6 days ago
Abortion in America: 3 years after Roe's repeal, in 7 charts
Three years ago, the Supreme Court issued a bombshell ruling that overturned Roe v. Wade, ending nearly 50 years of precedent that had protected abortion rights throughout the United States.
'The Constitution does not confer a right to abortion … and the authority to regulate abortion is returned to the people and their elected representatives,' Justice Samuel Alito wrote for the majority in Dobbs v. Jackson Women's Health Organization.
That decision marked a huge victory for the anti-abortion movement, which had worked for decades to reverse the 1973 ruling in Roe that had required all states to allow abortions at least up to the point of fetal viability — roughly 24 weeks into pregnancy. It also sparked a political and legislative frenzy as states and voters reckoned with having the power to fully regulate abortion on their own for the first time in half a century.
Three years later, America is in a fundamentally different place than it was before the Dobbs decision. Beyond its direct impact on reproductive health care, the ruling also had major political implications across the country.
Here are some of the things that have changed — and a few that surprisingly haven't — since Roe was repealed.
The most obvious and immediate effect of Dobbs was the roll back of abortion rights in dozens of states. Thirteen states had 'trigger laws' in place that were designed to instantly impose strict new restrictions or outright bans the moment Roe was repealed. Some others had dormant anti-abortion measures still on the books that became active again once nationwide protections disappeared.
Today, abortion is essentially banned, with limited exceptions, in 12 states. Another 10 states ban abortions earlier in pregnancy than the standard established under Roe. Laws in the remaining half of states either mirror Roe's fetal viability standard or have no gestational limits on abortions.
We're only now beginning to understand the impact that these new bans have had. Somewhat unexpectedly, they don't appear to have reduced the number of abortions in the U.S. The best evidence we have suggests that the total has gone up since Roe was overturned.
There were just over 1 million abortions in the U.S. last year, about 100,000 more than there were in 2020, according to estimates by the Guttmacher Institute, a pro-reproductive rights research organization. That increase represents a break from a long-standing trend that had seen the total number of abortions per year cut nearly in half from their peak in the early 1990s.
How can the implementation of strict bans in large swaths of the country not cause the number of abortions to fall? Part of the answer is that abortion access in some red states was quite limited even when Roe was in place. But the main reason is a massive surge in abortion-related travel out of highly-restrictive areas to states with more permissive laws. Last year, more than 155,000 patients crossed state lines in order to obtain an abortion, according to Guttmacher Institute estimates. That's nearly twice as many as in 2020. Roughly 70% of the abortions in New Mexico and Kansas last year were performed on out-of-state patients, mostly from Texas. There were 35,000 abortions performed on out-of-state patients in Illinois, which borders several states with strict bans.
Two trends that were already in motion when the Dobbs decision came down may have also reduced the ruling's impact. The first is the growing importance of medications like mifepristone and misoprostol, which allow patients to have an abortion without undergoing a medical procedure. Medications had been an increasingly common alternative to traditional in-clinic abortions (alternatively known as procedural or surgical abortions) for years, but their use has accelerated even more since Roe was repealed. Last year, 63% of abortions were performed via medication, according to the Guttmacher Institute.
The second trend is the telemedicine revolution that was spawned by the COVID-19 pandemic two years before Dobbs was decided. Like nearly all types of doctor's visits, the share of abortion-related appointments that happen virtually has skyrocketed over the past five years. By the end of 2024, a quarter of all abortions were provided by telehealth, according to the Society of Family Planning.
Roe's repeal didn't just affect the total number of abortions, but its broader affects on health and fertility are still coming into focus. The limited data available does offer some hints.
Research released earlier this year found that strict abortion bans do appear to have resulted in more than 20,000 more babies being born than would otherwise be expected in restrictive states, particularly among Black and Hispanic mothers and people with low incomes. But that same research found a troubling increase in infant mortality within those same groups. A separate study by the Gender Equity Policy Institute estimated that mothers in restrictive states are twice as likely to die due to pregnancy-related complications as those in more 'supportive' states.
Dobbs was decided just four months before the 2022 midterm elections, instantly moving abortion up the list of most important issues in races across the country. Blowback over the ruling is credited with helping Democrats hold off a widely expected 'red wave' and maintain control of the Senate.
With the status quo on abortion suddenly upended, states also had to decide what their own policies on the issue would be. That led to a wave of ballot initiatives that allowed voters, for the first time, to decide how accessible abortion should be in their states. Since 2022, there have been 14 separate state ballot measures to either protect or expand abortion access. Eleven were approved, including initiatives that repealed highly restrictive laws in Missouri and Ohio that went into effect when Roe was repealed. Several initiatives that would have rolled back abortion protections and granted lawmakers more power to restrict abortion have failed.
It hasn't been a clean sweep for pro-abortion initiatives, however. Last year, voters in Florida, Nebraska and South Dakota had a chance to significantly expand abortion rights in their states. All three measures came up short. The most glaring example of the limits of abortion as a political issue came in the 2024 presidential election, which saw Donald Trump win a second term even though his three Supreme Court picks provided the decisive votes to overturn Roe.
The Dobbs decision clearly had an impact on American's views about abortion, but polls show that the shift has been relatively small. In a nation where elections are often decided by the slimmest of margins, that can matter a lot. But public opinion on abortion appears to have been deeply entrenched after decades of heated debate over the issue. Even after such a dramatic change in the nation's laws, polls only moved a few percentage points, leaving overall sentiment roughly where it has stood for 50 years.
Three years is too short of a time period to fully understand the impact of something as monumental as Roe's repeal. Abortion opponents are continuing to push for even more restrictions, as reproductive rights supporters fight to make abortion more accessible. No doubt that the courts will have plenty of say in how those battles are decided.
