Three Years After Roe: The Changing Landscape of Reproductive Rights
Since the 2022 ruling, abortion access in the U.S. has been shaped by shifting laws, state-level responses, and growing public debate.
Three years ago, the Supreme Court overturned Roe v. Wade, returning abortion rights to a state-by-state basis. Since then, more than 12 states—including Texas, Mississippi and Arkansas—have enacted near-total bans on abortion, while others, like Florida and Georgia, have imposed strict limitations, including bans after six weeks of pregnancy. In contrast, states such as California, Maryland, New York, Michigan and Illinois have passed legislation enshrining abortion access into state law. Meanwhile, in states where abortion is outlawed, people have been prosecuted for miscarriages and for seeking care outside their home states—underscoring the fractured state of reproductive health care in a post-Roe America.
Abortion by Zip Code
Post-Roe, abortion rights depend on where you live. Twelve states—Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Oklahoma, South Dakota, Tennessee, Texas and West Virginia—have fully banned abortion. Seven others have enacted restrictions, including four states—Florida, Georgia, Iowa and South Carolina—that ban the procedure after six weeks of pregnancy, sparking backlash as studies show most people are unaware they are pregnant at six weeks. Nebraska and North Carolina have banned abortion after 12 weeks, while Utah imposes a limit at 18 weeks.
In Ohio, where abortion remains legal, lawmakers have introduced legislation aimed at banning the procedure.
“[It] is a very, very simple and beautiful piece of legislation in that all it does is identify all human beings as persons deserving equal protection of the law—both born humans and pre-born humans,” said Austin Beigel, who is against abortion, to ABC News.
“So, it identifies those personhood rights starting at the moment of fertilization. When the new, distinct organism is formed—the new human life—that being now has equal protection under the law.”
In that same report, Kellie Copeland, an abortion rights advocate and executive director of the advocacy group Abortion Forward, said the bill goes against the will of voters, referencing a 2023 referendum that upheld legal abortion in the state.
“This is the most extreme and anti-life legislation that you can imagine,” she said.
“It would strip Ohioans of their constitutionally guaranteed right to bodily autonomy, and that’s the goal of this legislation.”
At the federal level, the Trump administration has ended a Biden-era policy that required hospitals to perform emergency abortions in cases such as ectopic pregnancy and preeclampsia—a life-threatening complication involving high blood pressure and organ damage—even in states where abortion is banned.
“CMS will continue to enforce EMTALA, which protects all individuals who present to a hospital emergency department seeking examination or treatment, including for identified emergency medical conditions that place the health of a pregnant woman or her unborn child in serious jeopardy,” the Department of Health and Human Services (HHS) said in a previous report by The Introspective.
“CMS will work to rectify any perceived legal confusion and instability created by the former administration’s actions.”
Meanwhile, abortion remains legal in 31 states, including New York, Maryland, California, Michigan, Virginia and Illinois.
The Human Cost
Since Roe v. Wade was overturned, doctors have left states with abortion bans and relocated to states where the procedure remains legal. A survey found that 42% of abortion care providers moved to another state.
“When abortion providers end up moving, that doesn’t mean that it’s only the abortion provision that ends up being relocated—their whole primary practice is being relocated, and that means that patients end up being left behind, without access to the full spectrum of reproductive health care,” said Dana Howard, an assistant professor at Ohio State University, in a report by Time.
In South Carolina, 13% of the state’s counties are considered maternity care deserts, highlighting the impact of Dobbs v. Jackson—the ruling that overturned Roe.
Companies have also exited states that banned abortion. Amanda Ducach, CEO of Ema, a women’s health company, moved her offices out of Texas following the ban.
“I also had a high-risk pregnancy when the Supreme Court overturned Roe v. Wade in 2022,” Ducach wrote in the Houston Chronicle, adding that she moved to Massachusetts.
“After that, I no longer felt safe raising a family or scaling a health care company in Texas.”
Many Americans have traveled across state lines to receive reproductive care. Research shows that more than 1 in 7 people who had an abortion last year traveled to another state—totaling 155,000 people. Texas saw the highest outflow, with more than 28,000 residents leaving the state for abortion care.
“I pull into the parking lot and I see license plates from Texas and Louisiana and Tennessee, so I know that these patients have traveled a minimum of four hours,” Jennifer Pepper, president and CEO of Choices Center for Reproductive Health, told CNN.
“If they could just go down the street to their regular OB/GYN, they could be in and out under an hour. It’s a lot of wasted hours for a lot of people who are taking care of children and teaching and being nurses and just caring for our communities. That’s what I think about when I see the patients.”
Despite restrictions, abortion rates have risen in the three years since Roe was overturned, largely due to the proliferation of telehealth, which allows patients to receive abortion pills by mail. A report from The Guardian found that 25% of abortions in 2024 took place via telehealth—up from 19% in 2023.
“There’s more abortion taking place in Mississippi today than there was prior to Dobbs,” said Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project (MAP), which ships abortion pills nationwide.
“That really speaks to how little access some folks had to in-clinic abortion care prior to Dobbs, and how shield law provisions and telemedicine have really stepped into that space.”
At the same time, some women who have experienced miscarriages have faced prosecution. One example is Brittany Watts, an Ohio woman charged with abuse of a corpse after having a miscarriage. She later filed a federal lawsuit alleging that medical staff fabricated the case in coordination with a police officer.
“This case is a perfect example of the broader implications of the overruling of Roe v. Wade in the Dobbs case. Brittany was not seeking an abortion,” said Julia Rickert, one of her attorneys, in a report.
“But the repercussions of the Dobbs decision meant that her pregnancy, her choices, and her medical crisis were viewed in a different way.”
Another high-profile case involved Adriana Smith, a Georgia woman declared brain dead while nine weeks pregnant. She was kept on life support against her family’s wishes due to Georgia’s Living Infants Fairness and Equality (LIFE) Act—also known as the “heartbeat law”—which bans abortion after cardiac activity is detected.
In a statement to NBC News, Emory Hospital, where Smith died, defended its decision.
“Emory Healthcare uses consensus from clinical experts, medical literature, and legal guidance to support our providers as they make individualized treatment recommendations in compliance with Georgia’s abortion laws and all other applicable laws,” the statement read.
Shortly after what would have been her 31st birthday, Smith was taken off life support following the birth of her son, who remains in the hospital’s intensive care unit (ICU).
“He’s expected to be OK,” Smith’s mother, April Newkirk, told NBC Atlanta.
“He’s just fighting. We just want prayers for him. Just keep praying for him. He’s here now.”