this is during the first trimester for one (Michoacan) and with no set limit for the other (Yucatán).[131]

Medical abortion

Medical abortion via mifepristone and misoprostol was approved for abortion in the United States by the FDA in September 2000.[132] As of 2007[update], it was legal and available in all 50 states, Washington, D.C., Guam, and Puerto Rico.[133] It was a prescription drug, and required that it could only be distributed to the public through specially qualified licensed physicians.[134]

In the midst of the COVID-19 pandemic on December 16, 2021, in light of the difficulties in accessing in-person healthcare services, the FDA approved the distribution of mifepristone via mail.[135] In states where abortion is banned or restricted, women are able to obtain pills through ordering from overseas online pharmacies, purchasing from pharmacies in Mexico, from services such as Aid Access,[136] or through a network of U.S.-Mexico border organizations that includes Red Necesito Abortar, Las Libres [es], and Marea Verde.[137][138][139][140][141]

In January 2023, the U.S. Department of Justice stated that USPS mailing of pills for medication abortion, even into states where abortion services are restricted, does not violate federal law.[142] In 2023, online access to abortion medication by mail delivered by the US Postal Service is currently available to citizens of all states.[143]

In light of the Dobbs decision, the Alliance Defending Freedom launched a lawsuit in November 2022 in the Northern District of Texas under Judge Matthew J. Kacsmaryk to seek to overturn the FDA's original approval of mifepristone. The Alliance argued that the FDA had ignored some studies that showed the medication to have harmful side effects, while the current federal administration under Joe Biden, the manufacturers of the drugs, and several doctors vouched for the safety of the drugs and the lack of standing in the plaintiff's case. Despite this, Judge Kacsmaryk ruled for the Alliance on April 7, 2023, reversing the FDA's approval and banning mifepristone across the United States after seven days.[144] A district judge in a separate lawsuit, Thomas O. Rice of the Eastern District of Washington, ruled that the FDA should not reverse access to mifepristone in 16 states.[145] Kacsmaryk's ruling was partially reversed by a panel on the Fifth Circuit Court of Appeals, leaving mifepristone on the market but reverting efforts made by the FDA to liberalize its use over seven years.[146] The case is expected to be ruled on by the Supreme Court.[145] Mifepristone is used for abortion in the tenth week of pregnancy. With the fact reported by the Guttmacher Institute, that more than half of abortion in the US is done with drugs,[147] the judge's decision will have a strong consequence.[148]

Legal status

Federal legislation

Since 1995, led by congressional Republicans, the U.S. House of Representatives and U.S. Senate have moved several times to pass measures banning the procedure of intact dilation and extraction, commonly known as partial birth abortion. Such measures passed twice by wide margins, but President Bill Clinton vetoed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Congressional supporters of the bill argue that a health exception would render the bill unenforceable, since the Doe v. Bolton decision defined "health" in vague terms, justifying any motive for obtaining an abortion. Congress was unsuccessful with subsequent attempts to override the vetoes.

The Born-Alive Infants Protection Act (BAIPA) was enacted August 5, 2002, by an Act of Congress and signed into law by George W. Bush. It asserts the human rights of infants born after a failed attempt to induce abortion. A "born-alive infant" is specified as a "person, human being, child, individual". "Born alive" is defined as the complete expulsion of an infant at any stage of development that has a heartbeat, pulsation of the umbilical cord, breath, or voluntary muscle movement, no matter if the umbilical cord has been cut or if the expulsion of the infant was natural, induced labor, cesarean section, or induced abortion. The Born-Alive Abortion Survivors Protection Act is a proposed piece of legislation that would result in criminal penalties for any practitioner who denies a born-alive infant care.

On October 2, 2003, with a vote of 281–142, the House approved the Partial-Birth Abortion Ban Act to ban intact dilation and extraction, with an exemption in cases of fatal threats to the woman. Through this legislation, a doctor could face up to two years in prison and civil lawsuits for performing such a procedure. A woman undergoing the procedure could not be prosecuted under the measure. On October 21, 2003, the United States Senate passed the bill by a vote of 64–34, with a number of Democrats joining in support. The bill was signed by President George W. Bush on November 5, 2003, but a federal judge blocked its enforcement in several states just a few hours after it became public law. The Supreme Court upheld the nationwide ban on the procedure in the case Gonzales v. Carhart on April 18, 2007, signaling a substantial change in the Court's approach to abortion law.[149] The 5–4 ruling said the Partial Birth Abortion Ban Act does not conflict with previous decisions regarding abortion.

