National

Data: Guttmacher Institute, KFF and Axios research; Map: Axios Visuals

The Supreme Court's ruling overturning Roe v. Wade last year gave states the power to individually regulate abortion — or even ban it completely — before viability, known as the point when a fetus can survive outside the womb.

The big picture: The legality of abortion later in pregnancy has changed dramatically post-Roe.

Under Roe, states could regulate abortion after viability, which is generally considered to be between 24 to 28 weeks after a patient’s last menstrual period.

Despite Roe, some states implemented bans before the 24-week mark largely based on the "unfounded assertion" that a fetus can feel pain at 22 weeks, according to the Guttmacher Institute, a research organization that supports abortion rights.

States now have a variety of gestational limits on the procedure.

Fertilization: 15 states have laws in effect banning nearly all abortions starting at fertilization. However, abortions resumed in Wisconsin in September 2023 as courts weigh whether a law from 1849 bans the procedure. 

Six weeks: South Carolina and Georgia are the only states that have laws in effect banning abortions when cardiac activity has been detected in an embryo, which is at around six weeks.

12 weeks: Nebraska and North Carolina are the two states that currently ban abortion at the 12-week mark.

15 weeks: Arizona and Florida ban abortion at 15 weeks. 

18 weeks: Utah is the only state that currently bans abortion at 18 weeks of pregnancy.

22 weeks: Iowa, Kansas and Ohio ban abortions at 22 weeks of pregnancy. In Ohio, abortions will be allowed up to the point of viability starting in December, after the state voted to protect abortion rights. 

Over half of states have restrictions in place only at or after viability, or have no limit at all.

24 weeks: Four states ban abortions at 24 weeks of pregnancy.

Viability: 14 states ban abortions after the fetus is considered viable. Some laws that don't specify a limit say it's up to the abortion provider's "judgment" to determine whether a fetus is viable.

Third trimester: Virginia is the only state that prohibits abortions in the pregnancy's third trimester, which starts at around 25 weeks, per Guttmacher. It's also the lone southern state that hasn't banned or restricted abortion since the end of Roe.

No limit: Six states and Washington, D.C., do not impose any term restrictions. That has not changed since the overturning of Roe.

Of note: Most states with restrictions have exceptions, including to preserve a pregnant person's life or health, though they are often narrowly defined. 

About 93% of reported abortions in 2019 were performed at or before 13 weeks of pregnancy, 6% were conducted between 14 and 20 weeks and 1% were performed at or after 21 weeks, according to the most recent data from the Centers for Disease Control and Prevention.

People who tend to have abortions later in a pregnancy do so because of "medical concerns such as fetal anomalies or maternal life endangerment, as well as barriers to care that cause delays in obtaining an abortion," per KFF.

Nine states that restricted abortion offer exceptions for fetal anomalies, according to a KFF tracker of abortion limits and exceptions.

Abortion at any stage is still difficult to access for many people.

Nationwide, only 54% of Americans said it would be "very" or "somewhat" easy to obtain an abortion, down from 64% in 2019, per a Pew Research Center survey in April. 

In 2017, Guttmacher reported that there are no abortion clinics in around 89% of counties across the U.S. 

In addition, several states have requirements for patients and providers that Planned Parenthood calls “unreasonable” and “medically unnecessary.”

Providers who perform abortions near a state's gestational limit face additional hurdles. They must be "really good at ultrasound" to determine the exact gestational age of the pregnancy to avoid violating the law, Hanna Peterson, an abortion provider in Kentucky, told Axios.

Ahead of the 2024 election, abortion is already dividing GOP presidential candidates over whether the federal government should restrict access nationally. 

A six-week abortion ban in Florida signed into law by Gov. Ron DeSantis is held up until the state's Supreme Court rules on the 15-week one.

After Ohio voted to protect abortion rights, advocates are to trying to get similar measures on the ballot in 2024 in key states like Arizona, Nevada and Florida as well as Republican-dominated Nebraska and South Dakota.

Where abortion access is protected without Roe v. Wade

Safe haven states scramble to accommodate non-resident abortions

Editor's note: This story has been updated.

