Louisiana  restricts surrogacy to married, heterosexual couples who are using their own gametes. Surrogacy via egg and/or sperm donation is prohibited. No compensation of the surrogate is allowed, prohibiting commercial surrogacy statewide. All parties must have been Louisiana residents for at least six months at the time of entering the surrogacy contract. The surrogacy must be considered medically necessary, and court approval prior to embryo transfer is required. [ 155 ]


On April 1, 2024,  Michigan  legalized compensated and altruistic surrogacy agreements. [ 156 ]
Previously, Michigan forbade all surrogacy agreements, compensated or not, with it having been a felony to enter into such agreements, punishable by fines of up to $50,000 and up to five years in prison.  [ 157 ]


Since 2014, New Hampshire is recognized as a surrogacy friendly state, with laws in place to protect all parties to a surrogacy arrangement.  All intended parents, irrespective of marital status, sexual orientation, or a genetic connection to the child, are able to establish their legal parental rights through pre-birth orders placing their names directly on the child's initial birth certificate. Reasonable compensation to the surrogate is permitted by statute. [ 158 ]


As of February 15, 2021, New York law allows for compensated gestational surrogacy agreements and provides a simple path to establish legal parental rights for parents who rely on assisted reproductive technology to have children. [ 159 ]   The law, the Child-Parent Security Act, also created a first-in-the-nation "Surrogate's Bill of Rights" governing all of the surrogacy arrangements under its auspices. [ 160 ]


On 23 May 2019, Gov.  Kevin Stitt  signed into law HB2468, [ 161 ]  which legalizes and recognizes the validity of both compensated and uncompensated gestational surrogacy agreements.  Under the bill, a comprehensive court procedure is created to validate all gestational agreements. The bill also allows a court to enter pre-birth orders establishing parentage prior to the birth of the child. The bill applies to gestational agreements entered into by single individuals, as well as heterosexual and homosexual couples, who wish to become parents. [ 162 ]


Rhode Island permits gestational surrogacy, as cited in the Uniform Parentage Act, which took effect January 1, 2021. This act allows couples, married or unmarried, or individuals, homosexual or heterosexual, to use their own gametes or those of an egg and/or sperm donor to conceive a child via surrogacy. It also allows pre-birth orders, as long as at least one intended parent is a US resident. [ 163 ]


There is no law prohibiting gestational surrogacy in Wisconsin. In July 2013 the  Wisconsin Supreme Court  ruled in the case of Rosecky v. Schissel that the surrogacy agreement between the parties was legal and enforceable, [ 164 ]  striking down an earlier  Circuit Court  ruling and thus setting a precedent in the state.  Chief Justice   Shirley Abrahamson  and Justice  Ann Walsh Bradley  filing a strongly worded concurring  opinion , stating that “A parenting agreement is a valid enforceable contract,” “unless enforcement is contrary to the best interests of the child.” [ 165 ]


Baby M : New Jersey 1988. The surrogate mother in a traditional surrogacy arrangement decided to keep the resulting child. The intended parents sued to have themselves recognized as the legal parents. The New Jersey Supreme Court found that the surrogacy contract was invalid as a matter of New Jersey public policy. However, the intended parents were given custody of the child because the courts thought they would provide a better home for the baby than the surrogate mother, who was instead given visitation rights.


Surrogacy for humanitarian purposes has been allowed in Vietnam from 2015 after the amended Family and Marriage Law passed with nearly 60% of votes from the National Assembly.


Under the new law, surrogacy will only be allowed among married couples, who do not have any common child, after doctors confirm the wife can not give birth even with technical support. The surrogate must be a relative of either the husband or wife, and have already given birth successfully. A woman is only allowed to be a surrogate once in her life and must produce her husband's approval if she's married. The embryo must be created by the intended parents' sperm and ovum. [ 166 ]  The process must be voluntary and follow in-vitro fertilization regulations.


MR and DR v An t-Ard-Chláraitheoir  [2014] IESC 60, [2014] 3 IR 533 [ 1 ] [ 2 ]  is a reported  Irish Supreme Court  case decision. The Court held that the  Civil Registration Act  2004 [ 3 ]  only allows the birth mother to be on the birth certificate. It was decided that children born through surrogacy will have the name of their birth mother on their birth certificate and not the mother who is going to raise them. [ 4 ] [ 5 ]


R wanted her name to be on the birth certificate of the twins L carried to term for her by  surrogacy . The registrar would not let this happen. R then went to the High Court to get an order from the court telling the registrar to change the birth certificate. R argued in the High Court that section 37 of the Status of Children Act [ 3 ]  meant that a person's genes decide whether or not they can be a mother. The registrar's case was based on a legal principle called "mater semper certa est," which means "the mother is certain" This is the idea that the mother of a child is the woman who gave birth to that child. The High Court sided with R, and the registrar filed an appeal.


