Roe v. Wade was the 1973 U.S. Supreme Court decision that recognized a constitutional right to abortion under the Fourteenth Amendment’s guarantee of personal liberty. It governed abortion law in the United States for nearly 50 years until the Court overturned it in 2022 in Dobbs v. Jackson Women’s Health Organization, ruling that the Constitution contains no such right and returning the question to state legislatures. Today, whether you can obtain an abortion, and under what conditions, depends almost entirely on the state you are in.
What Roe Decided in 1973
The case came out of Texas, where criminal statutes made it a felony to perform an abortion unless the procedure was necessary to save the pregnant woman’s life. A woman using the pseudonym “Jane Roe” challenged those statutes, and the Supreme Court ruled 7–2 in her favor.1Supreme Court of the United States. Roe v Wade, 410 US 113
Justice Blackmun’s majority opinion held that the Constitution’s protection of personal liberty is broad enough to cover the decision whether to end a pregnancy. The Court had recognized a right to privacy in earlier cases, most notably Griswold v. Connecticut, which struck down a state ban on contraceptives.2Justia. Griswold v Connecticut, 381 US 479 Roe extended that reasoning to abortion, treating it as a private medical decision.
The right was not absolute. To balance it against the state’s interests in maternal health and potential life, the Court created a framework tied to the three trimesters of pregnancy. In the first trimester, the decision belonged to the patient and physician with no state interference. In the second trimester, the state could regulate the procedure in ways reasonably related to protecting the patient’s health. In the third trimester, once the fetus reached viability, the state could regulate or ban abortion entirely, so long as it preserved an exception for the life or health of the mother.1Supreme Court of the United States. Roe v Wade, 410 US 113
The ruling immediately invalidated criminal abortion statutes across the country and put the doctor-patient relationship under a constitutional standard rather than a patchwork of state criminal codes.
How Casey Modified the Rule
By 1992, the Court’s makeup had shifted, and Pennsylvania’s Abortion Control Act gave the justices a vehicle to reconsider Roe. That law required informed consent, a 24-hour waiting period, parental consent for minors with a judicial bypass option, and spousal notification for married women.3Justia. Planned Parenthood of Southeastern Pa v Casey, 505 US 833
In Planned Parenthood v. Casey, a fractured Court upheld what it called the “essential holding” of Roe: that a woman has the right to choose an abortion before viability without undue interference from the state. But it replaced the trimester framework with a new test. Under the undue burden standard, a state regulation was unconstitutional only if it placed a substantial obstacle in the path of someone seeking a pre-viability abortion.3Justia. Planned Parenthood of Southeastern Pa v Casey, 505 US 833
That was a more permissive standard. Informed consent, waiting periods, and parental consent generally passed; the spousal notification requirement was struck down.4Supreme Court of the United States. Planned Parenthood of Southeastern Pennsylvania v Casey Casey governed abortion law for the next three decades, though lower federal courts often reached conflicting results applying its standard.
How Dobbs Overturned Roe
Mississippi passed a Gestational Age Act banning most abortions after 15 weeks, well before viability. The state’s only remaining abortion clinic sued, and in June 2022 the Supreme Court used the case to overrule both Roe and Casey by a 6–3 vote. The Court held that the Constitution does not confer a right to abortion.5Supreme Court of the United States. Dobbs v Jackson Womens Health Organization
Justice Alito’s majority opinion applied the test from Washington v. Glucksberg: an unenumerated right receives Fourteenth Amendment protection only if it is “deeply rooted in this Nation’s history and tradition” and “implicit in the concept of ordered liberty.” The Court concluded that abortion fails this test, pointing to the widespread criminalization of abortion at the time the Fourteenth Amendment was ratified in 1868.5Supreme Court of the United States. Dobbs v Jackson Womens Health Organization
The majority called Roe “egregiously wrong” from the day it was decided and said Casey’s undue burden test had proven unworkable in the lower courts. The three dissenting justices argued that the majority was undermining the Court’s legitimacy by abandoning precedent to reach a preferred outcome.5Supreme Court of the United States. Dobbs v Jackson Womens Health Organization
With the constitutional right removed, any legal challenge to an abortion restriction now faces rational basis review, the most deferential standard in constitutional law. A law survives rational basis review as long as it bears a reasonable relationship to a legitimate government interest, and almost any regulation clears that bar. The Court said the authority to regulate abortion now belongs to elected officials at the state level.6Constitution Annotated. Amdt14.S1.6.4.3 Abortion, Dobbs v Jackson Womens Health Organization, and Post-Dobbs Doctrine
Where Abortion Law Stands Now
Regulation of abortion falls to individual states under the Tenth Amendment, which reserves powers not granted to the federal government to the states or the people.7Congress.gov. Tenth Amendment As of early 2026, roughly 13 to 14 states enforce near-total bans, 9 states and the District of Columbia impose no gestational limits, and the rest fall on a spectrum, with bans taking effect anywhere from 6 to 22 weeks of pregnancy.