Safe haven states scramble to accomodate non-resident abortions

How late in pregnancy each state allows abortions

Abortion before the overturning of Roe was still legal at later stages in pregnancy — but that's changed drastically.

Abortion

Axios Explains: Abortion

The Supreme Court&#x27;s ruling overturning <a class="gtmContentClick" data-vars-link-text="Roe v. Wade" data-vars-click-url="https://www.axios.com/2022/05/03/roe-v-wade-supreme-court-leak-stuns-nation" data-vars-content-id="1938cca9-bab0-4be4-a177-2173e08081f7" data-vars-headline="How late in pregnancy each state allows abortions" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/05/03/roe-v-wade-supreme-court-leak-stuns-nation" target="_self">Roe v. Wade</a> last year gave states the power to <a class="gtmContentClick" data-vars-link-text="individually regulate abortion" data-vars-click-url="https://www.axios.com/2022/04/16/abortion-ban-red-states-tracking-roe-supreme-court" data-vars-content-id="1938cca9-bab0-4be4-a177-2173e08081f7" data-vars-headline="How late in pregnancy each state allows abortions" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/04/16/abortion-ban-red-states-tracking-roe-supreme-court" target="_self">individually regulate abortion</a> — or even <a class="gtmContentClick" data-vars-link-text="ban it completely" data-vars-click-url="https://www.axios.com/2022/04/12/oklahoma-governor-signs-law-abortion-ban" data-vars-content-id="1938cca9-bab0-4be4-a177-2173e08081f7" data-vars-headline="How late in pregnancy each state allows abortions" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/04/12/oklahoma-governor-signs-law-abortion-ban" target="_self">ban it completely</a> — before viability, known as the point when a fetus can survive outside the womb.The big picture: The legality of abortion later in pregnancy has <a class="gtmContentClick" data-vars-link-text="changed dramatically" data-vars-click-url="https://www.axios.com/2023/01/22/dobbs-decision-roe-anniversary-anti-abortion" data-vars-content-id="1938cca9-bab0-4be4-a177-2173e08081f7" data-vars-headline="How late in pregnancy each state allows abortions" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/01/22/dobbs-decision-roe-anniversary-anti-abortion" target="_self">changed dramatically</a> post-Roe.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

The first opioid overdose treatment to be sold without a prescription will hit store shelves next month — but at a price some experts worry is too high for widespread use.

Why it matters: The individuals with the greatest need might not be able to afford a co-pay, if health plans even opt to cover over-the-counter Narcan, which will retail for $44.99.

And 1 in 5 people with opioid use disorder are uninsured.

Driving the news: Manufacturer Emergent BioSolutions said on Wednesday that it's begun shipping out the two-dose, 4-milligram spray version of naloxone under the Narcan label to retailers like Walgreens, Walmart and Rite Aid.

The initial distribution will be "several 100,000 cartons of Narcan," said company spokesperson Matt Hartwig.

State and local government programs and harm reduction groups who distribute the treatment at no cost will be able to buy the packages for $41 starting Aug. 31.

Pricing could still vary depending on the retailer.

Zoom in: On Tuesday, Blue Cross Blue Shield of Massachusetts announced that it would fully cover over-the-counter Narcan for members.

Medicaid private plans have the option of covering OTC drugs but might require state agencies to first add naloxone to formularies, according to the National Health Law Program.

State of play: The Food and Drug Administration approved selling Narcan without a prescription in March after FDA advisers unanimously endorsed it in February.

RiVive, another over-the-counter naloxone nasal spray, won approval in late July and could be available early next year at a lower price than Narcan.

Naloxone acts in a fraction of the time it takes EMS technicians to arrive, which is critical when fentanyl can render a person unconscious within 90 seconds.

The presence of synthetic opioids more potent than fentanyl, like nitazene, could require up to four doses of naloxone, meaning multiple packs.

Narcan is coming to drug store shelves — for those who can afford it

Photo illustration collage of a Narcan package falling out of a plastic shopping bag in front of a background showing a gas station

Photo illustration: Annelise Capossela/Axios. Photos: Scott Olson, Spencer Platt/Getty Images

Opioid epidemic

White House sending nearly half-billion dollars to tackle overdose crisis

The new funding could help address system-wide failures that experts say have allowed overdose deaths to soar in recent years.