The Court allowed the appeal, meaning that only birth mothers could be on the birth certificate. Denham CJ, allowing the appeal said that there is no definition of mother in the Irish Constitution, however there is also no prohibition on legislating surrogacy. [ 6 ]  Laws on surrogacy would affect the rights of children and their genetic parents. It would create complex relationships and it is beyond the means of the court to make a precedent for surrogacy rights. [ 7 ]  Laws on surrogacy should be dealt with in the Oireachtas. [ 1 ]


The current legal position was fair because it made sense to say that the birth mother was the mother on the birth certificate. [ 1 ]  He went on to say that there might be legal issues if the birth mother was still listed as the mother after the baby was born. [ 1 ]  When the system doesn't regulate assisted reproduction, it doesn't recognize the existence of the genetic mother, which is important for the financial and personal life of the child's family. [ 1 ]


He did, however, say that there is a gap in the law when it comes to surrogacy. [ 8 ]  He commented on the fact that, generations of children have been born in Ireland through assisted reproduction in a legal gray area where the only limits are the rules of the private market and the practitioners' sense of responsibility.


R deserved to be acknowledged as the mother, but the law did not permit this. The Oireachtas is tasked with writing the laws, and the courts are tasked with applying the law. [ 1 ]


The need for surrogacy legislation was discussed in his opinion. The failure to enact new legislation in the field of assisted reproductive technology is significant because it has an intimate and personal effect on them (mothers and children), which makes law reform in this area necessary. [ 1 ]


In his ruling, McMenamin J pointed out that because science is always changing, the Legislature must keep up with new developments. [ 1 ]


In his opinion, the infant possessed traits from both the birth mother and the genetic mother. Without prejudicing the birth mother, he would have declared that R is the mother. [ 1 ]


According to Emily Logan, Chief Commissioner of the  Irish Human Rights and Equality Commission , the issues this case raised highlights critical concerns of human rights and equality relating to assisted human reproduction that has a legal void in Ireland. [ 9 ]


The Children and Family Relationships Act was enacted in 2015. [ 3 ]  Surrogacy was not included but assisted human reproduction was. [ 3 ]


The Oireachtas introduced a Bill on assisted human reproduction in 2017. [ 10 ]  This Bill would be Ireland's first piece of legislation to regulate surrogacy in Ireland.


Einat Ramon  (born 1959) [ 1 ]  was the first  Israeli -born woman to be ordained as a rabbi. [ 2 ]  She was also the first woman and the first  sabra  to head a Conservative rabbinical school, specifically the Schechter Rabbinical Seminary in  Jerusalem , where she was dean from 2005 to 2009. [ 1 ] [ 3 ]  Since 2011 she no longer identifies as a rabbi, heads the Marpeh training program for spiritual caregivers in Jerusalem, and teaches modern Jewish thought and  Jewish feminism  at the Schechter Institute. [ 2 ]


Ramon was ordained in 1989 at the  Jewish Theological Seminary  in New York. [ 3 ] [ 4 ]  Following that, she acted as interim rabbi at Berkeley Hillel and earned a doctorate in  religious studies  from  Stanford University . [ 1 ]  She worked as the “circuit” rabbi for Congregation Har-Shalom in  Missoula, Montana  before returning to Israel in 1994. [ 4 ]


Ramon served as dean of the Schechter Rabbinical Seminary in Jerusalem from 2005 to 2009. During that time she opposed the ordination of  homosexual  rabbis at Schechter and same sex marriage in the Conservative Movement, which prompted a falling-out with the North American Masorti seminaries that had just begun ordaining homosexual rabbis. [ 5 ]


She is the author of the book  A New Life: Religion, Motherhood and Supreme Love in the Works of  Aharon David Gordon , and has contributed to the book  New Jewish Feminism: Probing the Past, Forging the Future . [ 2 ]  She has also published articles on modern Jewish thought, Jewish feminism and Zionist intellectual history. [ 4 ]


In 2011 she left the Conservative Movement and the rabbinate due to ideological disputes. She no longer considers herself a rabbi.  Her affiliation is that of a modern Orthodox Jew. [ 6 ]


Since 2006, Dr. Ramon has been active in the clinical pastoral care movement in Israel. She has been involved in setting up the first clinical pastoral education unit in Israel, participating in the network and later the association of spiritual caregivers in Israel as the writer the ethical code for Israeli spiritual caregivers and the professional standards for training Israeli chaplains. In 2011 she had set up the only Israeli academic program specializing in Jewish spiritual care at the Schechter Institute.


