US military service members have long faced challenges accessing reproductive health care, especially abortion. The 2022 Dobbs v Jackson Women's Health Organization (Dobbs) Supreme Court decision and subsequent state-level abortion policy restrictions have exacerbated barriers to care for many communities, especially those with marginalized identities. To assess the impact of Dobbs on abortion access for US active-duty service members, we launched a qualitative study among active-duty service members who experienced pregnancy and considered or obtained abortion care after the Dobbs decision. Recruitment was challenging, and we completed only 3 interviews. The complexity of accessing abortion care for active-duty military service members has intensified, with long-standing barriers related to insurance, mobility, finances, and confidentiality compounded by post-Dobbs abortion restrictions in states where many service members are stationed and by the failure of policies to provide support. We drew on the existing literature and illustrative quotations from interview participants to explore the impacts of Dobbs on this population and reflected on the need to address barriers to abortion access for active-duty service members-a critical issue for military readiness as well as the health and well-being of service members. (Am J Public Health. 2026;116(7):1038-1043. https://doi.org/10.2105/AJPH.2026.308431).

Access to sexual and reproductive health care varies widely by geography, and state-level policies play a major role in establishing the contours that govern the coverage, provision, availability, and costs of services. The role of state-level policies has been amplified in the wake of the 2022 Supreme Court ruling in Dobbs v. Jackson Women's Health Organization, which eliminated the federal right to abortion care allowing states to set their own policies to ban or protect abortion. Additionally, states play a major role in shaping Medicaid policies that affect access to contraception and maternity care. This Perspective examines the many ways that state policy choices affects access to three interrelated areas of reproductive health care: contraception, abortion, and maternity care. State policy actions and decisions are at the core of reproductive health coverage and access. They are shaped by funding decisions, eligibility, and coverage polices established by the legislative and administrative bodies. This includes state policies related to contraceptive coverage and rights, Medicaid eligibility, telehealth and pharmacy access, scope of Medicaid and private insurance coverage, and efforts related to quality improvement and oversight. Affordability, availability, and coverage are still barriers to sexual and reproductive health services in many parts of the nation. Several states have intentionally erected barriers to abortion care, but structural challenges also affect contraception and maternity care access. Financing and regulatory policies treat contraception, abortion, and maternity care as distinct domains, but they are inextricably linked and many women often seek these services from the same clinicians. State level policies related to health coverage, reimbursement levels, workforce supply, and quality of care all overlap and affect the care that women receive and their experiences with the health care system. State policymakers play an outsize role in developing and implementing approaches to address their resident's reproductive health needs. The implementation of Medicaid work requirements and other federal cuts to health spending in the next several years is expected to lead to a major increase in people becoming uninsured at the same time that the reproductive health care safety-net faces financial uncertainty. States that take a coordinated, systems-level approach to health care can strengthen access, improve care delivery, and better meet patients' reproductive health care needs.

Doulas and acompañantes: Non-clinical abortion support after Dobbs

Maternal mental health disorders are among the leading causes of maternal morbidity and mortality. In the US, the 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization and ensuing state-level abortion restrictions have raised concerns that such policies may worsen maternal health and mental health outcomes. To examine the association of the implementation of Texas Senate Bill 8 (SB8) abortion law, which banned abortions after embryonic cardiac activity in September 2021, with maternal mental health outcomes. This repeated cross-sectional study used a difference-in-differences (DiD) design with pooled data from the 2016 to 2023 National Survey of Children's Health. The nationally representative sample included US mothers aged 18 to 49 years who lived with at least 1 child aged 0 to 17 years. Data were analyzed from April to October 2025. Mothers residing in Texas represented the treatment group, and mothers in states without abortion bans (Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wyoming) served as the control group. The primary outcome was mothers' self-reported fair or poor mental and emotional health. Logistic regression models, adjusted for child-, mother-, and household-level characteristics, were used to estimate changes in the probability of mental health outcomes for mothers coinciding with SB8 implementation. Similar models were estimated with maternal physical health and fathers' mental health as outcomes for sensitivity analyses. The sample included 4323 mothers in Texas (47.2% [95% CI, 45.1%-49.4%] aged 30-39 years) and 152 573 mothers in nonban states (47.1% [95% CI, 46.4%-47.7%] aged 30-39 years). Compared with mothers in nonban states, those in Texas experienced a statistically significant increase in the likelihood of reporting fair or poor mental health following SB8's implementation (DiD estimate, 2.52 percentage points; 95% CI, 0.02-5.01 percentage points). The largest increases were observed among mothers of children with public insurance (DiD estimate, 7.06 percentage points; 95% CI, 0.83-13.29 percentage points). No significant outcomes were observed for mothers' physical health outcomes or fathers' mental health in the sensitivity analyses. In this repeated cross-sectional study, the implementation of an abortion ban in Texas was associated with a worsening of maternal mental health among reproductive-age mothers relative to mothers in states without such bans. These results underscore the association of abortion restrictions with maternal mental health and highlight the need to strengthen support in the post-Dobbs policy environment.

