State Abortion Laws Research Articles

A Woman’s Right to Know: State Abortion Law and the Due Process Fair Notice Requirement

When the Supreme Court overturned Roe v. Wade in 2022, the loss of reproductive freedom was not the only health care crisis created by the Court. Across the country, people with chronic conditions, including autoimmune disease, were unable to access their prescription medication after abortion bans imposed restrictions on abortion-inducing drugs. Texas’s state medication abortion law, the Woman’s Right to Know Act, may prevent those with disabilities from accessing lifesaving medication with abortifacient properties. This unintended consequence puts health care professionals such as doctors and pharmacists at risk of legal liability for simply prescribing the best course of treatment. This Note argues that the Woman’s Right to Know Act has left health care professionals unable to understand what conduct is prohibited and provides too much discretion to law enforcement, rendering the law unconstitutionally vague. Clarifying the law and prohibiting provider liability is in the best interests of both patients and providers and will allow health care professionals to continue their work to protect patient health.

Tubal Sterilization Rates by State Abortion Laws After the Dobbs Decision

This study examines whether the use of sterilization procedures changed after the Dobbs ruling by restrictiveness of state abortion laws.

A matter of choice: a cross-sectional study examining the impact of the overturning of Roe v Wade on U.S. medical students’ perceptions and career decisions

Background In June 2022, the Dobbs decision by the U.S. Supreme Court overturned federal abortion protections. In states with restrictive abortion laws such as Indiana, which also has the country’s largest medical school and the third worst maternal mortality rate, the impact of this ruling may be huge on the medical field. The purpose of this study was to analyze perceptions of medical students in Indiana in their third and fourth years of education after the Dobbs decision to assess if the state’s current abortion restrictions impact their career choice. Methods Between December 2022 and March 2023, an anonymous survey was carried out at Indiana University School of Medicine, which included questions about personal beliefs on abortion and the current abortion laws in Indiana, as well as priorities when choosing residency training and practice locations. Results Our survey found that four-fifths of medical students in Indiana disagreed with the Dobbs decision. While most students (71.4%) had not considered state abortion laws when selecting a medical school, since the Dobbs decision, 66.3% of third-year and 40.3% of fourth-year students indicated that they would take abortion laws into account when choosing a residency program. 47.5% of female students stated that they will be seeking residency in a state where abortion is legal and 55.3% of single students were more likely to leave Indiana to practice medicine. Conclusion Our research suggests that physicians who are more liberal in their views on abortion may now be much less likely to practice in conservative states which will compound the healthcare outcomes secondary to the Dobbs decision. We emphasize the role that abortion laws have in shaping the landscape of healthcare workforce and the need for a more nuanced understanding of how societal structures impact women's reproductive decisions and career paths in medicine.

Patterns in Female Permanent Contraception After the Dobbs v. Jackson Ruling [ID 2683406

INTRODUCTION: On June 24, 2022, the Supreme Court reversed the constitutional right to abortion in Dobbs v. Jackson. We aimed to explore changes in interval female permanent contraception procedures before and after the Dobbs ruling. METHODS: We performed a retrospective chart review of interval female permanent contraception procedures at a large academic center between June 24, 2019, and May 25, 2023, using relevant CPT codes. Procedure counts pre- and post-ruling were compared. Chi-squared and difference-in-mean-proportions tests were used to explore differences across periods by patient characteristics. Institutional review board approval was waived for this study. RESULTS: There were 913 procedures performed during the observation period: 611 in the 3 years pre-ruling (June 24, 2019 to June 23, 2022) and 302 in the 11 months post-ruling (June 24, 2022 to May 25, 2023). There was a 49.5% increase in procedures between the pre-ruling and post-ruling timeframes. A higher proportion of patients who identify as White underwent procedures post-ruling compared to non-White counterparts (P<.001). Chi-squared testing indicated a relationship between insurance status and post-ruling procedures (P<.001). The largest proportion of patients who had procedures post-ruling were privately insured. Patients who had procedures post-ruling had lower gravidity compared to those who had procedures pre-ruling (P<.001). CONCLUSION: There was a significant increase in interval female permanent contraception procedures post-Dobbs ruling with significant differences found by race, insurance, and gravidity—notably, in a state without restrictive contraception or abortion legislation. As state abortion and contraception laws evolve, both state and national trends in female permanent contraception should be monitored.

