Roe Was Overturned a Year Ago. Here's Where Abortion Rights in the U.S. Stand
Fact checked by Nick Blackmer
It’s been a year since the U.S. Supreme Court voted to overturn Roe v. Wade, the landmark decision that guaranteed a constitutional right to abortion. Since then, there’s been a growing divergence between states that are bolstering access to reproductive health care and those that are restricting it.
In states where abortion is banned or restricted, people seeking to terminate a pregnancy must travel far out of state or risk the potential illegality of performing a medication abortion at home. Meanwhile, providers in states where abortion is still legal are being overwhelmed with new appointments from people both in and out of the state.
About 22 million women and children of reproductive age now live in states where abortion access is heavily restricted or totally inaccessible.
For many people, being close to an abortion provider is important to get the services and support they may need to end a pregnancy, Suzanne Bell, PhD, assistant professor of population, family, and reproductive health at Johns Hopkins University, told Verywell.
“When that provider disappears, there are just many more barriers that a pregnant person needs to overcome in order to access care,” Bell said. While navigating the expenses and uncertainties of finding abortion care within or outside of a state with abortion restrictions, patients may wait weeks longer to get abortion care.
Here’s what you need to know about where abortion care has become less accessible, where it’s been protected, and how the dynamics of that care have changed in the last year.
In 27 States, Most Women Have No Access to an Abortion Provider
Last spring, the U.S. Supreme Court heard the case Dobbs v. Jackson Women’s Health Organization. On May 2, a draft of the Court’s decision was leaked. It indicated the justices would use the Dobbs decision to overturn Roe v. Wade, the 1973 decision which established the constitutional right to an abortion.
There was a quick reaction to the leak. In Oklahoma, for instance, legislators passed a new law to ban abortion. In the following two months, abortion providers had entirely vacated Oklahoma and South Dakota.
Several states had laws on the books that would immediately prohibit abortion, should Roe ever be struck down. On June 24, the Court issued its final ruling, striking Roe. Once these so-called trigger laws went into effect, 11 states—including Oklahoma and South Dakota—lacked any abortion providers. Now, 13 states outlaw abortion.
Related: What Are Trigger Laws and What Do They Mean For Abortion Rights?
Between July 2022 and March 2023, there were nearly 3,000 fewer monthly abortions on average, not including those that fall outside the medical system, according to a report from the Society of Family Planning.
“In some states, new abortion restrictions have been litigated in court, resulting in week-by-week changes to the legal status of abortion, creating confusion and abortion care churn,” the authors of the report wrote.
Today, in these 14 states, 100% of women of reproductive age live in a county with zero abortion providers:
Texas
Tennessee
Missouri
Wisconsin
Alabama
Louisiana
Kentucky
Oklahoma
Mississippi
Arkansas
Idaho
West Virginia
South Dakota
North Dakota
While Verywell data includes women aged 15 to 44 in order to define “reproductive age,” this does not represent all people in need of an abortion.
“As we approach a year since Roe was overturned, it’s hard to fathom how severely abortion rights and access have been compromised in the past year,” Herminia Palacio, Guttmacher Institute President and CEO said in a statement. “Even when Roe was in place, many people struggled to access abortion care—especially those marginalized by systemic racism and economic insecurity. But since Roe’s fall, trigger bans and new bans have quickly decimated abortion rights and access across the country.”
Related: A Verywell Report: Restricting Abortion Will Cost Women Their Lives
Where Has Abortion Access Improved?
As of now, 25 states and D.C. allow abortion past 22 weeks of pregnancy. In 20 of those states, new laws or court decisions have bolstered abortion rights. Some states have enshrined the right to abortion in their state constitution. Others passed laws to protect out-of-state abortion care seekers.
As a result, some states have seen more physician-provided abortions in the last year. Florida, Illinois, North Carolina, Colorado, and California became so-called “surge states,” where tens and thousands of people flocked to get care after Dobbs. Even if those states had restrictions like required in-person counseling and waiting periods, they didn’t stop people from seeking abortion care, according to the Society of Family Planning.
According to Bell, geography plays the biggest role in determining which states have the biggest influx in out-of-state abortion seekers.
“Places in the Midwest, like Illinois, are seeing huge increases because much of the Midwest and the South have banned or severely restricted abortion,” Bell said. “In places that are proximate to other liberal states that have continued to provide abortion, you might not see as much of an increase. It really comes down to what’s happening in those neighboring states.”
Still, the increased abortion rates in some states haven’t compensated for the reductions seen in states where abortion was banned. That trend may hold as new laws further restrict pregnant people’s abortion options.
