In 2024, the US sexual and reproductive health and rights (SRHR) landscape remained deeply fragmented. Many states enacted policies to expand access to sexual and reproductive health services, including state constitutional protections for abortion that passed by ballot initiative in seven states. But other states started or continued enforcing draconian abortion bans and other restrictions that limit people’s bodily autonomy and aim to instill fear around seeking abortion care. 

With an incoming Trump-Vance administration in 2025, this divide between protective and restrictive states may widen: Protective states may find innovative ways to support sexual and reproductive health care and rights, while restrictive states may double down, emboldened by a hostile administration. Moreover, new federal policies, such as additional restrictions on medication abortion pills or even a national abortion ban, could impact everyone, regardless of what state they live in.

In this year's state trends analysis, we will examine the state policies that laid the groundwork for these national dynamics. This year, we are also including statements from partner organizations across the United States who are working to safeguard reproductive health and rights. Their perspectives highlight how state policies impact grassroots organizations and the communities they serve. 

Counts of State Legislation in 2024 (as of December 13, 2024)

Sexual and reproductive health and rights overall

2,458 provisions introduced that would protect sexual and reproductive rights or expand access to sexual and reproductive health (273 provisions enacted)

843 provisions introduced that would curtail sexual and reproductive rights or restrict access to sexual and reproductive health (39 provisions enacted)

Abortion

661 provisions introduced that would protect or expand access to abortion care (39 provisions enacted; 7 vetoed)

508 provisions introduced that would restrict access to abortion care (21 provisions enacted; 3 vetoed)

21 provisions introduced that added or expanded existing exceptions to abortion bans (none enacted)

Gender-affirming care

60 provisions introduced that would protect or expand access to gender-affirming care (5 provisions enacted)

80 provisions introduced that would restrict access to gender-affirming care (6 provisions enacted)

Contraception

359 provisions introduced that would protect or expand access to contraceptive services (28 provisions enacted)

Attacks on Sexual and Reproductive Health and Rights

In 2024, policymakers hostile to SRHR continued to target key areas where they were already enforcing bans and restrictions, such as abortion, pregnancy criminalization and gender-affirming care, while also finding new ways to restrict access to essential health services. Twenty-one abortion restrictions were enacted in 2024, many of which increased funding to anti-abortion centers. These interconnected attacks highlight the need for policy that expands and protects access to the full spectrum of SRHR.

Abortion bans

As of December 13:

• 13 states are enforcing total bans
• 28 states are enforcing abortion bans based on gestational duration
  • 7 states currently ban abortion at or before 18 weeks' gestation
  • 21 states ban abortion at some point after 18 weeks

Abortion bans in early pregnancy are concentrated in the South, Southeast and Midwest, affecting not just state residents but also creating regional ripple effects. Guttmacher data shows that interstate travel for abortion care doubled from 2020 to 2023. As more states impose bans, people need to travel further for care, which is increasingly difficult for those with limited resources, especially given that donations to abortion funds are dwindling.

View interactive version of the map.

The inequitable harms of abortion bans were highlighted this year by reporting on the preventable deaths of several women denied care due to abortion bans in Georgia and Texas. Amber Thurman and Candi Miller, two Black women in Georgia, died in 2022 because they were denied abortion care or feared seeking care under the state’s abortion ban. Three women in Texas—Porsha Ngumezi, a Black woman, Josseli Barnica, an immigrant from Honduras, and Neveah Crain, a teenager— died after they were denied miscarriage care under the state’s abortion ban. 

New gestational bans 

Two states (Florida and Iowa) started enforcing more stringent abortion bans this year. 

• Florida: On May 1, Florida started enforcing a six-week abortion ban after the state Supreme Court upheld a 15-week ban that was previously in effect. Many people don’t know they’re pregnant at six weeks, and additional restrictions in Florida make it difficult to access care in that limited time frame.
  • Guttmacher data show that the number of clinician-provided abortions in Florida decreased by 31% in May and by 36% in June, compared with the average number during the first three months of the year. 
  • An abortion rights measure on Florida’s November 2024 ballot that would have provided a legal basis to challenge the six-week ban garnered more than 57% support, but it did not clear the state’s high threshold (60%) for passing a constitutional amendment.
• Iowa: On July 29, Iowa started enforcing a six-week ban, following a decision by the Iowa Supreme Court. Access in the state was already limited by the small number of clinics and restrictions that make obtaining care in a six-week time frame almost impossible. Even before the six-week ban was enacted, hundreds of Iowa residents were already crossing state lines to seek care across the Midwest, and that will almost certainly increase with this ban in effect.
  • Guttmacher data shows that after the six-week ban went into effect, there was a 38% decrease in the average number of abortions from the first six months of the year.
  • This suggests that some Iowa residents who were not able to receive an abortion under the newly imposed law traveled out of state for care, while others may have been forced to continue their pregnancy. 