US State Abortion Law in an International Context: Distinguishing Religion and Politics

US State Abortion Law in an International Context: Distinguishing Religion and Politics

Abortion Trigger Laws Compared With the Emergency Medical Treatment and Labor Act.

In 2022, the Supreme Court decision in Dobbs v Jackson Women's Health Organization reneged the Constitutional right to an abortion. Many states now enforce laws that ban abortions. There are significant conflicts between state abortion laws and federal regulations that mandate proper assessment, treatment, and stabilization of patients who present for emergency care. This conflict places physicians in an untenable position when treating patients who have a pregnancy that endangers their life. In states that deem abortion a felony, transfer of these patients can extricate the physician, who is in a difficult position. Currently, it is the only reasonable option for hospitals and physicians who are trapped between conflicting state laws and Emergency Medical Treatment and Labor Act rules and regulations.

Perceptions of abortion access across the United States prior to the Dobbs v. Jackson Women's Health Organization decision: Results from a national survey.

Abortion is common in the United States (US), although access is becoming more difficult for some. In addition to restrictive policies that ban most abortion, limit the number of providers and increase costs, barriers to access also include less supportive cultural climates and stigma related to abortion. Prior to the Dobbs v. Jackson Women's Health decision of the United States Supreme Court, research suggested that people generally believed it was easy to access abortion, but this research did not examine the underlying factors that drive these perceptions. In 2019, using data from closed and open-ended survey questions, we examined differences in people's assessment of abortion access within the state they reside and factors that influence those perceptions. We recruited English- and Spanish-speaking US adults (N = 2599) from Qualtrics' national panel using quota-based sampling to participate in a web-based survey. We used multinomial logistic regression to examine predictors of access perceptions across demographic characteristics and thematic analysis to analyze open-ended responses. Fifty-three percent of participants believed abortion was easy to access in their state. Spanish speakers and participants from legislatively "hostile" states were more likely to perceive access as difficult. Legality-related knowledge and pro-life identity were associated with perceiving abortion access as easy. Prior to Dobbs, participants' interpretation of the ease or difficulty of accessing abortion were subjective. Misconceptions about state abortion laws and the prevalence of providers were common, suggesting a need for more education about abortion laws, policies, and access.

Mental Health Matters: A Look At Abortion Law Post-Dobbs.

In June 2022, in Dobbs v. Jackson Women's Health, the U.S. Supreme Court overturned the precedent set by the 1973 decision in Roe vs. Wade, leaving access to abortion to be regulated by each state, rather than a U.S. constitutional right. Some states are setting gestational age limits, beyond which point only under certain circumstances can an abortion be obtained. Other states are banning abortion outright (regardless of gestational age) unless an "exception" is met. Certain states include an exception for abortion when a woman's physical health is at risk if they continue the pregnancy, but, at the same time, do not provide an exception for women whose mental health is at risk (a "mental health exception").Mental health conditions that develop, continue, or are exacerbated during pregnancy may be manageable or treatable, and women may want to continue their pregnancy even while experiencing such conditions. However, the absence of a choice to terminate their pregnancy as a result of these mental health conditions means women who are unable to successfully manage or treat their mental health during pregnancy have no choice but to experience the impact on their mental health - and reconcile any resulting impact on the fetus.This article will discuss the role a mental health exception plays in state abortion statutes by analyzing the impact of pregnancy on mental health and resources available to support those who experience mental health impacts during pregnancy while, simultaneously, advocating for the inclusion of a mental health exception in state abortion laws.

Attitudes Among Society of Women in Urology Members Toward Dobbs v. Jackson Women’s Health Organization

To evaluate attitudes of women in urology regarding the Supreme Court ruling Dobbs v. Jackson Women's Health Organization, including impacts on personal/professional decision-making and the urology workforce. An IRB-exempt survey including Likert questions on participant views and free text questions was distributed to 1200 members of the Society of Women in Urology on 9/2/2022. Participants were medical students, urology residents, fellows, and practicing/retired urologists over 18. Responses were anonymous and aggregated. Quantitative responses were characterized with descriptive statistics and free-text responses were analyzed using thematic mapping. To complement this analysis, urologist density was mapped by county using 2021 National Provider Identifier data. State abortion laws were categorized based on Guttmacher Institute data on 10/20/2022. Data were analyzed using logistic regression, Poisson regression, and multiple linear regression. 329 respondents completed the survey. 88% disagree/strongly disagree with the Dobbs ruling. 42% of trainees may have changed their rank list if current abortion laws existed during their match. 60% of respondents said Dobbs will impact where they choose their next job. 61.5% of counties had zero urologists in 2021, 76% of which were in states with restrictive abortion laws. Urologist density was inversely associated with abortion law restrictiveness compared with the most protective counties. The Dobbs ruling will significantly impact the urology workforce. Trainees may change how they rank programs in states with restrictive abortion laws, and urologists may consider abortion laws when choosing jobs. Restrictive states are at higher risk for worsening access to urologic care.

