June 24, 2022 marked a turning point in U.S. history: the loss of the federal constitutional right to abortion. Ruling in Dobbs v. Jackson Women’s Health Organization, the U.S. Supreme Court overturned Roe v. Wade—the landmark 1973 decision that established a fundamental right to abortion under the U.S. constitution.

Dobbs gave states the greenlight to ban or severely restrict abortion—which 20 of them have done. Other states have moved to build new legal protections for reproductive rights, with tensions rising across state lines. At the federal level, anti-abortion extremists are pushing restrictions that would apply nationwide. Meanwhile, the Center for Reproductive Rights and other advocacy and activist groups continue to advance reproductive autonomy in courts and legislatures.

From heightened maternal deaths to the rising use of medication abortion, the impacts of Dobbs are piling up nationwide. But the future of U.S. abortion rights remains unsettled.

Here are five trends shaping the post-Roe reality.

State courts and constitutions

1. State courts and constitutions are determining access.

Without a federal constitutional right to abortion, state courts and constitutions are crucial to protecting and expanding abortion rights. High courts in 12 states have affirmed some level of protection for abortion, with three of these decisions coming after Dobbs. Courts in five states have denied it.

This makes individual judges key players, and decisions about constitutional protections for abortion can rapidly be upended when court membership changes. In South Carolina, for example, a state Supreme Court justice who voted to strike down the state’s six-week abortion ban retired and was replaced. The state then passed a nearly identical ban, which the court upheld just seven months later. Anti-abortion legislators are trying to use this to their advantage—in Kansas, an August ballot initiative is looking to make judges sit for partisan elections in the hopes of weeding out pro-abortion candidates.

At the same time, voters are taking matters into their own hands. Since the fall of Roe, 10 states—Arizona, California, Colorado, Maryland, Michigan, Missouri, Montana, New York, Ohio, and Vermont—have passed constitutional amendments explicitly protecting the right to abortion. Nevada and Virginia will have similar amendments on the ballot in November 2026.

Legal battles between states

2. Legal battles between states are heating up.

What happens when one state tries to prosecute abortion providers in another?

This is the kind of question being raised by the current abortion rights landscape, as people in ban states increasingly turn to out-of-state providers for care. In 2025, roughly 142,000 people traveled to another state for abortion care, with many more accessing medication abortion via telehealth. Since Roe was overturned, the total number of abortions in the U.S. has not declined because of the significant increase in telehealth, including from healthcare providers practicing in states with shield laws.

As of today, 18 states have some form of these laws, which protect healthcare providers in states where abortion is legal from being penalized for serving patients from other states. Shield laws block out-of-state subpoenas and investigations and prevent providers from being extradited. In some states, these laws also protect providers from having to share patient information and allow people targeted by out-of-state lawsuits to countersue.

Meanwhile, states hostile to abortion have been ramping up their efforts to target out-of-state providers—like Texas, which passed a “bounty hunter” law last year allowing private citizens to sue anyone who manufactures, distributes, mails, or provides medication abortion in or to Texas.

Medication abortion under attack

3. Medication abortion access is under attack.

Medication abortion now accounts for 63% of U.S. abortions. Medication abortion prescribed via telehealth has become a lifeline–particularly for patients far from clinics, for whom the nearest provider could be hours away.

Anti-abortion extremists want to sever that lifeline. Their main target is mifepristone, one half of the two-pill regimen that’s commonly used in the U.S. In 2022, they took aim at mifepristone in the lawsuit FDA v. Alliance for Hippocratic Medicine. The case reached the Supreme Court in 2024, where the Court dismissed the case without ruling on the merits—leaving the door open to further attacks on the drug.

Today, three separate cases that seek to restrict access to mifepristone nationwide are making their way through federal court. Louisiana v. FDA asks the court to reinstate a medically unnecessary in-person dispensing requirement, which would force people across the country to travel to a health center to be handed the medication, rather than receive it by mail or at their local pharmacy (as they can with virtually every other prescription). Missouri v. FDA and Florida v. FDA both go even further, with Florida requesting a nationwide ban on the drug.

Under pressure from anti-abortion extremists, the FDA is also conducting a “review” of mifepristone—despite decades of data showing it is safe. This review could be used to introduce new restrictions on the drug. The Center is currently suing the Trump administration for withholding information about its decision to reevaluate mifepristone.

Other rights at risk

4. Other rights are at risk, too.

Dobbs marked the first time in history that the Supreme Court took away a fundamental right. In Roe, the Court determined that the right to abortion was included in the 14th Amendment’s guarantee of “liberty,” which protects against government overreach into certain private parts of people’s lives. This same amendment has been used to guarantee other rights like contraception and gay marriage.

But Dobbs adopted a crushingly narrow view of liberty, freezing rights at the time the 14th Amendment was ratified in 1868 and ignoring its purpose. This sets a dangerous precedent, posing the risk of undermining other constitutional protections that are also grounded in bodily autonomy and self-determination—such as contraception, gay marriage, and gender-affirming care.

Already, Dobbs is being weaponized against trans rights. The Supreme Court extended its flawed reasoning from Dobbs into United States v. Skrmetti, which upheld a Tennessee law that banned gender-affirming care for trans young people. And one court has used its retrograde approach to constitutional interpretation to curb young people’s access to birth control.

The fight continues

5. The fight continues.

Today, the Center and partners are working to build a stronger, more comprehensive right to reproductive autonomy and lay the groundwork for a better future:

• Challenging abortion bans in 10 states and filing cases under new reproductive freedom amendments, we’ve helped to strike down numerous unconstitutional restrictions and to build legal precedent that acknowledges and protects reproductive rights.
• We’ve represented 34 women across four states who were denied health-saving abortions, seeking justice for the serious harms they incurred.
• We’ve filed amicus briefs to spotlight the real-world consequences of limiting access to reproductive healthcare and are tracking legal developments in courts across the country.
• We’re advising on and advocating for shield laws, and we’re actively involved in the civil defense of individuals and organizations who have been caught in the crosshairs and sued for their alleged involvement in abortion care within states that have banned abortion.

This fight is far from over. But regardless of what any judge or politician says, abortion remains a fundamental human right—and we won’t give up before the law acknowledges that.