How abortion access has changed in the year since Dobbs

On June 24, 2022, the Supreme Court struck down long-standing abortion protections that had been guaranteed under its 1973 landmark Roe v. Wade decision. While the ruling in Dobbs v. Jackson Women’s Health Organization did not come as a surprise—a draft decision leaked weeks before its official release—the fallout was immediate, as the decision upended healthcare across the US.

Several states outlawed abortion, and abortion clinics closed their doors. Other states preserved access to the procedure, leading clinics there to brace for an influx of out-of-state patients.

Ob-gyn residency programs were forced to rethink abortion training in ban states, and this prompted some medical students to reconsider their career plans. Additionally, a legal fight put in jeopardy the fate of a key drug used in medication abortions—even in states that enshrined the procedure into their state constitutions.

“Where things are now really reflect a lot of what we had anticipated—and had feared—would come to pass,” Andrea Miller, the president of the National Institute for Reproductive Health, told Healthcare Brew. “Everyone is being affected by this.”

Healthcare Brew broke down what’s happened in the year since the Dobbs decision.

States respond

States are largely split over whether to restrict or protect abortion access after the court overturned Roe.

Abortion remains legal in 23 states and DC—and 20 have strengthened abortion protections in response to Dobbs. Three states—California, Michigan, and Vermont—took that a step further, enshrining the right to abortion in their constitutions. Additional states, like New York, are expected to do the same.

By contrast, 14 states have outlawed abortions in most cases. These states are Arkansas, Alabama, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin.

Georgia banned most abortions at around six weeks gestation—a period when most people are unaware they are pregnant. Meanwhile, Nebraska lawmakers also banned most abortions after 12 weeks gestation. North Carolina’s 12-week abortion ban will take effect on July 1.

Other states—Arizona, Florida, Indiana, Iowa, Ohio, Montana, South Carolina, Utah, and Wyoming—have also taken steps to restrict or outlaw abortion in the wake of the Dobbs decision. But those efforts are largely on hold due to legal challenges.

Medication abortion fight

Courts have also become the latest battlefront in the fight to outlaw mifepristone, one of two drugs commonly used in medication abortions.

The mifepristone lawsuit centers on the Food and Drug Administration (FDA) approval of the medication more than 20 years ago as well as recent efforts to expand the drug’s access via telehealth dispensing. Mifepristone remains available in most states as the federal Fifth Circuit Court of Appeals weighs the case—and access would likely continue if the appellate court’s ruling is appealed to the Supreme Court.

If mifepristone loses federal approval through the legal battle, just one FDA-approved drug option, misoprostol, will remain for people seeking medication abortions in the US. Such an outcome could make it harder for people in all states to get medication abortions—one of the most common methods for the procedure.

Meanwhile, the drug industry has raised concerns about the potential effect such a ruling could have on other FDA-approved medications.

“The fact that a judge could determine whether this medication is available or not—versus scientists or medical professionals—is still kind of jaw-dropping,” said Jenny Higgins, a professor of obstetrics and gynecology at the University of Wisconsin-Madison. “It’s good that we would have one medication abortion still available, but [a decision like this would be] an affront to public health and medicine.”

Healthcare effects

Beyond restricting abortions, the Dobbs decision has made it harder for some people to access ob-gyn and reproductive healthcare due to clinic closures and providers relocating to states with less hostile policies, some experts warned. And that fallout is exacerbating existing health disparities, as people who already struggled to access such care now face additional barriers.

States that banned abortions (or are considering bans) are more likely to have maternity care deserts; higher rates of maternal and infant mortality, particularly among people of color; higher death rates for reproductive-aged women; and more racial inequities in healthcare, according to a December 2022 Commonwealth Fund report.

Researchers with the University of Texas at Austin and the University of California San Francisco found that laws enacted after Dobbs worsened health outcomes, and increased the cost and complexity of care. For example, some patients experienced “preventable complications” because clinicians felt their “hands were tied,” the researchers wrote in a May 2023 report.

A February 2023 study published in the Journal of General Internal Medicine, meanwhile, found that eight in 10 current or future physicians surveyed after Dobbs said they’d prefer to work or train in states without abortion bans or restrictions. More than 75% said they would not even apply to residency programs in abortion-restricted states.

“There’s a significant chilling effect,” Miller said.