Introduction

In the four years since Dobbs, legal challenges to state abortion bans have been testing state constitutions, with state courts deciding whether existing guarantees of liberty, privacy, equality, and other rights protect reproductive autonomy. And in states where voters have passed constitutional amendments that explicitly protect either the right to abortion or reproductive rights more broadly, litigation is helping make these new rights a reality. Lawsuits are also challenging health and life exceptions to abortion bans—undermining anti-abortion legislation by repeatedly showing that these exceptions don’t work.

State supreme court rulings

State supreme court rulings

State courts determine rights and access

In the absence of a federal constitutional right to abortion, the courts in every state can restore or safeguard access by interpreting their unique state constitutions to separately and independently protect reproductive autonomy including abortion. Sources of abortion rights in state constitutions include liberty, privacy, equality, life, inalienable rights, and other guarantees. A ruling by a state supreme court provides powerful protection since it will endure unless overturned by a later state supreme court decision or ballot amendment to change the constitution.

In the four years since Dobbs, a wave of challenges have asked state courts to strike down bans and other restrictions by recognizing a right to abortion for the first time. Overall, the outcomes have been mixed. High courts in Wyoming,¹ North Dakota,² and Oklahoma³ have held that their constitutions protect abortion rights fully or in some circumstances, opening the door to expanding their scope. Showing that a broad range of constitutional provisions can robustly protect abortion, the North Dakota and Oklahoma courts applied inherent rights and due process clauses, while the Wyoming Supreme Court relied on a 2012 amendment to the Wyoming constitution enshrining each adult’s fundamental right to make their own healthcare decisions.⁴ On the other hand, high courts in Idaho,⁵ South Carolina,⁶ and Indiana⁷ have held that their constitutions do not protect a right to abortion, upholding bans with virtually no exceptions. Furthermore, state supreme courts in Iowa⁸ and Florida⁹ overturned prior decisions recognizing a right to abortion that pre-dated Dobbs, rewarding legislative efforts to pass unconstitutional bans, and in the case of Florida jettisoning almost 25 years of precedent protecting abortion access in the state.

While the record of state supreme court rulings on constitutional abortion rights post Dobbs has been mixed, decisions that establish protections for abortion show one path forward to rebuilding rights and access outside the federal courts. After a challenge brought by the Center in 2022 led the Oklahoma Supreme Court to recognize a right to life-preserving abortions (including when health conditions impose heightened life risks), the court blocked a criminal abortion ban and held that additional restrictions likely violated this right, including a waiting period and certification requirement for doctors.¹⁰ The Center and partners will continue to push for expanded rights as state supreme courts provide legal building blocks.

State judges matter more than ever

A key lesson from post-Dobbs litigation to protect abortion rights in state constitutions is that the makeup of state courts matters. Decisions about abortion protections can rapidly be upended when membership changes. In South Carolina, the state Supreme Court permanently struck down a six-week abortion ban in January 2023, holding that it violated an explicit state constitutional privacy right. Just seven months later, after the justice who authored the opinion retired and her seat was filled, the court upheld an almost-identical ban by reasoning that it complied with any right to privacy and the constitution did not protect a fundamental right to abortion.¹¹ State court membership can change quickly, with seats vacated by retirements and other circumstances. Legislatures also attack courts that uphold abortions rights, for example in Kansas where a voter initiative to make judges sit for partisan election will appear on the August 2026 ballot.¹²

Abortion ban exceptions

Abortion ban exceptions

Patient lawsuits have shown that exceptions don’t work

States with post-Dobbs abortion bans leave pregnant people who are experiencing medical crises with nowhere to turn. Hospitals across the country have refused to offer abortion to pregnant patients experiencing severe complications, from preterm premature rupture of membranes (PPROM) with sepsis, to fatal fetal conditions that also threaten a patient’s physical and mental health. While state abortion bans typically include limited exceptions for situations when abortion is necessary to preserve life and sometimes health within narrow constraints, post-Dobbs realities show that these exceptions do not work in practice. Medical providers in states with abortion bans struggle to apply vague and unworkable language in meaningful ways, resulting in patients being denied timely abortion care, even when doing so will have devastating consequences.

After Dobbs, the Center filed the first lawsuit in over 50 years that was brought on behalf of women denied abortion care.¹³ In the four years since, it has filed lawsuits on behalf of 34 women in four states who suffered severe harms from denial of abortion care, including loss of fertility and permanent physical and emotional anguish. These cases ask courts to clarify the scope of exceptions in bans and hold that state constitutions protect a right to abortion when life or health is at risk. Demonstrating exceptional courage, patient plaintiffs have shared their stories publicly and in court with the goal of holding states accountable and persuading judges to address the harms of abortion bans when state officials and legislators refuse.

To date, the Texas Supreme Court has issued a final ruling refusing to meaningfully clarify or expand the state’s exception and finding no constitutional violations.¹⁴ Lower courts in Idaho and Tennessee have provided some relief and guidance to providers by holding that exceptions apply in certain limited but important circumstances, with litigation in Tennessee ongoing.¹⁵

Overall, cases challenging flawed life and health exceptions have helped show that abortion bans are placing patients across the country in peril, and limited exceptions can never work. Legal trials where patients share their stories have moved the public and elevated these issues for the press. Still, courts that deny relief and refuse to credit constitutional rights to life, safety, and bodily integrity are endangering pregnant people’s health and lives.

