This article is written by Pruthvi Ramakanta Hegde. This article covers the abortion ban in the US, with special reference to the overturned decision of Roe v. Wade case. Further, it covers abortion-related laws, the legality of abortion in different states of the US, different judicial pronouncements with regard to abortion in the US, the president’s opinions towards the ban on abortion, and also covers the effects of such a ban in the US.

This article has been published by Shashwat Kaushik.

Introduction

Every woman has the right to make decisions about their own bodies. This includes the choice to have an abortion, which is a medical procedure that ends a pregnancy. However, in some parts of the United States, there are some judicial decisions that prohibit women from having abortions. The rules made by some states say women cannot have an abortion after a certain time or under certain conditions. These rules can make it difficult for women to get the healthcare they need. The bans on abortion have made it really hard for women and girls to get the healthcare they need. This denies them their basic rights to healthcare, including sexual and reproductive health. These bans could lead to violations of women’s rights to privacy, freedom to control their own bodies, and freedom from discrimination and violence based on their gender. It is a serious issue that affects many aspects of women’s lives. However, abortion is not completely banned in the US, as in some parts, it is deemed legal. In some places, it is deemed illegal. 

Meaning of abortion

Abortion occurs when a pregnancy ends before the baby can survive outside the mother’s womb. It is a kind of medical process done by competent medical practitioners. It can happen in two ways:

• Miscarriages happen naturally, without any human intervention or agency. They can happen for different reasons like sickness, injury, problems in genes, or when the mother’s body and the baby’s body do not work well together.
• Sometimes, even if the foetus dies in the womb, it may not be discharged, which is called a missed abortion.
• Induced abortions mean a process that happens with human intervention or agency. These are done for different reasons. They could be to save the mother’s life or protect her physical or mental health. In some cases, they are done if the pregnancy resulted from rape or incest. Abortion might also be chosen if the baby would have serious health problems or if there are social or economic concerns like the young age of the mother or financial strain on the family. These involve physically removing the foetus from the uterus. Common surgical methods include:
  • Vacuum aspiration (also known as suction abortion)
  • Dilation and Curettage (D&C)
  • Dilation and Evacuation (D&E)
  • Hysterotomy
  • Hysterectomy

There are different medical methods for abortion. In the first trimester, i.e., up to around 12 weeks, methods like suction or scraping may be used to remove the contents of the uterus. In later stages, i.e., up to around 16 weeks, techniques like dilation and curettage might be used. Between 12 and 19 weeks, a saline solution or prostaglandins can be used to trigger contractions. These methods can have severe side effects. In the second trimester or later, surgical removal of the uterus contents, called hysterotomy, may be done. Generally, the later the abortion, the higher the risk of complications for the mother.

Abortion ban in the US 

When laws restrict abortions, it affects certain groups of women and girls more. These groups include those who are already facing challenges, like people from minority communities, immigrants, those with disabilities, or those who are not financially well. Even if there are some rules allowing abortions in certain cases, these rules are often too strict. Due to these bans, millions of women and girls in the United States are having a harder time getting the healthcare they need for sexual and reproductive issues. This happened after the Supreme Court overturned the judgement of Roe v. Wade in 2022 in the case of Dobbs v. Jackson Women’s Health Organization in 597 U.S. (2022).

Position before Roe v. Wade case

Before Roe v. Wade, women could have abortions in the U.S., but only until about four months into pregnancy when they could feel the baby moving. Back in the 1800s, there were some rules about selling drugs that could cause abortions, but they were not very strict. Doctors wanted to stop abortions partly because they did not want competition from midwives and homoeopaths who helped women with childbirth. Some people were against abortions because they worried there would not be enough white, American-born, Protestant babies. The Catholic Church said abortions were morally wrong in 1869, and in 1873, Congress made it illegal to report birth control or abortion drugs through the mail. By the late 1800s, most of the country had made abortion illegal. In the 1960s, people started talking more about women’s rights and birth control. In Griswold v. Connecticut (1965), the Supreme Court said that married couples could use birth control, and in the case of Eisenstadt v. Baird (1972), this right was extended to unmarried individuals. In 1970, Hawaii granted permission for residents to have abortions. In the same year in 1970, New York enacted a new legislation, Bill of A361B, which legalised abortion without requiring residency.

Judgement of Roe v. Wade (1973) 

The Roe v. Wade case was the initial judgement made in 1973 that legalised abortion in the United States. It was about a woman named Norma McCorvey who wanted an abortion. However, in Texas at the time, the law prohibited most abortions unless the mother’s life was at risk. So she could not get it because of this law. The Texas statutes in question, specifically Articles 1191-1194 and 1196 of the State’s Penal Code, criminalise the act of “procuring an abortion.” This means that under these laws, it is considered a crime to intentionally cause or assist in the termination of a pregnancy. However, it can be made in cases where the mother’s life is at risk. Further, she went to the U.S. Supreme Court by using the name “Jane Roe” to protect her identity. She filed a federal lawsuit against Henry Wade, who was the district attorney of Dallas County, Texas. Roe claimed that she was not married and was pregnant. She wanted to have an abortion done by a qualified doctor in a safe place. But, in Texas, she could not do it legally because her life was not in danger. She also could not afford to travel to another place where it was legal and safe to have an abortion. Roe believed that the Texas laws were unclear and violated her right to privacy. She also contended that her rights under the First, Fourth, Fifth, Ninth, and Fourteenth Amendments of the U.S. Constitution were being violated. Similarly, on these grounds, she had challenged the constitutionality of Texas statutes as they criminalised abortions. She wanted to fight not only for herself but for all other women in similar situations. So, she asked the court to consider her case on behalf of all these women. Even after she had her baby, the case kept going because it was important to decide if similar situations should be allowed in the future.

The U.S. Supreme Court said that, in the first three months of pregnancy, a woman can decide about abortion without interference from the state. In the next three months, the state can only step in if the woman’s health is at risk. In the final three months, when the baby can live outside the womb, the state can limit abortion but must allow exceptions if the mother’s health is at risk. The Court, in a 7–2 decision, decided that the state’s strict abortion laws went against a person’s right to privacy, which is inferred from the protections of liberty provided by the Fourteenth Amendment. They said that until a baby can survive outside the womb, usually between 24 and 28 weeks, a woman can choose to have an abortion. This choice is based on her privacy rights according to the Constitution of the US. 

In addition, a married couple named John and Mary Doe joined the lawsuit. They argued that those laws violated their right to make decisions about having children together. However, the U.S. Supreme Court decided they did not have the right to bring their claim. After looking at the arguments, the court said that everyone, whether single or married, has the right to decide about having children. This right is protected by the Ninth Amendment, which is part of the Fourteenth Amendment. So, the Texas laws against abortion were seen as unconstitutional because they were too unclear and broad and also violated people’s Ninth Amendment rights. Some judges disagreed, saying the court was going too far and taking power from the states. They thought issues like abortion should be decided by lawmakers, not judges. Others supported the decision, seeing it as progress for women’s rights.

Overturning of the Roe v. Wade judgement 

The U.S. Supreme Court of the United States has overturned the decision of the Roe v. Wade case while deciding the case of Dobbs v. Jackson Women’s Health Organization (2022).

Background of the case 

In March 2018, the Mississippi State Legislature passed a law called the Gestational Age Act (HB 1510), which banned almost all abortions after 15 weeks of pregnancy. The only abortion clinic in Mississippi, i.e., the Jackson Women’s Health Organization, immediately challenged this law in court. The lower court supported the clinic’s argument, stating that states are not allowed to forbid abortions before the baby can live on its own outside the mother’s womb, which typically happens around 24 weeks into the pregnancy. The court also permanently stayed the enforcement of the law. The decision was later upheld by a three-judge panel of the U.S. Court of Appeals for the Fifth Circuit. 

Mississippi appealed this decision to the U.S. Supreme Court, which agreed to hear the case in May 2021. The specific issue under consideration was whether it is always against the Constitution to prohibit abortions before the foetus can live on its own. Mississippi argued that previous Supreme Court decisions allowing pre-viability abortions were wrong and that the state should be allowed to regulate abortions before viability as long as it does not create too much difficulty for women seeking abortions. They also claimed that since the only abortion provider in Mississippi does not perform abortions after 16 weeks, the law would not significantly impact women’s ability to get abortions in the state.

Issue 

The issue in this case is the constitutionality of Mississippi’s law prohibiting nearly all abortions beyond 15 weeks (gestational age).

Majority opinions

Justice Samuel Alito and the majority court opined that the Constitution does not directly state abortion, and there is no clear protection for it in any constitutional rule. They think that past decisions like Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) did not have strong reasoning based on constitutional law, so they decided to overturn them. Justice Alito also says that abortion is not something deeply rooted in American history because it used to be mostly illegal in the country. He points out that abortion is different from other rights that are protected by the Fourteenth Amendment as it involves ending foetal life. Further, Justice Alito opined that abortion is a significant moral issue. The Constitution allowed states to prohibit abortion; however, Roe and Casey wrongly took that power. Justice Alito further held that these decisions needed to be overturned, and he gave that power back to the people and their elected representatives. 

Judgement

The U.S. Supreme Court held that the Constitution of the United States does not give people the right to have an abortion. This ruling went against both Roe v. Wade (1973) and Planned Parenthood v. Casey (1992) decisions. The judges decided, with a vote of 7-2, that governments cannot create laws to forbid abortions. They stated that a woman’s right to end her pregnancy is safeguarded by the U.S. Constitution.

Supreme Court judge’s opinions with regard to abortion 

The following are the opinions of the U.S. Supreme Court judges, which include:

Chief Justice of the United States John Roberts has been involved in several important abortion cases. He supported restrictions on abortion in 2007 and disagreed with a decision in 2016 that overturned Texas laws on abortion, which only allowed it if the mother’s life was at risk. However, in 2020, when a similar law from Louisiana came up, he voted against it and wrote an opinion to strike it down. He felt that the 2016 decision was wrong but still had to consider whether to follow it in the 2020 case.

Justice Clarence Thomas believes that Roe v. Wade, the landmark Supreme Court decision that legalised abortion nationwide, should be overturned. He voted against Roe in 1992 when he dissented in the Planned Parenthood v. Casey case. Justice Thomas views abortion as a significant issue because they opine that abortion involves a woman’s control over her body and the potential for human life. Thomas says the Constitution does not demand that states allow abortion. He thinks each state should decide if the advantages of abortion are more important than the problems of unwanted pregnancies.

Justice Stephen Breyer supports abortion rights and has also led the Supreme Court to defend them in 2000 and 2016. He recognises that abortion is a controversial issue. Some people consider it as causing harm to innocent lives, while others fear that banning abortion would harm women’s dignity. However, Breyer believes that the Constitution protects fundamental individual freedom. Further, Justice Stephen Breyer also believes that, despite people disagreeing, the Court has consistently said women have the right to choose abortion.

Justice Elena Kagan has been a consistent advocate for abortion rights during her over 11 years as a Supreme Court justice. She strongly believes in following legal precedents and has criticised Texas’s new abortion law, calling it clearly unconstitutional and in direct conflict with previous Supreme Court decisions like Roe v. Wade and Casey. Before becoming a justice, Kagan dealt with abortion issues while working in the Clinton White House. She co-authored a memo advising support for a late-term abortion ban with a health exception for political reasons.

Justice Neil Gorsuch, on the other hand, has a relatively short record on abortion cases. He sided with allowing Texas’s restrictive abortion law to take effect but has stated that his concerns were primarily about procedural issues rather than the subject matter itself. Gorsuch also dissented in the case of June Medical Services L.L.C. v. Russo (2020), involving abortion clinic restrictions in Louisiana.