White House

The Biden administration on Thursday announced it&#x27;s providing an additional <a class="gtmContentClick" data-vars-link-text="$450 million" data-vars-click-url="https://www.whitehouse.gov/briefing-room/statements-releases/2023/08/31/fact-sheet-on-intl-overdose-awareness-day-the-biden-harris-administration-announces-more-than-450-million-in-new-funding-to-support-president-bidens-unity-agenda-efforts-to-beat-t/" data-vars-content-id="cc60887e-6556-4a18-8930-8cbbc7c1269d" data-vars-headline="White House sending nearly half-billion dollars to tackle overdose crisis" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.whitehouse.gov/briefing-room/statements-releases/2023/08/31/fact-sheet-on-intl-overdose-awareness-day-the-biden-harris-administration-announces-more-than-450-million-in-new-funding-to-support-president-bidens-unity-agenda-efforts-to-beat-t/" target="_blank">$450 million</a> toward expanding <a class="gtmContentClick" data-vars-link-text="overdose prevention" data-vars-click-url="https://www.axios.com/2023/03/29/fda-approves-first-over-the-counter-opioid-overdose-treatment" data-vars-content-id="cc60887e-6556-4a18-8930-8cbbc7c1269d" data-vars-headline="White House sending nearly half-billion dollars to tackle overdose crisis" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/03/29/fda-approves-first-over-the-counter-opioid-overdose-treatment" target="_self">overdose prevention</a> strategies to beat back an epidemic killing more than 100,000 Americans each year.Why it matters: The new money could help address system-wide failures that experts say have allowed overdose deaths to soar in recent years, such as limited treatment options, housing services and data to track the crisis.

San Diego

Axios San Diego

San Diego County crisis centers answered more than 1,000 additional calls to its crisis lines since the national 988 suicide prevention and mental health hotline launched last year.

That's about a 2% increase with the new service.

Why it matters: The three-digit hotline was developed to make it easier for people to seek mental health help.

What's happening: In San Diego County, when someone with a local area code calls 988, they are automatically transferred to the local Access and Crisis Line to be connected with a trained counselor and services near them or someone they know who needs help.

The county answered about 20,500 calls that came through the 988 hotline in its first year, data provided by the county shows.

Zoom out: Nearly 10% of the more than 58,000 made from California residents to the national 988 suicide prevention and mental health hotline went unanswered by in-state counselors between April and May, per an analysis from health research outlet KFF.

That's the highest number of calls and the 14th lowest rate in the U.S.

Between the lines: These missed calls are happening at a time when most Americans remain unaware the 988 national suicide prevention and mental health hotline exists.

And at the service's one-year mark, few states had established long-term funding commitments to sustain it, Axios' Sabrina Moreno reports.

By the numbers: Last year, 360 people died by suicide in San Diego County, per a report this month by the county's Suicide Prevention Council.

That's a slight increase from the 358 recorded in 2021 — the lowest number in 10 years.

While suicides declined overall between 2012 and 2021, death rates increased 7% for youth and young adults between ages 10 and 24.

Context: San Diego County's 10.9 suicides per 100,000 residents in 2022 is below the 2021 national suicide rate (14.1) but higher than California's (10.1), per the latest data from the CDC.

Of note: In June, the county approved $4.1 million to join a state youth suicide-focused pilot program to develop new prevention efforts.

The big picture: Since the National Suicide Prevention Lifeline was replaced last year with an easier-to-remember number, 988 has been contacted nearly 5 million times nationwide.

Yes, but: Plans to use some of the nearly $1 billion in federal funding for a nationwide public service campaign haven't materialized, partly due to early concerns that marketing 988 could overwhelm the lifeline past capacity.

Ahead of its launch, fewer than half of public health officials charged with deploying 988 said they were confident they had the necessary staff to field the expected surge in calls.

Zoom in: San Diego County allocated $1.5 million of its fiscal 2022-23 budget to update telephone infrastructure and double its on-call workforce with a plan to hire 20 counselors, the Union-Tribune reported.

Staffing levels "will be enhanced based on call volume and need," a county spokesperson told Axios Tuesday.