Ramon is married to Rabbi  Arik Ascherman , an American-born  Reform  rabbi and  human rights   activist


"Certification for the first "spiritual Care Provider Group," JPOST, 11.07.2013,


The  Surrogacy Arrangements Act 1985  (c. 49) is an  act  of the  Parliament of the United Kingdom  that prohibits commercial  surrogacy  arrangements. It received Royal Assent on 16 July 1985.


The act came about as a response to the birth, on 4 January 1985, of Britain's first commercial surrogate baby amid a widespread public outcry. [ 1 ]


The act was amended by the  Human Fertilisation and Embryology Act 1990  (so that surrogate mothers can always keep the baby if they change their mind) [ 2 ]  and the  Human Fertilisation and Embryology Act 2008 .


From 1996-1998  Margaret Brazier  chaired a review of surrogacy arrangements. [ 3 ] [ 4 ]  It made a number of recommendations including that only expenses, including loss of earnings, should be paid to surrogate mothers, and that all surrogacy agencies should be registered with the  Department of Health . [ 5 ] [ 6 ]


Surrogacy  is legal in  Canada , provided that it is an altruistic (unpaid) act. In 2004, the federal government of Canada passed the Assisted Human Reproduction Act (AHRA), which criminalized commercial (paid) surrogacy. The validity of surrogacy contracts and the process for establishing the child's parentage is governed by provincial and territorial laws.


Surrogacy is increasingly becoming more common in Canada due in part to the rise of  infertility  issues, and International intended parents being attracted by the high-quality  universal health care  and relatively liberal regulations. However, Canada's surrogacy laws are still subject to criticism, and many have pushed for revision of the law since the Act was passed.


Based on the 1993 report by the  Royal Commission on New Reproductive Technologies , as well as input from experts and individuals directly affected by assisted human reproduction technology, the federal government of Canada passed the  Assisted Human Reproduction Act  in 2004. [ 1 ]   It makes it illegal to pay a surrogate, egg donor, or sperm donor in Canada. It also criminalizes commercial "intermediaries," such as surrogacy agencies, from arranging surrogacy services or matching prospective parents and surrogates. [ 1 ]   The Act establishes a minimum age of 21 for surrogates. [ 2 ]


While monetary or other gain is illegal, the Act allows the intended parent(s) to reimburse a surrogate for out-of-pocket expenses incurred in relation to the surrogacy. Including  maternity clothes , medications, and travel. [ 3 ]  A surrogate may be reimbursed for lost wages; however, a doctor must declare in writing that  bed rest  is medically necessary for this reimbursement to be legal. Receipts must generally back reimbursements and cannot result in financial gain for the surrogate. [ 4 ]


As of 2018, there has only been one conviction under the Act: a 2014 case in which an Ontario company, Canadian Fertility Consultants, was fined $60,000 for purchasing eggs and paying surrogates. [ 5 ] [ 6 ]


The federal government determines and maintains surrogacy laws, while provincial and territorial governments oversee surrogacy agreements and parental rights. The intended parent(s) go through the parentage declaration process to be recognized as the child's only legal parent(s). However, this process and the requirements that must be met for the declaration to be approved vary depending on the province/territory, resulting in some cases where the intended parent(s) must adopt the child. [ 7 ]


Surrogacy contracts and parental rights laws have been found to use  heteronormative  assumptive language. Some provinces have addressed this choice of language to be more inclusive. In 2016, Ontario passed the All Families Are Equal Act, which meant that parentage laws had to be reworked for families with only one or more than two intended parent(s) and include inclusive language for same-sex couples. [ 8 ]


In Alberta, a court order is required for parentage declaration. If there is no genetic link between the child and at least one of the intended parents, parents will have to go through the adoption process. If only one parent has a genetic link, they will appear solely on the birth certificate, and the other parent will have to adopt the child. [ 9 ] [ 7 ]