Brett Kavanaugh, appointed by Trump, initially sided with the administration in the Garza v. Hargan (2017) case involving abortion. However, he later dissented in the Louisiana case and voted to allow the Texas law to take effect. 

Laws governing abortion in the US

There are various laws that regulate abortion in the US. Certain rules are different for different states, depending on the rules of the state legislature. On the other hand, the judiciary has framed some standards in various cases which also govern abortion in the U.S. Some of the major abortion laws are:

Viability standards 

After Roe v. Wade, the Court established the “viability” standards, which allow states to regulate or even ban abortions after the foetus is viable. It is typically around 24 weeks of pregnancy. However, states cannot prohibit abortions that are necessary to protect a woman’s life or health. After Roe v. Wade, the Supreme Court said that states can make rules about abortion after around 24 weeks of pregnancy, when a foetus can survive outside the womb. But they cannot ban abortions if it is needed to protect the woman’s life or health. So, while states can put limits on abortion later in pregnancy, they cannot completely prohibit it if it is necessary for a woman’s safety.

Meaning of viability

Foetal viability means the ability of a human foetus to survive outside the mother’s womb as it continues to develop. In places that follow this idea, abortion is usually allowed or easier to get before this point. After viability, abortion rules are stricter, and it is harder to get one except in specific cases. Originally, after Roe v. Wade in 1973, this was typically considered to be around 28 weeks. However, with advancements in medical technology, experts now believe viability occurs earlier, around 23 to 24 weeks. Some people question if this gradual approach to abortion is right, but many places still use viability as a legal rule.

Some medical institutions, like Riley Hospital for Children at Indiana University Health Hospital, claimed that they can support life as early as 22 weeks with the right tools. Dr. Peter H. Schwartz from the Indiana University Center for Bioethics explains that viability is more about medical care than ethics. It is not easy to predict when a prematurely born baby will be viable, as it depends on various other factors. The Supreme Court’s recent leaked draft opinion in the Dobbs v. Jackson Women’s Health Organization case focuses heavily on the concept of foetal viability.

Targeted Regulation of Abortion Providers (TRAP)

Targeted Regulation of Abortion Providers (TRAP) is a set of rules that specifically target doctors who offer abortions. These laws impose stricter and more complicated requirements on abortion clinics compared to other medical practices. TRAP laws may require abortion procedures to be performed in expensive facilities, even when less expensive options are deemed sufficiently safe. They could also require doctors who perform abortions to have admitting privileges at nearby hospitals, even though it is not medically necessary.

Impact of the regulation

These regulations raise the cost of abortion services and make them harder to find. They limit women’s access to safe and legal abortion care by interfering with their reproductive choices. TRAP laws are often pushed under the guise of protecting women’s health but actually aim to restrict abortion access.

These extra and unnecessary government rules, which many states are adopting more and more, make it harder to get abortions and make them more expensive. This will adversely impact women’s health and make it harder for them to make decisions about their bodies. These laws threaten women’s access to safe, legal, and good-quality reproductive health care. Politicians use these tactics to make it tricky for clinics to offer abortions, even though they say it is for women’s health. Their real aim is to make it tough for women to get abortions. For instance, when Governor Phil Bryant signed a law in Mississippi in 2012 requiring doctors to have special privileges at hospitals, he said it was a step towards ending abortion in the state.

Texas abortion laws

In the United States, Texas has the strictest abortion laws. They include restrictions such as a ban on abortions after 20 weeks of pregnancy, except in cases of serious health risks to the mother or severe foetal abnormalities. The major laws are elaborately explained below:

Texas Health and Safety Code

The Texas Health and Safety Code, specifically Title 2, Subtitle H, Chapter 170A, pertains to the rules for the performance of abortions. These sections were added by Acts 2021 and went into effect on August 25, 2022. The important provisions consists of:

• Section 170A.001 contains the major definitions, which are as follows:
  • “Abortion” means the termination of a pregnancy.
  • “Fertilisation” is the process where a male sperm penetrates a female ovum’s protective layer.
  • “Pregnant” describes the state of a female carrying a developing, living unborn embryo or foetus stage of an unborn child’s development from fertilisation to birth.
  • “Reasonable medical judgement” refers to the medical judgement made by a knowledgeable physician regarding a case and its treatment options for the medical conditions involved.
  • “Unborn child” signifies a living member of the human species from fertilisation until birth.
• Section 170A.002 prohibits abortion but provides some exceptions too. The section states that:
  • It is illegal to knowingly perform, induce, or attempt an abortion. 
  • Exceptions include that, if a pregnant person’s life is in danger because of the pregnancy, a doctor is allowed to perform an abortion. However, the method used to perform the abortion must prioritise the survival of the unborn child if possible without putting the pregnant person’s life or major bodily functions at greater risk. 
  • Further states that a physician cannot perform an abortion if they were aware, at the time of the procedure, that the risks to the pregnant woman’s life or major bodily functions originated from conduct likely to result in death or serious impairment of the major bodily function of the pregnant female.
  • Accidental or unintentional injury or death of the unborn child during medical treatment by a licensed physician provided to a pregnant female does not constitute a violation of this law.

• Section 170A.003 states that this chapter does not permit the imposition of criminal, civil, or administrative liability or penalties on pregnant women undergoing, attempted, or induced abortions.
• As per Section 170A.004, violating Section 170A.002 is a criminal offence. The severity of the offence depends on whether the abortion resulted in the death of the unborn child. Generally, an offence under this section is a felony of the second degree. However, if it results in the death of a child, it is considered a felony or first degree offence. 
• As per Section 170A.005, a person violating Section 170A.002 may face a civil penalty starting at $100,000 per violation. The Attorney General is authorised to pursue such penalties, along with recovering incurred attorney’s fees and costs, by filing an action.
• According to Section 170A.006, the existence of civil or criminal penalties under this chapter does not nullify any other legal remedies available in civil suits.
• Section 170A.007 states that, besides other punishments and penalties prescribed in this chapter, any healthcare professional who performs, induces, or attempts illegal abortions may lose their licence, registration, or any other relevant authorization by the proper licensing organisation.

Chapter 171 of the Health and Safety Code

Chapter 171 of the Health and Safety Code contains different rules for abortion. This chapter is also called the “Woman’s Right to Know Act”. This code aims to regulate the practice of abortion. 

General provisions

The important general provisions of this Act are as follows:

• As per Section 171.003, only licensed physicians can perform abortions in the state.
• As per Section 171.0031, physicians performing abortions must have admitting privileges at a nearby hospital and shall provide patients, i.e., pregnant persons, with contact information for assistance or complications. If a doctor breaks the rules in Subsection (a), it is a crime. This type of crime is called a Class A misdemeanour. The punishment is a fine, but it cannot be more than $4,000.
• Under Section 171.004, abortions of foetuses aged 16 weeks or more can only be performed at specific medical facilities, such as an ambulatory surgical centre or hospital licensed to perform the abortion.
• Under Section 171.005, the commission is responsible for making sure this chapter is followed, except for Subchapter H.  But certain sections are enforced through private civil actions, as described in Section 171.208, and cannot be enforced by the commission.
• Section 171.006, requires reporting of any complications resulting from abortions, with specific details on the issues and patients, to the state commission. Section 171.006, as added by H.B. 215, states that physicians performing abortions on minors must document how consent was obtained and report it to the state commission.
• According to Section 171.008, physicians must document and maintain records specifying the reasons for performing abortions, particularly in cases of medical emergencies or for preserving the health of the pregnant woman.

Informed consent

Subchapter B of the Code outlines the requirements for informed consent in the context of abortion procedures. It covers:

• As per Section 171.011, it mandates the informed consent of the pregnant woman, and abortion cannot be performed without the voluntary and informed consent of the woman.
• Section 171.012 contains details of voluntary and informed consent that consist
  • Providing information about the physician’s name, medical risks associated with the abortion procedure, gestational age of the unborn child, medical risks associated with carrying the child throughout the period of pregnancy, and available medical assistance and support options.
  • Offering printed materials provided by the commission that describe the unborn child, list agencies offering alternatives to abortion, and provide information about sonogram services.
  • Performing a sonogram at least 24 hours before the abortion or at least two hours before if the woman waives the 24-hour requirement, explaining the results to the woman, and making the foetal heartbeat audible if present.
  • The woman certifies her understanding and makes certain decisions before the abortion procedure.
• Section 171.0121 requires the signed, written certification received by the physician to be placed in the woman’s medical records before the abortion begins.
• Section 171.0122 allows the pregnant woman to choose not to view the printed materials or sonogram images and not to hear the heartbeat or receive verbal explanations under certain circumstances, which are provided in Section 171.012(a)(4)(C). Those circumstances are as follows:
  • The pregnancy has resulted from sexual assault, incest, or another offence under the Penal Code that has been reported to law enforcement or not reported due to safety concerns.
  • The pregnant woman is a minor seeking an abortion following judicial bypass procedures under Chapter 33 of the Family Code.
  • The foetus has an irreversible medical condition or abnormality, which was previously confirmed by reliable diagnostic procedures and documented in the woman’s medical records.
• Section 171.0123 mandates that, if the woman chooses not to have an abortion after receiving information, she must be provided with publications about paternity establishment and child support.
• Section 171.0124 provides an exception for medical emergencies, allowing abortions without informed consent in such situations.
• Section 171.013 requires physicians or their agents to provide copies of informational materials to the woman at least 24 hours before the abortion or by mail if requested.
• Section 171.014 states details of the content and format of the informational materials, such as those that must be provided to the woman, including information about medical risks, alternatives to abortion, and characteristics of the unborn child.
• Section 171.015 requires the informational materials to include a list of public and private agencies offering assistance with pregnancy, childbirth, and child dependency.
• Section 171.016 mandates the inclusion of materials in the informational packet describing the anatomical and physiological characteristics of the unborn child at different gestational ages.
• Section 171.017 specifies that the 24-hour waiting periods for informed consent can run concurrently with notice the periods required by Chapter 33 of the Family Code for unemancipated minors.
• Section 171.018 defines performing an abortion without informed consent as an offence, punishable by a fine not exceeding $10,000.

