Four years after Dobbs, state lawmakers are shifting from outright bans to a sweeping strategy of lawsuits, criminal penalties and cross-state battles aimed at cutting off the last remaining routes to abortion care.
The first year of Trump’s second term marked major blows for reproductive healthcare. Medicaid funding cuts forced about 50 Planned Parenthood clinics to close throughout the U.S. and blocked 1.1 million Planned Parenthood patients on Medicaid from using their insurance to pay for reproductive healthcare. Twenty-three independent abortion clinics throughout the country also shut down in 2025, according to Abortion Care Network’s annual report.
2025 also saw some new, troubling trends in state-level reproductive healthcare policies, including restrictions on medication abortion and shield laws and criminalization for people who help patients access abortions.
“Prior to [2025], much of the focus was on straightforwardly banning and restricting access to abortion care,” said Kimya Forouzan, principal state policy advisor at the Guttmacher Institute, at a webinar outlining Guttmacher’s policy analysis about 2025’s state policy trends for reproductive healthcare access. “In response, patients, providers and helpers showed incredible resiliency in finding ways to ensure that abortion care is still available for many people.”
Forouzan continued: “Now, state legislators are increasingly going after these avenues of care and pushing forth criminalization of care.”
Currently, 13 states have total abortion bans in effect. Another 28 have bans based on gestational duration (including states such as Florida and Georgia, which cap abortion at six weeks, before most women even know they’re pregnant).
Now, at the start of 2026, there are only nine states where it is possible to get a legal abortion with no restrictions.
In 2025, Guttmacher tracked 841 legal provisions introduced throughout the U.S. that would restrict access to sexual and reproductive healthcare. Of these, 70 were enacted—many attacking abortion pills and other channels for abortion access that have managed to survive post-Roe v. Wade.
Now, four years after the Supreme Court’s Dobbs decision overturned Roe, here are some of the key ways states are pushing harder than ever to end any access to abortion.
1. Attacking Medication Abortion and Shield Laws
Right now, 22 states and Washington, D.C., have shield laws to protect reproductive healthcare providers.
Eight of these states extend their protections to doctors providing telehealth care to patients in other states, including states with different abortion laws.
State shield laws came to public attention in 2025 when Texas Attorney General Ken Paxton and Louisiana Attorney General Liz Murrill both tried to extradite New York OB-GYN Dr. Margaret Carpenter, who allegedly mailed medication abortion to patients in both states, which outlaw abortion. Because New York has a shield law in place to protect healthcare providers like Carpenter who treat patients in other states, New York Gov. Kathy Hochul said there was “no way in hell” she would extradite Carpenter for prosecution.
A near-identical situation is playing out right now in California, where Gov. Gavin Newsom has likewise refused to extradite Dr. Rémy Coeytaux after Murrill claimed he illegally mailed abortion pills to a Louisiana patient. And in late January, Texas A.G. Paxton also sued Delaware abortion provider Debra Lynch of the organization Her Safe Harbor for allegedly mailing abortion pills to out-of-state patients.
Although so far shield laws have protected doctors like Carpenter and Coeytaux, recent attacks on medication abortion are seeking to make it impossible for doctors to provide this kind of care to patients in other states, even if they have legal protection. Since the end of Roe, abortion pills—mifepristone and misoprostol—have been crucial for continued abortion access. Abortion pills accounted for 63 percent of all U.S. abortions in 2023, the first year after Dobbs, according to Guttmacher data. This is likely an undercount because it doesn’t cover pills ordered online and discreetly mailed to patients in states with abortion bans.
In 2025, legislators in nine states introduced 23 bills to criminalize the sale, purchase or distribution of medication abortion pills. Many of these bills cited junk science about the so-called dangers of abortion pills, which are FDA-approved and have been proven safe in more than 100 studies, or the completely unfounded claim about medication abortion supposedly contaminating drinking water that has been gaining traction with antiabortion groups.
Of these 23 bills, one became law: Texas’ HB 7, which enables private citizens to sue anyone who manufactures, distributes or mails abortion medication to residents of Texas, took effect Dec. 4, 2025.
Under this law, Texans are encouraged to sue doctors who prescribe medication abortion. If the plaintiff in one of the lawsuits is related to the fetus, they can receive $100,000. Texas residents can also sue websites such as Aid Access and The MAP, which mail abortion pills to all 50 states, and even family and friends who order abortion pills for a patient.
“Many Texans can’t leave the state for care,” said Lucie Arvallo, executive director of Jane’s Due Process, at the Guttmacher panel in December. Jane’s Due Process is a youth advocacy organization that helps young people in Texas navigate parental consent laws and other barriers to accessing abortion and birth control. “For these people, abortion pills via telemedicine have become a lifeline. This bill is an attempt to cut that lifeline off.”
