(NEW YORK) — The landscape of abortion rights has shifted dramatically in the 11 months since the U.S. Supreme Court overturned Roe v. Wade, ending federal protections for abortion rights.
The decision left it up to states to decide how to regulate abortion services.
States in the West and Northeast have since taken steps to expand and protect abortion rights, while states across the South, Great Plains and Midwest have moved to ban or restrict abortion care.
Sixteen states have ceased nearly all abortion services.
South Carolina became the latest state to greatly restrict abortion access this week after its governor signed a six-week ban into law.
Florida could be the next state to severely restrict abortion services. If a state court upholds a 15-week abortion ban, a new six-week abortion ban will go into effect.
The ban would prohibit all abortions after fetal cardiac activity is detected, which generally occurs around six weeks of pregnancy, before most women know they are pregnant. The ban makes exceptions for when the woman’s life or health is at risk and cases of rape or incest, under certain conditions.
If allowed to go into effect, the ban will limit access to many women in the South who live in areas where Florida would have been the closest state where they could access care.
Medication abortions
Meanwhile, a court case in Texas is seeking to revoke the Federal Drug and Food Administration’s approval of one of the medications used in chemical abortions — mifepristone — across the country, even in states where abortion is protected.
The case is currently before the Fifth Circuit Court of Appeals but is expected to reach the U.S. Supreme Court. Mifepristone remains available while the case continues.
Wyoming became the first state to ban medication abortions in March.
How abortion bans largely work
Nearly all bans throughout the country target physicians, making it illegal for them to provide abortion services punishable by fines, jail time and their medical licenses being revoked.
Some bans — modeled after a Texas law — make it a crime to aid women in accessing abortion care and establish civil liability against individuals who violate state bans.
Texas, which has several abortion bans in place, allows people to sue anyone who “aids or abets” an illegal abortion, to collect a bounty of at least $10,000.
Physicians warn that the anti-abortion landscape in some states will discourage doctors and future doctors from moving to states banning or restricting abortion. This could also have implications for reproductive and female health care in the states.
Residency programs in states with bans in place saw a drop in the number of OB-GYN residency applications, according to recent data from the Association of American Medical Colleges. While there was an overall decrease in the number of all residency applications submitted in 2023, the decrease was sharper in states with complete bans compared to states without restrictions, according to the data.
There was a 10.5% decrease in OB-GYN applicants in states with complete bans in 2023 compared to 2022 residency applications, according to the study. In states without restrictions, the decrease was only 5.3%, data shows.
How pregnant women are being affected
Some women have come forward with stories about how abortion bans have impact them and their access to reproductive health care. In a first since Roe was overturned, 15 Texas women filed a lawsuit against the state, saying that its near-total ban put their lives in danger.
Abortion ban challenges in other states face legal challenges from abortion providers, on behalf of their patients, abortion clinics and pro-abortion rights groups.
Kylie Beaton, a woman in Texas, told ABC News she was forced to carry a nonviable pregnancy to term, watching her son die days after he was born. Beaton was unable to access care in New Mexico because she was too far along when she received her diagnosis — past the facility’s cutoff point — despite the state allowing abortion at all stages of pregnancies.
The only other option was a facility in Colorado that provided late-term care, but Beaton and her husband could not afford the $10,000 to $15,000 it would have cost. Beaton has since joined other women suing Texas over its ban.
Women forced to travel to receive abortion care also risk having to continue further along into their pregnancies. The further along a pregnancy, the more complex, risky and expensive the abortion care.
Even with exceptions to abortion bans, women have reported having to wait until their health deteriorates or until their life is in danger before they could get care in states with near-total or total bans.
“Heartbeat” laws which prohibit abortions when cardiac activity can be detected have in some cases complicated care for women whose water breaks before their pregnancy is viable.
Kristen Anaya, who lives in Texas, told ABC News she had to wait until she went into sepsis before she could get abortion care because her fetus still had a heartbeat, despite her high fever and shaking uncontrollably for hours — both signs of an infection.
In Florida, Anya Cook was sent home from a hospital after losing nearly all her amniotic fluid because she wasn’t at a high risk for any complications, despite the risk that she could go into sepsis without delivering the fetus—which can be fatal. She later delivered in the bathroom of a hair salon, bleeding so much she lost half the blood in her body and had to be hospitalized for six days, she told ABC News.
She needed two subsequent procedures to remove the remainder of her placenta. This pregnancy was her 17th miscarriage in just two years, she told ABC News.
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