Pauses and resumptions in abortion care

Court challenges in two states highlight how bans create chaos, confusion and lingering impacts. 

• North Dakota: North Dakota’s total abortion ban was repealed on September 26 following a state court ruling that the state constitution protects the right to abortion.
  • The total ban was in effect for only 18 months but access remains limited. Since the state has a ban on telemedicine abortion care and no brick-and-mortar clinics, the repeal of the total ban may expand access only to emergency abortion care.
  • North Dakotans still need abortions. Guttmacher data shows 780 patients from North Dakota obtained abortions in Minnesota in 2023.
• Georgia: Georgia’s six-week ban was repealed on September 30 by a lower court and then reinstated a week later on October 7 by Georgia’s Supreme Court.
  • In 2023, the first full year the six-week ban was in effect, there were a total of 31,800 clinician-provided abortions in Georgia, a 24% decrease from 2020.
  • Denied abortion access in their state, Georgia residents have been forced to travel across the Southeast and beyond for abortion care, with more than 13,000 patients crossing state lines for care in 2023 and some traveling as far as North Carolina, New York and Illinois. 

Attempts at increased pregnancy criminalization

Pregnancy criminalization can take various forms, including arrests, investigations or interactions with the family policing system—punitive actions that typically stem from perceived substance use during pregnancy, suspicions about self-managed abortions or adverse birth outcomes. People living with low incomes are at the greatest risk of surveillance and criminalization.

In 2024, 13 states introduced 31 provisions aimed at intensifying the criminalization of pregnancy outcomes, but none of these provisions were enacted. These provisions include increased penalties for substance use in pregnancy. Along with restrictions such as abortion support bans and the reclassification of abortion medications as controlled substances, which will be explored in later sections, these provisions are part of an emerging trend toward increased state surveillance and punishment around pregnancy and its outcomes.

Since the overturning of Roe, pregnant individuals have faced increased scrutiny and risk of criminalization. A report by Pregnancy Justice indicates that at least 210 people were charged with pregnancy-related crimes in the year after Roe was overturned—the highest annual total recorded.

Funding for anti-abortion centers 

Anti-abortion centers (also called crisis pregnancy centers) aim to prevent pregnant people from obtaining abortion care and contraception. Although they are not licensed medical facilities, these centers often pose as abortion clinics and target people with few financial resources by providing free but very limited services, like pregnancy tests and ultrasounds. They also routinely offer false information and coercive counseling to delay and deter abortion and collect extensive personal data on pregnant people.

In 2024, most of the abortion restrictions that were enacted (16 out of 21) focused on funding anti-abortion centers, either through direct public allocations or authorizing tax credits for donations to these centers. 

• Eight states allocated more than $1 million dollars to anti-abortion centers in 2024, with the most funding allocated in Florida ($29.5 million dollars), Tennessee ($23 million) and Missouri ($8.65 million).
• In Missouri, some of this funding was diverted from the Temporary Assistance for Needy Families (TANF) program, which is designed to support low-income families and children. 

Notably, the 11 states that allocated funds to anti-abortion centers already ban or severely restrict abortion access, and these initiatives may be more focused on preventing abortion seekers from accessing accurate information and increasing pregnancy-related surveillance.

Gender-affirming care bans

Four states (NH, OH, SC and WY) enacted bans on gender-affirming care in 2024, for a total of 26 states that have enacted bans on gender-affirming care for trans youth. Two of those bans are currently blocked and not in effect, while New Hampshire’s ban will go into effect in 2025.

In addition to bans on care, two states (Idaho and South Carolina) also banned public funds from being used for gender-affirming care. South Carolina’s legislation also bans Medicaid coverage for gender-affirming care for people younger than 18.

• Kansas Governor Laura Kelly vetoed legislation in April that would have banned hormonal and surgical gender-affirming care for people younger than 18 and would have prohibited public funding for such care. The bill also would have required providers to gradually reduce treatment for patients already receiving it if stopping abruptly was deemed harmful. 

Efforts to restrict gender-affirming care and efforts to restrict abortion care follow a similar playbook and often originate from the same policymakers. These connections were made explicit in a case heard this term by the US Supreme Court, U.S. v. Skermetti, on whether Tennessee’s ban on gender-affirming hormone therapies for transgender minors violates the Equal Protection Clause of the US Constitution. The case cites the Dobbs decision several times as the basis to restrict gender-affirming care, demonstrating how the conservative movement may use the decision’s precedent to target other forms of health care.

Evolving Threats

Policymakers who seek to curtail SRHR are increasingly focused not just on restricting care provision but also on generating additional barriers, fear and confusion for those seeking care. This trend includes creating barriers to health care access for young people, such as parental involvement laws and abortion support bans, as well as new restrictions on medication abortion pills.

