这堕胎景观美国的发生了巨大变化因为最高法院推翻了罗伊诉韦德案六个月前。
推翻罗伊案的决定保证了堕胎护理的宪法权利，这意味着各州现在可以选择居民堕胎的权利。
一些州要么有所谓的触发法律生效或在Roe案之前的法律，在法院判决后执行。
与此同时，其他一些州颁布了加强堕胎权利的法律，或拒绝了进一步限制堕胎的投票倡议。还有一些州两者都没有。
“这些法律变化都发生了，我们去了这个拼凑，”凯蒂·沃森医学社会科学、医学教育和产科副教授费恩伯格医学院西北大学的妇产科医生告诉ABC新闻。"各州采取了不同的立场，六个月过去了，情况仍在变化."
至少有14个州几乎停止了堕胎护理
自从罗伊案被推翻以来，至少有14个州几乎停止了所有堕胎服务。
根据古特马赫研究所的研究、阿拉巴马、阿肯色、爱达荷、肯塔基、路易斯安那、密西西比、密苏里、俄克拉荷马、南达科他、田纳西、德克萨斯和西弗吉尼亚已经完全禁止堕胎，只有有限的例外。
此外，在威斯康辛州，堕胎服务已经停止，“由于该州罗伊案前禁令的法律不确定性，”古特马赫研究所说。
威斯康星州有一个20周的禁令，但也有一个罗伊案前的堕胎禁令，现在罗伊案已被推翻，该禁令可能会生效。佐治亚州也实施了为期六周的禁令。
此外，佛罗里达州有15周的禁令生效。亚利桑那州也有15周的禁令，但要到2023年才会执行。
与此同时，在印第安纳州、北达科他州、俄亥俄州、犹他州和怀俄明州，堕胎禁令获得通过，但目前在法律诉讼进行期间被阻止。
十几个州致力于保护堕胎权
虽然许多州在Roe诉Wade案被推翻后颁布了堕胎限制，但多个州采取了保护堕胎的措施，并承诺为堕胎提供资金。
Guttmacher说，在过去的一年里，包括加利福尼亚、马萨诸塞州、新泽西州、新墨西哥州、纽约州和俄勒冈州在内的各州集体承诺为堕胎提供超过2.5亿美元的资金。
保护堕胎机会的其他努力包括缅因州、马萨诸塞州、新泽西州和纽约州四个州改善堕胎机会的新法律，以增加获得堕胎护理的提供者和患者的安全。
根据古特马赫的说法，14个州通过了所谓的庇护法旨在保护跨州旅行接受堕胎的人和照顾这些病人的提供者。这意味着他们不能因为在外州堕胎而被起诉。
选民去投票站就堕胎权投票
罗伊诉韦德案的失败增加了11月份2022年中期选举的风险，因为多个州的选票上都有堕胎相关的问题。
堪萨斯选民果断地拒绝出价取消州宪法中对堕胎的保护。
投票是在该州最高法院于2019年决定堪萨斯州宪法确立堕胎的基本权利后进行的。
堪萨斯州的投票是最高法院之后的第一次州级测试投票推翻罗伊诉韦德案。
在加州，选民决定修改州宪法，禁止州政府否认或干涉一个人的“生殖自由”。投票者也接受了立法者的建议，保护选择堕胎或使用避孕药具的基本权利。
根据古特马赫研究所的说法，目前，堕胎在加州是合法的，直到怀孕24到26周。
在佛蒙特州，选民们同意修改该州宪法，将包括堕胎在内的“个人生殖自主权”纳入其中。尽管目前在佛蒙特州怀孕的任何阶段堕胎都是合法的，但是在修正案被接受之前，该州的宪法并没有明确保护堕胎的权利。
与此同时，密歇根州选民批准了一项宪法修正案，将增加对生育权的保护。该修正案将生殖自由定义为“做出和实施与怀孕有关的所有事项的决定的权利，包括但不限于产前护理、分娩、产后护理、避孕、绝育、堕胎护理、流产管理和不孕症护理。”
密歇根州自1931年以来禁止堕胎的法令在州法院受到了挑战州法官在9月份裁定该禁令是违宪的，禁止州检察长和州检察官执行。
在肯塔基州，选民否决了该州宪法的一项修正案，该修正案规定堕胎权不存在，也不要求政府为堕胎拨款。
堕胎是目前在该州被禁止在Roe案被推翻后，触发法开始生效。反对禁令的争论将很快在肯塔基州最高法院进行听证，这是修正案本可以阻止的。
蒙大拿州选民否决了一项提案，该提案要求修改州宪法，将所有“活着出生”的胎儿定义为法人，包括那些在试图堕胎后出生的胎儿。该提案将赋予任何活着出生的胎儿获得适当和合理的医疗保健和治疗的权利。