For most of the past year, Florida and North Carolina were “holdouts” in the South, Bell said. Then, in April 2023, Florida lawmakers enacted a six-week abortion ban, making it one of the most restrictive states in the country. North Carolina followed in May, with a 12-week ban.
As of May, Verywell research indicates that people living in Florida are already seeing a reduction in their access to abortion providers.
Related: 7 Things to Know About Your Reproductive Rights in a Post-Roe World
Abortion Bans Force More Out-of-State Travel
Abortion seekers in states with restrictions must now travel further to access care. A Guttmacher Institute survey from July 2022 found that about 12% of respondents traveled out of state to access abortion care.
This often introduces logistical complications, such as the expense of travel, taking time off work, finding childcare, and making an appointment at a clinic that could already be overwhelmed with patients. Overcoming those hurdles could delay a person’s care, causing them to get an abortion much later than they wanted to.
“Once you get beyond the second trimester, it’s just much more involved and there are even fewer providers that can provide later abortion care,” Bell said. “When people are unable to get first trimester abortions in their state or in a neighboring state, the longer they wait, the more expensive it can get, and the more involved the procedure can get—it can become a multi-day procedure.”
The Guttmacher study also found that people living in states with abortion care restrictions were more than twice as likely to have paid out of pocket for abortion and were more likely to say that financial barriers delayed their care.
Abortion Costs
According to data from KFF, the median cost of abortions for people paying out of pocket ranges from $568 to $775. A medicated abortion costs less than a procedure, and a first trimester abortion costs less than a second trimester abortion.
It's up to states to decide whether or not insurance covers abortions, even in private insurance plans. Post-Dobbs, 11 states restrict abortion coverage in private plans, while 26 ban abortion coverage in marketplace plans. Only seven states require private plans to cover abortion services.
“These bans mean that medically complex patients would be forced to put their health and well-being at risk, and that many people who do not have resources may be forced to remain pregnant,” Smita Carroll, MD, MBA, MPH, complex family planning fellow at the University of New Mexico School of Medicine and a fellow with Physicians for Reproductive Health, told Verywell. “People with resources and support, despite the Dobbs decision, have always and will always be able to access the abortion care that they need. People without resources are either forced to travel long distances or ultimately remain pregnant. This inequity in access to care should never exist.”
Black and Hispanic populations and those living below the poverty line were already two to three times more likely to seek an abortion before Dobbs. These groups are also at greater risk of poor pregnancy and birth outcomes, such as maternal morbidity and mortality, preterm births, and late entry into prenatal care.
A Move Toward Telehealth
As brick-and-mortar services shutter, virtual clinics are becoming more popular. People seeking to terminate a pregnancy can arrange a telehealth visit with a clinician through sites like Hey Jane, Carafem, and Pills by Post. Patients typically receive the abortion medication through the mail and can self-administer it at home.
Most telehealth providers are restricted by state laws. Aid Access, a non-profit that ships medication abortion to the U.S. from abroad, will send prescriptions to all 50 states, regardless of abortion restrictions. An analysis from November 2022 found that requests for the abortion pill increased by more than 250% after Dobbs compared to before the draft leak. The largest increases were in states with total bans.
In December 2022, the Justice Department said that the U.S. Postal Service and other mail carriers are legally allowed to carry prescription abortion drugs, even to states with abortion restrictions.
The Next Year May Look Similar
As of June, a total of 40 legal cases have been filed challenging abortion bans, with 29 still pending, according to the Brennan Center for Justice.
“I think the next year is going to look, unfortunately, a lot like this year in that we’re going to continue to see lots of cases in the courts challenging abortion bans, and on the other side, people challenging protections of abortion providers, mifepristone, etc.,” Bell said.
In May, the Senate failed to pass the Women’s Health Protection Act, which would have re-established the federal right to abortion. Congress may continue to try to protect abortion in future bills. In the meantime, Bell said abortion providers are being pushed out or voluntarily leaving their professions, and medical education for reproductive health providers has become substandard in states with abortion bans.
“The longer we live in this under post-Dobbs reality, the more likely it is that we’re going to have a lack of providers that are able and willing to provide this care, even if there is a federal law protecting the right to abortion,” Bell said.
Besides, a return to the landscape under Roe likely wouldn’t be sufficient to ensure people have adequate reproductive health care.
“Even prior to the Dobbs decision, abortion access was still out of reach for many communities,” Carroll said. “We should always hope for and demand a future for abortion access that is better than even the conditions prior to Dobbs.”
What This Means For You
Several organizations provide support for people seeking to terminate a pregnancy from states with abortion bans. For instance, Plan C provides information and options for getting abortion medication at home. The National Abortion Federation connects patients with reputable abortion providers and the National Network of Abortion Funds offers financial and logistical support for abortion-seekers.
