The State Of Abortion Access In 2026

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0:21It's been nearly four years since the Dobbs decision that overturned Roe v. Wade. My choice! My body! My choice! My body! My choice! Since then, abortion access across the U.S. has changed rapidly, and the fight around care continues. 13 states now have a total abortion ban, while five have restricted it after six weeks of gestation. The latest is Wyoming. Republican Governor Mark Gordon signed that bill into law last month. But in Wyoming and elsewhere, legal challenges are keeping abortion laws in constant flux and adding uncertainty around reproductive care. Recently, a Georgia a woman was released on bond after being charged with murder for allegedly using an abortion pill to terminate her pregnancy.

1:05New data from the Guttmacher Institute finds that the number of abortions has remained relatively unchanged from 2024 to 2025, in large part because of medication abortions. Republicans are now cracking down on these medications, requesting an investigation, and pushing the FDA to review their safety. I'm Jen White. You're listening to the 1A Podcast. We'll be back with more after this short break. Stay with us.

1:34These days, it feels like the news changes every hour. Well, NPR has a podcast that does that too. NPR News Now brings you a fresh five-minute episode every hour of the day with the latest, most important headlines in episodes that are clear, fact-based, and easy to digest. Listen to NPR News Now on the NPR app or wherever you get your podcasts. Welcome back to the 1A Podcast. Today, we're discussing abortion access nearly four years after the overturn of Roe v. Wade. Let's meet our guests. Mary Ziegler is a law professor at UC Davis. She's also the author of Personhood, the New Civil War over Reproduction, and Roe, the History of a National Obsession.

2:18Mary, welcome back to the program. Thanks for having me. Also with us, Shefali Luthra. She's a reproductive health reporter at the 19th and author of Undue Burden, Life and Death Decisions in Post-Roe America. Shefali, great to have you join us again. Thanks for having me. And Kaylee Baden is with us. She's the vice president for public policy at the Guttmacher Institute. That's a research organization which aims to advance reproductive rights. Kaylee, it's great to have you. Great to be here. Thank you. So let's talk through the latest data on the number of abortions across the U.S. Kaylee, talk us through this new report from the Guttmacher Institute.

2:51Yeah, absolutely. Thanks so much. So at Guttmacher, we provide estimates on the numbers of clinician-provided abortions, really so we can understand how legal and policy changes are playing out for the many people who need abortion care. So we did just release new data with those estimates for 2025, as well as looking at the state-by-state data, and particularly the numbers and travel patterns for folks who travel across state lines to get abortion care. And so we already knew that overturning Roe v. Wade did not stop abortion, and we are seeing that continue to be true. So our 2025 numbers, as you said, remain relatively stable compared to 2024.

3:29And I think it's important for people to know that's an increase since the pre-dobst time period. We have numbers from 2019 and 2020 in particular. And so I think the takeaway is that despite the 13 states that have banned abortion, people are still needing and getting abortion care. In fact, they're doing so in higher numbers than while Roe stood. And there's a lot of things we could get into about what that looks like and what that means. Well, one of our text club members writes, people just travel out of state. They go on vacation. Mandates don't change behaviors. Were you able to drill down on how many people are traveling for abortion care?

4:02We are, yes. So, first, important to know, interstate travel for abortion care happened while Roe stood, of course, for many reasons. Policy ones, geographic ones, personal preference. before the Dobbs decision of returning a row, about one in five patients traveled across state lines for care. We saw that nearly double. And we have seen those numbers continue to hold. We've had a little bit of a decline in crossing state lines for travel. Nationally, about 142 ,000 people traveled across state lines to get an abortion in 2025. As I said, that's a little bit of a decline from 2024 and down from its peak in 2023, kind of right after the Dobbs decision.

