Roe v. Wade was the 1973 U.S. Supreme Court decision that recognized a constitutional right to abortion, and it governed American abortion law until the Court overturned it in 2022. The 7-2 ruling anchored that right in the Fourteenth Amendment’s protection of personal privacy and set out a trimester framework that barred states from banning the procedure in the early months of pregnancy. After the Court’s reversal in Dobbs v. Jackson Women’s Health Organization, the power to regulate or prohibit abortion returned to the states, and the legality of the procedure now depends entirely on where a person lives.
What the 1973 Ruling Actually Said
The case began with Norma McCorvey, a Dallas resident who used the pseudonym Jane Roe to challenge a Texas law that criminalized abortion except when necessary to save the mother’s life. The named defendant was Henry Wade, the district attorney of Dallas County. The Supreme Court issued its decision on January 22, 1973, with Justice Harry Blackmun writing for the majority and only Justices White and Rehnquist dissenting.1Justia. Roe v. Wade
The Court held that the Due Process Clause of the Fourteenth Amendment protects a right to privacy broad enough to cover a woman’s decision to end a pregnancy.2Cornell Law School. Jane Roe, et al., Appellants, v. Henry Wade That right was not absolute. The Court accepted that governments have legitimate interests in maternal health and in potential life, and that those interests grow stronger as pregnancy progresses.
To weigh those interests, the Court built a trimester framework. In the first trimester, the decision belonged to the woman and her doctor, with no room for state interference. After that point, a state could regulate the procedure in ways reasonably tied to maternal health, such as rules about where an abortion could take place or who could perform it.3Congress.gov. Amdt14.S1.6.4.1 Abortion, Roe v. Wade, and Pre-Dobbs Doctrine In the third trimester, the state’s interest in potential life became strong enough to justify banning abortion outright, so long as exceptions existed to protect the mother’s life or health.2Cornell Law School. Jane Roe, et al., Appellants, v. Henry Wade
The framework gave courts a clear rule, but it also tied the law to the medical science of 1973. As neonatal care advanced and viability shifted earlier, the trimester lines came under pressure from both sides of the debate.
How Casey Changed the Standard in 1992
Nearly two decades later, the Court revisited abortion law in Planned Parenthood of Southeastern Pennsylvania v. Casey. The case involved a Pennsylvania statute that imposed a 24-hour waiting period, informed consent requirements, parental consent for minors, and a requirement that married women notify their husbands before obtaining an abortion.4Justia U.S. Supreme Court Center. Planned Parenthood of Southeastern Pa. v. Casey
The Court preserved Roe’s core holding that the Constitution protects the choice to end a pregnancy before viability, but it discarded the trimester framework. A joint opinion by three justices replaced it with the “undue burden” test: a state regulation is unconstitutional if it has the purpose or effect of placing a substantial obstacle in the path of a woman seeking a pre-viability abortion.5Cornell Law School. Planned Parenthood of Southeastern Pa. v. Casey The controlling line shifted from a calendar to the biological point at which a fetus can survive outside the womb.
Under the new test, states gained significant room to regulate. The Court upheld the waiting period, informed consent provisions, and parental consent for minors. It struck down only the spousal notification requirement, finding it would be a substantial obstacle for women in abusive relationships.4Justia U.S. Supreme Court Center. Planned Parenthood of Southeastern Pa. v. Casey The undue burden standard governed for the next thirty years and produced a patchwork of state rules that limited access without technically banning the procedure.
How Dobbs Overturned Roe in 2022
On June 24, 2022, the Supreme Court decided Dobbs v. Jackson Women’s Health Organization, overruling both Roe and Casey. The 6-3 opinion, written by Justice Samuel Alito, held that the Constitution does not confer a right to abortion and returned the power to regulate the procedure to the states.6Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization
The majority applied a historical inquiry, asking whether a right to abortion is “deeply rooted in this Nation’s history and tradition” or “implicit in the concept of ordered liberty.” Finding that it met neither test, the Court concluded that no constitutional provision, whether framed as privacy, liberty, or autonomy, protects the decision to end a pregnancy.6Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization
Much of the opinion dealt with stare decisis, the principle that courts generally follow their own precedents. The majority argued that Roe was “egregiously wrong” from the start, that its reasoning was exceptionally weak, and that the decision had failed to settle the national debate. The Court also narrowed what counts as reliance on a precedent, rejecting the argument that people had organized their lives around abortion access in a way that warranted keeping Roe in place.
Chief Justice Roberts concurred in the judgment upholding the Mississippi law at issue but wrote separately, arguing the Court should not have overruled Roe entirely. Justices Breyer, Sotomayor, and Kagan dissented, writing that the decision stripped women of a right they had held for half a century. Justice Kavanaugh’s concurrence addressed several practical questions, including his view that the constitutional right to interstate travel would bar a state from stopping its residents from traveling elsewhere for an abortion.6Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization
Where State Abortion Law Stands Now
With the federal constitutional right gone, abortion is now a state issue. As of early 2026, roughly 13 states enforce total or near-total bans at any stage of pregnancy. Many of these took effect through trigger laws, statutes drafted years in advance to activate the moment Roe fell. At the other end of the spectrum, several states and the District of Columbia impose no gestational limits, and others have codified abortion access into state law with protections up to viability or beyond.
Penalties for violating state bans vary widely. In the strictest states, performing an illegal abortion is typically a serious felony. Some states impose potential prison terms of five years to life and fines as high as $100,000 per violation. Others assign lower felony grades with sentences of three to ten years. These penalties generally target providers rather than patients, and most ban statutes explicitly exempt the pregnant person from prosecution.