Suicide is a leading cause of death among US adolescents, and restrictive abortion policies may influence suicide risk by increasing uncertainty and reducing perceived control over life trajectories, particularly among female adolescents who face disproportionate barriers to abortion access. Following the 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization, multiple states implemented total abortion bans. Their association with adolescent suicidality has not been quantitatively assessed. To evaluate whether implementation of total abortion bans was associated with suicidal ideation and suicide attempts among female high school students. This cross-sectional study used difference-in-differences and event-study analyses of data from the Centers for Disease Control and Prevention Youth Risk Behavior Surveys (2017, 2019, 2021, and 2023) conducted among female and male students in grades 9 to 12 at public high schools in 15 participating states. Analyses were conducted between January 2025 and February 2026 and stratified by sex. State-level implementation of a total abortion ban during the 12 months preceding survey administration. Outcomes of interest were self-reported suicidal ideation (serious consideration or planning) and suicide attempts (≥1) in the past 12 months, measured using Youth Risk Behavior Survey items. The analytic sample included 338 324 students (median [IQR] age, 16 [15-17] years), of whom 169 967 (50%) were female. Among female students, increases in suicidal ideation were greater in states that implemented abortion bans than in states that did not (adjusted difference-in-differences estimate, 4.3 [95% CI, 1.6 to 6.5] percentage points). For suicide attempts, the corresponding estimate was similar but less precise and did not reach statistical significance (adjusted difference-in-differences estimate, 3.2 [95% CI, -0.4 to 6.1] percentage points). Among male students, estimates were smaller and not statistically significant (adjusted difference-in-differences estimate: ideation, 1.1 [95% CI, -0.9 to 4.4] percentage points; attempts, -0.3 [95% CI, -3.2 to 6.6] percentage points). For both sexes, event-study estimates reinforced the difference-in-differences findings and showed no evidence of differential prepolicy trends. In this cross-sectional study of high school students, implementation of total abortion bans was associated with increased suicidal ideation among female students, with similar but less precise estimates observed for suicide attempts. These findings suggest that the policies in these states may adversely influence female adolescents' mental health and underscore the importance of accessible suicide prevention and mental health services in affected states.

N Engl J Med . 2025 Dec 18;393(24):2478–2482. doi: 10.1056/NEJMms2510113. In the years following Dobbs v. Jackson Women’s Health Organization , the consequences of state abortion bans are becoming increasingly visible, in expected ways, and in deeply troubling new ones. Whereas unsafe abortions in the pre-Roe era often occurred outside medical institutions, today, patients are experiencing harm inside hospitals, where physicians hesitate to act because of fear of criminal liability. The result is restricted access to abortion and disruption of established medical standards of care.

To assess trends in births by maternal race and ethnicity following the Dobbs v. Jackson Women's Health Organization (Dobbs) decision. Retrospective analysis of the Centers for Disease Control and Prevention Natality Live Birth database with detailed geographical data available (2018-2023). States were classified by abortion policy environment based on the Center for Reproductive Rights' five-tier framework. For this analysis, states classified as hostile or illegal were grouped as restrictive, while those classified as expanded access or protected access were grouped as protective. We compared rates of births in restrictive vs. protective states before and after the Dobbs ruling on June 24, 2022, stratified by maternal race and ethnicity. The period from July to December 2022 was considered transitional and excluded from the analysis. The proportion of births among Hispanic patients in restrictive states increased by 12.8 %, while the proportion in protective states increased by 7.6 % (p<0.01). Rates of births among non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients in restrictive states decreased by 3.8 and 5.6 %, respectively (p<0.001). Rates of births among NHW and NHB patients in protective states also decreased by 2.4 and 6.4 %, respectively (p<0.001). Changes for Asian/Pacific Islander and other racial groups were small (<1 % relative change). Following the Dobbs decision, birth rates in restrictive states increased most among Hispanic individuals, while non-Hispanic White and Black populations saw declines. These trends highlight racial and ethnic disparities in the impact of abortion restrictions.