4:40It is still a significant amount of people and I think a really critical part of the abortion provision infrastructure. Shefali, I want to bring in some interesting new reporting from you. People may be traveling for care, but abortion laws are now also affecting the rental market. What did you find? I wrote about this study that I just found so fascinating. It's one of a growing body of academic literature that looks at how abortion bans and abortion law are changing these other components of how we live and where we live and what our lives are like based on whether a state allows or does not allow abortion.

5:16And this particular paper looked at rental markets that were comparable and trending in the same direction before the Dobbs decision. And what they found was that there was actually a very clear and fairly immediate consequence when states implemented abortion bans. Places with more restrictions saw decreases in rent and increases in vacancies. and the researchers I spoke to were struck by how substantial this was and how clear it was and what they said was this is showing that people when they have a choice are factoring in abortion law as a reason to live somewhere and they are choosing to live somewhere with more permissive laws as opposed to less permissive ones and with rent in particular you're not locked in because you don't own your property you have some freedom to pick where you will live and this reflects what we are seeing in reality as well.

6:08We know that people have moved. We know that doctors in particular have chosen where to live and where to practice based in part on a state's abortion laws. I think this is really important because it shows that this is not necessarily a niche or limited to health issue. It has dramatic implications for virtually all sectors of our economy. Well, that echoes a message we got from one of you. I live in a forced birth state. It prevented me from having a third child and made my husband get a vasectomy. It's too dangerous to be pregnant in Alabama. We've considered moving and family members have rejected med school here because of the total ban.

6:47We will encourage our children to leave Alabama for college and move. Mary, the overturning of Roe created this patchwork of abortion laws in the U.S., one that's constantly changing. As we said, the latest is out of Wyoming, which just passed a law that would restrict abortions after six weeks. Talk us through that change and what stands out to you around what happened in Wyoming. Well, Wyoming is very much in flux because there we have a state Supreme Court that recently struck down another state abortion ban, a more stringent one, on the theory that abortion is protected by the state's constitution which was actually itself changed as part of the backlash to Obamacare to recognize what the Constitution called a right to health.

7:35So we don't know whether the Wyoming Supreme Court will invalidate this new restriction, although that seems relatively likely. But we also don't know how far these rights to health amendments will go in securing access in other states. It's an interesting kind of unintended consequence of fights about Obamacare that we're now seeing them repurposed in the fight to expand abortion access. Well, we've been hearing from many of you. Another member of our tech club writes, I had an abortion in Georgia before the six-week restriction went into effect. I didn't learn about the genetic problems of the fetus until after six weeks, so I wouldn't be able to get that abortion now.

8:17I would have to carry an unviable fetus to full term and give birth if I had those circumstances today. Thank you for sharing that with us. You can add your voice to the conversation. If you live in a state where access to abortion care has shifted, what have those changes meant for you or your loved ones? If you're a provider in a state that has restricted access, what has that meant for you? We'd especially love to hear from providers for a future show, too. So email us at 1a at wamu.org. Shefali, we mentioned this case out of Georgia. A woman was charged with murder after allegedly taking an abortion pill to terminate her pregnancy.

8:53Give us a quick rundown of the details of that case. So, as you mentioned, this woman was charged with murder after allegedly taking medications to end her pregnancy. This happened in December. She was brought to court in the past couple of weeks. And the judge and, in fact, the district attorney have both expressed some skepticism about whether there actually is a strong case against her, whether Georgia's abortion law or murder laws in general can be used to target this woman in particular or the pregnant person. And this is really important because it's a very clear source of tension in the anti-abortion movement.

9:35It's kind of a next frontier, if you will, this question as to whether abortion laws can be used to target people who themselves get abortions. We're still waiting to see the next steps in this case. The woman was released on bond. the judge set a very, very low bond, a bond of$1 for the murder charge in particular, which indicates, many say, that he doesn't necessarily think this is a very strong argument. But we will be looking to see if a law like the Georgia law in particular is used in this vein again, because it does have language in there that suggests a fetus has the same rights as a person.

