A year after the fall of Roe v. Wade, abortion access is reshuffled on state lines

Nearly a year after the U.S. Supreme Court overturned Roe v. Wade, the 1973 ruling that found a constitutional right to abortion, the decision has left a fractured and still-changing map of U.S. abortion access.

Since the high court left abortion decisions to states in the case known as Dobbs v. Jackson Women’s Health Organization, according to the Center for Reproductive Rights and other groups tracking the issue, most abortions are now banned or unavailable in 14 states:

  • Alabama

  • Arkansas

  • Idaho

  • Kentucky

  • Louisiana

  • Mississippi

  • Missouri

  • North Dakota

  • Oklahoma

  • South Dakota

  • Tennessee

  • Texas

  • West Virginia

  • Wisconsin

Other states have enacted gestational limits, including Georgia, which bars abortions after six weeks of pregnancy, earlier than most people even discover they are pregnant. A 12-week ban is set to take effect this summer in North Carolina.

Abortion restrictions remain blocked in some states amid legal challenges or reviews, including six-week bans in Ohio, South Carolina and Florida; full bans are currently on hold in the courts in states including Arizona and Indiana.

At the same time, voters and lawmakers in some states have moved to expand or protect abortion rights, including California, Illinois, Vermont, Oregon and New York.

Voters in Kansas and Kentucky rejected ballot measures that sought to amend their state constitutions to declare that they contain no right to an abortion, though Kentucky still bans abortion.

As of the end of May:

How has the patchwork of state laws affected abortion access?

A security guard stands inside Choices Center for Reproductive Health in Carbondale, Illinois. April 2023.

Special report: How one quiet Illinois college town became the symbol of abortion rights in America

The move by Republican-dominated state legislatures to enact restrictions has squeezed access to abortion for millions of Americans.

In the first three months after the Supreme Court rescinded the right to abortion, 66 clinics across 15 states were forced to stop offering abortions, according to the Guttmacher Institute, a research group that supports abortion rights.

In many cases, those seeking abortions –  particularly in the mid- and Deep South, were forced to travel much further and costlier trips for care.

In Texas, for example, travel time to the nearest abortion facility increased by nearly 8 hours, according to a November study in JAMA.

Another analysis found that residents or Arkansas and Missouri had to drive more than 220 miles to reach a provider after the ruling. In other areas, driving distances saw less of a change partly because of bans blocked amid legal challenges.

An anti-abortion sign in a yard in Carbondale, Illinois. December 2022.

According to an April report by Human Rights Watch, about 22 million women and girls of reproductive age in the US now live in states where abortion access is heavily restricted and often totally inaccessible.

Across the country, abortion advocates have worked to help fund more costly and distant travel. But Jennifer Pepper, CEO of Memphis-based Choices Center for Reproductive Health, which now operates a clinic in Southern Illinois, said the costs and difficulties associated with travel remain a daunting barrier for some seeking abortions.

Abortion clinics cross state lines in Virginia, Nevada, elsewhere

A temporary signs hangs on the outside of the Bristol Women's Health Clinic on in Bristol, Virginia, in February.
Anti-abortion signs are displayed outside Bristol Women's Health Clinic.

Pepper’s clinic is among those who have moved their abortion services from states that banned abortion to those where it is protected, setting up practices near state lines to minimize travel distances.

That has created new battlegrounds in a series of small U.S. towns such as  Bristol, Virginia and West Wendover, Nevada.

In Carbondale, Illinois, a local hospital stopped performing elective abortions decades ago. Now, the city hosts the state’s southernmost clinics, and is the closest destination for abortion for 1.2 million women who live across parts of the South, one researcher estimated.

The city’s new role has drawn both support and opposition – a change that USA TODAY has chronicled over much of the past year.

Bristol, Virginia, has also seen fights over whether clinics should be able to move to the city from states such as Tennessee, Kentucky and West Virginia, which enacted abortion restrictions. The struggle began when an abortion clinic that had long operated in Tennessee moved just over the Tennessee state line into Bristol.

Anti-abortion activists have sought zoning changes to bar them, a strategy pursued in other towns. The owner of the Bristol Women’s Health clinic, Diane Derzis –  who also owned the clinic in Jackson, Mississippi, at the center of the Supreme Court’s decision – has faced a lawsuit seeking to terminate the lease on the clinic’s building.

Derzis told USA TODAY the location, though controversial to some, is a critical point of access.

“We're seeing (clients) from Alabama, Mississippi, Alabama, Louisiana, Florida, Georgia, all because there's a huge swath of no service,” she said.

What’s the status of the legal challenge to the abortion pill?

Patients defend mifepristone access: 'It felt like coming up for air'

Looming over the shifts in access to physical clinics is the fight over the abortion pill mifepristone, part of a two-pill regimen that now accounts for more than half of U.S. abortions.

The Alliance for Hippocratic Medicine, a coalition of anti-abortion groups, is suing the FDA to reverse approval of mifepristone, claiming the drug comes with medical risks and that its approval process was rushed.

​​But health experts and leading medical associations dispute that, saying mifepristone safe and effective for abortion and miscarriage care and has a decadeslong safety record.

Last month, a panel of three federal court judges heard arguments in a lawsuit aiming to withdraw the drug’s approval. After the panel makes its decision, the ruling will likely be appealed to the U.S. Supreme Court, USA TODAY has reported.

A number of states also restrict access to medication abortion, according to Guttmacher, including 15 that require it be provided by a physician, one that bans mailing pills to a patient.

Contributing: USA TODAY, Associated Press 

This article originally appeared on USA TODAY: Where is abortion banned or protected?