The decision was decades in the making.
Anti-abortion lawmakers and legal groups fought for years for the chance to take away what was a constitutional right for a generation of American women.
On 24 June 2022, they won. The Supreme Court struck down Roe v Wade, upending access to abortion care for millions of women.
Within months of the decision in Dobbs v Jackson Women’s Health Organization, more than a dozen states moved to effectively outlaw all abortions, with criminal and civil penalties for providers and patients alike.
Two years later, nearly half of all US states have criminalized abortion care in some form, while Democratic-led states have sought to become sanctuaries for the roughly 30 million women living under abortion bans.
An investigative series and documentary — The A-Word — from The Independent this week uncovers this “war on women” and the politically volatile debate over the future of critical healthcare for tens of millions of Americans.
Watch the full documentary here.
Abortion is now banned at all stages of pregnancy, with only limited exceptions, in more than a dozen Republican-controlled states. The procedure is outlawed past six weeks, before many women know they are pregnant, in at least three other states, while several others have imposed other restrictions and barriers to care in a constantly evolving and legally confusing map for abortion access.
Today, horrific stories of women in dire need of emergency abortions fill courtroom testimony and lawsuits that have joined an explosion of litigation targeting anti-abortion laws across the country.
The case of Amber Nicole Thurman — who died after lethal delays in her medical care following a rare complication from a medication abortion in Georgia, where abortion is outlawed at six weeks of pregnancy — has magnified the state of anti-abortion laws in the wake of Dobbs.
The Independent spoke with women who experienced life-threatening complications with unviable pregnancies, including Nicole Blackmon, who was forced to continue a pregnancy in Tennessee and gave birth to a stillborn baby at 31 weeks.
Breanna Cecil was 11 weeks pregnant when she learned during an ultrasound that the fetus was diagnosed with acrania, a fatal condition in which the fetus is born without a skull. She was denied an abortion under Tennessee’s ban, which prohibits abortions if there is a detectable “heartbeat”. She desperately sought an abortion in the state before ultimately traveling to Chicago for care.
“I started doing my own research, in the parking lot before work, just calling these places, crying,” Cecil told The Independent’s The A-Word. “One lady made me so mad — ‘we’re not doing elective abortions.’ What makes you think this is an elective abortion? … I remember telling the doctors and nurses, ‘Did I do something wrong? What did I do to deserve this?’”
Another patient in Tennessee said she was forced to bleed out in an emergency room until doctors could determine there was no heartbeat before they could perform an abortion.
“We just kept having to do ultrasound after ultrasound to keep confirming that there’s no chance that pregnancy could continue, as much as I would love to say I could’ve had that child,” she said. “The reality of pregnancy is not every pregnancy will continue.”
Abortion patients surrounded by anti-abortion states have been forced to travel hundreds of miles to seek care, facing significant financial hurdles and growing waiting lists at clinics in states where their care is legally protected.
America’s Balkanized state of abortion access means that millions of people cannot legally access care that, in many cases, they can receive across state lines.
Anti-abortion laws have thrust providers in those states into legally murky healthcare decisions under threats of criminal and civil penalties.
“It just created this whole gray area that we didn’t know how to navigate, and no one knew how to navigate,” Tennessee obstetrician-gynecologist Dr Laura Andresen told The A-Word.
Andresen ultimately hired an attorney to support her practice.
“There were patients waiting for 10 hours while the doctor consulted legal teams,” she said. “Those decisions were being made and you’d just hope like crazy that nobody was coming after you.”
Threats to abortion access have also had far-reaching impacts on standard medical care in restrictive states, causing more delays for critically needed care and worsening health outcomes for mothers and families.
More than one-third of the US is considered a maternity care desert, according to charity March of Dimes, where there is not a single birthing facility or obstetric clinician, and states with the most severe restrictions on abortion have the fewest policies in place to support raising families.
Meanwhile, anti-abortion lawmakers are funneling money to church-allied crisis pregnancy centers, so-called “fake clinics” designed to prevent women from seeking abortions.
Exclusive reporting from The Independent this week will reveal how millions of dollars in taxpayer money — with little oversight — is used to support clinics that steer patients away from abortion care.
The Independent spoke to five women who accidentally walked into these clinics; four of them later sought abortion care, while another became an advocate for abortion rights.
The changing landscape of abortion care has also exposed what was already a fragile reproductive healthcare system and a patchwork of abortion access even before Roe was overturned.
Women in many states already endured waiting periods, mandatory ultrasounds and prohibitive costs in a private insurance-dominated healthcare system.
Yet despite a surge in new restrictions, the number and rate of abortions in 2023 hit their highest point in over a decade, according to reproductive health rights research group the Guttmacher Institute.
Black women make up around 15 percent of the US female population, yet made up over four in 10 abortions in 2021 (42 percent). The Independent explored alarming maternal mortality rates among Black women — which transcend economic barriers — and how doulas are seeking to fill the gaps in maternal care.
The latest CDC data (from 2021) also shows that the majority of women who undergo an abortion are in their twenties (57 percent). And despite common misconceptions, most women who have abortions have also previously given birth (61 percent) at least once.
The Supreme Court’s 1973 decision in Roe v Wade — which hinges on a woman’s right to privacy — affirmed that the Constitution protects the right to abortion care. That remained the standard for nearly 50 years.
Restricted by what was then a constitutional right, anti-abortion lawmakers — aided by a coalition of powerful right-wing interest groups and a far-right Evangelical Christian nationalist agenda — pressed restrictions on abortion access over the decades that followed, testing legal boundaries until the judicial makeup was prepared to overturn them.
The so-called “pro-life” movement fueled the Republican Party and shaped the courts and state and federal legislation across the country, carving out over decades the political and legal path to the end of Roe.
Donald Trump — empowered by congressional Republicans and a party he shaped into his image — appointed three justices to the Supreme Court during his presidency. Meanwhile, a long-simmering legal challenge to Mississippi’s anti-abortion law — drafted by a right-wing Christian legal group with the specific intent of challenging Roe v Wade — was making its way to the most powerful court in the country.
That 2022 decision remains overwhelmingly unpopular, with major opinion polls routinely showing roughly that two-thirds of Americans disagree with the ruling and do not want the federal government implementing national restrictions.
Trump, now running for the presidency a third time, has repeatedly taken credit for overturning Roe, while he and his running mate JD Vance appear to have tried to publicly modulate their positions on the future of abortion access depending on the political blowback that awaits their answer.
Trump’s Democratic opponent Kamala Harris — like President Joe Biden — has pledged to sign legislation that would put into law what Roe v Wade had promised, if she is elected.
But doing so would require a committed Congress, where Republicans have endorsed national bans and refused to endorse federal protections for birth control and in vitro fertilization (IVF).
Anti-abortion proposals outlined in the Trump-allied Project 2025 document have already been playing out at the state and local level, and a second Trump administration with a Republican-controlled Congress could rely on so-called “backdoor” bans to outlaw widely used abortion drugs and threaten contraception access and IVF.
In the states, anti-abortion officials are still suing to block government approval of mifepristone, after the Supreme Court kept open the door for future legal challenges to a drug that is used in roughly half of all abortions in the US.
Anti-abortion lawmakers are also pursuing measures to make it illegal to cross state lines to seek abortion care or to even drive someone to an abortion clinic, proposals that join the long list of legal battles surrounding abortion care playing out in courtrooms across the country.
But abortion rights will literally be on the ballot this November.
Voters in at least 10 states are weighing in directly on the future of their abortion access — not just by deciding the next president but by determining whether their state legally protects a right to abortion. Anti-abortion groups and officials are already gearing up for a legal battle.
