Planned Parenthood v. Casey: Ruling and Undue Burden Standard

In Planned Parenthood v. Casey, decided in 1992, the Supreme Court reaffirmed the constitutional right to a pre-viability abortion recognized in Roe v. Wade but replaced Roe’s trimester framework with a new “undue burden” standard that gave states considerably more room to regulate. The ruling governed abortion law in the United States for thirty years until the Court overturned it in Dobbs v. Jackson Women’s Health Organization in 2022.

The Pennsylvania Law Behind the Case

The case challenged the Pennsylvania Abortion Control Act of 1982, which imposed five requirements on anyone seeking an abortion. Doctors had to provide specific information about the procedure’s health risks, the probable gestational age of the fetus, and the medical risks of carrying a pregnancy to term. Physicians also had to tell patients that the state published printed materials describing fetal development and listing agencies offering alternatives to abortion. A 24-hour waiting period followed that counseling session before the procedure could go forward.¹

Three other provisions rounded out the law. Married women generally had to sign a statement confirming they had notified their husbands. Minors needed the consent of at least one parent, though a judicial bypass allowed a minor to seek a judge’s approval instead. And abortion facilities had to file detailed reports with the state about each procedure performed.²

What the Court Held

The Court did two things at once. It refused to overturn Roe v. Wade, holding that the Constitution still protects a right to abortion before fetal viability. And it discarded Roe’s rigid trimester framework, replacing it with a new test that let states regulate abortion much more freely, as long as those regulations did not go too far.³

Applying that new test to the Pennsylvania statute, the Court upheld four of the five challenged provisions and struck down one. Informed consent, the 24-hour waiting period, parental consent for minors, and the facility reporting rules all survived. The spousal notification requirement did not.

The Undue Burden Standard

Under Roe, pregnancy had been divided into three trimesters, with the state’s power to regulate escalating at each stage and almost no regulation permitted in the first trimester. That framework had been criticized for years as unworkable and disconnected from medical practice, and the joint opinion in Casey abandoned it.³

In its place, the Court asked a single question: does the regulation, in purpose or effect, place a “substantial obstacle” in the path of a woman seeking an abortion before viability? If yes, it is an undue burden and unconstitutional. If no, it stands, even if the state’s clear aim was to discourage abortion and encourage childbirth.³

The “purpose or effect” language meant courts had to look at both what the legislature intended and what a law actually did in practice. A regulation could be struck down even where lawmakers claimed a benign purpose, so long as the real-world impact created a significant barrier. But the “substantial obstacle” threshold was intentionally set high. Minor inconveniences, modest cost increases, and short delays would not qualify. That gave states meaningful room to legislate that Roe had not permitted.

Which Pennsylvania Rules Survived

The informed consent requirement was upheld. The Court reasoned that requiring doctors to share information about health risks, fetal development, and alternatives served the state’s interest in making sure a patient’s decision was fully informed. The information was plainly designed to discourage abortion, but providing it did not prevent anyone from obtaining one.³

The 24-hour waiting period was upheld on similar reasoning. Critics argued it forced patients to make two trips, increasing costs and logistical difficulty, particularly for women in rural areas. The Court acknowledged those burdens but concluded they did not rise to the level of a substantial obstacle for most women.³

Parental consent for minors was upheld largely because the judicial bypass gave minors an alternative path when obtaining a parent’s permission was not feasible or safe.³ The facility reporting requirements survived as well.²

Why Spousal Notification Was Struck Down

The spousal notification rule was the one provision the Court found unconstitutional. Evidence in the record showed that for women in abusive or controlling relationships, telling a husband about a planned abortion could trigger physical violence, psychological harm, or economic retaliation. Even though the provision affected a relatively small percentage of women, the Court held that it was those very women, the ones who most needed to make the decision independently, for whom the requirement created a substantial obstacle.³ The provision became the clearest illustration of what an undue burden looked like in practice.

The Unusual Joint Opinion

Casey produced one of the most unusual alignments in Supreme Court history. No single opinion commanded a full majority on every issue. Three justices appointed by Republican presidents, Sandra Day O’Connor, Anthony Kennedy, and David Souter, co-authored a joint opinion that controlled the outcome.³

Justices Blackmun and Stevens joined those three in reaffirming Roe’s core holding, producing a 5–4 vote on that question. Chief Justice Rehnquist and Justices Scalia, White, and Thomas would have overturned Roe entirely.⁴ The practical result was that the undue burden framework became binding law even though only three justices fully endorsed it. That fragile coalition shaped American abortion law for the next three decades.

How Casey Was Applied Before It Fell

Over the two decades that followed, state legislatures passed hundreds of regulations testing the boundaries of what Casey allowed. Two Supreme Court cases sharpened how courts applied the undue burden test.

Whole Woman’s Health v. Hellerstedt (2016)

In 2016, the Court struck down a Texas law that required abortion providers to have admitting privileges at a nearby hospital and required clinics to meet the building standards of ambulatory surgical centers. Both requirements imposed substantial obstacles without producing meaningful health benefits. The decision clarified that courts must weigh the burdens a law imposes on abortion access against the benefits the law actually delivers, rather than simply accepting a legislature’s stated health justification at face value.⁵ That balancing approach gave the undue burden standard more analytical teeth than it had carried in the original Casey opinion.

June Medical Services v. Russo (2020)

Four years later, the Court reviewed an almost identical Louisiana law requiring admitting privileges. The district court had found that enforcing the requirement would have reduced the state’s abortion providers so drastically that roughly 10,000 women per year would have been served by a single clinic with a single doctor, creating longer wait times and disproportionate burdens on low-income patients who could not travel.⁶ The Supreme Court agreed and struck down the law. But the majority was fractured, with Chief Justice Roberts concurring on narrower grounds that questioned the balancing test from Whole Woman’s Health. That internal disagreement signaled the standard’s growing instability.

Is Casey Still Good Law?

No. On June 24, 2022, the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned both Roe v. Wade and Casey. The majority concluded that the Constitution does not confer a right to abortion and that authority over abortion policy belongs to state legislatures.⁷

With the undue burden standard eliminated, the Court replaced it with rational basis review, the most deferential standard in constitutional law. Under rational basis review, a state abortion regulation is presumed valid as long as it serves any legitimate governmental purpose.⁷ In practice, that standard is very difficult for challengers to overcome, and it opened the door for outright bans.

The consequences were immediate. States with trigger laws, bans written in advance to take effect the moment Roe and Casey fell, began enforcing them within days. Other states revived pre-Roe abortion prohibitions that had stayed on the books but were unenforceable under Casey. Casey’s undue burden framework, for all its imperfections, had provided a national floor. Without it, each state now writes its own rules.

1
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 18 Chapter 32 – Section 3205
2
Justia. Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833
3
Cornell Law School. Planned Parenthood of Southeastern Pennsylvania v. Casey (1992)
4
Cornell Law School. Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 – Dissent
5
Justia. Whole Woman’s Health v. Hellerstedt, 579 U.S. ___ (2016)
6
Supreme Court of the United States. June Medical Services L.L.C. v. Russo
7
Legal Information Institute. Dobbs v. Jackson Women’s Health Organization (2022)