Intended parent(s) have two options for establishing parental rights: they can go through the administrative process of a statutory declaration or, if necessary, a court-ordered parentage declaration. No genetic link between the intended parent(s) and the child is required for parent(s) to appear on the birth certificate. Up to 6 parents can be listed on the birth certificate. [ 7 ]


While no genetic connection is required, the surrogate's name is initially listed on the birth certificate along with the intended father (if there is one). The surrogate's name will be removed or replaced when a court-ordered declaration of parentage is approved. [ 9 ]


The surrogate's name and the intended father (if there is one) are initially listed on the birth certificate. The surrogate's name will be removed or replaced when a court-ordered declaration of parentage is approved. However, if neither intended parent has a genetic link with the child, they will have to adopt the child. [ 9 ]


Intended parents can apply for interim custody before the birth of the child; however, the surrogate's name will appear on the birth certificate initially. Intended parents will go through the parentage declaration process before appearing on the birth certificate. If there is no genetic link between the child and at least one of the intended parents, parents will have to go through the adoption process. [ 9 ] [ 7 ]


There are no clear laws or guidelines for intended parent(s) and surrogates. While parentage declarations are available, adoption is believed to be the preferred or more commonly used legal process for establishing parentage in the Northwest territories. [ 7 ]


In Nova Scotia, a court-ordered declaration of parentage is required. Surrogates, alongside intended fathers (if there is one), are named on birth certificates; however, the surrogate’s name will be replaced/removed once a court order is approved. If there is no genetic link between the intended parent(s) and the child, an adoption process will be required. [ 7 ]


In Ontario, the intended parent(s) can go through the administrative process of a statutory declaration or a court-ordered declaration of parentage. However, if the intended parent(s) choose the statutory declaration process, it can only be signed by the surrogate a week after the birth. Whereas a court-ordered parentage declaration can be processed immediately after birth. Up to 4 parents can be listed on the birth certificate. [ 9 ] [ 7 ]


As of March 2021, an administrative process rather than a court-ordered process is legal for establishing parentage. However, the surrogate's name will still initially appear on the birth certificate, and a court order is required for the name to be removed from the birth certificate. [ 9 ] [ 7 ]


In Quebec, birth certificates can solely list the surrogate name or the intended father's (if there is one) name. Alternatively, they can list both the surrogate's and the intended father's (if there is one) names. The other intended parent (if there is one) must go through the adoption process to establish parentage. If neither intended parent has a genetic link with the child, parents must go through the adoption process. [ 9 ] [ 7 ]  Until it was repealed on June 6, 2023, Article 541 of the  Quebec Civil Code  rendered all surrogacy contracts null. [ 10 ] [ 11 ]  In a 2009 case, a Quebec surrogate gave up her legal claim to her baby, having made an arrangement with a couple. The intended father was recognized as a legal parent because his sperm had been used to conceive the child, but the court denied any legal rights to the intended mother, leaving the child with no legal mother. [ 12 ]  In four subsequent cases, Quebec courts have allowed intended parents to adopt a child born via surrogate. [ 13 ]


A court-ordered parentage declaration and a pre-existing surrogacy agreement are required. Surrogates are initially listed on the birth certificate alongside the intended parent(s). However, no genetic link is required to establish parental rights in Saskatchewan. [ 9 ] [ 7 ]


In Yukon and Nunavut, no clear information is available on guidelines or laws for how intended parents establish rights; however, parentage declarations are available. [ 7 ]


Surrogacy in Canada has increased in popularity over the past two decades. [ 14 ]  Between 2001 and 2012, 803 IVF-conceived births were recorded for  gestational surrogates  in Canada (statistics on  traditional surrogacies  - are not available). [ 15 ]   There are many reasons a person or couple would choose to use a surrogate. [ 16 ]  Primarily, the rise of infertility (a study found that 1 in 6 Canadians can face fertility issues) [ 17 ]  and Same-sex couples choosing to have children [ 16 ]  have been linked with this rise. The increase in surrogacies is also connected to Canada becoming a popular site for international surrogacy. [ 18 ]


The increased demand for surrogates and the limited amount of people willing to be surrogates has led many to seek surrogacy agreements internationally. [ 19 ]  Canada is one of the few countries which allows international surrogacy and does not discriminate on the basis of marital status or sexual orientation. [ 18 ]  However, surrogacy agreements and parentage laws differ from those set out for surgery agreements between Canadian intended parent(s) and Canadian surrogates.