Abortion and sonograms

Chapter 171 also provides the provisions for the sonogram and its requirements. A sonogram, also known as ultrasonography or ultrasound imaging, is a medical imaging technique that uses high-frequency sound waves to create images of structures inside the body. In the context of pregnancy, a sonogram is commonly used to visualise the foetus inside the uterus. It allows healthcare providers to monitor the growth and development of the foetus. It assesses the health of the pregnancy and detects any complications. The provisions of the sonogram are as below:

• Section 171.012(a)(1) provides certain conditions to be satisfied in order to consider an abortion voluntary and informed. There are two conditions, namely, that the doctor who will perform the abortion must inform the pregnant woman about their name and the specific medical risks related to the particular abortion procedure to be used, including the following:
  • Risks of infection and haemorrhage.
  • Potential harm to future pregnancies and the risk of infertility.
  • Possibility of increased risk of breast cancer after an induced abortion and the protective effect of completing a pregnancy in preventing breast cancer.
  • The likely gestational age of the unborn child at the time of the abortion.
  • The medical risks associated with continuing the pregnancy to full term. 
• As per Sections 171.012(a)(2), the doctor who will perform the abortion or the doctor’s representative shall inform the pregnant woman that:
  • Medical assistance benefits may be accessible for prenatal care, childbirth, and neonatal care.
  • The father is responsible for supporting the child, regardless of whether he has offered to pay for the abortion.
  • There are public and private agencies offering counselling on pregnancy prevention and referrals for obtaining pregnancy prevention medications or devices, including emergency contraception for victims of rape or incest. 
• As per Section 171.013, the doctor or someone working for a pregnant woman must give the pregnant woman certain printed materials as described by Section 171.014. These materials are provided by the commission and can also be found on a website sponsored by the commission. They contain information about the unborn child and list agencies that provide alternatives to abortion. Further, they include a list of agencies offering free sonogram services for pregnant women. The doctor or their representative should inform the pregnant woman about these materials and ensure she has access to them.
• As per Section 171.012(a)(4), before any sedation or anaesthesia is given to the pregnant woman, and at least 24 hours before the abortion, or at least two hours before the abortion if the pregnant woman confirms that she lives 100 miles or more away from the nearest abortion provider:
  • A doctor or a certified sonographer must perform a sonogram on the pregnant woman.
  • The doctor must show the sonogram images to the woman in a way that she can see them clearly.
  • The doctor must explain the sonogram results in simple terms, including describing the size of the embryo or foetus, if there is a heartbeat, and the development of body parts.
  • If there is a heartbeat, the doctor or a certified sonographer must let the woman hear it and explain what it means.
• Section 171.012(a)(6) provides conditions under which, before carrying out the abortion, the doctor who will perform it receives a copy of the signed, written certification as required by Subdivision (5).
• Section 171.012(a)(7) states that pregnant women will be given the name of each person who gives or explains the necessary information mentioned in this section.
• As per Section 171.012(a-1), when someone comes to the facility for abortion-related services, neither the facility nor anyone there can accept any payment or make any financial deals except for the services required by sub-section (a). The cost of these required services cannot be more than what the government has set as the reimbursement rate for such services.
• As per Section 171.012(b), information about abortion, including a sonogram, must be given to the pregnant woman either in person or through a private phone call, but not by audio or video recording. 
• As per Section 171.012(c), the doctor or their agent must give the pregnant woman the website address where she can see the printed materials required by law.
• As per Section 171.012(d), the information provided to the woman must include details about the likelihood of getting child support if she decides to have the baby.
• As per Section 171.012(f), the doctor must provide the woman with informational materials as required by law.

Medical records related to abortion procedures

Section 171.0121 of the Texas Health and Safety Code pertains to the requirements regarding the retention of medical records related to abortion procedures. It contains the following:

• Before the abortion procedure begins, the physician must place a copy of the signed, written certification received under Section 171.012(a)(6) in the pregnant woman’s medical records.
• The facility where the abortion is performed must retain a copy of the signed, written certification required under Sections 171.012(a)(5) and (6) until
  • The seventh anniversary of the date it is signed, or
  • If the pregnant woman is a minor, the latter of
    • The seventh anniversary of the date it is signed, or
    • The woman’s 21st birthday

Rights of pregnant women regarding their choice to view certain materials and images

Section 171.0122 outlines the rights of pregnant women regarding their choice to view certain materials and images, as well as to hear specific information related to abortion procedures: 

• A pregnant woman has the option to choose not to view the printed materials provided under Section 171.012(a)(3) after she has been provided with them.
• A pregnant woman has the option to choose not to view the sonogram images required to be provided to and reviewed with her under Section 171.012(a)(4).
• A pregnant woman has the option to choose not to hear the heart auscultation required to be provided to and reviewed with her under Section 171.012(a)(4).
• A pregnant woman has the option to choose not to receive the verbal explanation of the results of the sonogram images under Section 171.012(a)(4)(C) in the following cases:
  • If her pregnancy is a result of a sexual assault, incest, or other violation of the Penal Code that has been reported to law enforcement authorities,
  • If not reported, there is a risk of retaliation resulting in serious bodily injury. 
• She is a minor and is obtaining an abortion in accordance with judicial bypass procedures under Chapter 33 of the Family Code; or 
• The foetus has an irreversible medical condition or abnormality, previously identified by reliable diagnostic procedures and documented in her medical file.
• Both the physician and the pregnant woman are not subject to penalties under this chapter solely because the pregnant woman chooses not to view the printed materials or sonogram images, hear the heart auscultation, or receive the verbal explanation if waived as provided by this section.

Paternity establishment and child support for pregnant women

Section 171.0123 deals with providing information to pregnant women who choose not to have an abortion after receiving a sonogram and other necessary information. The doctor or someone working with the doctor must give the pregnant woman a publication created by the Title IV-D agency. This publication explains how unmarried parents can establish legal paternity, the benefits of doing so for their children, and the steps to get a child support order. It also highlights the advantages of having a legal parenting order and covers the financial and legal responsibilities of parenting.

Exception for medical emergency

According to Section 171.0124, if there is a medical emergency, a doctor can perform an abortion without getting consent from the woman beforehand. However, the doctor still has to do two things, which include writing a note in the woman’s medical records explaining the emergency and informing the department within 30 days about the specific medical condition that caused the emergency. This exception is to make sure that, in urgent situations where the woman’s health is in danger, the doctor can act quickly without needing the usual consent process. This section was first added in 2011 and then changed a bit in 2015.

Distribution of state materials

As per Section 171.013, the doctor or someone working for the doctor must give the pregnant woman copies of certain materials described in Section 171.014 at least 24 hours before the abortion is scheduled to take place. They must also tell the woman where to find these materials on the internet, as required by Section 171.014(e).

If the woman prefers to view the materials online instead of getting physical copies, she is allowed to do so. However, she must provide a written statement to the doctor saying so. The doctor and their staff can distance themselves from the materials and decide whether or not to comment on them.

Informational materials

As per Section 171.014, the Department of Health and Human Services must create informational materials that contain:

• Information required by Sections 171.012(a)(1)(B) and (D) and (a)(2)(A), (B), and (C).
• Materials are required by Sections 171.015 and 171.016. These materials must be:
  • Published in both English and Spanish.
  • Presented in an easily understandable manner.
  • Printed with a font size that is large enough to be easily read.
  • The materials must be available for free upon request from the department, which will provide them in appropriate quantities to anyone who asks.

The department must review these materials annually to see if any changes are needed, and the executive commissioner will establish rules for making these changes. An internet website must be developed and maintained by the department to display the required information. The department must make efforts to protect the website against unauthorised changes and monitor it daily to prevent tampering. The website should not collect or keep any information about who accesses it. The American College of Obstetricians and Gynecologists must be used as a resource in creating the information required under various sections and in maintaining the department’s website.

Information relating to characteristics of unborn child

According to Section 171.016, the informational materials must contain content to educate the woman about the probable anatomical and physiological characteristics of the unborn child at two-week gestational increments from the time of pregnancy detection to full term. This includes information about the potential survival of the unborn child. Colour pictures representing the development of the child at these gestational increments must be included. These pictures should accurately depict the dimensions of the unborn child and must be realistic. The materials provided must be objective, non-judgmental, and designed to convey only accurate scientific information about the unborn child’s development at different gestational ages.

Offence

As per Section 171.018, a physician who intentionally performs an abortion on a woman in violation of this subchapter commits an offence. This offence is classified as a misdemeanour, punishable by a fine not exceeding $10,000. In this section, “intentionally” has the meaning assigned by Section 6.03(a) of the Penal Code.

Abortion is prohibited at or after 20 weeks post-fertilization

As per Section 171.041, this subchapter is cited as the “Preborn Pain Act”. The chapter consists of the following provisions that relate to abortion at the post-fertilisation age:

• As per Section 171.043, a physician must not perform or attempt to perform an abortion without first determining the probable post-fertilization age of the unborn child.
• As per Section 171.044, abortion of an unborn child of 20 or more weeks post-fertilization age is prohibited. No person may perform or attempt to perform an abortion on a woman if it has been determined that the probable post-fertilization age of the unborn child is 20 weeks or more.

Method of abortion

• Section 171.045 applies to abortions where the unborn child is 20 or more weeks post-fertilization age or when the age has not been determined but could reasonably be 20 or more weeks.
• A physician performing such an abortion must use a method that, in their reasonable medical judgement, provides the best opportunity for the unborn child to survive.

Exceptions

• As per Section 171.046, the prohibitions mentioned in Sections 171.043, 171.044, and the requirements under 171.045(b) do not apply in certain circumstances. Those circumstances are:
  • When the woman’s medical condition presents a risk of death or serious physical impairment,
  • When the unborn child has a severe foetal abnormality,
  • A physician may not perform an abortion if the risk arises from a diagnosis that the woman will engage in conduct resulting in her death or serious physical impairment.

Subchapter D: Abortion-inducing drugs

Subchapter D of the Code consists of abortion-inducing drugs. Some of the important provisions are: 

• Section 171.061 provides several definitions, including:
  • “Abortion”: Ending a pregnancy. It doesn’t include ending a pregnancy to treat a maternal disease.
  • “Abortion-inducing drug”: Any drug or substance given to end a pregnancy and likely cause the unborn child’s death. This includes drugs like Mifeprex, misoprostol, and methotrexate, but not drugs given for other medical reasons.
  • “Adverse event” or “abortion complication”: Any harmful outcome related to an abortion procedure.
  • “Gestational age”: How long it’s been since a woman’s last period.
  • “Medical abortion”: Using drugs to end a pregnancy.
  • “Physician”: A licensed medical doctor.
  • “Pregnant”: When a woman has an unborn child in her uterus.
  • “Unborn child”: A human offspring from conception until birth.

These definitions are part of the legal framework surrounding abortion-inducing drugs.

• As per Section 171.062, the Texas Medical Board is responsible for making sure the rules in this section are followed, despite any other laws.
• Section 171.063 prescribes several rules for abortion-inducing drugs, which cover:
  • No one can provide an abortion-inducing drug to a pregnant woman unless:
    • The person providing the drug is a doctor.
    • The way the drug is provided follows the rules in this section.
  • No one can send abortion-inducing drugs to a patient through a delivery service.
  • Before a doctor gives an abortion-inducing drug, they must:
    • Examine the pregnant woman in person.
    • Confirm that she is pregnant.
    • Record the age and location of the pregnancy.
    • Check the woman’s blood type and offer treatment if needed.
    • Make sure the woman did not receive treatment for Rh negativity before.
    • Do not give the drug to pregnant women if the pregnancy is over 49 days.
  • The doctor giving the drug must give the woman:
    • A copy of the drug’s label.
    • A phone number she can call anytime for help or questions.
  • The doctor must schedule a follow-up visit within 14 days to:
    • Confirm the pregnancy is ended.
    • Check for any ongoing bleeding.
  • The doctor must try to make sure the woman comes back for the follow-up visit and record any efforts made.
  • If a woman has a serious problem after taking the drug, the doctor must report it to the Food and Drug Administration (FDA) within three days.

Chapter 245 of the Health and Safety Code

Chapter 245 of the Health and Safety Code outlines the provisions for the abortion facilities. The important provisions of this chapter are provided below.

Short title

Section 245.001 says that this part of the law can be called the “Texas Abortion Facility Reporting and Licensing Act.”

Definitions

• Section 245.002 defines certain words in the law that cover:
  • Abortion: Stopping the development of a baby in a pregnant woman using tools, drugs, or other methods. But it doesn’t include regular birth control or taking pills to prevent pregnancy.
  • Abortion Facility: A place where abortions are done.
  • Department: The government group in charge of health services.
  • Ectopic Pregnancy: When a fertilised egg starts growing outside the uterus.
  • Executive Commissioner: The top person in charge of health and human services.
  • Patient: A woman who gets an abortion.
  • Person: This means an individual, i.e., one person, a business, or a group.