Laws mandating parental involvement

In 2024, state policymakers focused on restricting young people’s access to SRHR across various forms of health care and specifically through laws mandating parental involvement. In addition to creating obstacles for young people seeking abortion or contraception care, these laws can aggravate minors’ fears of being abused or forced out of their homes. These outcomes are particularly relevant as policymakers seek to limit other aspects of young people’s bodily autonomy.

• Idaho enacted a law in July that requires parental consent for all nonemergency health care provided to a minor (including STI testing and treatment) and that grants parents access to all of their child's health information.
• Also in July, Tennessee enacted a “family rights” bill intended to expand parental control over young people’s medical decisions and medical records, including those involving prenatal care, STI treatment and contraceptives, which previously did not require parental consent. Another law in Tennessee was enacted in April that allows parents access to their minor children’s prescription records, even if that care does not require parental consent. While the impact of these laws has been somewhat mitigated in the state, they signal a concerning trend toward restricting young people’s access to needed care.
• In March, the 5th Circuit Court of Appeals upheld a lower court ruling that requires Texas clinics receiving federal Title X funding to obtain parental consent before providing prescription contraceptives to minors.
• Eight bills introduced in six states would require young people to obtain parental notification or consent to obtain contraceptives. (Only the Tennessee law, discussed above, was enacted into law.)

Abortion support bans

Abortion support bans assign civil or criminal liability to adults who help minors travel out of state for abortion care and constitute one of the many unique barriers that young people face in accessing SRH care. Starting with Idaho’s enactment of the first abortion support ban in 2023, such bans have repeatedly been introduced across the country. The two that have been enacted (Idaho and Tennessee) have been partially blocked, although their impact on abortion funds, practical support organizations and the young people they assist remains harmful. This pattern creates a climate of fear and hostility that works to deter young people from seeking abortion care and to prevent others from assisting them, including practical support groups that help patients traveling for care.

• In 2024, three states (Alabama, Mississippi and Oklahoma) introduced abortion support bans, and one state (Tennessee) enacted such a ban. All of these states are already enforcing total abortion provision bans. 
• In December, the Ninth Circuit Court of Appeals reinstated the parts of Idaho’s support ban that prohibit “harboring, or transporting” a minor to help them access abortion care, similar to an earlier ruling in Tennessee. This law, like Tennessee’s, raises significant concerns for the work of abortion funds and other practical support organizations. 

New restrictions on medication abortion pills in Louisiana 

Medication abortion is an extremely safe and effective abortion method that accounted for 63% of all clinician-provided abortions in the United States in 2023. The most common medication abortion regimen uses two drugs: mifepristone and misoprostol, both of which are also used in miscarriage management and emergency obstetric care. The anti-abortion movement has repeatedly attempted to restrict access to these drugs, most recently in a 2024 US Supreme Court case that used discredited research to try to reimpose burdensome restrictions on mifepristone provision.

On October 1, Louisiana enacted a first-of-its-kind law that classifies both mifepristone and misoprostol as controlled substances/Schedule IV drugs, while imposing other harmful and medically unnecessary restrictions. Louisiana is already enforcing a total abortion ban, so this law will delay treatment for miscarriage management and emergency obstetric care. One additional state (Texas) has prefiled similar laws ahead of the 2025 legislative session.

Protections

As some states continued to restrict abortion access and test out new restrictions on contraception, other states successfully eliminated longstanding barriers to care. These successes were primarily due to the work of reproductive health, rights and justice advocates who spent years mounting campaigns to protect SRHR access. These advocates also utilized the success of recent ballot initiatives to challenge restrictions.

Improved coverage for abortion and contraception

In 2024, 13 states (Delaware, Georgia, Hawaii, Illinois, Kansas, Michigan, Minnesota, New Jersey, New York, North Carolina, South Carolina, Tennessee and Washington) introduced bills that would improve insurance coverage of abortion care. An additional three states (Florida, Kentucky and Wisconsin) introduced bills that would repeal existing bans on public funding and/or coverage for public employees in the state.

• Delaware, Minnesota and Illinois all passed laws that require insurance coverage of abortion without cost-sharing. The Delaware and Minnesota laws extend to state Medicaid programs, while Illinois had previously extended such coverage through Medicaid.

Twenty-eight states introduced bills that improve insurance coverage of contraception. Two states with strict abortion bans (Tennessee and Idaho) also enacted legislation to improve insurance coverage of contraception by allowing coverage for an extended supply.

Ballot initiatives as a basis for key improvements to access

Developments in 2024 also demonstrated the potential that ballot initiatives hold in creating substantive state-level change. While citizen-led ballot initiatives are not an option in many states, advocates in others have successfully used such measures to protect abortion access and other reproductive rights since Dobbs. 