10:17And that's really important. That opens up a whole world of possible charges against people who get abortions, if you think about this in an intellectually consistent way. And, of course, this is not the only time or the first time that law enforcement officials have tried to target a pregnant person for abortion. There hasn't really been—oh, I'm sorry. Yeah, but I wanted to hear from Mary on this. From a legal perspective, if the prosecutors are expressing skepticism around the facts of this case, how does a case like this move forward? How do you end up with someone being charged? Well, I think there are two main ingredients.

10:55The first is that prosecutorial decisions are really decentralized. So you can have a single prosecutor committed to a prosecution like this moving forward even without support from state officials at a higher level. The second factor is that Georgia's law, like so many abortion restrictions and bans, is written ambiguously. So prosecutors here are leaning really hard on the fact that after this woman took misoprostol, an abortion pill, there was later a live birth. So they're saying this is not just someone being prosecuted for a classic abortion. They're arguing the live birth somehow made a difference.

11:29It's not clear that that's going to hold up legally. But Georgia's law isn't written to be a beacon of clarity. And it does recognize this idea of fetal personhood, which is incredibly ambiguous in American law. There's lots of references to constitutional or other legal rights that begin when an egg is fertilized. And we don't know how or to what extent those are going to be enforceable. So I think it's in that gray area that we see this kind of charge moving forward. We have to go to a quick break, but before we do, we got this text from one of you. My daughter is six. I've stockpiled Plan B medications for her just in case.

12:05Will they be expired by the time she needs them? Probably, but at least she'll have something. Coming up, how Republicans are trying to crack down on access to abortion medications. That's after this break.

12:20Let's get back into what abortion access looks like in the U.S. today. And we're hearing from lots of you. A member of our text club writes, I proudly live in Colorado where we have very strong abortion access supported by most citizens and very high quality services available. Local providers have experienced a large increase in out-of-state pregnant people seeking services here. Another text club member writes, I'm very happy with these decisions because fewer babies are being killed. And another of you shares this, the life of the mother should always be more important than the embryo, but this heartbeat thing is ridiculous and infuriates me.

12:53But my generation fought for this freedom, and somehow the subsequent generations didn't appreciate it and let it evaporate. We'd love to hear your perspective and questions. Has your state been affected by the overturning of Roe v. Wade? Email us at 1a at wamu.org. We also got this. After I had my child, I was someone who had a pill abortion at home that was unsuccessful. It caused extreme bleeding, which forced me to go to the ER because of fear of bleeding out. I had to have an urgent medical abortion at the emergency room. They saved my life. I worry deeply about cases like mine where the pill does not fully work and they require medical care in a state where abortion is illegal.

13:31Mary, it seems that the Georgia case is a possible example of that experience. What are the implications more broadly of a case when a person comes into an emergency room seeking care? it may not be clear whether or not they took an abortion pill to terminate a pregnancy, but the providers maybe think there's that possibility. Yeah, we've seen an uptick in prosecution for conduct during pregnancy after Dobbs, a pretty substantial one. And we've also seen that a lot of the cases that end up moving forward in some way or another are initiated by health care providers who have suspicions that someone did in fact have an abortion rather than just experiencing a miscarriage.

14:17So I think the implications are twofold. One, of course, that means that people who are experiencing abortion-related complications may be exposed to criminal charges in ways we weren't used to before, or even just investigation and surveillance in ways that we might not expect. It also means there can be unintended consequences for people experiencing stillbirth and miscarriage because it can be quite hard to know or distinguish between abortion and miscarriage when someone is just presenting at a hospital. So that role of health care providers sometimes as informants will probably make pregnancy more dangerous for a variety of folks and make some people experiencing either miscarriage really or abortion-related complications reluctant to go to the emergency department because they might be afraid that they'll be perceived as having done something wrong.

