In June 2022, the US Supreme Court overturned Roe v. Wade, the landmark 1973 decision that ruled abortion a constitutional right in the United States. As a result, reproductive rights will be one of the most contentious issues on the 2024 ballot in state and federal elections. For the first time in generations, both the right and access to reproductive healthcare are in jeopardy. This includes contraception, IVF, emergency care during miscarriage and ectopic pregnancy, and abortion. As nurses, we need to understand the history of current issues and vote to protect the health and well-being of our patients.

A Brief History of Abortion Care in the United States

Abortion is the medical termination of pregnancy. There are four types of abortion.

• Medication Abortion is the most common type of abortion in the United States. In 2000, the FDA approved two oral medications for pregnancy up to 10 weeks: a dose of mifepristone, followed by misoprostol 24-48 hours later. Medication abortion has proven to be very safe for over 20 years, yet continued access to mifepristone will be determined by the Supreme Court this spring.

• Surgical Abortionsome text
  • Aspiration is the most common procedure for miscarriages up to 14 weeks.
  • Dilation and evacuation are performed after 14 weeks - the cervix is dilated and the pregnancy tissue removed.

• Induction Abortion is rare; labor is induced, and the fetus is delivered.

Before 1967, abortion was illegal in the United States unless the pregnancy posed a risk to a mother’s life. As a result, many women received unlawful, unsafe abortions by unlicensed providers, resulting in severe infections and deaths.

1967 to 1973

Four states, Alaska, Hawaii, New York, and Washington, repealed their abortion bans, and 13 other states expanded exceptions for physical or mental health of the mother, fetal abnormalities, rape, or incest.

1973: Roe vs. Wade

In 1969, Norma McCorvey (Jane Roe) sued the state of Texas for denying her an abortion because her pregnancy didn’t pose a medical risk to her life. On January 22, 1973, the Supreme Court ruled that the 14th Amendment of the US Constitution protected the right of an individual to choose to end their pregnancy before viability. Abortion became legal in all 50 states, and safe abortion care became accessible.

1976: The Hyde Amendment

The Hyde Amendment prevents federal dollars from being used for abortion in government insurance programs like Medicaid (except for incest, rape, or life-threatening risk to the pregnant woman). Sixteen states have been able to avoid this discriminatory law by using their state Medicaid funds for abortion. Biden excluded the Hyde Amendment from the 2022 budget.

1984: The Global Gag Rule

The Global Gag rule prevents foreign countries who receive US health aid from providing information, referrals, or advocating for abortion access. The Gag rule was expanded during Trump’s administration. Biden has rescinded the Global Gag rule.

1992: Planned Parenthood vs. Casey

In 1988 - 1989, Pennsylvania amended its abortion law requiring informed consent, 24 24-hour waiting period, spousal notice, and parental consent or judicial bypass for minors. In 1992, the US Supreme Court in Planned Parenthood vs. Casey reaffirmed the right to abortion in Roe and disallowed these provisions except for spousal notification. It also created the “undue burden” framework, which allows states to place restrictions on abortion that do not pose an “undue burden” on the woman.

2022: Dobbs vs. Jackson’s Women’s Health Organization

The state of Mississippi asked the Supreme Court to ban the pre-viability abortion ban and to overrule Roe. On June 24, 2022, the US Supreme Court ruled that the Constitution does not confer a right to abortion. Individual states now need to set laws and policies on abortion. This has resulted in chaos as individual states set policies and establish limits on abortion, causing significant discrepancies in access, availability, and safety across the United States.

Elections Matter

Since 2022, states are now making their own individual laws regarding access to abortion.

State constitutions and courts matter more than ever. Federal elections are also crucial. A Republican Congress could vote for a national abortion ban, while a Democratic Congress could codify abortion, making it legal nationally. Who we send to Congress and elect as our next President will have a significant impact on whether reproductive healthcare access will continue to be available across the United States.

Update on State Laws and Access to Abortion

The Kaiser Family Foundation, Guttmacher Institute, Planned Parenthood, and the New York Times provide the most up-to-date information on the rapidly changing state laws on abortion.

The key changes:

• Twenty-two states either ban or restrict abortion earlier than under Roe.
• Fourteen states ban abortion except for risk to the life of the mother: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia.
• Seven states ban abortion after a specific point in pregnancy: Georgia, South Carolina (6wks), Nebraska, North Carolina (12wks), Florida (6wks), Utah (18wks), Pennsylvania (24wks).

• One state banned abortion without exception: Arizona.

• Twenty-nine states protect abortion rights:some text
  • Three states blocked abortion bans: Iowa, Montana, and Wyoming.
  • Six states voted to protect abortion: California, Kansas, Kentucky, Michigan, Vermont, and Ohio voted for new state constitutional amendments.
  • Twenty states and the District of Columbia protected the right and access to abortion. (District of Columbia, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington).

• Thirteen states are working on ballot initiatives for the 2024 elections: Arizona, Arkansas, Colorado, Florida, Iowa, Maine, Maryland, Missouri, Montana, Nebraska, Nevada, Pennsylvania, and South Dakota.

• Eleven state initiatives uphold the right to abortion:some text
  • Three states with no gestational limits (Colorado, Montana, Nevada.)
  • Six states that ban abortion or have early gestational limits (Arizona, Arkansas, Florida, Missouri, Nebraska, South Dakota.)
  • Two states legislative initiatives to protect abortion rights (Maine, Maryland.) Maryland’s initiative is the only measure which will be on the ballot in 2024 so far.

• Two state initiatives ban abortion:some text
  • Two state legislatures introduced measures against the right to abortion (Iowa, Pennsylvania.)

Risks to Patients and Providers

Laws restricting or banning abortion are jeopardizing pregnancy care for both patients and providers. Women with serious diseases such as cancer, MS, heart, lung, or kidney disease are at risk for life-threatening complications during pregnancy, which pose significant challenges for healthcare providers. These stringent laws have instilled fear among nurses and other healthcare providers about losing their licenses, facing lawsuits, or even being charged with felonies while attempting to save a woman’s life. Numerous instances have been reported of women having to travel to other states to receive abortion care for rape, incest, and fetal abnormality. Women are being denied care during a miscarriage or ectopic pregnancy due to the lack of a clear definition of “the risk to a patient’s life.” Nurses must recognize that the Emergency Medical Treatment & Labor Act (EMTALA) overrides state laws and requires all emergency patients to receive appropriate screening, treatment, and transfer as needed.

Nurses need to stand together and advocate for our patients’ right to safe reproductive care everywhere. Visit https://nursesforamerica.net/reproductive-rights for ways to make a difference.