More and more, states are also targeting providers in shield law states by attaching additional criminal and civil care penalties to abortion care provided across state lines. In 2025, Louisiana passed a law allowing private citizens to sue shield state abortion providers (whom the law calls “abortion drug dealers”).
Not even two months into 2026, we’re already seeing more attempts by the GOP to cast doubt on the safety of medication abortion.
On Jan. 15, the Senate Health, Education, Labor & Pensions (HELP) committee held a hearing on abortion pills called “Protecting Women: Exposing the Dangers of Chemical Abortion Drugs,” where Louisiana AG Murrill repeated the baseless GOP talking point that access to abortion pills makes it more likely women will be “coerced” into unwanted abortions. (It’s actually far more common for abusers to force women to remain pregnant when they would rather abort.)
2. Pushing for ‘Fetal Personhood’
Near and dear to the antiabortion movement is the concept of “fetal personhood,” which suggests fetuses and embryos should have legal rights, even placing their rights above that of the pregnant patient.
In the four years since Dobbs, we’ve seen grim examples of this logic playing out in real life.
In 2025, the country witnessed the case of Adriana Smith, a Black woman in Georgia who died of blood clots in February while nine weeks pregnant. Despite Smith being brain-dead, and without consulting her family, the hospital kept her body “alive” for weeks on life support so the fetus could continue to gestate, a result of Georgia’s strict abortion ban. The case sparked widespread criticism from lawmakers and activists about women’s bodies being treated as incubators, not people, in abortion ban states, as well as comparisons to Black women historically being forced into involuntary reproductive servitude.
In 2025, 19 states introduced at least 37 bills that included language about fetal or embryonic personhood.
If passed, Texas’ HB 196 would require public schools to teach that “human life begins at conception” (an evangelical Christian-centric concept that goes against other religions including Judaism and established medical science).
Ironically, in 2025, Trump signed an executive order attempting to remove birthright citizenship for American-born children of immigrant parents, as guaranteed by the 14th Amendment, at the same time multiple antiabortion groups are trying to argue the 14th Amendment gives legal rights to fetuses.
This legislative trend has already continued into 2026.
On Jan. 14, South Carolina’s House debated HB 3537, which would make abortion a crime equivalent to “homicide of a person who had been born alive.”
3. Criminalizing Patients and Patient Helpers
Historically, antiabortion lawmakers and activists have shied away from criminalizing abortion patients, instead targeting providers, but that may be starting to change. In November, a South Carolina bill that would have criminalized patients who sought abortion care and potentially made them liable for the death penalty only narrowly failed to pass in the South Carolina Senate.
Even though this bill, which would have been the most punitive antiabortion law in U.S. history, failed, the fact it even made it to the state Senate may suggest a new trend in bills that don’t hesitate to criminalize patients as well as abortion providers.
“Senate Bill 323 reflected a growing strategy from antiabortion extremists. If they can’t fully ban abortion outright, they will criminalize as many aspects of pregnancy as possible, and South Carolina is becoming the testing ground for those tactics,” Dr. Amalia Luxardo, executive director of South Carolina gender justice organization WREN, explained at the Guttmacher panel.
Last year, eight states introduced 12 bills that could apply criminal or civil penalties to abortion funds, practical support networks or other groups that help patients access abortions. In the last few years since Dobbs, abortion funds, particularly in states with bans, have been a lifeline for women who have to travel out of state for abortion care. Many, including the Florida Access Network, assist patients who have to leave the state with travel and childcare funds for the journey.
Some bills, including Texas’ HB 991, would have empowered citizens to sue websites for simply providing information about medication abortion.
Some Silver Linings
In the midst of last year’s wave of antiabortion laws, there were some moments of hope.
Abortion is illegal in Tennessee, but in spring 2025, the state passed the Fertility Treatment and Contraception Act, one of the first reproductive justice bills to pass in the South since the Supreme Court overturned Roe v. Wade. Despite national threats to IVF and birth control access, the new law codifies the right to contraception and fertility treatments including IVF in Tennessee while protecting providers who offer this care.
“By explicitly protecting both contraception and fertility treatment, the law restores clarity and ensures that commonly used contraceptives like IUDs and emergency contraception remain both legal and accessible, and that fertility clinics can operate without fear,” said Kelli Nowers, executive director of the nonprofit AWAKE TN. “Protective legislation like this matters even more, because in the same session earlier this year, we saw a slate of bills that would have further restricted reproductive care.”
Still, pro-abortion lawmakers are gearing up for another year’s worth of fights against antiabortion laws and the GOP’s tactics to take away women’s access to reproductive healthcare.
“All in all, 2025 state legislative sessions demonstrated a vital point,” Forouzan said. “Attacks on abortion access and all forms of sexual and reproductive health and rights have in no way settled. State lawmakers continue to push forth legislation that seeks to limit the remaining avenues of care as well as criminalization.”
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