Anti-abortion groups hoped and strategized for decades for a June Supreme Court ruling that ended the court-protected right to abortion after nearly 50 years.
The consequences were immediate and far-reaching – and it’s not over yet.
The mid-year ruling overturning the 1973 Roe v. Wade decision establishing the right to abortion set the national political agenda for the rest of the year and moved access to abortion. The shifts are expected to keep coming as lawmakers, voters and judges weigh in.
After the Dobbs v. Jackson ruling that left abortion to the states, abortions were banned in some states. Elsewhere, officials introduced new abortion protections.
With the bans has spawned a generation of lawsuits over whether they conform to state constitutions.
In half a dozen statewide ballots this year, voters sided with abortion rights.
Here’s a look at what has changed, what hasn’t, and what remains unclear six months after the landmark Dobbs v. Jackson decision.
Abortion is currently considered illegal at all stages of pregnancy, with several exceptions, in 13 states: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin.
In Georgia, it’s banned as soon as heart activity can be detected — about six weeks, before women often realize they’re pregnant.
Some of the bans are in “trigger laws” passed years ago in anticipation of a ruling like Dobbs’s. Some are in laws that predate Roe v. Wade.
Lawmakers in Indiana and West Virginia passed new bans following this year’s ruling. Indiana’s enforcement has been suspended due to a legal challenge.
In both states there was little doubt that bans would be enacted, but there were emotional debates over whether or not to include exceptions in cases of rape and incest. Both states eventually included those exceptions — and for abortions in the event of medical emergencies.
Bans in Arizona, Montana, North Dakota, Ohio, South Carolina, Utah and Wyoming are also not in effect, at least for now, as courts decide whether they can be enforced in the future.
Even in places where legislators favor bans, debates continue over which exceptions should be included. Until now, states have allowed subsequent abortions to protect a woman’s physical health, but not always her mental health.
Before and shortly after the Supreme Court ruling, democratically controlled state and local governments took steps to protect access to abortion.
They have enacted laws and signed executive orders to protect those who perform abortions for out-of-state patients from extradition, prohibit state employees from assisting abortion-related investigations from other states, pay for increased safety in abortion clinics, and provide funds for abortions.
In November, voters in California, Michigan and Vermont passed ballot measures declaring that the right to abortion is protected by state constitutions. Voters in Kansas — who went to the polls in August — and Kentucky rejected measures that would have achieved the opposite, saying state constitutions did not guarantee the right to abortion. Montana voters rejected a ballot measure that would have forced medical personnel to intervene in the rare case of a baby born after an attempted abortion.
In December, New Jersey officials announced a grant to train more medical professionals to perform abortions.
It will take time to assess the full impact of the Dobbs ruling through data, including the number of abortions and births.
According to a study commissioned by the Society of Family Planning, the rate of abortions has fallen almost to zero in states with prohibition and has risen in neighboring states. Overall, the study found that the number of abortions fell.
But the study does not include self-managed abortions received outside clinics, medical offices, hospitals and virtual providers.
Doctors and researchers say the number of requests for medication for abortion pills rose dramatically after a draft version of the Dobbs ruling was leaked in May.
However, it will not be clear in the coming months whether the number of births has changed since the ruling.
Getting abortions is becoming increasingly difficult for women living in prohibition states, in some cases resulting in more medical complications and in others requiring residents to travel for hours or even days to reach a facility that can legally provide abortions.
The ruling also sparked other changes in life in the US: For some medical students, it meant residencies in liberal states became a priority. Teens and parents reconsidered birth control. Democrats seeking to protect abortion rights did better than expected in November’s US election, even retaining control of the US Senate.
And concerns that Supreme Court rulings could overturn other court-imposed protections related to marriage, sex and birth control led to the passage of a new federal law further protecting same-sex and interracial marriages.
There have been no highly publicized criminal charges for alleged violations of abortion bans since they went into effect — if at all.
“It may be a situation where the fear of persecution will have a greater impact than actual persecution,” said Mon Sahaf, deputy director of the Vera Institute of Justice.
Clinics in states with a ban have closed or stopped providing abortions. Some have taken extra caution and stopped abortions when legality in the state was uncertain.
Sahaf says enforcing abortion laws is tricky because it requires the use of medical records and can be seen as unfair in many communities.
Prosecutors have expressed reluctance to take on the cases. Ninety of them across the country pledged when Dobbs was announced that they would not enforce the ban on abortion. The group includes those in some of the most populous jurisdictions in states with prohibitions or severe restrictions, including the prosecutors overseeing prosecutions in Birmingham, Alabama; Atlanta; Columbus, Ohio; Dallas; Milwaukee; and Nashville, Tenn.
That does not mean that there are no legal ramifications for those seeking or performing abortions.
The Indiana attorney general last month asked the state’s medical licensing board to take disciplinary action against a doctor who spoke publicly about giving an abortion to a 10-year-old rape victim who traveled from Ohio after the that state’s abortion ban came into effect.
Abortion funds have been around for decades, largely as shoddy, volunteer-run groups with small budgets that try to help women pay for abortions.
The Dobbs ruling inspired more contributions to the groups, but also brought them more challenges and a bigger political and legal role, including suing over Texas abortion bans.
The groups are now helping women travel to other states for abortions, leading to higher costs for transportation, lodging, child care and other expenses.
“Anger outbursts” following the Supreme Court ruling helped the groups become less underfunded. Oaiaku Njoku, executive director of the National Network of Abortion Funds, said an influx of donations this year has enabled some funds to attract their first paid staff.
Destini Spaeth, director of the WIN Abortion Access Fund in North Dakota, said that in May, when a version of the Dobbs ruling was leaked, enough money was flowing into the fund, and in June, when the final decision was released, to a year of Services.
The fund, like other funds, pays for abortion care and related services such as transportation, shelter, medical testing and contraception
At another fund, Atlanta-based ARC Southeast, interim director Jalessah Jackson said her organization is getting fewer callers after Dobbs because of bans in the region. But costs for travel, childcare and other services have risen largely because people have to travel further for abortion care.
With divided partisan control in Washington, federal policy changes in 2023 are unlikely. Even with the Democrats at the helm this year, President Joe Biden’s administration efforts to protect abortion have run into roadblocks.
Still, state lawmakers are trying to strengthen both the ban on abortion and its protections.
Bills already introduced for state legislatures in 2023 include measures in Texas that would remove tax incentives from companies that help workers get abortions, and in Missouri and Montana to ban the introduction of pills used to to cause abortion to prohibit the state.
On the other hand, there are efforts in red states, including South Carolina, South Dakota and Texas, to change state constitutions to guarantee the right to abortion and plans by Minnesota Democrats, who will scrutinize the legislature in January, to introduce abortion protections in to be codified. law.