Licence requirement

Section 245.003 states that one cannot open or run an abortion facility without special permission from the government. Such a requirement is called a licence. Each abortion facility needs its own licence. Such a licence cannot be transferred to someone else.

Exemptions from licensing requirements

Section 245.004 lists some places that do not need a special licence to do abortions. Those are:

• Hospitals that already have permission to operate do not need a separate licence.
• A doctor’s office does not need a licence if the doctor does not do more than 50 abortions in a year.
• Some types of abortions do not count towards the 50, as mentioned in the law.
• Ambulatory surgical centres, which perform surgeries that do not require an overnight stay, do not need a special licence for abortions if they are already licenced under another law (Chapter 243).

For this section to apply, a facility must be mostly used for doing abortions. This means:

• Doing at least 10 abortions in a month, or at least 100 in a year.
• Even if a facility is open less often, it still counts if it does a certain number of abortions during the times it is open.
• If the facility advertises itself as a place that does abortions or applies for an abortion facility licence, it is considered to be mainly for doing abortions.
• If a facility is open at any time during the day and has a doctor ready to do abortions, it’s considered to be operating for abortions.
• These rules are meant to decide if a place needs an extra licence just for doing abortions or if they are already covered under other laws.

Licence application and issuance

Section 245.005 explains the process for applying for and receiving a licence to operate an abortion facility:

• Application submission: Anyone who wants to open or run an abortion facility must fill out an application form provided by the Department of State Health Services, (shortly known as the “Department”).
• Licence fee: Along with the application, the applicant must pay a non-refundable fee set by the executive commissioner, who is the top official of the Health and Human Services Commission.
• Requirement of physician: The application must show that the facility has one or more doctors on staff who are licensed by the Texas Medical Board.
• Licence issuance: The department shall give a licence if, after inspecting and investigating, it finds that the applicant and the facility meet the requirements and standards established in this law.
• Renewal condition: To keep the licence valid, the facility must pay an annual renewal fee and submit an annual report to the department.
• Public Information: Information about whether an abortion facility is licensed is available to the public under Chapter 552 of the Government Code. The department has to provide this information if requested.

Minimum standards

Section 245.010 lays out the basic standards that must be met by abortion facilities to ensure the health and safety of patients:

• Health and safety standards: The rules must include minimum standards that protect the health and safety of patients at abortion facilities. These standards must also require compliance with the requirements of Subchapter B, Chapter 171. Further, starting on September 1, 2014, the minimum standards for abortion facilities must be equal to those adopted for ambulatory surgical centres under Section 243.010.
• Physician requirement: Only a licensed physician, as defined by the laws governing medical practice in Texas, is allowed to perform abortions.
• Limitations: The executive commissioner is not given the authority to set the qualifications for licensed practitioners or to allow individuals who are not authorised under Texas law to provide healthcare services.

Physician reporting requirements; criminal penalty

Section 245.011 prescribes procedures for the physicians who perform abortions at abortion facilities. The procedure prescribed is provided below.

• Monthly report: Physicians who perform abortions at abortion facilities must fill out and submit a monthly report to the Department of State Health Services. This report must be completed on a form provided by the department.
• Patient anonymity: The report cannot include any identifying information about the patient.
• Report contents: The report must include various details about the abortion, such as the type of procedure, date performed, patient’s age, race, marital status, and residence, previous live births and abortions, reasons for the abortion, and other required information.
• Confidentiality: Information and records held by the department under this law are confidential and cannot be released to the public, except for specific purposes listed in the law.
• Offence and penalty: A person who commits an offence by violating sub-sections (b), (c), or (d) is a Class A misdemeanour.
• Submission deadline: Physicians must submit the required report to the department by the 15th day of each month for abortions performed in the previous month.
• Electronic reporting system: The department must establish a secure electronic reporting system for submitting these reports, and it should enforce procedures to ensure compliance.

Notification

Section 245.0115 requires the commissioner of state health services to notify the Texas Medical Board if there is a violation of the reporting requirements contained in Section 245.011. This notification must be made within seven days after the report is due.

Chapter 33 of Family Code 

Chapter 33 of the Family Code states the notice and consent to an abortion. Accordingly, the provisions of this chapter include:

Definitions

Section 33.001 contains definitions and includes:

• “Abortion” has the meaning assigned by Section 245.002, Health and Safety Code. This definition, as applied in this chapter, may not be construed to limit a minor’s access to contraceptives.
• “Foetus” means an individual human organism from fertilisation until birth.
• “Guardian” means a court-appointed guardian of the minor.
• “Medical emergency” has the meaning assigned by Section 171.002, Health and Safety Code.
• “Physician” means an individual licensed to practise medicine in this state.
• “Unemancipated minor” includes a minor who:
  • is unmarried, and
  • has not had the disabilities of minorities removed under Chapter 31.

Parental notice

Section 33.002 of this chapter deals with the various rules of parental notice and states that:

A doctor cannot do an abortion on a young person who is not legally an adult, unless:

• A physician cannot perform an abortion on a pregnant, unemancipated minor unless the following conditions are met:
  • The physician performing the abortion provides at least 48 hours of actual notice, either in person or by telephone, regarding their intent to perform the abortion to:
    • A parent of the minor, if the minor does not have a managing conservator or guardian; or
    • A court-appointed managing conservator or guardian; or
• The doctor gets a court order allowing the minor person to consent to the abortion, as explained in Section 33.003 or 33.004; or
• The doctor, who will perform the abortion, does the following duties:
  • Determines that a medical emergency exists.
  • Documents in writing to the Department of State Health Services and in the patient’s medical record provide the medical reasons supporting the doctor’s decision that a medical emergency exists.
  • Gives the necessary notice as mandated by Section 33.0022 (Medical Emergency Notification; Affidavit for Medical Record).
• If a person who should be notified under sub-section (a)(1) cannot be reached despite reasonable attempts, a physician has the option to proceed with the abortion after providing 48 hours of constructive notice. This notice is sent by certified mail, restricted delivery, to the last known address of the person who should be notified. The 48-hour period begins when the notice is mailed. If the required person is not notified within this timeframe, the abortion may proceed even if the mailed notice is not received.

Some other rules of the section include:

• The doctor can make a statement for the young person’s medical record, saying they have given the proper notice. If the doctor does this, it is assumed they followed the rules.
• The Department of State Health Services will make a form for the doctor to use when explaining a medical emergency.
• The doctor’s statement about a medical emergency is private and cannot be shared with others or forced to be shared in a legal case. The doctor must keep the young person’s medical records private, following the rules set by the Texas Medical Board.
• If a doctor intentionally violates these rules by doing an abortion on a young person without proper notice, they can be fined up to $10,000.
• It is not a crime if a young person lies about their age or identity to get an abortion, as long as the doctor couldn’t reasonably know the truth. However, if the doctor had known the truth with reasonable effort, it would still be a crime.
• If a doctor’s actions are questioned in court, they can ask the Texas Medical Board to review whether there was a real medical emergency. The board’s decision can be used as evidence in court.
• Doctors are required to verify the age of individuals seeking abortions to ensure they are old enough. To accomplish this, they should request proof of identity and age or obtain a copy of the court order that removes minority status.
• If proof cannot be given, the doctor should explain how to get it. If proof cannot be obtained and the doctor still does the abortion, they must note this and report it to the Department of State Health Services. The department has to tell the legislature each year how many abortions happen without proof of age and identity.

Requirement of consent

In Section 33.0021, a doctor cannot do an abortion if such acts violate Section 164.052(a)(19) of the Occupations Code.

Medical emergency notification

As per Section 33.0022, if a doctor decides there is a medical emergency under Section 33.002(a)(3)(A) and there is not enough time to notify or get consent as required by Sections 33.002 or 33.0021 in such circumstances,

• The doctor should try to tell the parent, guardian, or conservator in person or by phone within 24 hours after the abortion about:
  • The abortion is happening.
  • Why did the doctor think it was a medical emergency and needed to be done right away.
  • The doctor must, within 48 hours after the abortion, send a written notice to the last known address of the parent, guardian, or conservator by certified mail, restricted delivery, or return receipt requested. The doctor can use the last known address unless there is a clear reason not to. The doctor should keep a record in the minor’s medical file about the following things:
    • The return receipt from the written notice;
    • If the notice was returned as undeliverable.
    • The doctor must write an affidavit for the minor’s medical file explaining the specific medical emergency that required the abortion right away.

Judicial approval

Section 33.003 includes the provisions for judicial approval, which states as follows:

• A pregnant minor has the option to seek judicial approval to undergo an abortion without informing or obtaining consent from a parent or guardian.
• The application should be made in the minor’s county of residence at a specific court.
• If the minor’s parent or guardian holds a judicial position, they can file the request in a nearby county or where the abortion is planned.
• If the minor’s county has a small population, which is less than 10,000, they can file the request in nearby counties or where the abortion is planned.
• The application must include sworn statements. The application must be made under oath. It Include:
  • A statement that the minor is pregnant.
  • A statement that the minor is unmarried, under 18 years old, and has not had their legal restrictions removed.
  • A statement that the minor wishes to have an abortion without informing or getting consent from a parent, managing conservator, or guardian.
  • A statement regarding whether the minor has a lawyer. If so, it must provide the lawyer’s name, address, and telephone number.
  • A statement about the minor’s current residence, including their physical address, mailing address, and telephone number.
• The application should mention if the minor has a lawyer, along with their contact details, and if the minor has one helping them with the application.
• The court clerk gives a courtesy copy of the request to the assigned judge, who will hear the application.
• If the minor does not have a lawyer, the court appoints someone to represent their interests. The guardian ad litem cannot also be the minor’s lawyer.
• The appointed guardian ad litem can be a psychiatrist or psychologist, a clergy member, or someone chosen by the court.
• The court will schedule a time for a hearing on the application, and it will keep a record of everything said during the hearing. 
• The minor must attend the hearing in person; remote attendance by using electronic means is not allowed.
• The court is required to make a decision on the application within five business days of its filing and provide written reasons. If the minor requests an extension, the court must consider it. Regardless of whether an extension is granted, the court must prioritise these proceedings to ensure a prompt decision. 
• If the court denies the minor’s application, the minor can later submit a new application to the same court if they can prove that there has been a significant change in circumstances since the previous denial.
• All information remains confidential, and the court cannot disclose it to the minor’s parents.
• The clerk of the court provides reports to the state about these cases, and the state publishes annual reports based on this data.
• The application form for minors is checked by the Supreme Court’s clerk. There is no fee for the application.
• Once submitted, the minor cannot withdraw the application without court approval.
• If the application is filed and determined by the court, the minor cannot apply again as it is a res judicata unless significant changes occur.
• The minor’s lawyer must be fully informed and ensure the accuracy of the information provided.

Appeal

If a minor’s application under Section 33.003 is rejected, she can appeal to the court of appeals that deals with civil matters in the county where she filed the application under Section 33.004. The clerk of the court that rejected the application will send a copy of the appeal notice and record to the court of appeals, which will put the appeal on its docket. The court of appeals must decide on the appeal within 5 business days of receiving the notice of appeal. If the minor asks for more time, the court can extend the deadline. The appeal process will be given priority over other cases to ensure a quick decision, regardless of any extensions granted. The court of appeal’s decision is private and cannot be shared except with specific people or agencies involved in protecting the minor’s interests. The Supreme Court can make rules to keep these appeals confidential. The court of appeals can publish an opinion on the ruling as long as it does not reveal the minor’s identity. The Supreme Court’s clerk will decide on the form for the appeal notice used by the minor. The minor does not have to pay a fee for filing an appeal, and there are no court costs. A quick and confidential appeal process is available to any pregnant minor whose application to have an abortion without her parent’s or guardian’s knowledge is denied by the court of appeals.