Reproductive freedom amendments

Reproductive freedom amendments litigation

Making new rights a reality

As of April 2026, voters in 10 states—Arizona, California, Colorado, Maryland, Michigan, Missouri, Montana, New York, Ohio, and Vermont—have amended their state constitutions to expressly protect reproductive freedom.¹⁶ Some enshrine the fundamental right to abortion, while others cover a range of reproductive rights, including contraception, maternal health, and the right to make and effectuate decisions about pregnancy generally.¹⁷ Similar constitutional amendments will be on the ballot in Nevada and Virginia this coming November.¹⁸

State reproductive freedom amendments are a key first step to regaining or expanding access to reproductive healthcare, but they do not automatically strike down existing laws, and litigation to determine their reach has been an area of significant activity since Dobbs. So far, state courts have transformed access by applying reproductive freedom amendments to permanently strike down criminal abortion bans in Arizona (15-week ban) and Ohio (six-week ban).¹⁹ A Missouri court has blocked a total ban and multiple pre-viability bans while litigation proceeds.²⁰

Health care provider plaintiffs have also challenged a range of abortion restrictions that create barriers to care and were in effect even when a federal constitutional right to abortion existed. In a case filed by the Center in Arizona, a state trial court held that several schemes of laws violate Arizona’s fundamental right to abortion, including a biased counseling provision and mandatory delay/two-trip requirement, a ban on telemedicine abortion care, and a law banning abortion for patients with fetal diagnoses.²¹ The court determined that these laws do not improve or maintain the health of people seeking abortion and infringe on their autonomous decision making.²² A state trial court reached a similar conclusion in the Center’s case in Michigan, holding that a law mandating that people wait at least 24 hours after receiving biased counseling materials before they can access abortion care, as well as a law prohibiting advanced practice clinicians (APCs) from providing abortion care, violated Michigan’s reproductive freedom amendment.²³

State trial courts in Missouri and Ohio have similarly rejected or doubted the constitutionality of a range of laws including mandatory-delay requirements; biased counseling laws; telemedicine bans; provider restrictions; and onerous facility and staffing mandates.²⁴

Many of these kinds of restrictions were previously upheld in federal court and by the U.S. Supreme Court under the federal right to abortion that existed before Dobbs. State constitutional amendments now have the potential to expand access and shape stronger protections for reproductive autonomy. At the same time, they depend on courts applying them in line with voters’ demands for strong and enduring guarantees. Lower courts have permanently or temporarily blocked an array of longstanding barriers to care, but many of those decisions are still waiting to be reviewed by hostile state supreme courts. And already, some lower courts have rejected challenges based on perceived lack of standing and other issues.²⁵ Interpretation by judges over the long term will determine the power and impact of these groundbreaking amendments.

Countering legislative opposition

Precisely because reproductive freedom amendments can be powerful tools, anti-abortion lawmakers are pulling out the stops to roll them back by subverting the democratic process. A legislative initiative to repeal Missouri’s reproductive freedom amendment that voters approved in 2024 will appear on the ballot in November 2026.²⁶ Litigation brought by reproductive rights supporters challenging the ballot language stopped the state from concealing that the initiative would undo the prior amendment.²⁷

Laws struck down under voter-approved constitutional amendments include:

• Total bans
• Mandatory waiting periods
• Biased-counseling laws
• Telemedicine bans
• Reason bans
• Prohibitions on APCs–such as nurse practitioners, physician assistants, and certified nurse midwives–from providing abortion care
• TRAP (targeted regulation of abortion providers) laws, including medically unnecessary and burdensome facility and staffing requirements
• Fetal tissue disposal requirements²⁸

Pre-Dobbs state rulings

States with pre-Dobbs constitutional abortion protections

Using previous state court rulings for expanding access

Even when a federal constitutional right to abortion existed, the Center and partners brought litigation in state court over three decades to strengthen abortion rights under state constitutions and guarantee access beyond the federal system.²⁹ Before Dobbs, supreme courts in 11 states recognized constitutional protections for abortion independent from and stronger than federal protections.³⁰ These courts relied on liberty, natural rights, privacy, and other provisions in their state constitutions,³¹ with some also recognizing that abortion access is necessary for equality, even while the U.S. Supreme Court rejected equality frameworks.³²

Since Dobbs, these state constitutional protections have helped preserve and expand abortion access in the face of ongoing restrictive efforts. In Montana, the state Supreme Court held in 1999 that the state constitution’s fundamental right to privacy protects abortion within an individual’s broader right to “make medical judgments affecting her or his bodily integrity and health in partnership with a chosen health care provider free from government interference.”³³ Relying on that precedent, the Court has blocked a wide array of laws post-Dobbs, including a 20-week ban, medication abortion restrictions, laws limiting Medicaid coverage of abortion, and a law mandating that young people obtain parental consent before an abortion.³⁴

Likewise, the Kansas Supreme Court has struck down onerous facility and staffing requirements for abortion clinics³⁵ by applying state constitutional protections for “personal autonomy” including the right to abortion, which it first recognized in a case brought by the Center in 2019.³⁶ And in Alaska, where the Supreme Court recognized in 1997 that privacy fundamentally protects the right to abortion and has since struck down a thicket of restrictions, a trial court held unconstitutional a 50-year-old statute that prohibits APCs from providing abortion care.³⁷

Pre-Dobbs state supreme court decisions recognizing constitutional protections for abortion have safeguarded access across years and decades.³⁸ Post-Dobbs, active litigation by the Center and partners has expanded these precedents to benefit not only people who live in those states, but also those traveling because constitutional rights are absent and abortion is unavailable where they live. While these protections should be enduring, they are vulnerable when courts with changed membership move to overturn decisions based on hostility to abortion, as has happened in Florida and Iowa. Legislative attacks on courts that have recognized abortion rights are also ongoing, including in Kansas, where an August 2026 ballot initiative will ask voters to adopt partisan elections for Supreme Court justices.³⁹

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