5 ways the landscape has changed since the end of Roe v. Wade 'upended' abortion access

In the nine months since the U.S. Supreme Court overturned Roe v. Wade, a rapidly shifting patchwork of abortion bans and restrictions has unleashed confusion and uncertainty among patients and abortion providers nationwide.

The fallout began immediately as “trigger bans” went into effect in 13 states after the Dobbs v. Jackson Women's Health Organization decision struck down Roe, the 1973 ruling that had made abortion legal nationwide for decades. State legislatures have since passed and proposed additional bans and restrictions. Lawsuits on both sides of the abortion debate have thrown abortion access into a state of flux.

“The Dobbs decision has totally upended abortion access across the country,” said Elizabeth Nash, state policy analyst at the Guttmacher Institute, a research and policy organization that supports legal access to abortion. “And it's created a lot of chaos and confusion for patients and providers because these restrictions have become very hard to sort through.”

Here are five of the ways abortion access has changed since the overturning of Roe v. Wade:

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Abortion 'totally or almost completely banned' in 14 states; injunctions challenge bans

Fourteen states “have totally or almost completely banned abortion,” said Rose Mackenzie, ACLU campaign strategist. These states are Alabama, Arkansas, Kentucky, Louisiana, Idaho, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, Georgia and Wisconsin, she said.

In eight states, there are injunctions blocking such bans from taking effect while cases challenging them continue, Mackenzie said. These are Arizona, Utah, Wyoming, Montana, North Dakota, Iowa, Indiana and Ohio.

The 14 states that have completely or almost completely banned abortion account for about nearly a quarter of all women of reproductive age in the country, Nash said.

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Clinics have closed or stopped providing abortions in the wake of bans. People have been forced to travel out of state to get abortions. Average travel times to get abortion care has more than tripled, according to a study published in November.

In states that still have legal access to abortion, clinics are overwhelmed by out-of-state patients, making wait times longer, Mackenzie said.

Attacks on medication abortion

Since the Dobbs decision, there has been “a coordinated attack on access to medication abortion,” which makes up over half of all abortions in the U.S., Mackenzie said.

A Friday ruling by U.S. District Judge Matthew Kacsmaryk, a Trump appointee in Texas, threw government approval of mifepristone, a key abortion drug, into uncertainty, potentially decimating access to medication abortion nationwide. Minutes later, a federal judge in Washington, Obama appointee U.S. District Judge Thomas O. Rice, ordered the Food and Drug Administration not to make any changes that would restrict access to the drug in 17 states and D.C. that sued to expand access to mifepristone.

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For now, access to mifepristone remains unchanged, because Kacsmaryk gave seven days for the federal government to appeal, which the Justice Department has committed to do.

Meanwhile, about 10 pieces of pending legislation introduced in state legislatures are targeting medication abortion, Mackenzie said. Also last month, Wyoming became the first state in the country to ban the manufacturing, distribution and sale of abortion pills.

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Pharmacies have also become centers of the debate over medication abortion access. The FDA in January said any certified mail and brick-and-mortar pharmacy can dispense mifepristone. In February, attorneys general from 20 Republican states sent a letter to several pharmacies threatening legal action if they distribute the pill in their states. Walgreens came under fire after it responded to the letter by saying it would not distribute mifepristone in these states, including some where medication abortion remains legal.

“The legal landscape with medication abortion is constantly shifting, and it's a lot of waiting for the next shoe to drop,” Nash said.

Criminalization bills

Nearly all states that prohibit abortion have some form of criminal penalty for providers who offer abortions, Mackenzie said. At least six states have introduced bills that would allow prosecutors to criminally charge patients for their own abortions. In South Carolina, Republican lawmakers introduced one of the most severe bills seen nationwide that would make a person who has an abortion eligible for the death penalty, though support for the legislation has dwindled.

South Carolina and Nevada are the states that criminalize people for self-managed abortions. A self-managed abortion means ending one's own pregnancy without a doctor or health care provider.

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Nash said bills seeking to criminalize people for their own abortions don’t have support from the mainstream anti-abortion movement but may be introduced as a way to test the boundaries for what types of restrictions may be possible.

Still, the bills have had a “chilling effect” among providers, said Farah Diaz-Tello, senior counsel and legal director for the national nonprofit If/When/How Lawyering for Reproductive Justice. With criminalization laws and unclear language surrounding exceptions to abortion bans in emergency situations, providers are having to make difficult, sometimes life-or-death decisions about when they may be legally allowed to provide care, she said.

Texas Senate Bill 8 ‘copycats’

Before Roe v. Wade was overturned, Texas Senate Bill 8 was signed into law, allowing the state’s six-week abortion ban to be enforced through individual lawsuits against clinics, providers or anyone else who “aids or abets” an abortion.

Oklahoma and Idaho have since adopted legislation modeled off of the Texas law, Nash said. Missouri lawmakers also introduced a similar bill this year.

Most recently, a Texas man sued three women last month, claiming they helped his now-ex-wife get an abortion.

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Personhood bills

A growing number of “personhood bills” in state legislatures define life as beginning at fertilization or give embryos legal rights. Georgia and Arizona have “personhood laws,” though Arizona’s has been blocked by a court, Nash said. Several other states introduced such bills this year.

These bills may also threaten access to in vitro fertilization, a type of assisted reproductive technology.

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Other states protect, expand abortion access

Bills introduced in state legislatures are also seeking to punish businesses that help employees access abortion care, outlaw websites that include information about accessing abortion care, prevent patients from crossing state lines to access care, and remove exceptions to abortion bans including in life-threatening situations, among other efforts, several abortion policy experts told USA TODAY.

Meanwhile, other states are looking to protect and expand abortion access by codifying abortion rights through ballot initiatives, passing “shield laws” to protect providers from being prosecuted for giving abortion care to patients coming from out of state, increasing funding for abortion clinics, and bolstering access to medication abortion by allowing telehealth options for expanding the types of healthcare professionals allowed to offer abortions. Some states are also trying to prevent the criminalization of abortion, including California, which passed a bill last year affirming people’s right to be free from criminalization on the basis of their pregnancy outcome.

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Dozens of lawsuits have also been filed under state constitutions and statutes to challenge abortion bans. As of March 29, 38 cases have been filed in 21 states, according to a tracker by the Brennan Center, a nonprofit public policy institute.

“We're in really uncharted territory, so every step that states can take to protect people from criminalization and from violence by the state itself are going to be important in the near future,” Diaz-Tello said.

If/When/How offers a free legal helpline at (844) 868-2812 for people with questions about their access to abortion care and legal rights.

Contact Christine Fernando at cfernando@usatoday.com or follow her on Twitter at @christinetfern.

This article originally appeared on USA TODAY: Abortion access: 5 ways landscape has changed since end of Roe v Wade