Purpose Integrating health and social care services is a longstanding aspiration in England, but the question remains as to how to achieve it. This article compares the implementation approaches and its enablers and barriers of a strengths-based intervention (community-led support, CLS) in two sites, one led by a health organisation, i.e. National Health Service (NHS) and the other by a social care organisation, i.e. local authority. Design/methodology/approach This study was part of a wider research project that examined the implementation of CLS within five areas in England. A qualitative research design was adopted, drawing on seventeen semi-structured interviews with managers and frontline staff leading the implementation of CLS across health, social care and voluntary sector organisations. Data was analysed inductively for each site before comparing emerging codes between the sites. Findings Supportive leadership structures at various levels, a shared vision, pre-existing relationships with other sectors and introducing champions were helpful factors to adopt CLS. However, staff anxieties towards creative ways of working, the lack of involvement of individuals with lived experience and the insufficient integration of processes and systems hindered embedding CLS across the whole system. Originality/value Emphasis on a community oriented approach encourages local innovation based on the needs of a community. This study provides helpful insights into aspects supportive of implementation while highlighting unique challenges arising from integration.

Following Dobbs v. Jackson Women's Health Organization on June 24, 2022, abortion criminalization in the United States has converged with interoperable health data systems, making reproductive health documentation more portable and legally legible across jurisdictions. This analytic scoping review, guided by Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), examined U.S. literature published from June 2022 through October 2025 in PubMed, OpenAlex, Google Scholar, and HeinOnline. Sources were organized by evidentiary role into Tier C (legal and analytic conditions), Tier B (organizational adaptations), and Tier A (clinical impacts). The review mapped how surveillance pathways, including electronic health record and health information exchange interoperability, cloud hosting, billing and claims systems, and non-Health Insurance Portability and Accountability Act (HIPAA) consumer and law enforcement data, expand perceived liability and drive documentation and communication chill. Reported responses included vague documentation, reduced data capture, segmented records, and restricted information exchange. These adaptations may fragment care and delay intervention for emergency obstetric conditions. Tier A evidence included delays and higher diagnostic thresholds in ectopic pregnancy management, as well as increased maternal morbidity under mandated expectant management of previable preterm prelabor rupture of membranes and related second-trimester complications. These harms disproportionately affect patients experiencing structural racism, poverty, and intensified surveillance. We argue that these pathways constitute a form of slow harm, in which cumulative injury is produced through delay, fear, and institutional paralysis. Privacy-protective, equity-centered data governance and clearer clinical-legal guidance are needed to preserve safe documentation and coordinated emergency obstetric care.

The issue of food supply and security remains a major challenge and crisis for the world's growing population. In this study, a comprehensive analysis of the residues of fourteen organochlorine pesticides (OCPs) was conducted and detected using gas chromatography with an electron capture detector (GC/ECD) in sixty-one samples of twelve crops produced in ten counties within Ilam Province, southwest Iran. The samples included lentils, chickpeas, wheat, tomatoes, corn, rice, cucumbers, watermelons, melons, cantaloupes, edible (raw) vegetables, and stewed vegetables. The levels of all detected OCP residues in the twelve crop types were below the maximum residue limits (MRLs) established by Iran and the Food and Agriculture Organization/World Health Organization (FAO/WHO) (50µg/L). Lindane, Endrin, and Heptachlor were detected at the highest concentrations of OCPs across all crops, while Methoxychlor and Endosulfan were found at the lowest levels. No prior studies have focused specifically on detecting the presence of OCPs in certain products such as lentils and chickpeas, making this study unique in its findings. The target hazard quotient (THQ) and hazard index (HI) were used to estimate human health risk assessment (HRA) associated with OCP residues in the samples. The results indicated that the HI value was lower than 1 in both adults and children for all samples, suggesting no considerable risk for consumers. Overall, stringent control programs, integrated pest management, quality control, and periodic monitoring of crops before they are released to the market are essential.