蒙大拿州法院已经阻止了去年通过的三项堕胎禁令在诉讼进行期间生效。
患者为了寻求堕胎护理而远行
贝弗利·格雷博士北卡罗来纳州达勒姆市杜克健康中心的妇产科医生告诉美国广播公司，自从罗伊案被推翻后，本地和外州的病人都有所增加。
她说，“佛罗里达州有15周的禁令，佐治亚州和田纳西州有相当严格的禁令，然后南卡罗来纳州也有类似的禁令，病人最终都来北卡罗来纳州接受治疗。”“在诊所里，我们几乎每天都会看到一些患者为了寻求护理而四处奔波。”
“我认为这真的很可怕，因为患者可能会发现自己处于一种他们没有预料到并需要护理的境地，而他们的提供者可能因为现有的法律而无法提供循证护理，”她继续说道。
格雷说，在最高法院做出裁决后，她看到北卡罗来纳州寻求堕胎的病人数量“持续增加”，其中相当一部分人来自堕胎限制严格的邻近州。
“当南卡罗来纳州实施严格的禁令时，今年夏天有六七周我们有相当高的交易量，然后佐治亚州的法律开始生效，”她说。
更多:研究表明，禁止堕胎的州已经有很高的产妇死亡率和很少的医生
格雷说，这种增长在逻辑上具有挑战性。北卡罗来纳州在堕胎前有72小时的等待期，并且要求提供者阅读该州的强制性咨询脚本，其中包括关于怀孕期间可用的公共和私人服务以及堕胎和怀孕可能产生的不利影响的信息。
批评者称，该剧本是一种恐惧策略，旨在羞辱和吓唬人们不要堕胎。
“所以，有很多...在人们到达这里之前，物流和要求必须到位，所以这需要大量的协调，”格雷说。“我们有一个非常擅长处理...我们在诊所的每一天，大部分时间都在打电话和做后勤工作。”
诊所关闭或跨州搬迁
在最高法院做出裁决后，一些堕胎诊所被迫关闭或转移到其他州。
在罗伊案被推翻后，由于北达科他州目前正在进行的法律斗争，红河妇女诊所从北达科他州的法戈搬到了一英里半以外的明尼苏达州穆尔黑德，尽管堕胎在该州仍然是合法的。
自8月10日开业以来，RRWC导演塔米·克罗梅纳克尔告诉ABC新闻，搬家是苦乐参半，但他们已经找到了节奏。
“我们为北达科他州、南达科他州、明尼苏达州西北部的患者提供护理;我们有几个来自得克萨斯州的女孩，大概两个，”她说。“我们仍然能够在很短的时间内看到人们，我觉得我们就像hit一样——我不想称之为‘正常’——但我们又回到了过去在法戈看到的病人身上。”
她说，北达科他州和明尼苏达州之间的政治气候差异为堕胎护理提供了更多的自由。
“这是如此难以形容，我们可以只与一个人约会，而不必告诉他们国家让我们在北达科他州说的非常耻辱的可怕语言，”Kromenaker说。“实际上只有五分钟的路程，是同一个社区，但这两个州之间形成了鲜明的对比。”
虽然Kromenaker和她的同事目前正在该州进行法律斗争，以阻止堕胎禁令生效，但她说她不确定诊所是否会搬回来，或者她是否会在和平花园州开设第二家诊所。
“在北达科他州，对医疗服务提供者有这么多繁重的限制，除非或直到这些限制被取消——我的意思是，我们必须提前24小时告诉病人，‘堕胎终止了一个完整的独立独特的活着的人的生命。’我们不得不把国家的材料强加给妇女，她们无法拒绝，只能接受。我们受到药物流产疗法的限制，”她解释道。
“我需要看那些...在我们考虑回去提供护理之前，事情就过去了。就北达科他州目前的情况来看，我认为在相当长的一段时间内不会发生这种情况，”她补充说。
6 months after overturning of Roe v. Wade, what abortion access looks like in America
The abortion landscape of the United States has changed dramatically since Roe v. Wade was overturned by the Supreme Court six months ago.
