The Supreme Court overturned Roe v. Wade June 24, 2022. Since then, healthcare workers have been hesitant to provide some services, hospitals in states with abortion bans struggled to hire and pharmacies navigated confusion over which products they could dispense.
What's happened in the 12 months since the nearly 50-year precedent was struck down:
June 2022: Medical groups and healthcare organizations called the decision "shameful," "egregious" and "a step backwards." BHSH System, a 22-hospital system including Grand Rapids, Mich.-based Spectrum Health and Southfield, Mich.-based Beaumont Health, said there were "uncertainties" about the abortions it is allowed to provide — a glimpse into the nationwide confusion among healthcare workers as states could now ban abortion.
At the pharmacy counter, there was less access to medication abortion (mifepristone and misoprostol) and the emergency contraceptive Plan B. Demand for medication abortion, also known as abortion pills, increased in the weeks after the landmark ruling.
OB-GYN training was also facing an unpredictable future because these programs include abortion training.
July 2022: Leaders at hospitals and health systems described a changing legal landscape for each state's abortion law akin to tectonic plates regularly shifting under their feet.
The chemotherapy and autoimmune drug methotrexate was thrown into supply and access issues because a terminated pregnancy is one of its listed side effects. President Joe Biden signed an executive order to protect these pharmaceutical products and reproductive healthcare services, and HHS clarified that pharmacies that curb access to these drugs could face discrimination lawsuits.
HHS also said all hospitals must provide abortions in emergency cases.
Despite these assurances, hesitations in healthcare settings ran rampant. Pharmacists were unsure whether they could fill some prescriptions, #BoycottWalgreens circulated social media after a Walgreens pharmacist allegedly refused to fill a prescription for birth control, and physicians did not know if they could legally provide cancer drugs to pregnant people because some chemotherapies are dangerous for fetuses.
CVS workers in some states were instructed to verify prescription drugs were not intended to induce an abortion.
More than 40 abortion clinics closed in the four weeks after Roe was reversed.
August 2022: The Justice Department filed its first post-Roe lawsuit over abortion access. The suit was against Idaho's abortion restrictions.
Hospital administrators said they were concerned about recruiting and retaining staff as each state was deciding its abortion law. Also, medical staff were less open to taking jobs in states with strict abortion bans, making out-of-state recruitment more challenging, according to recruiters for Merritt Hawkins, AMN Healthcare's physician recruiting division.
Physicians were hesitant to prescribe a handful of therapies, including methotrexate, because they could injure fetuses.
More patients were requesting tubal sterilization.
Within 48 hours, two judges ruled differently on whether the Emergency Medical Treatment and Labor Act covered abortions: An Idaho judge ruled yes, a Texas judge ruled no.
September 2022: Four medical groups said Roe's reversal limited patients' access to medically necessary drugs and hindered clinicians from using their professional judgment.
October 2022-December 2022: Disagreements in pharmacies reached a high point. Walmart stopped requiring North Carolina pharmacy workers to confirm misoprostol was not intended for an abortion, while HHS launched an investigation into Walgreens and CVS over medication access concerns.
January 2023-February 2023: The FDA allowed eligible retail pharmacies to dispense abortion pills. CVS, Rite Aid and Walgreens expressed interest.
March 2023: After 20 attorneys general wrote to Walgreens expressing concern over its intent to dispense mifepristone where legally possible, Walgreens responded, saying it would not dispense the medication in their states. Though medication abortion remains legal in some of those states, there are laws in place requiring it to be provided by a physician, some of which are being challenged in court. A Walgreens spokesperson told Politico in March that there is "complexity around this issue" in those states.
Drugmakers of methotrexate declared a shortage.
April 2023: A federal judge in Texas ruled to suspend the FDA's decadeslong approval of one of the two abortion pills, mifepristone. An appeals court partially overturned that decision, saying that the statute of limitations bars retracting the drug's approval but ruled against a 2016 change that allowed the drug to be mail-ordered and used in the first 10 weeks of pregnancy instead of the first seven.
The Supreme Court said access to mifepristone will remain as normal as it mulls the case. No final decision has been made.
States that ban abortion noted a decrease in residency applicants.
May 2023: CMS began investigating two hospitals for allegedly not providing stabilizing care to a pregnant patient experiencing a medical emergency, which is an EMTALA violation.
In a state with a restrictive abortion law, one physician in a UCSF study said a patient who had an unwanted pregnancy was experiencing severe bleeding, but "our hands are tied."
"She is hemodynamically stable," the physician said. "This is a threatened, not inevitable, abortion. The pregnancy may continue. So we have to simply wait, either for bleeding to get worse or for her to get to viability [when she could be delivered]. … She may get to be cared for out of state, but she has social circumstances which seem to make that untenable."
In Indiana, a physician was reprimanded and fined $3,000 for talking about an abortion for a 10-year-old.
More physicians and residents said they refuse to practice and train in states with abortion bans.
June 2023: In a survey of more than 500 OB-GYNs, 70 percent said the Roe reversal worsened racial and ethnic disparities in maternal health, and more than half of respondents said Dobbs has negatively affected the ability to attract new OB-GYNs to the specialty.
One in 4 respondents said they had patients unable to obtain an abortion they sought, the survey found, and 55 percent reported an increase in the share of patients seeking contraception since the ruling, particularly sterilization (43 percent) and IUDs and implants (47 percent).
In a June 23 statement, the American Society for Reproductive Medicine said: "June 24, 2022, was a dark day in our nation's history. In one fell swoop, the U.S. Supreme Court took the sudden, unprecedented act of removing a key constitutional protection for American citizens. The right to reproductive autonomy has long been viewed, by most Americans and the law, as a fundamental right."