Civil penalty

As per Section 33.012, anyone who intentionally, knowingly, recklessly, or with gross negligence breaks the rules in this chapter owes the state a fine of at least $2,500 but not more than $10,000. Each time someone does or tries to do an abortion against these rules, it is a separate violation. The state cannot impose a fine.

• A minor who gets or tries to get an abortion.
• A judge or justice who handles a case under Section 33.003 or 33.004.
• Even if the minor agreed to the abortion, that does not stop the state from fining the person who did it.
• The attorney general will sue to collect these fines.

Vernon’s civil statutes

Vernon’s Civil Statutes of the State of Texas, specifically under Title 71, Chapter 6-1/2, address matters related to abortion. These statutes include:

• Article 4512.1: If someone intentionally gives a pregnant woman drugs or hurts her to make her have an abortion, they can go to jail for at least two years and up to five years. If they do it without her permission, the punishment is even harsher.
• Article 4512.2: If someone helps by giving the tools or means to have an abortion, knowing what they are used for, they are also guilty as an accomplice.
• Article 4512.3: If the methods used do not successfully cause an abortion, the person is still considered guilty of attempting to cause an abortion as long as it is proven that the methods were intended to achieve that outcome. They might have to pay a fine of not less than $100 and not more than a thousand.
• Article 4512.4: If a pregnant woman dies because of an abortion or an attempt to have one, it is treated as murder.
• Article 4512.5: If someone destroys the life of an unborn baby while the baby is being born, they can get a very long prison sentence, not less than 5 years.
• Article 4512.6: However, if a doctor advises that an abortion is needed to save the mother’s life, it is not treated as a crime.

The mentioned Article 4512.1, Article 4512.2, Article 4512.3, Article 4512.4, and Article 4512.5 were impliedly repealed in the case of McCorvey v. Hill, 385 F.3d 846 (5th Cir. 2004).

Hyde amendment

The Hyde Amendment is a law passed by the US Congress that imposes restrictions on how certain federal funds can be used for abortion services. It is named after Henry J. Hyde, the congressman who originally introduced it. This law is included in the annual spending bills for the Departments of Labor, Health and Human Services, Education, and related agencies.

The Hyde Amendment is a rule that stops federal funds from being used to pay for abortions in certain government health programs like Medicaid and Medicare. This rule applies nationwide and is not left up to individual state governments to decide on its applicability. Medicaid helps low-income people with medical costs, while Medicare helps older people and some disabled people with health coverage. This rule also affects other health programs funded by the government. However, it does not apply to all the money a program gets, only specific portions. Some states use their own money to pay for abortions beyond what the Hyde Amendment allows. Also, in student aid programs, some money is affected by the Hyde Amendment, but not all of it.

The most recent edition of the Hyde Amendment, which was in effect for the fiscal year 2022, says that federal funds cannot be used for abortions except in specific cases. These cases include pregnancies resulting from rape or incest, or when the woman’s life would be in danger if she did not have an abortion.

The Hyde Amendment has evolved over time regarding the exceptions it allows for using federal funds to cover abortions. Initially, it only included an exception for abortions necessary to save the woman’s life. However, by the fiscal year 1979 edition, it had expanded to include three exceptions:

• Life-saving exception: This exception allows federal funds to be used for abortions if the woman’s life is in danger due to the pregnancy.
• Rape or incest exception: This exception permits federal funds to cover abortions in cases of pregnancies resulting from rape or incest, but initially only if the incident had been reported promptly to the law damage exception. This exception allowed for abortions if carrying the pregnancy to term would result in severe and long-lasting physical health damage to the woman, as determined by two physicians.

Between fiscal years 1981 and 1993, the Hyde Amendment generally reverted to including only the life-saving exception. However, in fiscal year 1994, the rape or incest exception was re-introduced, this time without the requirement for prompt reporting. Since then, the Hyde Amendment has typically included both the life-saving exception and the rape or incest exception in its scope.

The Hyde Amendment limits federal funds for abortions in specific programs, like Medicaid and Medicare. Some other programs, like the Children’s Health Insurance Program (CHIP), have their own similar restrictions. These rules do not apply to all funding sources. Instead, they only affect certain parts of government money.

In the case of Harris v. McRae (1980), the Supreme Court supported the Hyde Amendment, saying it did not violate the Medicare Act, 1965, also known as the Social Security Act. They also held that it was not unfair to women because it did not outright stop them from getting abortions. However, after 1993, when exceptions for cases of rape or incest were added, some courts disagreed with state laws that limited abortion funding. They further held that Medicaid should cover certain medical services, including abortions, and felt the Hyde Amendment placed unfair restrictions, particularly for those needing abortions for reasons other than life-threatening situations.

Following the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, which overturned Roe v. Wade, states are expected to enact stricter abortion laws. These laws could be more limiting than the Hyde Amendment, which restricts federal funding for abortions. If the Hyde Amendment is brought back, conflicts might arise between it and state abortion restrictions, potentially leading to legal disputes. Furthermore, there may be questions regarding whether the Hyde Amendment extends to activities such as providing assistance for travel related to abortions rather than solely focusing on funding the procedure itself. This could potentially lead to additional legal challenges and debates surrounding abortion rights and funding.

Partial-Birth Abortion Ban Act of 2003

The Partial-Birth Abortion Ban Act of 2003 is a federal law that prohibits a specific type of abortion procedure called “partial-birth abortion”, also known as intact dilation and extraction. According to the law, this procedure involves a doctor intentionally delivering a living foetus partially outside the mother’s body and then performing an act that kills the foetus. Important provisions include:

• Under Code § 1531 of Title 18 of the United States Code, which prohibits a specific type of abortion procedure called partial-birth abortion.
• According to the law in Code § 1531(b)(1)(A), a partial-birth abortion happens when a doctor deliberately and intentionally delivers a living foetus partially outside the mother’s body. This can happen when either the entire head if it is presenting first or any part of the baby’s trunk past the navel if it is presenting feet or bottom first is outside the mother’s body. This is done with the intention of doing something to kill the foetus while it’s still partly inside the mother. The doctor must know that this action will kill the foetus, and they must actually go through with it.
• Under Section 1531(e) of the Code, a doctor who performs a partial-birth abortion could be fined or put in jail for up to two years. However, there is a part of the law, Section 1531(a), that says if a partial-birth abortion is necessary to save the life of the mother because she has a serious physical problem, illness, or injury, including problems from the pregnancy itself, then the doctor would not be charged with a crime.
• Furthermore, Section 1531(e) provides that, if a pregnant person asks or plans for a partial-birth abortion, they can also be held responsible for the conspiracy, which means being part of a plan to commit the act.

Constitutionality of Partial-Birth Abortion Act of 2003

The US Supreme Court, in the case of Gonzales v. Carhart (2007), upheld the constitutionality of the Partial-Birth Abortion Ban Act of 2003. The Attorney General appealed rulings by the Eighth and Ninth Circuit Courts of Appeals, both of which had struck down the law. The Supreme Court’s decision, delivered in a narrow 5-4 majority, held that Congress’s authority to enact the ban. It concluded that the law did not place an undue burden on a woman’s right to seek an abortion, as established by prior Supreme Court precedents such as Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey. Further, the Court found the law constitutional and rejected arguments claiming it was unclear or lacked provisions for protecting women’s health.

Criticism

Some people questioned this law because it did not include a rule to make sure women’s health was taken care of, not only their lives. Many people see this ruling as one of the biggest decisions on abortion in thirty years. It led to immediate reactions from politicians and experts in the medical field. The day after the ruling, two democrats introduced bills in Congress to make sure the government could not interfere with a woman’s right to choose whether to have a child or end a pregnancy. The New England Journal of Medicine joined the discussion, with its editor saying the U.S. Supreme Court should not be making medical decisions. The law says a “partial-birth abortion” is when a doctor partly delivers a living baby and then intentionally does something to kill the foetus. This procedure is mostly done in the second trimester of pregnancy. Some doctors and groups, like the American College of Obstetricians and Gynecologists, are worried about the ruling. They think it might ignore the safest option for some women and their health needs. Many groups, including Planned Parenthood and the American Civil Liberties Union, criticised the court’s decision. They think it is a step towards making abortion harder to obtain. The New York Times, a news portal, made the ruling its top story, saying it was bad for women’s rights. People are concerned that the court is more focused on the baby’s rights than the mother’s. Some people think it could even make it harder for women to get abortions.

Reasons for banning abortions in the US

Abortion bans in the United States happened because a group of people who do not want abortions, called the anti-abortion people group, started protesting against abortions. They have worked really hard to make it happen. Even though they are not the majority, they are good at organising and convincing politicians to support them. Over time, politicians who wanted to win elections started to support their cause to get votes. The way the US government works also helped them. Even though there are more Democrats than Republicans in the country, the system gives each state the same number of votes in the Senate, which is where they confirm judges. There were also social changes that made politicians think it was really important to stop abortions. For example, as the country becomes more diverse and less religious, some groups worry about losing their power. So, they work harder to keep things the way they want them to be. This led to the banning of abortions in many states, but they are not totally banned everywhere. Instead, some states have put restrictions on when and how abortions can be done.

Insights from the Pew Research Center Survey relating to abortion in the US

On January 11, 2023, the report submitted by the Pew Research Center, consists of various aspects of abortions in the U.S., along with data from the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute. These surveys cover a range of topics, including the attitudes of Americans towards the legality of abortion, opinions on specific abortion-related policies, and factors influencing individuals’ views on abortion. It consists:

The Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute track the number of legal abortions in the U.S. Both organisations reported data from 2020, showing that there were over 600,000 legal abortions performed in the country that year. However, there are differences in the exact numbers reported by each organisation. Since the legalisation of abortion in 1973, the number of abortions in the U.S. has generally declined, with occasional slight increases in certain years.

After the Supreme Court’s decision in June 2022, 62% of U.S. adults believed abortion should be legal in all or most cases, while 36% believed it should be illegal in all or most cases. A few people have extreme views on the matter. The exact number of abortions in the U.S. each year is challenging to determine due to differences in measurement methods between the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute.

The CDC collects data voluntarily reported by health agencies in most states and the District of Columbia. However, its figures do not include data from California, Maryland, or New Hampshire. In 2020, the CDC reported 620,327 abortions in the U.S., a slight decrease from the previous year. On the other hand, the Guttmacher Institute contacts every known abortion provider in the country and uses questionnaires and health department data to compile its figures. In 2020, Guttmacher reported 930,160 abortions, which is higher than the CDC’s figure. Both organisations include legally induced abortions performed by clinics, hospitals, or physicians’ offices, as well as abortions using pills dispensed from certified facilities. However, they do not account for abortion pills obtained outside of clinical settings.

The number of abortions in the U.S. has fluctuated over the years. After Roe v. Wade legalised abortion in 1973, the number increased steadily, peaking in the late 1980s and early 1990s. Since then, there has been a general decline, although with occasional increases in certain years. In 2020, the CDC reported over 600,000 abortions, while the Guttmacher Institute reported over 900,000. Regarding the abortion rate among women, both Guttmacher and the CDC show a decline over time. In 2020, Guttmacher reported 14.4 percent abortions per 1,000 women aged 15 to 44, while the CDC reported 11.2 percent abortions per 1,000 women in the same age range. However, there were slight increases in the late 2010s before a recent stabilisation or slight decrease.