The decision to reverse Roe, which guaranteed a constitutional right to abortion care, means states now choose how much access residents have to abortion.
Some states either had so-called trigger laws go into effect or laws that pre-dated Roe that were enforced following the court's decision.
Meanwhile, some other states enacted laws that strengthened abortion rights or rejected ballot initiatives that would have further restricted access to the procedure. And then there were states did neither.
"Both those legal changes happened, and we went to this patchwork," Katie Watson, an associate professor of medical social sciences, medical education, and obstetrics & gynecology at Northwestern University Feinberg School of Medicine, told ABC News. "And states took different positions and it's still in flux six months later."
Abortion care nearly ceased in at least 14 states
Since Roe was overturned, at least 14 states have nearly ceased all abortion services.
According to the Guttmacher Institute, Alabama, Arkansas, Idaho, Kentucky, Louisiana Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas and West Virginia have completely banned abortion with limited exceptions.
Additionally, in Wisconsin, abortion services have stopped "due to legal uncertainty around the status of the state's pre-Roe ban," the Guttmacher Institute states.
Wisconsin has a 20-week ban but also a pre-Roe abortion ban on the books that could go into effect now that Roe has been overturned. Georgia also has a six-week ban in place.
Additionally, Florida has a 15-week ban in effect. Arizona also has a 15-week ban, but it won't be enforced until 2023.
Meanwhile, in Indiana, North Dakota, Ohio, Utah and Wyoming, abortion bans were passed, but are currently being blocked while legal action proceeds.
Over a dozen states work to protect abortion access
While many states enacted abortion restrictions following the overturning of Roe v. Wade, multiple states adopted protections for and committed funding to abortion access.
States including California, Massachusetts, New Jersey, New Mexico, New York and Oregon committed over $250 million collectively to abortion funding over the past year, according to Guttmacher.
Other efforts to protect abortion access included new laws to improve abortion access in four states -- Maine, Massachusetts, New Jersey and New York -- to increase security for providers and patients accessing abortion care.
According to Guttmacher, 14 states adopted so-called shield laws designed to shield people who travel across states lines to receive an abortion and the providers who care for those patients. This means they can't be charged for receiving an abortion out-of-state.
Voters go to the polls to vote on abortion access
The fall of Roe v. Wade raised the stakes for the 2022 midterm election in November, as multiple states had abortion-related questions on the ballot.
Kansas voters decisively rejected a bid to remove abortion protections from its state constitution.
The vote came after the state's Supreme Court decided in 2019 that the Kansas constitution establishes a fundamental right to abortion.
The Kansas vote was the first state-level test after the Supreme Court voted to overturn Roe v. Wade.
In California, voters decided to amend the state constitution to prohibit the state from denying or interfering with a person's "reproductive freedom." Voters also accepted lawmakers' proposal to protect the fundamental right to choose to get an abortion or use contraceptives.
Currently, abortion is legal up until viability in California, which is about 24 to 26 weeks gestation, according to the Guttmacher Institute.
In Vermont, voters approved amending the state's constitution to include a right to "personal reproductive autonomy," which includes abortion. Although it is currently legal in Vermont at any stage of pregnancy, the state's constitution did not grant explicit protections for the right to abortion prior to the acceptance of the amendment.
Michigan voters meanwhile approved a constitutional amendment that would add protections for reproductive rights. The amendment defines reproductive freedom as "the right to make and effectuate decisions about all matters relating to pregnancy, including but not limited to prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management and infertility care."