Canada has become an attractive location for foreign intended parent(s). This is in part due to its high-quality  universal health care  and relatively liberal regulations that may be easier to navigate than those in the intended parent(s) home country. [ 18 ]   While it is illegal under the AHRA for Canadians to pay a surrogate, Canadian surrogates may legally accept payment from the international intended parent(s), provided that the transaction occurs outside Canada.


In 2016 and 2017, 45 of 102 babies born to surrogates in British Columbia had intended parent(s) outside of Canada (nationwide statistics are not collected). [ 18 ]


Children born through international surrogacy with at least one intended parent being a permanent Canadian citizen are considered Canadian citizens from birth. Importantly, this parent does not have to be genetically related to the child; however, they do have to have legal documents proving parentage. [ 20 ]


Canada's strict surrogacy laws were partly founded on feminist fears that commercial surrogacy in Canada could result in women being exploited. [ 21 ]  Despite this rationale, some debate the law and raise concerns that it may be causing more harm than good. While some believe the law needs to be reworked, others argue that commercial surrogacy should be legal altogether. [ 22 ]


They argue that while it is illegal for surrogates to profit from their own bodies financially, the ambiguous language behind the law is problematic and can result in exploitation. That is, while surrogates cannot be paid, there are surrogacy agencies that can accept payments. These agencies advertise services that help surrogates and intended parent(s) navigate the complex laws surrounding surrogacy. There are no clear guidelines from the federal, provincial or territorial governments stating how these agencies can be monetarily compensated for their part in the surrogacy process. Therefore, some argue that this allows the agencies to function through the grey areas of law and profit from unpaid surrogates. [ 22 ]


Another leading issue in the Canadian surrogacy law debate centres around international surrogacy. Many argue that babies born in Canada with international intended parents should not automatically have Canadian citizenship. This argument is hotly debated as it does not seem to be founded in genuine cases where Canadian surrogacy was chosen so that the child would have Canadian citizenship. [ 22 ]


International surrogacy concerns expand into how it affects Canadian healthcare. While Canadian taxpayers fund Canada's healthcare system in international surrogacy cases, it is accessed and benefits an international audience [ 23 ]


Further critics revolve around fears for Canadian surrogates who are left with the child if internationally intended parent(s) back out of the surrogacy agreement. [ 23 ]


In 2011, Cathleen Hachey, a New Brunswick, agreed to be a surrogate for a British couple; however, three months before the due date of the twins, the intended parents split up and decided to back out of the agreement. While Hachey was legally responsible for the children as she had been the egg donor, she was able to find an adoptive family; this case increased concerns surrounding international surrogacy. [ 24 ]


Surrogacy in India  and Indian surrogates became increasingly popular amongst intended parents in industrialised nations because of the relatively low costs and easy access offered by Indian surrogacy agencies. [ 1 ]  Clinics charged patients between $10,000 and $28,000 for the complete package, including fertilization, the surrogate's fee, and delivery of the baby at a hospital. [ 2 ]  Including the costs of flight tickets, medical procedures and hotels, this represented roughly a third of the price of the procedure in the UK and a fifth of that in the US. [ 3 ] [ 4 ]  Surrogate mothers received medical, nutritional and overall health care through surrogacy agreements. [ 5 ] [ 6 ]


In 2005, the government approved the 2002 draft of the National Guidelines for the Accreditation, Supervision and Regulation of ART Clinics in India, in 2002. [ 7 ]  Before commercial surrogacy was banned in 2015,  India  was a popular destination for surrogacy. The economic scale of surrogacy in India is unknown, but study backed by the United Nations in July 2012 estimated the business at more than $400 million a year, with over 3,000 fertility clinics across India. [ 8 ]


In 2013, surrogacy by foreign homosexual couples and single parents was banned. [ 9 ]  In 2015, the government banned commercial surrogacy in India and permitted entry of embryos only for research purposes. [ 7 ]  Shortly thereafter in 2016, a Surrogacy (Regulation) Bill [ 10 ]  was introduced and passed by  Lok Sabha , the lower house of the Indian parliament, proposing to permit only heterosexual Indian couples married for at least five years with infertility problems to access altruistic or unpaid surrogacy and thereby further banning commercial surrogacy. [ 11 ]  The 2016 bill lapsed owing to the adjournment  sine die  of the parliament session. [ 12 ]  The bill was reintroduced and passed by the Lok Sabha in 2019. [ 13 ] [ 14 ]  The bill would require to be passed by the  Rajya Sabha , upper house of the Indian parliament and presidential assent before it becomes an act and thereby a law. [ 15 ]