15:09Well, as we mentioned, we heard that we're seeing many people travel out of state for care. 22 states plus the District of Columbia have adopted shield laws for reproductive care. Kelly, explain what these shield laws are and how telehealth and medication abortion fits in. Absolutely. And first, let me just start that medication abortion is well-studied, incredibly safe, used in at least 100 countries. And our data show it's about at least 65 percent of abortions in the U.S. right now are provided via medication abortion. And so the shield laws are an important part of that. They're essentially legal protections enacted by states that minimize legal risks for usually abortion providers, sometimes gender-affirming care providers, and sometimes patients or others who kind of assist in helping match a patient to abortion care.

15:58And they really are designed to prevent out-of-state legal actions from affecting that provider in the care within the shield state, right? So really trying to make sure that an abortion ban's state laws don't and can't extend beyond the borders of that state. And they're really a core part of what we are seeing of the abortion provision landscape today because we have these eight states, as you said, who extend their protection to telehealth. And that is where we're able to ensure that a patient in Louisiana, for example, can get safe, legal, high-quality abortion care using telehealth under that protection of S.H.I.E.L.D.

16:34laws. Well, a joint statement with 13 organizations include the American, including rather the American College of Obstetricians and Gynecologists and the American Society for Reproduction say, quote, Our organizations maintain that mifepristone is a safe, effective, and integral part of the medical care that our members provide to their patients. We urge availability of mifepristone that is equitable, is free from needlessly burdensome restrictions, and reflects the full body of reputable, peer-reviewed, and scientifically valid medical literature demonstrating that mifepristone is an incredibly safe medication.

17:10But when we look at the implications of this, again, patchwork of abortion laws across the country, Mary, what sort of legal challenges are we seeing to shield laws? Well, there's really kind of a grab bag of challenges to shield laws. We're seeing states, particularly conservative attorneys general, trying to punch a hole through shield laws, through lawsuits and also attempted criminal prosecutions. We're seeing individual anti-abortion lawyers bringing wrongful death lawsuits, all of which are designed in some way to establish that a 19th century obscenity law operates as a de facto abortion ban.

17:52And in a kind of parallel but related development, we're seeing conservative attorneys general fighting with the Trump administration and trying to get the Trump administration to require people to meet with a physician in person before they can get that abortion medication, which would, of course, make shill laws sort of moot. So, shield laws are under fire in three different directions in lots of cases that are unfolding in federal courts. So, we're sort of at this moment of, I often compare it to, you know, there are lots of loaded guns lying on a table, and we don't know who's going to pick one up or when or what will happen.

18:25But there are a lot of these kinds of really potentially consequential developments that are still pending. We got this from another member of the Tex Club. I want my daughter to move out of state. Texas is not safe for young women. In Texas, residents are now able to sue people who they suspect are distributing abortion pills. Mary, what do we know about the success of these? These are civil cases. Yeah, it's still very early. And one of the things, of course, is these suits are designed to be applicable to folks who are not in Texas, right? So essentially to say, hey, you're a shill doctor in California.

19:02You're mailing pills into Texas. Texas law now says you can be sued for that. Now, of course, the complexity there is that California says, actually, no, we have a Sheil law. You can't do that. So sooner or later, we expect that that question is going to be posed to the federal courts, because when states can't disagree, can't agree on fundamental questions like this, that raises constitutional issues. It raises questions about which state's law even applies in the first place. And often it's federal judges who have to be brought in. So, so far, Sheil laws have held up, but we're in very early days, right?

19:35I mean, we really haven't seen any kind of meaningful federal litigation come to any kind of conclusion. So in terms of the fate of SHIELD laws, we really have to kind of follow this over the course of time and wait and see. I want to talk a bit about medication abortion in just a moment, but we've gotten two really interesting messages. One from Travis, who emails, I am the medical director for a perinatal hospice and palliative care program. We work with women and families who are carrying a pregnancy with known or suspected life-limiting diagnoses. Since bans have gone into place, shared decisions between women and their doctors have been significantly limited.