The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes.

When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes. Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.

The Dobbs Decision and Its Geographical Effect on Future Physician Training [ID: 1380882

INTRODUCTION: The United States is experiencing a physician shortage, particularly in rural and lower socioeconomic status regions. The Dobbs v Jackson Women's Health decision puts individual state health care access at the forefront of future physician's decisions on where to train and practice medicine. This study assesses how access to abortion care is changing where medical students choose to apply to residency. METHODS: This study surveyed third- and fourth-year U.S. medical students applying into U.S. residency programs from August 6, 2022, to October 22, 2022. Participants were selected via convenience sampling through social media and direct outreach to U.S. medical school admissions offices, medical student class presidents, and medical student organizations. 494 complete responses were analyzed. RESULTS: The majority (77.0%) of respondents across all medical specialties reported that access to abortion care, or lack thereof, affects the location of residency programs to which they apply. Over half (58.1%) of respondents said they are unlikely to apply to a residency program located in a state with abortion restrictions. The sample represented students applying to many specialties, with obstetrics and gynecology applicants comprising 21.6% of the sample. CONCLUSION: This study found that the majority of third- and fourth-year medical students' residency choices, across all specialties, are influenced by state abortion laws. Future physicians are choosing where to attend residency based on state abortion policies, indicating that access to abortion care is changing the landscape of medical practice, and has the potential to shift the geographical makeup of health care.

Undue Burdens: State Abortion Laws in the United States, 1994-2022.

State laws have influenced access to abortion in the 50 years since Roe v. Wade. The 2022 Dobbs decision returned questions about the legality of abortion to the states, which increased the importance of state laws for abortion access. The objective of this study is to illustrate trends in abortion-restrictive and abortion-supportive state laws using a unique longitudinal database of reproductive health laws across the United States from 1994 to 2022. This study offers a descriptive analysis of historical trends in state-level pre-viability abortion bans, abortion method bans, efforts to dissuade abortion, TRAP (targeted regulation of abortion providers) laws, other laws that restrict reproductive choice, and laws that expand abortion access and support reproductive health. Data sources include state statutes (from Nexis Uni) and secondary sources. The data reveal that pre-viability bans, including gestation-based bans and total bans, became significantly more prevalent over time. Other abortion-restrictive laws increased from 1994 to 2022, but states also passed a growing number of laws that support reproductive health. Increasing polarization into abortion-restrictive and abortion-supportive states characterized the 1994-2022 period. These trends have implications for maternal and infant health and for racial/ethnic and income disparities.

US State Abortion Law in an International Context: Distinguishing Religion and Politics

US State Abortion Law in an International Context: Distinguishing Religion and Politics

P097Resident initiated obstetrics and gynecology didactics as a method of keeping up with the evolving abortion legislative landscape

<h3>Objectives</h3> To determine the effect of a resident-initiated obstetrics and gynecology (Ob-Gyn) lecture on resident knowledge of abortion legislation and confidence in abortion advocacy. <h3>Methods</h3> In March 2022, in response to recent restrictive abortion legislation, residents requested urgent didactics. Given Ryan Program faculty schedule constraints, a second-year resident designed and executed a didactic session for other residents focused on abortion law. Attendees received an electronic RedCap survey pre- and post-didactics. Survey responses were compared utilizing a paired-T test, alpha=0.05. <h3>Results</h3> Eight residents attended the lecture and completed pre- and post-surveys. The average score on knowledge of abortion policy pre-didactic was 4.0 ± 2.8, which increased to 9.1 ± 2.4 post-didactics (p=0.002). Participants' Likert scale ratings of their knowledge of federal and state abortion law, their confidence explaining current legal challenges, and their knowledge of abortion increased significantly (law knowledge, 3.2 ± 1.4 to 4.4 ± 0.53, p=0.0015; current challenges, 2.6 ± 0.66 to 4.2 ± 0.56, p<0.0001; how to advocate 2.6 ± 0.55 to 4.5 ± 0.29, p<0.0001). All participants strongly agreed that the didactic was "useful and informative," "appropriate for my role and level of training" and "would like to see more lectures like this in the future." <h3>Conclusions</h3> Ob-Gyn residents have a desire to understand the legislative landscape of abortion access. A resident-implemented didactic on abortion law was effective in increasing knowledge and self-confidence regarding these topics.