In November 2024, seven states (Arizona, Colorado, Maryland, Missouri, Montana, Nevada and New York) approved ballot initiatives that are protective of abortion access, while three (Florida, Nebraska and South Dakota) were unable to pass such measures. Despite the Florida ballot initiative receiving a majority of votes, it fell short of the 60% threshold required for passage. By contrast, just hours after the Missouri ballot initiative passed, advocates in the state filed a lawsuit seeking to repeal the state’s total abortion ban. In December, some providers in Arizona resumed offering later abortion care, after the attorney general signed a stipulation that the state’s 15-week ban is unconstitutional and will not be enforced until the resolution of a lawsuit challenging it.

Earlier in 2024, previously successful ballot initiatives helped protect abortion access in several states.

• Michigan: On June 25, the Michigan Court of Claims issued a preliminary injunction against three abortion restrictions (a 24-hour waiting period, a ban on nonphysician provision, and a coercive counseling requirement), halting enforcement of the laws while litigation proceeds. This preliminary injunction was based in part on a state constitutional amendment protecting abortion rights, which was approved by Michigan voters in a 2022 ballot measure. 
• Ohio: On October 24, the Hamilton County Court of Common pleas issued a permanent injunction blocking Ohio’s six-week abortion ban. It marks the first time in the United States that an abortion ban has been permanently enjoined as a result of a state constitutional amendment for reproductive rights. Ohio voters established the amendment through a ballot initiative in 2023 and it has provided the legal basis of two previous victories for abortion access: 
  • On August 23, the Court of Common Pleas of Franklin County, Ohio issued a preliminary injunction blocking a set of laws in Ohio that mandate a 24-hour waiting period and in-person counseling before abortion care. 
  • In a separate ruling, the Court of Common Pleas of Hamilton County, Ohio temporarily blocked the state’s ban on telehealth provision of medication abortion. Additionally, the court ruled that medication abortion can be provided through at least 11 weeks of pregnancy and that nonphysician providers can offer this care. 
• Nevada: On September 12, Nevada’s Eighth Judicial District Court for Clark County struck down the state’s ban on using Medicaid funds to cover abortion care. The court ruled that the ban violated Nevada’s Equal Rights Amendment (ERA), which was added to the state constitution via ballot initiative in 2022.

The right to contraception

Opponents of abortion access increasingly seek to restrict other areas of SRHR, including contraception. In response, advocates in a number of states have sought to legally protect contraception access.

In 2024, 27 states, including some with abortion restrictions, introduced bills to protect access to birth control. Currently, 14 states and the District of Columbia have codified legal protections for contraception.

Shield laws and improved telehealth access

Since the Dobbs decision, state shield laws and the expansion of telehealth for medication abortion have helped ensure access for a significant number of people living in ban states. States with shield laws seek to minimize legal risks for people providing and individuals accessing various types of legally protected health care including abortion, and, in some cases, gender-affirming care. 

At present, 22 states and Washington, DC have some type of shield law or policy, although the specific protections, and whether they are established by statute or executive order, vary by state. Eight of those 22 states extend their protections to telehealth providers, meaning that clinicians in those states can utilize telehealth to provide medication abortion to individuals residing in states with abortion bans.

In 2024, 18 states introduced bills that made improvements to existing shield laws or introduced new shield laws. Some examples include:

• Maine and Rhode Island passed statutes to protect health care providers who offer abortion and gender-affirming care, including those who provide telehealth.
• Delaware added protections for providers of fertility treatment to their existing reproductive health shield law.
• However, in Virginia, the governor vetoed a shield bill.

Also in 2024, 13 states (Arizona, Delaware, Florida, Iowa, Kentucky, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, South Carolina and Tennessee) introduced bills that would improve access to telemedicine in the realm of sexual and reproductive health. Some examples include:

• Washington enacted a law that includes asynchronous services as part of telehealth, which means that communications between the patient and the health care provider can happen at different times.
• California passed a bill to extend coverage of asynchronous care by Medi-Cal, the state Medicaid program, to include telehealth communication initiated by patients, including via mobile apps. However, the governor vetoed the bill.

A Perilous Moment

Two and a half years after the Dobbs decision, the devastation caused by abortion bans and restrictions is clearer than ever. The deaths we know of so far—of Amber Thurman, Candi Miller, Josseli Barnica, Nevaeh Crain and Porsha Ngumezi—are preventable tragedies that reflect a broader landscape of fear and inequity, where even emergency, lifesaving abortion care is inaccessible to patients based on their zip codes. Additionally, while criminalization of pregnancy outcomes existed before Dobbs, these patterns of reproductive injustice have continued to expand, often aggravated by state policies that push the bounds of existing restrictions. Under the Trump-Vance administration, attacks on bodily autonomy will likely intensify at the federal and state level, even as patients remain determined to get the care they need. At this perilous moment, local organizations providing legal, practical and financial support will be more important than ever in the broader struggle for sexual and reproductive health, rights and justice.