Four years ago, they told you this was about giving power back to the states.
On June 24, 2022, the Supreme Court issued Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade and ending fifty years of federal constitutional protection for abortion. It was the first time in the Court’s history that a fundamental right, once recognized, was taken away rather than expanded. As of the start of 2025, roughly 62.7 million women and girls live under state abortion bans. That number did not stabilize after the initial shock. Eighteen states now have complete or six-week bans in effect, up from fourteen in the months right after the ruling.
The “states deciding” framing implied something tidy, an orderly patchwork of different rules in different places, but what it produced was a system where a fetus has more enforceable legal standing than the pregnant person carrying it.
Pregnancy Justice, a nonprofit that has tracked pregnancy-related prosecutions since before Dobbs, documented 412 criminal cases against pregnant people across 16 states in the first two years after the ruling. The majority of these cases happened in Alabama, Oklahoma, and South Carolina, the three states that have most aggressively enshrined what’s called fetal personhood into law, the legal theory that a fetus or even a fertilized egg holds the same rights as a born person. Twenty-two of those 412 people were prosecuted for experiencing a pregnancy loss. A miscarriage criminalized because someone in a position of authority decided it looked suspicious. In the vast majority of the 412 cases, prosecutors didn’t require proof that harm had actually occurred, only a perceived risk of it. Most of the people charged were low-income. Most cases involved allegations of substance use during pregnancy, for both legal and illegal substances.
Researchers who study this consider their own numbers an undercount because there is no centralized national database tracking these prosecutions, and charges are typically brought under ordinary child endangerment or neglect statutes rather than abortion-specific laws, which makes the true scope of this nearly impossible to measure fully.
The architects of these laws insisted, repeatedly, that pregnant women themselves would never be the ones prosecuted, that the laws targeted providers, not patients. The data says otherwise. The mechanism being used isn’t even the abortion ban itself in most cases. It’s the broader legal architecture of fetal personhood that the bans made possible, applied through existing criminal statutes that weren’t designed for this purpose and are now being stretched to cover it.
The health outcomes tell their own story, and we need to be precise about what the research shows rather than reaching for the most dramatic available number. A 2026 Johns Hopkins Bloomberg School of Public Health study using national vital statistics from 2016 to 2023 found that maternal and pregnancy-related mortality rose in states with complete or six-week abortion bans relative to states without them. Texas, specifically, saw maternal mortality rise 56% in the first full year of its ban, with the increase nearly doubling among white women and Black mothers in banned states, facing 3.3 times the mortality risk of white mothers in those same states. Other national-level studies looking at the broader post-Dobbs period have found the overall national picture more ambiguous, with some failing to detect a statistically significant nationwide increase, in part because maternal mortality is still a rare enough event that small sample sizes make short-term trends hard to measure with certainty, and in part because the COVID-19 pandemic disrupted the data in ways that make clean before-and-after comparisons difficult.
In every study period researchers have looked at, going back to before Dobbs, states that went on to ban abortion already had worse maternal health outcomes than states that protected it. The ruling didn’t create a new problem from nothing. It removed one of the few tools available for managing a crisis that already existed, in the states least equipped to absorb the loss of it, and it did so on top of preexisting racial disparities that didn’t move anywhere when the ruling came down. Latina mothers in Texas now face nearly triple the maternal mortality risk of those in California. The gap is widening in several states.
This was never a neutral redistribution of decision-making power. Power was redistributed away from individuals and handed to state legislatures and prosecutors, who have used it to surveil pregnancy outcomes, prosecute miscarriages, and watch maternal health gaps widen in exactly the populations that already had the least access and the worst outcomes before any of this happened.
Four years in, the people who said this was about local control have not had to live with the local control they imposed on everyone else. The people who have lived with it are the ones who were told that this had nothing to do with their actual bodies and everything to do with someone else’s idea of what their bodies were for.
It was never about states deciding for themselves. It was about deciding for you.
