The key abortion cases in United States law are a short list: Roe v. Wade (1973), Planned Parenthood v. Casey (1992), Whole Woman’s Health v. Hellerstedt (2016), and Dobbs v. Jackson Women’s Health Organization (2022), followed by two more recent Supreme Court decisions on medication abortion and emergency care. Together they trace an arc from a federal constitutional right to abortion, through a narrower version of that right, to the elimination of any federal protection and the return of the question to state legislatures.
Roe v. Wade (1973)
Roe v. Wade, 410 U.S. 113, established the first federal constitutional protection for abortion. The Supreme Court held that the Due Process Clause of the Fourteenth Amendment protects a right to privacy broad enough to encompass a pregnant person’s decision to end a pregnancy.1Supreme Court. Jane ROE, et al., Appellants, v. Henry WADE The right was not absolute.
The Court set up a trimester framework. In the first trimester, the decision belonged to the patient and their doctor without state interference. In the second trimester, states could regulate abortion in ways tied to protecting maternal health. In the third trimester, once the fetus was viable, states could ban the procedure as long as there were exceptions for the life or health of the pregnant person.1Supreme Court. Jane ROE, et al., Appellants, v. Henry WADE That framework governed abortion law nationwide for nearly two decades.
Planned Parenthood v. Casey (1992)
Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833, kept the core of Roe but changed the test. The Court abandoned the trimester framework and adopted the undue burden standard, which asks whether a law places a “substantial obstacle in the path of a woman seeking an abortion” before viability.2Justia. Planned Parenthood of Southeastern Pa. v. Casey Viability remained the dividing line, but the Court acknowledged that medical advances meant a fetus could reach viability earlier than in 1973.
Casey gave states more room to regulate abortion before viability. Waiting periods, informed consent requirements, and parental notification laws survived challenges as long as they did not create an insurmountable barrier. The decision also reaffirmed that states could prohibit abortion after viability, with an exception when the pregnant person’s health was at risk.3Library of Congress. 505 U.S. 833 – Planned Parenthood of Southeastern Pennsylvania v. Casey
Whole Woman’s Health v. Hellerstedt (2016)
Whole Woman’s Health v. Hellerstedt refined the undue burden test. The Court struck down Texas clinic regulations that required doctors to hold hospital admitting privileges and required clinics to meet surgical center standards. Judges, the Court said, must weigh a law’s actual burdens on abortion access against whatever health benefits it provides. Regulations that offer little medical benefit while shutting down clinics fail that balance.4Justia. Whole Woman’s Health v. Hellerstedt
Hellerstedt was the last significant refinement of the Roe-Casey framework before it was overturned.
Dobbs v. Jackson Women’s Health Organization (2022)
Dobbs v. Jackson Women’s Health Organization overruled both Roe and Casey. The majority declared that the Constitution “does not confer a right to abortion” and returned regulatory authority to state legislatures.5Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization The case had begun as a challenge to Mississippi’s ban on abortion after fifteen weeks, but the opinion went far beyond that narrower question.
The legal reasoning turned on the history and tradition test. Under that approach, a right not explicitly named in the Constitution only receives Due Process Clause protection if it was “deeply rooted in this Nation’s history and tradition” when the Fourteenth Amendment was adopted in 1868. Looking at how states regulated abortion in the mid-nineteenth century, the majority concluded that most states criminalized the procedure during that era and no historical tradition of protecting abortion access existed.5Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization Dissenters argued the same test would undermine other unenumerated rights the Court has recognized, including contraception access and marriage equality.
FDA v. Alliance for Hippocratic Medicine (2024)
After Dobbs, the sharpest ongoing legal fight has been over mifepristone, the first drug in the two-pill medication abortion regimen, which now accounts for a majority of abortions in the United States. In FDA v. Alliance for Hippocratic Medicine, the Supreme Court unanimously dismissed a challenge to the FDA’s regulatory decisions on the drug, holding that the group of doctors who brought the case lacked standing because none of them had been personally harmed by the FDA’s policies.6Supreme Court of the United States. FDA v. Alliance for Hippocratic Medicine
The ruling preserved the FDA’s 2016 and 2021 changes allowing broader prescribing authority and mail delivery of the drug, but only on procedural grounds. It did not resolve the underlying legal questions, and a new round of litigation quickly took its place. The Fifth Circuit later ruled that Louisiana had standing to challenge the FDA’s mifepristone regulations based on the state’s claimed injuries, and it granted a stay of the FDA’s 2023 prescribing rules. In May 2026, the Supreme Court issued an order continuing to block that appellate ruling while the litigation proceeds in lower courts. Mifepristone remains available by mail for now, but the legal footing is unstable.
Moyle v. United States (2024)
A separate case tested whether federal law requires hospitals to provide abortion when a patient faces a medical emergency, even in states with total bans. The Emergency Medical Treatment and Labor Act (EMTALA) requires every hospital that accepts Medicare funding to provide stabilizing treatment to anyone with an emergency medical condition, defined as a condition severe enough that the absence of immediate care could place the patient’s health in serious jeopardy or cause serious impairment to bodily functions.7Office of the Law Revision Counsel. 42 U.S. Code 1395dd – Examination and Treatment for Emergency Medical Conditions and Labor
The federal government’s position is that when abortion is the medically necessary treatment to stabilize a patient in an emergency, EMTALA requires the hospital to provide it, and federal law overrides any conflicting state ban under the Supremacy Clause. Several states disagree. Moyle v. United States, which challenged Idaho’s near-total abortion ban, put that conflict before the Supreme Court. In June 2024, rather than resolving the question, the Court dismissed the case as “improvidently granted” and vacated the stays it had previously entered, sending the dispute back to the lower courts.8Supreme Court of the United States. Moyle v. United States
The practical effect was to temporarily restore a lower court order that had blocked Idaho from enforcing its ban in emergency room settings. The underlying question of whether EMTALA preempts state abortion bans remains unresolved.9Congressional Research Service. EMTALA Emergency Abortion Care Litigation Over Idaho’s Abortion Restriction Heads to the Supreme Court Emergency physicians in ban states are left navigating a genuine conflict of laws in real time.
Where the Law Stands Now
Because Dobbs returned the question to state legislatures, abortion law in the United States is now a patchwork. Thirteen states enforce total bans, most of them under trigger laws that took effect within days or weeks of the decision. Eleven of the twelve states with enforceable bans impose criminal penalties on physicians who perform abortions, with consequences ranging from a few months in prison to what amounts to a life sentence. Alabama’s law classifies a violation as a Class A felony carrying a minimum of ten years and a maximum of ninety-nine years. Several states also impose substantial fines and automatic medical license revocation on conviction.
The legal movement has not run in only one direction. Voters in eleven states have approved constitutional amendments explicitly protecting reproductive rights since 2022, including seven in the November 2024 elections: Arizona, Colorado, Maryland, Missouri, Montana, Nevada, and New York. Earlier measures passed in California, Michigan, and Vermont in 2022, and in Ohio in 2023. Missouri’s amendment reversed a trigger ban that had been in effect since Dobbs.
The federal case law that once defined the outer limits of state authority no longer does. What controls now is a mixture of state constitutional provisions, state statutes, and unresolved federal questions about medication abortion and emergency care, which the Supreme Court has so far declined to decide on the merits.