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In the nearly two years since the Supreme Court overturned Roe v. Wade, abortion access has been in an almost constant state of flux.

State laws keep changing – with new bans taking effect in some places while new protections are enacted in others. And there have been a slew of lawsuits and ballot measures that may motivate voters come November.

Here are 6 facts about where things currently are with abortion and the election.

1) About half of states restrict abortion

In 14 states, there are total bans on abortion, with very limited exceptions in cases such as rape or to save the life or health of the mother. A few more states – including Florida – have six-week bans, and often that's so early in a pregnancy most people don't yet know they're pregnant. Another half dozen states have restrictions that limit abortion after 12, 15, 18 or 22 weeks of pregnancy.

In the states that ban or severely restrict abortion access, the number of abortions has dropped drastically.

But legal challenges and ballot initiatives mean the map could keep shifting. So far, voters will be weighing in on the right to an abortion in four states: Colorado, Florida, Maryland and South Dakota. Six more states are in the process of getting it on the ballot, including Missouri, Nebraska, Nevada, Arizona, Arkansas and Montana.

Idaho illustrates how abortion bans can affect a state's broader health care system. Doctors are leaving the state, and three maternity wards have closed since the abortion ban took effect there.

"We lost 58 obstetricians either to moving out of state or retiring, and in that same time period, only two OB-GYNs moved into Idaho," says Dr. Sara Thomson, an OB-GYN in Boise. "That is not really a sustainable loss-to-gain ratio."

It's not just Idaho – a lot of hospital systems in states with abortion bans are having recruiting problems. The Association of American Medical Colleges earlier this month reported a decrease in medical students applying to residencies in states that limit abortion access. Essentially, these early career doctors are saying they don't want to practice medicine with the threat of fines, jail time, and the loss of their medical license.

3) Abortions are actually increasing nationally

the number of abortions in the U.S. has continued to grow.

"We are seeing a slow and small, steady increase in the number of abortions per month and this was completely surprising to us," says Ushma Upadhyay, who co-leads the Society of Family Planning's WeCount project. According to their recent report, in 2023 there were, on average, 86,000 abortions per month compared to 2022, when there were about 82,000 abortions per month. "Not huge," says Upadhyay, "but we were expecting a decline."

A major factor in the uptick in abortions nationwide is the rise of telehealth, made possible in part by regulations first loosened during the coronavirus pandemic. Telehealth abortions now make up nearly 1 in 5 of all abortions in the U.S. Patients don't need to take off work and go to a clinic, they can connect with providers over text messages, phone calls or video, no matter where they live. Abortion medication is then mailed to them at home.

John Seago, president of Texas Right To Life, is concerned with the rise of abortions and increased access through telehealth.

"I'm afraid that we are going to wake up in 20 years and just kind of realize that we won in 

, and then we've been losing ever since," Seago says. He told NPR his group is currently working on how to bring criminal and civil challenges to tamp down on the number of abortions.

4) Some states have moved to make abortion access easier

Abortion was heavily regulated even while 

was the law of the land, and states like Michigan, Colorado, California, Minnesota and others 

They are passing laws to get rid of waiting periods and gestational limits, and they are allowing more types of providers like nurse practitioners, for instance, to perform abortions. Some states have stockpiled mifepristone, one of the medicines that can be used for abortion, in case access is curtailed federally in the future.

 as part of its health department, including a hotline and chat for people to find out where to get an abortion and how to get funding to cover the costs.

5) ‘Shield laws’ create new access in untested legal terrain

Another way some states have expanded abortion access is by passing "shield laws." These are laws that say doctors and nurses in states where abortion is legal can't be prosecuted by another state if they provide abortion across state lines. They apply if a woman travels to another state for an abortion or if the abortion provider mails pills to someone in a state with restrictions.

Lauren, who is 33 and lives in Utah, got a telehealth abortion from a provider in a state with shield laws. Lauren got pregnant on birth control and decided quickly that she couldn't afford another child. (NPR is not using her last name because she's worried about professional repercussions.)

Abortion is technically legal in Utah until 18 weeks, but access is severely restricted. It can only be performed in hospitals, for instance. So Lauren chose an online company called Aid Access, that provides telehealth abortion for people in all 50 states.

"In my situation, I felt more at ease than I would in a physician's office and more comfortable, to be honest," she explains. "Especially with a provider within the state of Utah – I feel like there's always a judgmental indication or undertone."

She filled out a form online with questions about how far along she was and her medical history, connected with a doctor via email and text messages, and received abortion medication in the mail. She had her abortion at home.

Some anti-abortion rights groups are hoping to test the legality of shield laws by bringing charges against a doctor, but that hasn't happened yet.

6) The Supreme Court could shake things up again

There are two major decisions on abortion pending right now before the Supreme Court.

One is about the abortion pill mifepristone. The Court could restrict this drug for the whole country and totally change access to medication abortion through telemedicine. Court watchers think it won't go that way, but no one knows for sure.

The other case is about abortion in emergency situations and it centers on Idaho's medical exception. It's a fight over whether federal or state law should have priority. The oral arguments left legal analysts unsure about which way the Court was leaning.

Both of these decisions are expected in late June or early July, just a few months before the election. Regardless of what the justices decide, it's going to catapult abortion back into the headlines a few months before the election. 

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Election 2024

Selena Simmons-Duffin

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Elissa Nadworny 

State laws on abortion keep changing — with new bans taking effect in some places while new protections are enacted in others. And abortion will be on the ballot in at least four states.

6 key facts about abortion laws and the 2024 election

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