Reality check: More than 80% of Americans still aren't familiar with the new hotline, according to a recent National Alliance on Mental Illness survey.

And funding remains uncertain — only California and five other states have enacted legislation to create monthly phone line fees to support the system, similar to how communities fund 911.

The bottom line: "We have to remember, we're at the beginning of what's going to be a marathon, not a sprint," said Chuck Ingoglia, CEO of the National Council for Mental Wellbeing.

"It's taken 15 years for 911 to evolve to the kind of system that it is today. We're just one year in."

If you or someone you know may be considering suicide, call or text the National Suicide Prevention Lifeline at 988. Ayuda disponible en español.

California answers 988 calls more than most states

The new three-digit national suicide hotline launched to make it easier for people to seek help.

Illustration of Illustration of person dialing 988 on smartphone

California

San Diego County crisis centers answered more than 1,000 additional calls to its crisis lines since the national 988 suicide prevention and mental health hotline launched last year.<ul><li>That&#x27;s about a 2% increase with the new service.</li></ul>

News

The Food and Drug Administration on Monday approved the first vaccine that can be given to pregnant patients to protect infants against respiratory syncytial virus, or RSV. 

Why it matters: The shot from Pfizer would give built-in protection against RSV to newborns, when they're most vulnerable to a virus that is a leading cause of death for infants worldwide and overwhelmed children's hospitals last fall.

Of note: Another new drug, Beyfortus, from Sanofi and AstraZeneca will be available for infants younger than 8 months old born during their first season of RSV, in addition to those between 8 and 19 months who are at high risk. 

Details: Pfizer's vaccine, Abrysvo — which was previously approved for older adults — protects infants from severe RSV in their first six months by creating antibodies that neutralize the virus and can be transferred in the womb.

Late-stage trial data found the vaccine was 82% effective at protecting infants from severe disease in their first three months and was 69% effective over six months.

It will be administered as a single-dose injection between weeks 32 and 36 of pregnancy, per an FDA statement.

This is a more limited window than what FDA advisers recommended in May, when they endorsed giving the shot as early as 24 weeks  However,  panel members said the data left the optimal timing unclear. 

What they're saying: "This approval provides an option for healthcare providers and pregnant individuals to protect infants from this potentially life-threatening disease," said Peter Marks, director of FDA's Center for Biologics and Research.

Catch up fast: Independent advisers to the FDA in May endorsed Pfizer's vaccine to protect infants but expressed concerns about insufficient data on safety.

Some panel members worried about the FDA's ability to track maternal health outcomes after the vaccine's approval.

Other panelists noted the risk of preterm births, which led GlaxoSmithKline to halt a trial of an RSV vaccine last year.

Pfizer officials said there is no definitive evidence of increased risk.

What's next: A CDC panel of outside vaccination experts still have to formally recommend the vaccine before it can be used in pregnant patients.

The panel is scheduled to meet in October, but with RSV season approaching, it could call a special meeting before then.

FDA approves Pfizer’s maternal RSV vaccine

The Food and Drug Administration on Monday approved the first vaccine that can be given to pregnant patients to protect infants against RSV.

Illustration of three boxes that have a checkmark made of a syringe.

Food and Drug Administration (FDA)