20:12Women no longer have the ability to choose how their pregnancy progresses in the face of known life-limiting diagnoses for the fetus. And we also got this from Denise, a sustaining member of MPR, who emails, I am a lay sex educator for the Unitarian Universalist Association sexuality education program. For the past four years, I've been leading sexuality education classes for eighth graders in Minnesota. We've had to completely shift our teachings on abortion and which online resources provide reliable information. We now have to instruct our students to not trust the CDC or NIH and to instead seek out unbiased information from sources like Britain's National Health Service and the Guttmacher Institute.

20:56Shefali, I want to first come to you on this because part of what we've been paying attention to are potential unintended or surprising, maybe not for all people, but somewhat surprising outcomes of this shift in the laws that govern abortion care. What have you been paying attention to in the last four years? What shifts are you seeing? I think the thing that really stays with me the most is the confusion that people experience about their rights and what abortion or reproductive health care in general is available to them. And I've spent a lot of time traveling to clinics in states with bans or where laws have changed recently.

21:40And you hear from these patients and, for instance, they maybe don't know about telehealth abortion as an option. Maybe they didn't know that an abortion ban took effect two days ago and that their laws have suddenly changed. Maybe they didn't know about a 24-hour waiting period. That means that even though they show up today, they can't get an abortion until tomorrow at the earliest. Or they are now being forced to find out what are the laws not only in, say, Florida, but also North Carolina and Virginia and South Carolina and Georgia to figure out where can I go to get care the soonest that I know I will get and that I can afford to get to and that I will have someone to stay, take time off work, all these different factors.

22:19And it's just so striking because the confusion seems tremendous. I do not know all the state laws of neighboring states for all sorts of things near where I live, but when people seek reproductive health care, they are now being tasked with knowing so much about something that is changing so quickly, it can be very overwhelming even in a case like this where people are often very, very determined to get health care. I'd love to hear your thoughts as well, Kelly. That last listener mentioned the Guttmacher Institute as a place they're looking to for reliable information. Yeah, thank you. I think reliable information is so important.

22:57We know misinformation and disinformation are very much on the rise. And I think some of that is just, some of that's intentional and some of that is the confusion and chaos noted That is caused by what feels like a never-ending series of state laws, court decisions, federal regulatory and other efforts, right? That really does mean that the landscape for your rights and where you can get health care is very confusing. I always am called back to the last election where right after the Dobbs decision, right, that President Trump seemed to be pushing this idea that send it back to the states and that would sort of solve this 50-year policy challenge, right?

23:39Well, that is obviously not true. This is only actually overturning Roe v. Wade has really only opened up entirely new avenues of legal policy and personal confusion for people who need health care. We got this question from Em, who asks, if the health care providers are reporting suspected abortions, isn't that a violation of federal HIPAA laws that protect patients' privacy? Mary? Well, it turns out HIPAA has a lot of exceptions. And there was actually an attempt during the Biden administration to tighten up when law enforcement—so there are law enforcement-related exceptions to HIPAA as the sort of long and short of it.

24:14there was an attempt during the Biden administration to limit the kinds of information that healthcare providers would make available to law enforcement when it came to reproductive healthcare, but that attempt was upended during the Trump administration. So now we're back in a position where HIPAA wouldn't clearly provide any protection. Generally speaking, the idea is that if a crime has been committed, it's important that law enforcement be aware of that. And that sounds perfectly good until you realize that in so many parts of the country today, abortion is a crime. We've been talking about how more people are turning to medication abortion in this new landscape of laws.

24:52And this has in turn created a new battlefront. Last week, Senate Republicans launched an investigation into abortion pill manufacturers. It's being led by Republican Senator Bill Cassidy of Louisiana. At the same time, Missouri Republican Senator Josh Hawley introduced a bill that would revoke FDA approval for the abortion drug mifepristone. Shefali, talk us through these efforts by Republicans. And we'll mention here that we did reach out to Senator Hawley about his legislation. We did not hear back. I think it's first really important to note that Senator Hawley's bill is likely not going anywhere.