Few studies, mostly from the era before the Dobbs v. Jackson Women's Health Organization US Supreme Court decision, have projected increases in pregnancy-related and maternal mortality in states with restrictive abortion laws. However, the association between post-Dobbs abortion bans and pregnancy-associated mortality remains unclear. To examine the associations of complete and 6-week abortion bans with pregnancy-associated mortality in the US. This retrospective, population-based cohort study included 14 states with abortion bans and 37 control states, including the District of Columbia, without abortion bans. US National Center for Health Statistics birth and mortality data from 2018 to 2023 were analyzed using synthetic control methods with staggered adoption, comparing ban states to their synthetic controls. Data were analyzed from July to December 2025. State-level implementation of complete or 6-week abortion bans. The primary outcome was pregnancy-associated mortality. Secondary outcomes included pregnancy-related, maternal, and nonobstetric causes of death. Mortality ratios were examined quarterly and between preban and postban periods. From 2018 to 2023, there were 22 011 131 live births and 12 993 pregnancy-associated deaths. Pregnancy-associated mortality declined by 9.8% in nonban states (54.5 [95% CI, 53.3 to 55.8] to 49.2 [95% CI, 46.5 to 52.0] deaths per 100 000 live births). In states with bans, smaller declines were observed: 2.4% in states excluding Texas (83.2 [95% CI, 80.1 to 86.3] to 81.2 [95% CI, 74.5 to 88.4] deaths per 100 000 live births) and 3.3% in Texas (54.2 [95% CI, 50.5 to 58.1] to 52.4 [95% CI, 47.4 to 57.7] deaths per 100 000 live births). Increases were largest among non-Hispanic Asian (41.0%; from 39.5 [95% CI, 27.7 to 54.7] to 55.7 [95% CI, 26.7 to 102.4] deaths per 100 000 live births) and non-Hispanic Black or African American (17.8%; from 140.2 [95% CI, 131.7 to 149.1] to 165.2 [95% CI, 144.2 to 188.3] deaths per 100 000 live births) individuals in ban states excluding Texas. Synthetic control analyses yielded an estimated difference of 5.1 (95% CI, -7.9 to 18.2) pregnancy-associated deaths per 100 000 live births, which was not statistically significant. Overall estimates for pregnancy-related mortality (-2.0; 95% CI, -11.5 to 7.5), maternal mortality (-3.0; 95% CI, -10.2 to 4.2), and nonobstetric causes (1.2; 95% CI, -7.3 to 9.7) were likewise not statistically significant. State-specific estimates were heterogeneous, but none reached statistical significance. Covariate-adjusted models yielded similar results. This cohort study found that abortion bans were not associated with statistically significant overall or state-specific increases in pregnancy-associated mortality. The short postban observation window and wide CIs highlight the need for continued surveillance as more post-Dobbs data become available.

Pre-abortion counseling laws—often framed as informed consent requirements—remain widespread even as the legal landscape surrounding abortion has shifted dramatically following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. These laws, which mandate that pregnant patients receive specific information prior to obtaining an abortion, frequently disseminate biased, inaccurate, or medically unnecessary content designed to dissuade patients from choosing abortion. This Note argues that such laws undermine medical ethics and impede a patient’s decisional autonomy. It begins by examining the current state of pre-abortion counseling laws in a post-Dobbs world. It then explores the intersection of informed consent and the fiduciary duty concept in a doctor-patient relationship. The Note concludes by proposing an ethical fiduciary theory for pre-abortion counseling laws. Through this lens, pre-abortion counseling laws can be reformed to promote ethical medical practice and protect the autonomy of those seeking abortion care.

Background: Health Organization (1994) categorized this Gram-negative microaerophilic bacterium as a Class 1 carcinogen, and it infects more than half of the world's population.Materials and Methods: The study was conducted between the period of November 2020- 2022, for which two gastric biopsy samples were obtained, one for PCR and one for RUT.Results: A total of 102 samples were collected from patients undergoing endoscopy. In the total sample subjected to endoscopy, the RUT was positive among 24 (23.5%) and negative among 78 (76.47%). In PCR detection by use of the UreB primer, the positivity was 38 (37.25%), while the negativity of the biopsy sample was 64 (62.7%).Conclusion: PCR is a useful confirmatory diagnostic method to detect the presence of H.pylori because of its high sensitivity and specificity, which should be utilized by the gastroenterology unit for routine diagnosis.