The judicial interpretation of the U.S. Constitution regarding abortion, following the Supreme Court of the United States's 1973 landmark decision in Roe v. Wade, and subsequent companion decisions, is that abortion is legal but may be restricted by the states to varying degrees. States have passed laws to restrict late-term abortions, require parental notification for minors, and mandate the disclosure of abortion risk information to patients prior to the procedure.[150]

The official report of the U.S. Senate Judiciary Committee, issued in 1983 after extensive hearings on the Human Life Amendment (proposed by Senators Orrin Hatch and Thomas Eagleton), stated: "Thus, the [Judiciary] Committee observes that no significant legal barriers of any kind whatsoever exist today in the United States for a mother to obtain an abortion for any reason during any stage of her pregnancy."[151]

One aspect of the legal abortion regime now in place has been determining when the fetus is "viable" outside the womb as a measure of when the "life" of the fetus is its own (and therefore subject to being protected by the state). In the majority opinion delivered by the court in Roe v. Wade, viability was defined as "potentially able to live outside the mother's womb, albeit with artificial aid. Viability is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks". When the court ruled in 1973, the then-current medical technology suggested that viability could occur as early as 24 weeks. Advances over the past three decades allow survival of some babies born at 22 weeks.[152]

As of 2006[update], the youngest child to survive a premature birth in the United States was a girl born at Kapiolani Medical Center in Honolulu, Hawaii, at 21 weeks and 3 days gestation.[153] Because of the split between federal and state law, legal access to abortion continues to vary by state. Geographic availability varies dramatically, with 87 percent of U.S. counties having no abortion provider.[154] Moreover, due to the Hyde Amendment, many Medicaid state programs do not cover abortions; as of 2022, 17 states including California, Illinois, and New York offer or require such coverage.[155]

The legality of abortion is frequently a major issue in nomination battles for the U.S. Supreme Court. Nominees typically remain silent on the issue during their hearings, as the issue may come before them as judges.[156]

The Unborn Victims of Violence Act, commonly known as Laci and Conner's Law, was passed by Congress and signed into law by President Bush on April 1, 2004, allowing two charges to be filed against someone who kills a pregnant mother (one for the mother and one for the fetus). It specifically bans charges against the mother and/or doctor relating to abortion procedures. Nevertheless, it has generated much controversy among pro-abortion rights advocates who view it as a potential step in the direction of banning abortion.

In 2021, the Women's Health Protection Act, which would codify abortion rights into federal law, was introduced by Judy Chu.[157] The bill passed the U.S. House of Representatives but was rejected by the U.S. Senate.[158]

After the Dobbs decision, Merrick Garland, the U.S. Attorney General, asserted that under federal law, states do not have the right to restrict access to FDA-approved abortion pills, but Louisiana passed a law to ban mailing them.[159] Legal experts cited as a potentially persuasive precedent the 2014 district decision in Zogenix v. Patrick, in which the court ruled that under the doctrine of federal preemption, Massachusetts could not ban the opioid Zohydro because it had been approved by the FDA.[160][161]

On September 13, 2022, Republican senator Lindsey Graham introduced legislation that would ban abortion nationwide after 15 weeks of pregnancy with exceptions for rape, incest, and the life of the patient, named the Protecting Pain-Capable Unborn Children from Late-Term Abortions Act.[162][163][164] Graham had previously introduced the Pain-Capable Unborn Child Protection Act, which set the period at 20 weeks.[165]

Penalties by state

Currently, 13 states have criminal penalties for performing abortions, regardless of gestational age.[166] The penalties in states that have made abortion illegal vary, as outlined below.