Addressing a Crisis in Abortion Access: A Case Study in Advocacy.

As restrictions on abortion increase nationwide, it is critical to ensure ongoing access to abortion care throughout pregnancy. People may seek abortions later in pregnancy as a result of financial or legal barriers that delay care or because of changing circumstances, such as the status of their partner, the health of other children, employment, or a new fetal diagnosis. New York State has been a beacon for abortion access since 1970. Yet, after Roe v Wade was decided, New York State abortion law was not in compliance with federal law, and risk-averse medical institutions hesitated to provide later abortions, forcing patients out of state for care. After years of advocacy, the Reproductive Health Act was passed in 2019. Clinicians and advocates collaborated to translate policy into expanded practice at NYC Health + Hospitals, the largest public health care system in the United States. NYC Health + Hospitals conducted an internal review, identified barriers to abortion care, and addressed these through improvements in public and internal communication, strengthening of procedural skills, and a better referral system. As a result, abortion services have become visible and the system's capacity and gestational age limit have expanded. The example of NYC Health + Hospitals is an instructive model to ensure that abortion care is provided to the most vulnerable patients, including those who need care later in pregnancy. Given the ongoing threat to reproductive rights, this example of expanded access is particularly timely.

Abortion travel within the United States: An observational study of cross-state movement to obtain abortion care in 2017

In the United States, abortion access is often more limited for people who live in states with few abortion facilities and restrictive abortion legislation. Pregnant people seeking an abortion thus often travel to access care. We calculated state-specific abortion rate (number of abortions per thousand women ages 15 to 44) and percentage of patients leaving for abortion care using CDC 2017 Abortion Surveillance data, the Guttmacher Institute's Abortion Provider Census and Pregnancies, Births and Abortions in the United States report, and US Census data. We categorized percent leaving by abortion policy landscape using the Guttmacher Institute's classification of state abortion laws, and by facility density (number of abortion facilities per million women ages 15 to 44), calculated using Census and Guttmacher data. We ran correlational tests between each of our variables (percent leaving, facility density, and policy environment), as well as between percent leaving and facility density within policy environment. In 2017, an average of 8% of US patients left their state of residence for abortion care. Percent leaving varied widely by state: 74% left Wyoming, 57% left South Carolina, and 56% left Missouri, while 13 states had fewer than 4% of patients leaving. States with more restrictive laws averaged 12% of patients leaving, while states with middle ground or supportive laws averaged 10% and 3% leaving, respectively. Pairwise correlations between percent leaving, facility density, and policy score were all statistically significant, though correlations between percent leaving and facility density within policy environment were not. Many patients travel across state lines for abortion care. While patients may leave for a range of reasons, restrictive state-level abortion policy and facility scarcity are associated with patients leaving their state of residence. This study was supported by a philanthropic foundation that makes grants anonymously.

The Rise of the Anti-Abortion Movement in North Dakota and the Defeat of the 1972 Initiative to Liberalize State Abortion Laws

AbstractThe 1972 abortion-initiative campaign in North Dakota provides an example where elites on one side of an issue were able to provide cues and get supporters to participate in an election while the other side was unable to do so. North Dakota Right to Life through the formation of branch chapters and its work with the Catholic churches became the focus of the anti-initiative campaign. Flush with resources, the NDRL made sure that its supporters turned out to such an extent that initiative voters outnumbered presidential voters in most counties. While the pro-initiative elements proved effective at getting the question on the ballot, they were unable to get their message out, let alone galvanize supporters. The result was confusion among potential supports and lower turnout rates in the most populous counties.