A newer enforcement mechanism deputizes private citizens. Some states allow individuals to sue anyone who performs or assists in an abortion, with monetary awards for successful suits. The chilling effect reaches beyond providers to people who drive a friend to an appointment, offer financial help, or provide counseling, depending on how broadly a state defines “aiding” the procedure.
The greatest real-world confusion sits around medical exceptions. States with bans generally include exceptions to save the mother’s life, but the legal definitions vary and are often vague. Some statutes require a doctor to determine that a medical emergency poses a risk of death; others extend the exception to serious and irreversible impairment of a major bodily function. Doctors in states with narrow exceptions face the prospect of felony charges if a prosecutor later disagrees with their medical judgment.
State Constitutional Amendments
Voters in several states have moved abortion law out of the legislature and into their state constitutions. In 2023, Ohio approved an amendment establishing the right to make reproductive decisions, including abortion, up to fetal viability. In 2024, voters in Arizona, Colorado, Maryland, Missouri, Montana, Nevada, and New York approved amendments enshrining reproductive protections. Missouri’s result was notable because the state had one of the first trigger bans to take effect after Dobbs.
Nebraska went the other direction, approving a 2024 amendment protecting unborn children from abortion in the second and third trimesters. Constitutional provisions of either kind are harder to undo than ordinary legislation because they require another statewide vote. More ballot measures are expected as advocacy groups organize campaigns in states where legislative positions diverge from public polling.
Medication Abortion and the FDA
Medication abortion now accounts for a growing majority of abortions in the United States. The FDA first approved mifepristone in September 2000 for ending a pregnancy through seven weeks of gestation, and extended the approved use to ten weeks in 2016.7Food and Drug Administration. Questions and Answers on Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation The two-drug regimen involves taking mifepristone on the first day, a second medication 24 to 48 hours later, and a follow-up appointment one to two weeks afterward.
Because mifepristone is regulated federally, the intersection of FDA approval and state abortion bans is one of the most contested legal questions after Dobbs. A group of medical organizations challenged the drug’s approval, seeking to pull it from the market. In June 2024, the Supreme Court unanimously dismissed the case, FDA v. Alliance for Hippocratic Medicine, on standing grounds, ruling that the plaintiff doctors and organizations, who did not prescribe or use the drug, could not show a concrete injury.8Supreme Court of the United States. FDA v. Alliance for Hippocratic Medicine The federal approval stayed in place, but the Court did not decide whether states can ban an FDA-approved drug within their borders.
That tension is unresolved. States with abortion bans generally prohibit dispensing mifepristone to end a pregnancy, even though the drug remains federally approved. Whether federal drug regulation preempts state prohibitions is likely to generate further litigation.9Congressional Research Service. Medication Abortion: A Changing Legal Landscape For now, access to medication abortion follows the same state-by-state map as surgical procedures.
Emergency Care and EMTALA
A federal law called the Emergency Medical Treatment and Labor Act, or EMTALA, requires any hospital that accepts Medicare funding to stabilize patients with emergency medical conditions.10Office of the Law Revision Counsel. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor The law defines an emergency condition as one where the absence of immediate treatment could place a patient’s health in serious jeopardy or cause serious impairment to bodily functions.
The conflict is direct. When a pregnant patient arrives at an emergency room with a life-threatening complication and the medically appropriate stabilizing treatment is ending the pregnancy, EMTALA’s mandate collides with a state ban. Physicians in states with strict bans have reported delaying treatment for conditions like ectopic pregnancies, severe infections, and dangerous hemorrhaging while waiting for a patient’s condition to deteriorate enough to clearly satisfy the legal exception.
The Supreme Court had a chance to settle the EMTALA question in Moyle v. United States, a case involving Idaho’s near-total ban. In June 2024, the Court dismissed the case without ruling on the merits, calling the grant of certiorari “improvident.”11Supreme Court of the United States. Moyle v. United States That restored a lower court order allowing emergency abortions in Idaho under EMTALA while the underlying litigation continues, but it produced no national rule. Hospitals and physicians in other ban states navigate the overlap between federal emergency-care obligations and state criminal law without a clear answer from the highest court.
Interstate Travel and Shield Laws
One of the first practical questions after Dobbs was whether a state could stop its residents from traveling elsewhere for an abortion. Justice Kavanaugh’s concurrence took the position that the constitutional right to interstate travel bars any state from doing so.6Supreme Court of the United States. Dobbs v. Jackson Women’s Health Organization No state has enacted or successfully enforced an outright travel ban, though some have explored laws targeting people who help someone travel, rather than the traveler.
Going the other direction, more than 20 states and Washington, D.C. have enacted shield laws to protect abortion providers from legal consequences originating in other states. The most comprehensive versions block state agencies from cooperating with out-of-state investigations related to legal abortions, prohibit enforcement of other states’ judgments against local providers, protect medical licenses from discipline based on care that was lawful where it was performed, and restrict disclosure of patient medical records related to reproductive healthcare. Some shield laws also extend protections to patients and to those who assist them.
Absent a federal statute from Congress, the post-Dobbs landscape will keep taking shape at the state level, through legislation, ballot measures, and state courts interpreting state constitutions. The questions Roe attempted to settle in 1973 have not disappeared. They have moved to different courts, different legislatures, and different battlegrounds.