A state abortion ban on the books in Michigan since 1931 is being challenged in state courts, but a state judge ruled in September that the ban is unconstitutional, barring its enforcement by the state's attorney general and state prosecutors.
In Kentucky, voters rejected an amendment to the state's constitution that specified the right to abortion does not exist, nor is the government required to allocate funding for abortion.
Abortion is currently banned in the state after a trigger law went into effect when Roe was overturned. Arguments against the ban will soon be heard in the Kentucky Supreme Court, something the amendment would have prevented.
Montana voters rejected a proposal to change the state constitution to define all fetuses "born alive" as legal persons, including those born after an attempted abortion. The proposal would have granted any fetus born alive the right to appropriate and reasonable medical care and treatment.
Montana state courts have blocked three abortion bans passed last year from going into effect while litigation continues.
Patients travel further to seek abortion care
Dr. Beverly Gray, an obstetrician and gynecologist at Duke Health in Durham, North Carolina, told ABC News that ever since Roe was overturned, there has been an increase in patients, both locally and from out-of-state.
"With Florida having a 15-week ban, Georgia and Tennessee having fairly strict bans, and then South Carolina kind of going back and forth with bans, patients ended up coming to North Carolina for care," she said. "We're seeing a handful of patients almost every day in clinic that are traveling for care."
"I think it's really scary for patients who might find themselves in a situation that they weren't expecting and needing care and their providers may not be able to provide evidence-based care because of laws that are now in place," she continued.
Gray said she has seen a "sustained increase" in the number of patients seeking abortions in North Carolina after the Supreme Court decision, and that a significant number of them have come from neighboring states with strict abortion restrictions.
"When South Carolina had their strict ban in place, there were like six or seven weeks this summer we had a fairly high volume and then when Georgia law went into effect," she said.
Having this increase can be logistically challenging, Gray said. North Carolina has a 72-hour waiting period before an abortion can be performed and providers are required to read a mandatory counseling script from the state, which includes information about public and private services available during pregnancy and possible adverse effects of abortion and pregnancy.
Critics say the script is a fear tactic to shame and scare people out of having abortions.
"So, there's a lot of ... logistics and requirements that have to be in place before people can get here, so it requires a lot of coordination," Gray said. "We have someone who pretty much deals with ... phone calls and logistics most day, every day that we're in clinic."
Clinics closing down or moving across state lines
Following the Supreme Court's decision, several abortion clinics were forced to either shut down or move their practices out of state.
The Red River Women's Clinic moved from Fargo, North Dakota, to Moorhead, Minnesota -- a mile-and-a-half away -- after Roe's overturn due to the legal battles currently being waged in North Dakota, although abortion is still legal in the state.
Since opening on Aug.10, Tammi Kromenaker, director of RRWC, told ABC News it was bittersweet to move but they've found a rhythm.
"We're providing care to patients in North Dakota, South Dakota, northwestern Minnesota; we have had a couple of gals from Texas come, like two," she said. "We're still able to see people in a very short amount of time, I feel like we've just like hit -- I don't want to call it 'normal' -- but we're back to seeing patients that we used to see in Fargo."
She said the difference in political climate between North Dakota and Minnesota offers more freedom with abortion care.
"It's so indescribable that we can just make an appointment with a person without having to go through telling them very stigmatizing awful language that the state made us used to say in North Dakota," Kromenaker said. "Literally just being five minutes away, it's the same community, but it's such a stark contrast between the two states."
Although Kromenaker and her colleagues are currently fighting legal battles in the state to prevent abortion bans from going into effect, she said she's not sure if the clinic would ever move back or if she would open a second clinic in the Peace Garden State.
"There are so many onerous restrictions on providers in North Dakota, that unless or until those are taken away -- I mean, we had to tell patients 24 hours ahead of time, 'Abortion terminates the life of a whole separate unique living human being.' We had to force materials from the state on women, they couldn't refuse it, they had to receive it. We were restricted in our medication abortion regimen," she explained.
"I need to see those ... things go away before we would think about going back and providing care there. And I just don't see, with the way North Dakota is right now, that happening for quite some time," she added.