The most common types of abortions in the United States are surgical abortions and medication abortions.

• Medication abortions: This method involves taking pills to terminate a pregnancy. It became more prevalent after the Food and Drug Administration (FDA) approved abortion pills in 2000. In 2020, for the first time, the majority of legal abortions in the U.S. were medication abortions, accounting for 53%. The two pills commonly used together for medication abortions are mifepristone and misoprostol. Mifepristone blocks hormones that support pregnancy, while misoprostol causes the uterus to empty. Medication abortions are considered safe and can be used until 10 weeks into pregnancy, according to the FDA.
• Surgical abortions: These procedures involve physically removing the foetus from the uterus. During the first trimester of pregnancy, surgical abortions typically use a suction process. In the second trimester, a process called dilation and evacuation is used, which involves dilating the cervix and removing the foetus and other tissues from the uterus.

Medical complications from abortions in the U.S. are relatively rare. About 2% of all abortions involve some type of complication for the woman, according to an article in Statpearls, an online healthcare resource. Most complications are considered minor, such as pain, bleeding, infection, and post-anaesthesia complications.

The CDC also calculates case-fatality rates for women from legally induced abortions, which means how many women die from abortion-related complications for every 100,000 abortions. The rate has decreased over time. For example, during the period from 2013 to 2019, the rate was 0.43 percent deaths per 100,000 legal induced abortions, while during the period from 1973 to 1977, it was higher at 2.1 deaths per 100,000 legal-induced abortions.

In 2019, the CDC reported four deaths due to complications from induced abortions, following two deaths in 2018 and three deaths in 2017. Since 1990, the annual number of deaths among women due to induced abortion has ranged from 2 to 12, according to the CDC. The number of deaths from induced abortions was considerably higher in the past, particularly in the 1960s, before abortion was legalised. For example, in 1965, there were 235 deaths from abortions, according to reports by the then-U.S. Department of Health, Education, and Welfare. However, with the legalisation of abortion and improvements in healthcare and safety standards, the number of deaths has significantly decreased over time.

Current legal status of abortion in different states of the US

In the United States, there are many states that have banned abortion after the Supreme Court overturned the decision in the case of Roe v. Wade. However, some states consider abortion legal, and they have not imposed a total ban on abortion. It is important to note that this ruling is not binding on state governments because of the federal system in the U.S. This means states can create their own laws about abortion. The Dobbs case ruling is significant because it might lead to changes in abortion laws across different states. Some states may use this ruling as a basis to introduce stricter regulations on abortion, while others may uphold more lenient laws. The impact of the Dobbs case on abortion laws will vary from state to state, depending on how each state chooses to respond to the ruling. Some of the states and their current legal status regarding abortion are provided below.

Wyoming

In Wyoming, abortion is currently regulated by laws that have been blocked by the courts. Further, in March, Wyoming passed a law called the Life is a Human Right Act in 2023, which specifically bans abortion pills. However, these regulations are not currently enforced due to court intervention. According to Wyoming’s regulations, abortion is prohibited after viability unless it is necessary to save the life of the pregnant person or in cases of medical emergencies. This means that abortions are generally not permitted once the foetus is considered capable of surviving outside the womb, unless there are exceptional circumstances, such as a threat to the life of the pregnant person or medical emergencies.

Alabama

In Alabama, there are laws that make abortion mostly illegal. In May 2019, Alabama passed one of the most restrictive abortion laws, the Human Life Protection Act. The abortion laws in Alabama are very strict. According to Title 26 of the 2022 Code of Alabama, abortion is only allowed if it is necessary to prevent a serious health risk to the pregnant woman. There are no exceptions for cases of rape or incest. Further, Alabama has other laws related to abortion, including bans at twenty weeks post-fertilization and at viability, as well as restrictions on certain abortion procedures. Pregnant individuals in Alabama are also required to undergo a mandatory forty-eight-hour waiting period, biassed counselling, and an ultrasound before obtaining an abortion. The Human Life Protection Act (HLPA) was enacted in Alabama as an attempt to challenge Roe v. Wade. Until June 2022, it served as a trigger law, meaning it would criminalise all abortions immediately if Roe v. Wade was overturned. However, after a final opinion was issued in the case of Dobbs v. Jackson Women’s Health Organization, the injunction against enforcement of the HLPA was dissolved, and the law is now in effect.

Despite these strict laws, abortion remains a controversial issue in Alabama. 

Arizona

In Arizona, abortion is currently legal until the point of viability, which is typically around 24 weeks of pregnancy. In Arizona after Roe v. Wade overturned decisions that ban most abortions. However, exceptions are given in cases where, to save the life of the pregnant woman, abortions are allowed. There is a new bill, SB 1164, set to ban abortions after 15 weeks of pregnancy. This law has an exception if the pregnant person’s life is in danger. So, for now, abortion is legal in Arizona until viability, but there are ongoing legal debates and changes in laws that could affect this status in the future. 

Brittany Fonteno, the president and CEO of the Arizona branch of Planned Parenthood, criticised the ban as “archaic” and expressed concern that it would regress Arizona back nearly 150 years. Further, Senator Krysten Sinema emphasised the importance of a woman’s right to make healthcare decisions in consultation with her family and doctor. She condemned the ruling for removing basic rights that Arizona women have relied upon for over a century and argued that it endangers their health, safety, and well-being. Senator Mark Kelly also criticised the decision, stating that the repeal of Roe v. Wade has set back women’s rights in Arizona by decades. He highlighted the significant impact of the decision, suggesting that it sets women’s rights back 158 years, to a time before Arizona was even a state. Kelly vowed to continue fighting to restore abortion rights for future generations.

Arkansas

In Arkansas, it is now against a law called the Arkansas Human Life Protection Act to have an abortion at any time during pregnancy. This change happened after the Supreme Court said Roe v. Wade was not valid anymore. If someone in Arkansas wants an abortion, they have to wait 72 hours, talk to a counsellor, and get an ultrasound first. Some ways of having an abortion are not allowed, and there are rules against having an abortion for certain reasons, like choosing the sex of the baby or if the baby might have Down syndrome, but the rule about choosing the sex has been stopped for now. If someone under 18 years of age wants an abortion, they need to get permission from a parent, legal guardian, or judge. It is hard to get money from the government or private insurance to pay for an abortion. During the COVID-19 sickness, Arkansas tried to stop abortions for a while but then said they could happen with some rules. The state of Arkansas had a plan in place to immediately stop nearly all abortions if the Roe case decision was overturned. Now, in Arkansas, it is not allowed to have an abortion at all.

California

In California, abortions are legal until the point of viability, which is typically around 24 weeks of pregnancy. The U.S. Supreme Court has acknowledged the right to abortion under the state Constitution, and there are laws in place that protect access to abortion services. So, for now, abortion remains legal in California. In California, individuals who are pregnant have certain legal rights regarding abortion:

• Right to choose before viability: Individuals in California have the legal right to choose to have an abortion before the foetus is considered viable. Before this point, individuals can decide to have an abortion based on their own reasons.
• Abortion for life or health reasons: Individuals in California can also choose to have an abortion at any time if it is necessary to protect their life or health. If continuing the pregnancy would endanger their life or health, they have the legal right to terminate the pregnancy.
• Right to privacy: In California, individuals have the right to make these decisions without interference from the government or other parties. 

The ACLU of Northern California provides a summary of abortion rights in the state, offering information and support regarding these legal protections.

Wisconsin

In Wisconsin, there is a near-total ban on abortions that went into effect shortly after a Supreme Court decision overturned the Roe case. This ban initially caused clinics to stop offering abortion services because of concerns about an 1849 law that seemed to prohibit almost all abortions. However, Planned Parenthood resumed offering abortion services in September 2023 after a court ruling clarified that the 1849 law did not actually prohibit people from seeking abortions.

Currently, in Wisconsin, abortions are prohibited after conception, except when the life of the pregnant person is endangered. So, there is effectively a near-total ban on abortions in the state.

Colorado

In Colorado, abortions are legal throughout pregnancy, and individuals have the right to seek an abortion at any stage of pregnancy. A state law called the Reproductive Health Equity Act in Colorado protects access to abortion services by ensuring that individuals have the legal right to make choices regarding their reproductive health.

Connecticut and Delaware

In Connecticut and Delaware, abortions are legal until viability, which typically occurs around 24 weeks of pregnancy. State laws in Connecticut and Delaware protect access to abortion services by ensuring that individuals have the legal right to make decisions about their reproductive health care.

District of Columbia 

In the District of Columbia (Washington, D.C.), abortions are legal throughout pregnancy. This means individuals have the right to seek an abortion at any stage of pregnancy. The District’s legal code, the Human Rights Act of 1977, protects access to abortion services.

New Jersey 

Abortion is still legal in New Jersey, even after the Supreme Court overturned Roe v. Wade, and individuals in New Jersey have the right to choose whether to terminate or continue a pregnancy as per the Freedom of Reproductive Choice Act of 2021. The Supreme Court’s decision did not affect this right in New Jersey. In New Jersey, individuals have the option to receive a prescription for medication abortion, and they can utilise telehealth services for this purpose. Further, individuals from other states can come to New Jersey for abortion care if they wish. So, basically, in New Jersey, people have the right to make their own choices about abortion, and there are options available for those seeking abortion care.

New Mexico 

In New Mexico, after the Supreme Court overturned Roe v. Wade, abortion will still be accessible. However, the state courts have not decided if the state constitution protects the right to abortion. New Mexico prohibits certain types of abortion procedures, such as D&X procedures. In 2021, the state removed the requirement for parental consent for a minor’s abortion. There are also targeted regulations for abortion providers, including reporting requirements. Violating certain abortion laws can lead to criminal penalties. While New Mexico’s constitution includes an equal rights Amendment, the state supreme court has not confirmed if it protects the right to abortion. New Mexico provides public funding for medically necessary abortions. The governor has issued executive orders to protect abortion providers from out-of-state investigations and legal actions. Further, funds have been allocated to develop a new abortion clinic near the state’s border with Texas. In 2023, the state passed a law to ensure access to reproductive healthcare, including abortion and gender-affirming care. Public bodies are prohibited from interfering with such care and can face penalties for violating the law. Statutory protections shield providers, patients, and those helping others access abortion and gender-affirming care from professional licensure consequences and out-of-state investigations and legal actions. Abortions are prohibited after viability, except in cases of life endangerment or medical emergencies for pregnant women.

New York

In New York, abortion has been legal since 1970, and it is allowed by law. In 2019, a law called the Reproductive Health Act was passed to make sure abortion stays accessible and protected. This law says that abortion is an important part of healthcare. Even after the overturned decision of Roe v. Wade, abortion is still legal. In New York, people can get an abortion up to 24 weeks into a pregnancy without any special restrictions. After that, they can still get an abortion if the baby does not survive after birth or if the pregnant person’s health, including mental health, is at serious risk. Even someone under 18 years of age can get an abortion without informing their parents. Doctors and other healthcare providers in New York have to keep medical information private, including if someone is getting an abortion. In New York, the government covers the cost of abortions, and private insurance companies are required to include coverage for abortion services in their plans. If insurance includes pregnancy care, it must also include abortion care starting from 2023. This makes sure that people can afford the care they need.