Some of these bans took effect automatically after Dobbs through so-called trigger laws written years earlier for exactly that outcome; nine trigger bans are currently in force. Other states revived pre-Roe statutes that had been unenforceable for decades. Criminal penalties for providers vary widely, with fines from a few thousand dollars into six figures and prison sentences that can reach 20 years or even life depending on the state.
Ballot Measures
Voters, not just legislators, have shaped the map. In 2024, voters in Arizona, Colorado, Maryland, Missouri, Montana, Nevada, and New York approved constitutional amendments protecting abortion rights. Measures failed in Florida, Nebraska, and South Dakota. Nebraska voters simultaneously approved an amendment restricting abortion after the first trimester, so competing measures passed on the same ballot. Constitutional amendments are harder for legislatures to reverse than ordinary statutes, which makes them a durable form of protection or restriction.
Shield Laws
As of early 2026, 22 states and the District of Columbia have enacted shield laws that protect patients and providers from out-of-state legal consequences for reproductive care that is legal where it is performed. Common provisions include refusing to comply with out-of-state subpoenas or investigations, blocking extradition, and preventing licensing boards from disciplining providers over out-of-state legal actions. Some states allow individuals targeted by out-of-state lawsuits to countersue. A smaller group extends these protections to telehealth consultations.
Medical Exceptions
States with abortion bans typically include exceptions for medical emergencies, but definitions vary and tend to be narrow. Some limit the exception to situations where the pregnancy threatens the patient’s life. Others include risks of “substantial and irreversible impairment of a major bodily function,” but that language has produced significant uncertainty. Some providers delay medically appropriate care while seeking legal guidance, particularly in cases involving severe fetal abnormalities or worsening conditions that are not yet immediately life-threatening.
Emergency Room Care and EMTALA
One of the biggest unresolved questions after Dobbs involves the Emergency Medical Treatment and Labor Act, a federal law that requires hospitals participating in Medicare to stabilize any patient with an emergency medical condition. EMTALA defines an emergency medical condition broadly, covering symptoms severe enough that the absence of immediate treatment could reasonably be expected to place the patient’s health in serious jeopardy or cause serious impairment to bodily functions.8ECFR. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor
The conflict is that EMTALA may require a hospital to provide an abortion as stabilizing treatment in a situation where state law prohibits it. In Idaho, a federal court blocked the state from enforcing its near-total ban when it conflicted with EMTALA. The case, Moyle v. United States, reached the Supreme Court, but the justices dismissed it without ruling on the merits and sent it back down. The injunction protecting emergency abortion access in Idaho was reinstated.9Supreme Court of the United States. Moyle v United States
Texas reached the opposite result. A federal court there permanently blocked the federal government from enforcing EMTALA in a way that would require abortion care when Texas law prohibits it, and the Fifth Circuit upheld that order.10CMS. Emergency Medical Treatment and Labor Act The Supreme Court has not resolved whether EMTALA preempts state abortion bans in emergencies, so hospital emergency departments in different parts of the country operate under contradictory federal obligations depending on which circuit they fall within.
Mifepristone and Medication Abortion
Medication abortion using mifepristone now accounts for the majority of abortions performed in the United States, and its regulation has become a separate legal front. In 2024, the Supreme Court unanimously dismissed a challenge to the FDA’s loosened restrictions on mifepristone in FDA v. Alliance for Hippocratic Medicine, ruling that the plaintiffs lacked standing. That left mifepristone available under current FDA rules, which allow prescriptions via telehealth and delivery by mail.11Supreme Court of the United States. FDA v Alliance for Hippocratic Medicine
The litigation did not end there. Louisiana filed a separate challenge, and in May 2026 the Fifth Circuit ruled that mifepristone could no longer be mailed, a decision that would have applied nationwide. The Supreme Court stayed that ruling, keeping telehealth and mail access in place while the case continues. Legislation has also been introduced in Congress to roll back the FDA’s 2023 modifications to mifepristone’s prescribing rules.12Congress.gov. HR 679 – 119th Congress Mifepristone’s availability could change depending on how these cases and bills play out.
Deducting the Cost of Out-of-State Care
If you travel to another state for a legal abortion, the IRS treats the procedure as a deductible medical expense. Publication 502 specifically lists abortion as an includible expense. Transportation costs that are primarily for and essential to medical care qualify as well. Lodging is deductible up to $50 per night per person, including a companion whose presence is medically necessary, as long as the lodging is not extravagant and the trip does not have a significant element of personal recreation. The deduction is available only if you itemize and your total medical expenses exceed 7.5% of your adjusted gross income.13Internal Revenue Service. Medical and Dental Expenses
Some employers, particularly those with self-funded health plans, have begun offering travel benefits for reproductive healthcare. These employer plans may have some protection under the federal Employee Retirement Income Security Act, which generally preempts state civil laws that try to regulate employee benefit plans. ERISA does not preempt state criminal laws of general applicability, so an employer offering travel assistance for an abortion could face uncertain legal exposure in states where aiding the procedure carries criminal penalties.