ABSTRACT The post-Dobbs decision has exacerbated the challenges Black women face in navigating sexual and reproductive health. The ruling in Dobbs v. Jackson Women’s Health Organization not only ended federally protected access to abortion but also expanded state authority to impose stricter barriers to sexual health care. As a result, Black women face increased difficulty not only in obtaining abortions but also in securing necessary and preferred contraceptive methods. Addressing culturally responsive sexual and reproductive health needs, especially in the post-Dobbs era, requires a focus on interventions that leverage trusted sources of information, such as parental ties, and systems at both familial and community levels. This study provides an overview of the sexual and reproductive health (SRH) landscape before and after the Dobbs decision, focusing on Black women and the historical role of Black fathers in their daughters’ SRH education. Results from chi-square, Cramér’s V, and Somers’ D tests revealed significant associations within a sample of N = 735 young adult Black women. Participants who received information about contraceptives from their fathers used them more frequently than those who did not. Additionally, those who received this information during adolescence were more likely to use contraceptives later in life. Having early conversations about sex with their fathers was also linked to contraceptive use in young adulthood. These findings highlight the crucial role Black fathers play in helping their daughters navigate limited SRH resources, particularly in the post-Dobbs era, increasing the likelihood of access to necessary contraceptive methods.

Preliminary analyses have suggested that state-level abortion policy following Dobbs v Jackson Women's Health Organization (Dobbs) may affect the health care workforce, including residency applications. To assess disparities in the residency application rate to programs in abortion-restricted states compared with programs in nonrestricted states following the Dobbs decision by gender of applicants across all medical specialties and to compare how these differences may vary by specialty. This cross-sectional study with interrupted time-series analysis used anonymized program-level residency application data from the Association of American Medical Colleges Electronic Residency Application Service (ERAS) from 2019 to 2023. Residency programs across all medical specialties with complete application data across the study period were included. The application cycle immediately prior to the Dobbs decision, 2020-2021, was the base year for analysis. New or intensified state-level abortion restrictions enacted post-Dobbs in June until October 2022, the 2023 ERAS submission deadline. The primary outcome was the disparity in application rates to programs between restricted states and nonrestricted states. The application rate was calculated as the number of applications to each program per 100 000 total applications across all programs nationwide annually. Regression models explored the interaction between the exposure and application cycles, controlling for program fixed effects, program size, applicant degree type, and in-state applicants. Among 4315 residency programs with 24 193 864 total applications (43.9% from women and 56.1% from men), the disparity in the application rate to programs in abortion-restricted states changed by -0.38 (95% CI, -0.70 to -0.05) among women and -0.56 (95% CI, -0.95 to -0.17) among men applying to residency, reflecting an absolute difference of -7833.2 (95% CI, -14 429.7 to -1030.7) applications from women and -12 789.2 (95% CI, -21 695.9 to -3882.4) applications from men to programs in abortion-restricted states. Differences were greater among abortion-related specialties, including obstetrics and gynecology, family medicine, internal medicine, and emergency medicine (-1.17 [95% CI, -1.89 to -0.45] for women and -1.54 [95% CI, -2.39 to -0.69] for men), and decreased among the most competitive specialties (ie, dermatology; neurosurgery; orthopedics; ear, nose, and throat; and plastic surgery) (-0.02 [95% CI, -0.37 to 0.40] for women and -0.13 [95% CI, -0.44 to 0.18] for men). In this cross-sectional panel analysis of residency applications to 4315 programs, the Dobbs decision was associated with a significant decrease in residency applications in abortion-restricted states compared with nonrestricted states among both women and men. These findings provide early evidence that Dobbs may be associated with state-level disparities in the overall health care training pipeline and workforce.

The Shifting Policy Landscape in Reproductive Health.

Objectives. To quantify the impact of state abortion bans on trends in fertility and preterm birth following the June 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization. Methods. We tested for changes in birth rates and preterm birth rates occurring in the first 18 months following the Dobbs decision by fitting 2-way fixed effects and staggered difference-in-difference models to compare trends in states that banned abortion and those that did not. Results. We detected a statistically significant increase in the birth rate and preterm birth rate among non-Hispanic (NH) Black women above what would be expected in the absence of a ban, averaging a 3.5% increase in the birth rate and 2.1% higher incidence of preterm birth. Impacts were similar in analyses limited to births to women with Medicaid coverage, where trends among NH Black women in states that banned abortion were significantly elevated. Conclusions. The emerging impact of state laws that ban abortion has been uneven, with trends in birth rates and preterm birth increasing especially among NH Black women in states that banned abortion. (Am J Public Health. 2026;116(3):345-350. https://doi.org/10.2105/AJPH.2025.308355).