Vermont 

In Vermont, abortion will remain legal. The state passed comprehensive abortion rights legislation in 2019, and voters approved Proposal 5 in November 2022, which solidifies reproductive freedom in the Vermont constitution. Vermont requires abortion providers to submit reports to the state, but there are no significant restrictions on the types of healthcare practitioners who can provide abortion care. Vermont has statutory protections for abortion as a fundamental right throughout pregnancy. Public funding is available for medically necessary abortions. Additionally, in 2023, the state passed laws to protect healthcare providers, patients, and those aiding others in accessing abortion and gender-affirming care from facing consequences related to their professional licences and from investigations or legal actions originating from outside the state. Vermont previously had a law imposing criminal penalties on third parties involved in abortions, but it was declared invalid by the Vermont Supreme Court in 1972 and repealed by the legislature in 2014.

Virginia 

Abortion is legal in Virginia until the third trimester of pregnancy. While the state Supreme Court has not recognized a right to abortion under the state Constitution, there are also no state laws specifically protecting access to abortion. Section 18.2-76 of the Code of Virginia says that, before a doctor or a special nurse can do an abortion or any other procedure to end a pregnancy, they have to get written permission from the pregnant woman. If the woman cannot make decisions for herself because a court says she cannot, or if the doctor or nurse thinks she cannot, then they need written permission from a parent, guardian, or someone else trusted to make decisions for her.

West Virginia 

The legality of abortion in West Virginia is uncertain. The state could attempt to enforce its pre-Roe law, which bans all abortions except those necessary to save the life of the pregnant person. However, this law was deemed unconstitutional by the 4th Circuit Court of Appeals in 1975. There is ongoing debate among proponents and opponents of abortion rights about whether this law could be enforced without further court action. Subsequently, on September 16, 2022, Governor Jim Justice signed House Bill 302 into law, officially banning abortions in West Virginia with limited exceptions. The bill is referred to as the “protect life” law. 

Rhode Island 

Abortions are legal until viability, and a state law called the Reproductive Privacy Act, which was codified into law on June 19, 2019, protects access to abortion services.

Pennsylvania

Abortion is legal up to the 23rd week of pregnancy, and after that, abortions can be performed if the life or health of the pregnant person is in danger. Abortions cannot be based on the sex of the foetus. Some steps must be taken, including confirming the pregnancy with a medical provider, receiving counselling, waiting 24 hours, and giving informed consent. Minors under 18 years of age can get abortions with parental consent or by obtaining court approval through a judicial bypass process. Harassment, intimidation, or interference with accessing abortion facilities is against federal law. If faced with such actions, individuals can call 911 for emergencies or contact local law enforcement or the Federal Bureau of Investigation (FBI). Organisations like the Women’s Law Project and the National Abortion Federation provide information and assistance regarding abortion rights and access in Pennsylvania.

South Dakota 

Abortion is illegal in South Dakota, except in cases where it is necessary to save the life of the pregnant person. The state has a trigger law, SL 2005, ch. 187, § 6, that immediately prohibits all abortions upon the U.S. Supreme Court’s decision to overturn Roe v. Wade.

Tennessee 

Abortion is temporarily legal until viability in Tennessee. However, the state has a trigger law that will ban nearly all abortions 30 days after the U.S. Supreme Court overturns Roe v. Wade. This law contains an exception for cases where it is necessary to save the life of the pregnant person.

Oregon 

Abortions are legal throughout pregnancy, and a state law called House Bill 3391 protects access to abortion services.

Utah

In Utah, the legal status of abortion is currently uncertain due to legal complications. Abortion is technically legal in Utah, but there are significant restrictions in place. The state passed a law in 2020 called the “trigger law,” called Senate Bill 174 (SB174). This law would make abortion mostly illegal in Utah, except in cases where the life of the mother is in danger or if there is a risk of permanent impairment of body functions. The United States Supreme Court overturned Roe v. Wade in June 2022, leading to Utah’s abortion ban. The law includes narrow exceptions, such as cases of rape, incest, the life of the mother, and certain foetal abnormalities. However, enforcement of this law is on hold because organisations like Planned Parenthood and the ACLU are challenging its constitutionality. Some politicians in Utah, like Senator Dan McCay and Senator Mike Lee, are supportive of restricting abortion. They believe it is important to protect unborn lives and that each state should have the right to make its own laws regarding abortion. Further, a new law called House Bill 467 was passed in 2023. This law would make it more difficult to get an abortion by requiring it to be performed in a hospital and placing stricter regulations on abortion clinics. However, Utah’s abortion laws are facing legal challenges and ongoing debates regarding reproductive rights and access to abortion services. 

Texas

Following the Supreme Court’s decision overturning Roe v. Wade on June 24, 2022, abortion is now banned in Texas. The new law, the Texas Heartbeat Act of 2021, imposes strict restrictions, prohibiting abortions once cardiac activity is detected in the embryo, typically around five to six weeks into the pregnancy. In Texas, abortion is highly restricted by law. A law passed in 2022, known as Chapter 170A of the Texas Health & Safety Code, prohibits almost all abortions except in certain circumstances. According to Section 170A.002 of the said Code, performing or inducing an abortion is generally banned, except when the life or health of the pregnant person is at risk. Further, each violation of the law can result in a civil penalty of at least $100,000, along with attorney’s fees and court costs. This penalty is separate from any other civil liabilities a person may face. Moreover, healthcare professionals who violate the law could have their licences or permits revoked. Furthermore, the law does not provide exemptions for cases of rape or incest, only allowing for a narrow exemption in cases of medical emergencies. As a result, access to abortion in Texas has become severely limited.

Florida

The recent actions by Florida lawmakers and Governor Ron DeSantis have made the state one of the most restrictive in the country regarding abortion rules. They voted to prohibit abortions after six weeks of pregnancy by passing Senate Bill No. 300. Florida will now have some of the strictest abortion rules in the country. Before this change, Florida was a common place for people from nearby states to go for abortions. Now, individuals seeking abortions may have to travel farther to states like North Carolina or Illinois for care. The decision came after the Supreme Court said states could make their own abortion rules. Those who support abortion bans claim it is about protecting life and altering the current state of affairs regarding abortion. State Representative Jenna Persons-Mulicka emphasised the importance of standing for life and supporting Florida families through this legislation.

Georgia

In Georgia, abortion is legal until a heartbeat is detected in the embryo, which usually happens around the 5th or 6th week of pregnancy. This rule was enforced on July 20, 2022, after the Supreme Court decision in the case of Dobbs v. Jackson Women’s Health Organization.

Since 2007, Georgia has had rules saying people seeking abortions must get an ultrasound first. Georgia has been trying to make abortion harder since 2011. In 2019, they tried to pass a law making abortion illegal as soon as a heartbeat is detected in the embryo, usually around six weeks into pregnancy. But a federal judge said this law went against a big Supreme Court decision from 1973, so it did not go into effect. There is a protest in Georgia fighting for abortion rights. They got a lot of donations after the 2019 law was passed. As of July 20, 2022, House Bill 481 banning abortion after a heartbeat is detected is in place. However, in the cities of Atlanta and Savannah, abortions after the fifth or sixth week of pregnancy are not considered crimes.

South Carolina

In South Carolina, there has been a big change in the law about abortion because of a recent decision by the state’s highest court. The court said it is permissible to enforce the “Heartbeat Protection Act of 2021.” This law says most abortions cannot happen after six weeks of pregnancy, when the baby’s heartbeat can be heard. But there are some exceptions, including if the pregnant person’s life is in danger or if the baby has a serious problem that cannot be fixed. There are also limited exceptions up to 12 weeks for victims of rape and incest. But groups like Planned Parenthood South Atlantic and other medical providers do not agree with this decision. They say it will hurt the people of South Carolina in a way that cannot be fixed.

Effect of such a ban

The Supreme Court’s decision in June 2022 to overturn Roe v. Wade changed the rules about abortion across the country. Accordingly, each state could make its own laws about abortion. After this decision, 13 states quickly put into action what are called “trigger laws.” These laws had been waiting around, ready to go into effect if Roe v. Wade was overturned. These trigger laws promised to make abortion illegal or harder to get in those states.

Abortion bans would affect many women, about one in four aged 15 to 44, who decide to have abortions. If the Supreme Court lets states say abortion is not a crime, about 16 states would still allow it because their state laws protect it. But, in the other 34 states, people would talk about making abortion illegal and when it could still be allowed.

In states where the rules are more relaxed, getting an abortion would still be possible. But, in stricter states, it would be hard, especially for those who cannot travel for it. Abortion rules often mean people have to pay a lot, wait a long time, and have fewer places to go for help.

At times, laws like TRAP make it extremely difficult for abortion clinics to remain operational, often leading to their closure. This makes it even harder for certain groups, especially those who do not have much money or who come from communities with more people of colour. When safe abortion care is not easy to find, some people might turn to risky options like buying pills from unsafe places. This can be really dangerous. It can also make them feel really sad or even make young people think about hurting themselves.

Non-profit groups assist individuals in affording abortions, without their help, some people might be forced to have babies they do not want or cannot afford, or they might resort to unsafe methods to end a pregnancy. Even though it is hard, supporters keep fighting for the right to choose and for safe abortion care.

Since Roe v. Wade case was overturned, almost 20 states have made it harder or even impossible to get abortions, especially those with low incomes and from communities that are often treated unfairly and might have to have babies they did not plan for.

But are these states ready to help these parents and kids? Sadly, the evidence suggests many families will struggle. In states with tough abortion laws, mothers and kids have less access to healthcare and money, which leads to worse health problems.

An expert from the Brookings Institution, Stuart Butler, says this is like a double punch for people in these states, especially in the South. They are less likely to get help for themselves and their kids, and they have less access to healthcare during pregnancy and for their kids afterwards. This could mean more tough times, health issues, and even deaths unless things change.

Studies show that being refused an abortion can cause big problems for people and their families, like money troubles and feeling bad. A Turnaway Study found that people who could not get an abortion had worse money and mental health than those who got one.

Dr. Diana Greene Foster, who led the Turnaway Study, says not being able to get a safe and legal abortion can cause long-lasting harm, both to health and finances. Sadly, without better help from society, these problems will keep happening. Even before the recent legal changes, the states with the toughest abortion laws already had the worst health outcomes for mothers and kids. This shows how important it is to have good support systems for families, especially in states with strict abortion laws.

Further, before the Dobbs v. Jackson Women’s Health Organization ruling, the 14 states with the strictest abortion laws already had the worst health outcomes for mothers and children in the country. This emphasises the importance of having comprehensive support systems for families, especially in states with restrictive abortion laws.

Researchers from the Johns Hopkins Bloomberg School of Public Health found something interesting when they looked at national surveys. They noticed that in states where abortion was banned after the Supreme Court’s decision, there was a small but significant increase in people reporting feelings of anxiety and depression. This was especially true for women aged 18 to 45.

It seems like changes in abortion laws might be making some people feel more anxious and sad. This shows that laws about abortion do not just affect physical health but can also impact the mental well-being of women.

The Dobbs decision may be causing increased symptoms of anxiety and depression, even in women who are not pregnant or are currently being denied an abortion, for several reasons. One important factor is reproductive autonomy, which means having control over one’s own reproductive choices. This concept is closely linked to personal and economic freedoms, which are also important for mental well-being.

When the Supreme Court overturned Roe v. Wade, it meant that abortion rights, which were once protected by the federal government, could suddenly disappear in a state. This sudden change can make people feel uncertain and worried about their future. Even if someone is not seeking an abortion themselves, they might be concerned about the risks of living in a state where access to abortion is restricted. This uncertainty and fear about losing fundamental rights can affect a person’s overall sense of security and contribute to feelings of anxiety and depression.