Abortion Travel Within the United States: An Analysis of Cross-State Movement to Obtain Abortion Care in 2018

Background: In the United States, pregnant people seeking an abortion often travel in order to access care. Abortion access is often more limited for people who live in states with few abortion facilities and restrictive abortion legislation. Methods: We computed state-specific abortion rate (number of abortions per thousand women ages 15-44) with CDC 2018 Abortion Surveillance data and Census data. We calculated percentage of abortion patients leaving their state of residence for abortion care for each state using the CDC’s 2018 Abortion Surveillance data. We categorized percent leaving by policy restrictiveness using NARAL’s classification of restrictiveness of state abortion laws. We categorized percent leaving by “facility density” (number of abortion facilities per million women ages 15-44), calculated using Census data and ANSIRH’s Abortion Facility Database. We created a map of percent leaving by state and a scatterplot of percent leaving against facility density. Thirty-nine states with high quality data are included in our analysis. Findings: In 2018, an average of 8% of US patients left their state of residence for abortion care. Percent leaving varied widely by state: 59% left South Carolina, 53% South Dakota, 46% Mississippi, and 42% Kentucky, while 5% or fewer of patients left from 16 of the states we evaluated. States with more restrictive laws averaged 9% of patients leaving, while states with less restrictive or more protective laws averaged 4% of patients leaving. States in the bottom quartile for facility density averaged 32% leaving, while states in the top quartile averaged 2% leaving. Interpretation: Many patients travel across state lines for abortion care. Restrictive state-level abortion policy and facility scarcity may play a role in patients leaving their state of residence. Funding: This study was supported by a philanthropic foundation that makes grants anonymously. Funding: This study was supported by a philanthropic foundation that makes grants anonymously. The Declaration of Interest: The authors have no conflicts of interest to report.

Women's knowledge of their state's abortion regulations. A national survey

ObjectivesStates vary significantly in their regulation of abortion. Misinformation about abortion is pervasive and propagated by state-mandated scripts that contain abortion myths. We sought to investigate women’s knowledge of abortion laws in their state. Our secondary objective was to describe women’s ability to discern myths about abortion from facts about abortion. Study designThis was a cross-sectional study of English- and Spanish-speaking women aged 18–49 in the United States. We enrolled members of the GfK KnowledgePanel, a probability-based, nationally-representative online sample. Our primary outcome was the proportion of correct answers to 12 questions about laws regulating abortion in a respondent’s state. We asked five questions about common abortion myths. We used descriptive statistics to characterize performance on these measures and bivariate and multivariate modeling to identify risk factors for poor knowledge of state abortion laws. ResultsOf 2223 women contacted, 1057 (48%) completed the survey. The mean proportion of correct answers to 12 law questions was 18% (95% CI 17–20%). For three of five assessed myths, women endorsed myths about abortion over facts. Those who believe abortion should be illegal (aOR 2.18, CI 1.40–3.37), and those living in states with neutral or hostile state policies toward abortion (neutral aOR 1.99, CI 1.34–2.97; hostile aOR 1.6, CI 1.07–2.36) were at increased odds of poor law knowledge. ConclusionsWomen had low levels of knowledge about state abortion laws and commonly endorse abortion myths. Women’s knowledge of their state’s abortion laws was associated with personal views about abortion and their state policy environment. ImplicationsSupporters of reproductive rights can use these results to show policy makers that their constituents are unlikely to know about laws being passed that may profoundly affect them. These findings underscore the potential benefit in correcting widely-held, medically-inaccurate beliefs about abortion so opinions about laws can be based on fact.

Striving to Rollback or Protect Roe: State Legislation and the Trump-Era Politics of Abortion

AbstractAbortion’s centrality to the Christian Right, together with that movement’s importance to Republican Party politics, as well as the policy realities of abortion, have all combined to make regulating abortion a fixture within U.S. state politics for decades. While the levels and forms of state activity have varied since the 1980s, the Trump presidency has produced strategic changes in the content and perceived importance of abortion policy. Notably, recent changes in the state politics of abortion have not just been on the side of Republican states restricting abortion access, the most traditional and highest profile form of policy activity in this area, but have also taken the form of Democratic states actively defending abortion access. This article provides an overview of the interrelated changes in party politics, perceptions of political opportunities, and the content of state abortion regulations. It concludes that the frequency of state abortion laws has increased modestly during the Trump presidency, but substantive shifts in recent policies create the potential to fundamentally reorganize state and national abortion politics.