One Year after Roe v. Wade Was Overturned: The State of Abortion Care in the United States

One year after the US Supreme Court issued its decision to overturn Roe v. Wade, the state of abortion care in the country has descended into “chaos, conflict, and confusion,” says Nicole Huberfeld, a professor of health law at Boston University. In the year since the June 24, 2022, ruling, access to abortion and reproductive healthcare has splintered. The high court’s 6-3 decision—split along its ideological divide—in Dobbs v. Jackson Women’s Health Organization held that the Constitution does not confer a right to abortion. This decision overruled the earlier, seminal abortion cases Roe and Planned Parenthood of Southeastern Pa. v. Casey, and turned over the authority to regulate abortion to individual state legislatures.

The Splintered Legal Landscape across the Country

“The decision to return this decision over abortion access to the people and their elected officials has initiated a period of almost unprecedented conflict between state laws,” says Huberfeld. In half of states, abortion will now be significantly restricted or outlawed. Below is the current breakdown of the state of abortion access as of June 2023:

• Outright Banned: Fourteen states, including Idaho, Texas, Oklahoma, North Dakota, South Dakota, Louisiana, Arkansas, Missouri, Mississippi, Tennessee, Kentucky, Wisconsin, Alabama, and West Virginia.
• Restrictive Gestational Limits (6 to 20 weeks): Six states, including North Carolina, Georgia, Florida, Nebraska, Utah, and Arizona.
• Legality Yet to be Determined: Five states, including Indiana, Montana, Ohio, South Carolina, and Wyoming, where state courts have yet to determine the legality of proposed bans.
• Remains Legal: 25 states (including Massachusetts) and Washington, D.C.

The Institutional Impact and "Medical Brain Drain"

Many of the long-term effects of bans on abortion and access to reproductive health are as yet unknown, but broader institutional trends are starting to take shape. Medical students are opting not to study in states that have restricted abortion or outright banned it, according to the American Academy of Medical Colleges, which collected data from the 2023 hospital matches of medical residency programs. Among future OBGYNs, this trend is even more pronounced.

“We’re going to see a major medical brain drain in abortion-restrictive states, and that is already starting,” says Huberfeld. The migration of medical providers and medical students will only serve to compound unequal access to healthcare for populations that are already underserved. Very rural communities and communities of color that are already out of reach of fast, quality healthcare will become only more detached as doctors flee states where abortions are banned.

Shield Laws and Healthcare Protection

In response to the overturning of Roe v. Wade, some states have enacted shield laws to protect healthcare providers from out-of-state malpractice suits. For example, in New York, state legislators passed a law to protect doctors who prescribe and send abortion pills to patients in states that have outlawed abortion. Similarly, Massachusetts Governor Charlie Baker signed an executive order that he says will “protect reproductive health care providers who serve out-of-state residents.”

Despite these protections, reproductive justice scholars and lawyers believe the worst is yet to come. “There are certainly pockets of the country where abortion is still legal, and yes, many states stepped up and passed these shield laws, but as a general matter I don’t think we’ve hit rock bottom yet,” says BU LAW Professor Aziza Ahmed. “I think we are still very much in the downfall.”