Research shows that when abortion access is restricted in states, more people feel anxious and depressed, even if they are not directly affected by the laws. Laws about abortion can make lots of people worried and sad, not just those who want an abortion.

So, it is not just about the immediate impact of limiting abortion. These laws can have other effects too, like making more people struggle with their mental health. When states are thinking about new laws about reproductive health, they need to think about how they might affect people’s mental well-being. This could mean that more people might need help with their mental health, or they might end up using mental health services more often. It is important for policymakers to think about the mental health impact of their decisions when making laws about abortion.

Experts from the United Nations warn that the bans on abortion in the United States are endangering the lives of millions of women and girls. They argue that these bans violate international human rights laws and affect women and girls from different backgrounds, especially those facing challenges like minority communities, migrants, disabled persons, or low income. The bans make it difficult for women and girls to access important healthcare services, violating their rights to privacy, bodily autonomy, and safety. They also create fear among healthcare workers and lead to privacy violations through surveillance technology. The government should change these laws to ensure everyone can access safe and legal abortion care when needed.

Executive order passed by President

President Joe Biden took action to protect abortion rights after the Supreme Court made a big decision against them. Biden said it is Congress’ job to make sure abortion rights are protected by law, and he will sign any bill that comes his way. He also encouraged women to vote for more Democrats who support abortion rights and warned that, if the Supreme Court keeps making decisions against abortion, other important rights might be at risk too.

He signed an order to make sure people can still get abortions and birth control easily. This order also keeps people’s private health information safe and helps them get accurate information about reproductive health care. However, some ideas, like using certain federal places for abortions or clarifying the rules about bringing abortion pills across borders, were not included. Order consists:

• Reports and task force: The President wants a report from the Health and Human Services Secretary about what they are doing to help with reproductive health care access. He is also setting up a task force, including the Attorney General, to work on this issue.
• Access to contraception: The Health and Human Services Department will work to make sure people can get emergency contraception and long-acting reversible contraception, like intrauterine devices (IUDs). They are also making sure patients have full rights to emergency medical care.
• Education and outreach: There will be more efforts to educate the public about abortion rights and access to care.
• Legal representation: Private lawyers and organisations will help people lawfully seeking abortions and those providing them with legal support.
• Protecting privacy: The President wants to protect people’s privacy when they look for reproductive health care services. This includes steps to prevent deceptive practices and ensure access to accurate information.
• Safeguarding information: The Health and Human Services Department will take steps to protect sensitive information related to reproductive health care under the Health Insurance Portability and Accountability Act (HIPAA). They will also issue guidance to clarify when doctors can share patient information.
• Safety measures: The order aims to ensure the safety of people seeking abortion care, including protecting mobile clinics that provide care to out-of-state patients.

Landmark court decisions with respect to abortion

Planned Parenthood of Southeastern Pennsylvania v. Casey (1992)

This case involved a challenge to a Pennsylvania law that placed certain restrictions on abortion, like mandatory waiting periods and requiring women to get counselling before having an abortion.

The main question in this case was whether these restrictions violated the constitutional right to abortion established in Roe v. Wade.

The Supreme Court ruled that some parts of the Pennsylvania law were valid, but others were not. They said that states can regulate or even ban abortion after a foetus becomes able to survive outside the womb, called “viability.” However, they also said that before viability, women have a constitutional right to choose to have an abortion. The Court said that states can put some restrictions on abortion, like waiting periods or counselling, but they cannot make it too hard for women to get an abortion. If the restrictions create an “undue burden,” that is, they make it too difficult for women to access abortion, then they are not allowed. So, in essence, the Court said states can regulate abortion, but they have to do it in a way that does not unfairly burden women seeking abortions.

Gonzales v. Carhart (2007)

The case involves the constitutionality of the Partial-Birth Abortion Ban Act, which was passed by the U.S. Congress in 2003 and made it illegal to perform a specific type of abortion procedure called intact dilation and extraction. This procedure is often referred to as “partial-birth abortion.”

The issue was raised in 1992 with regards to whether the Partial-Birth Abortion Ban Act violated the Constitution, specifically the right to abortion established in Roe v. Wade and subsequent cases?

The Supreme Court upheld the Partial-Birth Abortion Ban Act as constitutional. They said that banning this specific abortion procedure did not create an “undue burden” on women seeking abortions. The Court determined that the government had a legitimate interest in regulating this particular procedure because it believed it was cruel and inhumane. Therefore, the ban was allowed to stand, and intact dilation and extraction became illegal in the United States.

Whole Woman’s Health v. Hellerstedt (2016)

In 2013, Texas passed a law called House Bill 2 (HB2) that put tough rules on abortion clinics. One rule said abortion clinics had to be as safe as surgery centres. Among its provisions, the rule HB2 states that doctors doing abortions had to be able to admit patients to nearby hospitals.

The main issue in this case was whether these rules were fair or whether these rules made it too hard for women to get abortions, which is a right protected by the Constitution.

The Supreme Court said the rules in HB2 were not fair. They said the rules made it too hard for women to get abortions without making them any safer. They decided that these rules went against the Constitution and could not be enforced. So, this decision highlights that abortion clinics in Texas could keep operating without following the strict rules of HB2.

June Medical Services v. Russo (2020)

In 2014, Louisiana enacted a law called Act 620. This legislature mandated that doctors providing abortion services must obtain admitting privileges at hospitals within 30 miles of their clinics. This requirement essentially meant that abortion providers had to establish a formal relationship with a nearby hospital.

In this case, the central issue at hand was whether Act 620 violated the constitutional right to abortion established in the case of Planned Parenthood of Southeastern Pennsylvania. v. Casey by imposing an undue burden on women seeking abortion services.

The Supreme Court struck down Act 620 as unconstitutional. They determined that the requirement for admitting privileges did not significantly enhance the safety of abortion procedures. Instead, it created a substantial burden for women seeking abortions without any valid medical justification. Consequently, the Court ruled that Act 620 contravened the constitutional right to abortion as recognized in Planned Parenthood v. Casey and was, therefore, invalid.

This decision highlights that women in Louisiana could continue to access abortion services without needing their doctors to have special hospital connections.

Conclusion

Abortion bans in the United States make it difficult for people to get the healthcare they need. Even though the Supreme Court’s ruling does not force states to follow it because of the way the U.S. government works, it still has a big impact on society. States now have more freedom to make their own abortion laws based on what the Supreme Court said.

Abortion laws are different in each state and often affect certain groups more than others. Even though initial court cases like Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania. v. Casey protected the right to abortion; in later days, these decisions were overturned in the case of Dobbs v. Jackson Women’s Health Organization, making it harder to get an abortion.

Abortion bans are especially hard on people who are already facing challenges, like those who do not have much money, people of colour, LGBTQ+ folks, and those who live far from cities. Laws like “heartbeat bills” and “personhood” rules make it more complicated to get an abortion, which can be confusing and stressful. 

These laws do not just affect abortion; they also make it harder to get other kinds of healthcare, like birth control, pregnancy checkups, and care for mothers. Also, laws that stop government money from paying for abortions, like the Hyde Amendment, make it even harder for some people to get the care they need.

Despite these challenges, there are groups fighting against these laws. They are using the law and getting involved in politics to try to change things. It is important for everyone to support the right to make our own choices about our bodies and to ensure that everyone can get the care they need, no matter who they are or where they live. 

Frequently Asked Questions (FAQs)

Are there organisations that provide assistance to women facing abortion bans?

Yes, there are several organisations that offer support, resources, and assistance to women affected by abortion bans, including Planned Parenthood, NARAL Pro-Choice America, the American Civil Liberties Union (ACLU), and various local and regional abortion funds.

What is the current status of abortion bans in the US?

The status of abortion bans varies by state and is subject to change due to ongoing legal challenges and legislative actions. Some states have successfully passed restrictive abortion laws, while others have faced legal setbacks or have laws that are temporarily blocked by court injunctions.

What is a “personhood” Amendment and how does it affect abortion laws?

A “personhood” Amendment is an established law or constitutional change that gives legal personhood to foetuses. This means it considers the foetus as a separate legal person with rights from the moment of conception. These amendments are intended to effectively ban abortion by granting legal rights to the foetus.

What is the “global gag rule” and how does it relate to abortion bans in the US?

The “global gag rule,” also known as the Mexico City Policy, is a US government policy that prohibits foreign non-governmental organisations (NGOs). Such organisations receive US funding for providing or promoting abortion services, even with their own non-US funds. This rule stops international organisations from talking about or providing abortions. Even if these organisations get money from sources other than the US, they cannot offer abortion services or talk about them. This rule makes it harder for people in other countries to access important information and services related to reproductive health.

References 

• https://www.ohchr.org/en/press-releases/2023/06/united-states-abortion-bans-put-millions-women-and-girls-risk-un-experts-say
• https://www.forbes.com/sites/alisondurkee/2023/03/02/us-abortion-bans-are-a-human-rights-crisis-that-violate-international-law-groups-tell-un/?sh=3cd377494c62
• https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html
• https://www.britannica.com/science/abortion-pregnancy
• https://www.oyez.org/cases/2021/19-1392
• https://constitutioncenter.org/the-constitution/supreme-court-case-library/dobbs-v-jackson-womens-health-organization
• https://www.wthr.com/article/news/health/fetal-viability-explained/531-c39665b1-1bcd-46d3-88be-4620894b23a5
• https://academic.oup.com/jlb/article/7/1/lsaa059/5918485
• https://reproductiverights.org/targeted-regulation-of-abortion-providers-trap/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857800/#:~:text=The%20nine%20member%20US%20Supreme%20Court%20ruled%20five,to%20protect%20women%27s%20health%2C%20not%20just%20their%20lives.
• https://crsreports.congress.gov/product/pdf/IF/IF12167
• https://www.law.cornell.edu/wex/partial-birth_abortion_ban_act_of_2003
• https://publichealth.jhu.edu/2024/abortion-bans-impact-on-mental-health
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9873925/
• https://www.healthywomen.org/your-care/abortion-opponents-chipping-reproductive-rights
• https://www.theguardian.com/us-news/2022/jun/24/how-americans-lost-federal-abortion-rights
• https://www.politico.com/news/2022/06/24/abortion-laws-by-state-roe-v-wade-00037695
• https://www.washingtonpost.com/politics/2022/06/24/abortion-state-laws-criminalization-roe/
• https://www.theguardian.com/us-news/2022/sep/24/arizona-abortion-ban-law
• https://reproductiverights.org/maps/state/alabama/
• https://reproductiverights.org/maps/state/arkansas/
• https://www.theguardian.com/us-news/2023/oct/24/georgia-abortion-ban-supreme-court
• https://faq.sll.texas.gov/questions/46594
• https://www.deseret.com/utah/2023/6/23/23771511/utah-abortion-law-after-roe-v-wade-dobbs
• https://edition.cnn.com/2023/08/23/politics/south-carolina-supreme-court-six-week-abortion-ban/index.html
• https://edition.cnn.com/2022/07/08/politics/what-is-in-biden-abortion-executive-order/index.html
• https://abcnews.go.com/Politics/biden-signs-executive-order-abortion-access-amid-pressure/story?id=86447547
• https://www.nj.gov/oag/library/2022/Know-Your-Rights-Abortion-Rights-06-30-22.pdf
• https://reproductiverights.org/maps/state/new-mexico/#:~:text=While%20the%20New%20Mexico%20Constitution%20contains%20an%20equal,provides%20public%20funding%20for%20medically%20necessary%20abortions.%20
• https://reproductiverights.org/maps/state/vermont/
• https://ag.ny.gov/publications/abortion-legal-and-protected-new-york-state