The Food and Drug Administration on Monday approved the first vaccine that can be given to pregnant patients to protect infants against <a class="gtmContentClick" data-vars-link-text="respiratory syncytial virus," data-vars-click-url="https://www.axios.com/2022/11/01/rsv-vaccines-could-be-coming" data-vars-content-id="ff779d88-c36d-432f-aaf7-aa2e3d5cdea6" data-vars-headline="FDA approves Pfizer’s maternal RSV vaccine" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/11/01/rsv-vaccines-could-be-coming" target="_self">respiratory syncytial virus,</a> or RSV. Why it matters: The shot from Pfizer would give built-in protection against RSV to newborns, when they&#x27;re most vulnerable to a virus that is a leading cause of death for infants worldwide and <a class="gtmContentClick" data-vars-link-text="overwhelmed children&#x27;s hospitals" data-vars-click-url="https://www.axios.com/2022/10/21/rsv-children-respiratory-virus-outbreak-cases" data-vars-content-id="ff779d88-c36d-432f-aaf7-aa2e3d5cdea6" data-vars-headline="FDA approves Pfizer’s maternal RSV vaccine" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/10/21/rsv-children-respiratory-virus-outbreak-cases" target="_self">overwhelmed children&#x27;s hospitals</a> last fall.Of note: Another <a class="gtmContentClick" data-vars-link-text="new drug" data-vars-click-url="https://www.axios.com/2023/08/03/cdc-endorses-first-rsv-infant-shot" data-vars-content-id="ff779d88-c36d-432f-aaf7-aa2e3d5cdea6" data-vars-headline="FDA approves Pfizer’s maternal RSV vaccine" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/08/03/cdc-endorses-first-rsv-infant-shot" target="_self">new drug</a>, Beyfortus, from Sanofi and AstraZeneca will be available for infants younger than 8 months old born during their first season of RSV, in addition to those between 8 and 19 months who are at high risk. Details: Pfizer&#x27;s vaccine, Abrysvo — which was <a class="gtmContentClick" data-vars-link-text="previously approved for older adults" data-vars-click-url="https://www.axios.com/2023/06/01/fda-approves-pfizer-rsv-vaccine-second" data-vars-content-id="ff779d88-c36d-432f-aaf7-aa2e3d5cdea6" data-vars-headline="FDA approves Pfizer’s maternal RSV vaccine" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/06/01/fda-approves-pfizer-rsv-vaccine-second" target="_self">previously approved for older adults</a> — protects infants from severe RSV in their first six months by creating antibodies that neutralize the virus and can be transferred in the womb.<ul><li>Late-stage trial data found the vaccine was 82% effective at protecting infants from severe disease in their first three months and was 69% effective over six months.</li><li>It will be administered as a single-dose injection between weeks 32 and 36 of pregnancy, per <a class="gtmContentClick" data-vars-link-text="an FDA statement." data-vars-click-url="https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants?utm_medium=email&amp;utm_source=govdelivery" data-vars-content-id="ff779d88-c36d-432f-aaf7-aa2e3d5cdea6" data-vars-headline="FDA approves Pfizer’s maternal RSV vaccine" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants?utm_medium=email&amp;utm_source=govdelivery" target="_blank">an FDA statement.</a></li><li>This is a more limited window than what FDA advisers recommended in May, when they endorsed giving the shot as early as 24 weeks However, panel members said the data left the optimal timing unclear. </li></ul>What they&#x27;re saying: &quot;This approval provides an option for healthcare providers and pregnant individuals to protect infants from this potentially life-threatening disease,&quot; said Peter Marks, director of FDA&#x27;s Center for Biologics and Research.Catch up fast: Independent advisers to the FDA in May <a class="gtmContentClick" data-vars-link-text="endorsed Pfizer&#x27;s vaccine" data-vars-click-url="https://www.axios.com/2023/05/18/fda-advisers-rsv-maternal-vaccine" data-vars-content-id="ff779d88-c36d-432f-aaf7-aa2e3d5cdea6" data-vars-headline="FDA approves Pfizer’s maternal RSV vaccine" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/05/18/fda-advisers-rsv-maternal-vaccine" target="_self">endorsed Pfizer&#x27;s vaccine</a> to protect infants but expressed concerns about insufficient data on safety.<ul><li>Some panel members worried about the FDA&#x27;s ability to track maternal health outcomes after the vaccine&#x27;s approval.</li><li>Other panelists noted the risk of preterm births, which led GlaxoSmithKline to halt a trial of an RSV vaccine last year.</li><li>Pfizer officials said there is no definitive evidence of increased risk.</li></ul>What&#x27;s next: A CDC panel of outside vaccination experts still have to formally recommend the vaccine before it can be used in pregnant patients.<ul><li>The panel is scheduled to meet in October, but with RSV season approaching, it could call a special meeting before then.</li></ul>

Sabrina Moreno

Stories

How late in pregnancy each state allows abortions

California answers 988 calls more than most states

White House sending nearly half-billion dollars to tackle overdose crisis

Narcan is coming to drug store shelves — for those who can afford it

FDA approves Pfizer’s maternal RSV vaccine