This chart lists only the penalties authorized specifically by the state laws which explicitly restrict (or ban) abortions. The chart does not address the risk of being prosecuted for violating any other law because of the abortion. The jurisprudence surrounding this question – whether laws such as "fetal-personhood laws",[167] or laws originally intended to protect pregnant women and their pregnancies from external aggressors, can now also be used to prosecute women who obtain abortions, or who terminate their own pregnancies, deliberately or unintentionally[168] – is unsettled, variable, and, in some states, unclear.[169] States with criminal penalties that are blocked by a court, have yet to take effect, or are unenforced are denoted by a grey background.

State Sentence
Abortion providers Patients getting abortions
 Alabama Performing an abortion is a Class A felony punishable by imprisonment for at least 10 years up to 99 years or life. Attempting to perform an abortion is a Class C felony punishable by imprisonment for at least 1 year and 1 day up to 10 years.[170] None authorized by the state's ban on abortion.[171]
 Arizona Performing or attempting to perform an abortion is punishable by imprisonment for a minimum of 2 years and a maximum of 5 years.[172]
 Arkansas Performing or attempting to perform an abortion is an unclassified felony punishable by imprisonment not to exceed 10 years and/or a maximum fine of $100,000.[173] None authorized by the state's ban on abortion.[174]
 Idaho Performing an abortion is a felony punishable by imprisonment for not less than 2 and not more than 5 years and/or a maximum fine of $5,000.[175] Purposely terminating a pregnancy other than by live birth is a felony punishable by imprisonment for not less than 1 and not more than 5 years and/or a maximum fine of $5,000.[176]
 Indiana Performing an illegal abortion is a Level 5 felony punishable by imprisonment for 1 to 6 years and/or a fine of up to $10,000.[177] None authorized by the state's ban on abortion.[178]
 Kentucky Intentional termination of life of an unborn human being is a class D felony punishable by imprisonment for not less than 1 and not more than 5 years.[179] None authorized by the state's ban on abortion.[180]
 Louisiana Committing an abortion is punishable by imprisonment for not less than one year and not more than ten years and/or a fine of not less than $10,000 or more than $100,000.[181] None authorized by the state's ban on abortion.[182]
 Mississippi Performing or attempting to perform an abortion is punishable by imprisonment for not less than 1 year and not more than 10 years.[183] None authorized by the state's ban on abortion.[184]
 Missouri Performing an abortion is a class B felony punishable by imprisonment for at least five years and no more than fifteen years.[185] None authorized by the state's ban on abortion.[186]
 North Dakota Performing an abortion is a class C felony punishable by imprisonment for a maximum of five years and/or a fine of $10,000.[187] None authorized by the state's ban on abortion.[188]
 Oklahoma Performing or attempting to perform an abortion is a felony punishable by imprisonment for a term not to exceed ten years and/or a maximum fine of $100,000.[189] None authorized by the state's ban on abortion.[190]
 South Dakota Procurement of abortion is a class 6 felony punishable by up to two years imprisonment and/or a fine of $4,000.[191]
 Tennessee Performing or attempting to perform an abortion is a class C felony punishable by imprisonment for not less than 3 years and not more than 15 years.[192] None authorized by the state's ban on abortion.[193]
 Texas Performing or attempting to perform an abortion is a first-degree felony if an unborn child ("an individual living member of the homo sapiens species from fertilization until birth, including the entire embryonic and fetal stages of development") dies as a result of the offense punishable by imprisonment of not less than 5 years and not more than 99 years and a maximum fine of $10,000; or a second-degree felony otherwise punishable by imprisonment of not less than 2 years and not more than 20 years and a maximum fine of $10,000.[194] None authorized by the state's ban on abortion.[195]
 Utah Killing an unborn child (not defined in the statute) is a second-degree felony punishable by imprisonment for not less than 1 and not more than 15 years.[196]
 West Virginia Performing an illegal abortion is a felony punishable by imprisonment for a minimum of 3 years and a maximum of 10 years.[197] None authorized by the state's ban on abortion.[198]
 Wisconsin Performing an abortion is a class H felony punishable by imprisonment for a maximum of 6 years and/or a fine of $10,000.[199] None authorized by the state's ban on abortion.[200]
 Wyoming Violation of abortion restrictions is a felony punishable by imprisonment for not more than 14 years.[201]

State-by-state legal status