Cephalopods and crustaceans are known to bioaccumulate heavy metals, potentially posing both non-carcinogenic and carcinogenic health risks to consumers. This study was conducted to determine heavy metal concentrations and assess associated health risks in the edible tissues of 84 cephalopod and crustacean samples. Heavy metal concentrations and assess associated health risks in the edible tissues of 84 cephalopod and crustacean samples collected from selected wholesale markets and major fish landing ports throughout Peninsular Malaysia. The analysis focused on nine heavy metals: selenium (Se), cadmium (Cd), lead (Pb), copper (Cu), zinc (Zn), antimony (Sb), tin (Sn), chromium (Cr), and manganese (Mn). The samples were digested using a microwave digestion system, and heavy metal concentrations were analysed using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Results showed that Mn was the most abundant metal, followed by Cr and Zn. Octopus (C. indicus) had the highest Mn concentration (5.01 mg/kg WW), while Rainbow shrimp (P. sculptilis) had the highest overall metal concentration (91.02 mg/kg WW). Significant differences were observed between cephalopods and crustaceans, with Cd and Sn concentrations being notably higher in cephalopods (p < 0.001). However, no significant associations were observed between heavy metal concentrations and sample weight or length, indicating a greater influence of environmental factors. Principal Component Analysis (PCA) explained 80.4% of the variance, with Cd, Sn, Pb, Cu, Zn, Cr, and Mn accounting for the majority of the variance. Estimated weekly intake (EWI) values ranged from 0.002 to 26.30 µg/kg bw/week for cephalopods and 8.02 × 10-6 to 243.175 µg/kg bw/week for crustaceans. All metal levels were below the permissible limits set by the Food and Agriculture Organisation of the United Nations/World Health Organisation (FAO/WHO). Hazard Index values were <1, indicating low non-carcinogenic risk, and Total Carcinogenic Risk values for Pb and Cr were below 1 × 10-4, suggesting negligible carcinogenic risk.

In June 2022, the United States Supreme Court overturned the landmark case of Roe v. Wade in Dobbs v. Jackson Women’s Health Organization, leaving abortion access up to individual states. Among others, Texas shut down all legal access to procedural abortion and abortion pills, posing dire risks to young adults engaging in sexual activity. Using grounded theory techniques to analyze qualitative data from in-depth interviews with 32 undergraduate students from a large public university in Texas, this article documents the emotional consequences of the abortion ban among a population that is known for their high rates of sexual activity, both casually in hookups and within relationships. This study focuses on the gendered ways college students emotionally react to the statewide ban on abortion. Results indicate that many women report experiencing the loss of reproductive rights as an emotional burden, sparking their fear, anxiety, and stress. This study details how students’ reactions to the abortion ban are shaped by gendered health inequalities and perceived roles in reproduction.

How does the US Supreme Court establish its legitimacy? Over the last two hundred years in US society, the Court has interpreted the US Constitution on watershed issues such as slavery, segregation, and marriage equality. And yet the Constitution is just 7591 words. A puzzle thus emerges: how does the Court intelligibly interpret this short text for US society? This article develops a new theoretical and empirical cultural sociological account of such Supreme Court decision-making, which it calls “communicative legitimacy.” According to this theory, which draws on Jeffrey Alexander’s civil sphere theory, the Court consistently and inevitably draws on a shared American cultural discourse, thus rendering Constitutional values intelligible and legitimate to the broader civil sphere. This article shows this through two historical case studies. First, it explores the cases guaranteeing and then overturning the right to abortion, from Roe v. Wade (1973) to Dobbs v. Jackson Women’s Health Organization (2022). Second, it reviews the cases guaranteeing the right to bear arms, beginning with District of Columbia v. Heller (2008). The two sets of cases, at first blush, appear diametrically opposed: Roe is a triumph for the left, Heller a victory for the right. But, in fact, these cases reveal the same pattern: the Court’s defenders draw on the discourse of liberty to hail the decision as a restoration of the Constitution, while the opposition draws on the discourse of repression to accuse the Court of “creating a Constitutional right out of nowhere.” This article thus unveils a hidden Supreme Court meta-language, contributing a new cultural sociological understanding of the Supreme Court as a societal institution with unique communicative authority and symbolic power in US society.