In 2008, a baby (Manji Yamada) born through surrogacy was unable to leave India for three months after her birth because she held neither Indian nor Japanese nationality. The case came before the  Supreme Court of India . [ 16 ]  The issue was resolved after the Japanese government issued a one-year visa to her on humanitarian grounds. The Japanese government issued the visa after the Indian government granted the baby a travel certificate in September 2008 in line with a Supreme Court direction. [ 17 ]


In 2009 in  Jan Balaz v. Anand Municipality and ors. , [ 18 ]  the  Gujarat High Court  conferred  Indian citizenship  on two twin babies fathered through compensated surrogacy by a German national in  Anand district . [ 19 ]  The court observed: "We are primarily concerned with the rights of two newborn, innocent babies, much more than the rights of the biological parents, surrogate mother, or the donor of the  ova . Emotional and legal relationship of the babies with the surrogate mother and the donor of the ova is also of vital importance." The court considered the surrogacy laws of countries like Ukraine, Japan, and the United States.


Because India does not offer  dual citizenship , [ 20 ]  the children will have to convert to  Overseas Citizenship of India  if they also hold non-Indian citizenship. [ 21 ]  Balaz, the petitioner, submitted before the Supreme Court that he shall be submitting his passports before the Indian Consulate in Berlin. He also agreed that a NGO in Germany shall respond back to India on the status of the children and their welfare. The Union of India responded that India shall make all attempts to have the children sent to Germany. German authorities have also agreed to reconsider the case if approached by the Indian. [ 22 ]


In May 2010, the Balaz twins were provided the exit and entry documents that allowed them to
leave India for Germany. The parents agreed to adopt them in Germany according to German rules. [ 23 ]


According to  The Guardian , a surrogate mother died because she didn't get the proper medical attention. [ 24 ]  Conservative estimates show that more than 25,000 children are now being born through surrogates in India every year in an industry worth $2 billion. [ 24 ]  Domestic demand is increasing, but as fertility levels drop elsewhere, at least 50% of these are "commissioned" by overseas, mainly western, couples. [ 24 ]  Most of the industry is operating unchecked. India's medical research watchdog drafted regulations more than two years ago, yet they still await presentation in parliament, leaving the surrogates and baby factories open to abuse. [ 24 ]


The  Indian Council for Medical Research  has given guidelines in the year 2002, approved by the government in 2005, regulating Assisted Reproductive Technology procedures. [ 7 ]  The Law Commission of India submitted the 228th report on Assisted Reproductive Technology procedures discussing the importance and need for surrogacy, and also the steps taken to control surrogacy arrangements. The following observations had been made by the Law Commission:


The Assisted Reproductive Technology Bill, 2013 has been pending for quite a while and it has not been presented in the Indian Parliament. It will not allow commercial surrogacy that involves exchange of money for anything other than paying for medical expenses for the mother and the child. [ 25 ]


The bill would prohibit these from surrogacy: couples already having one child, foreigners or Overseas Citizens of India (OCI), holders as well as live-in-Partners, single people, homosexuals and widows. There has been significant criticism of the bill. [ 26 ]


In 2016, a Surrogacy (Regulation) Bill [ 10 ]  was introduced and passed by  Lok Sabha , the lower house of the Indian parliament, proposing to permit only Indian heterosexual couples married for at least five years with infertility problems to access altruistic or unpaid surrogacy and thereby banning commercial surrogacy. [ 13 ] [ 11 ]  The 2016 bill lapsed owing to the adjournment  sine die  of the parliament session. [ 12 ]  The bill was reintroduced and passed by the Lok Sabha in 2019. [ 13 ] [ 14 ]


The Surrogacy Bill (Regulation) 2019 was enacted by the Minister of Health and Family Welfare on 15 July 2019. Harsh Vardhan introduced in Lok Sabha. The bill defines surrogacy as the practice of a woman intentionally handing over a child to a couple of their choice after the birth with the intention of handing the child over to a couple of their choice.


Surrogacy Regulations: This bill prohibits commercial surrogacy, but allows altruistic surrogacy. Altruistic surrogacy does not provide financial compensation to the surrogate mother other than medical expenses and insurance coverage during pregnancy. Commercial surrogacy includes surrogacy or related procedures performed for economic benefit or compensation (cash or in kind) beyond basic medical expenses and insurance coverage.


Surrogacy and Abortion: A child born through surrogacy is considered the biological child of the intended couple. Surrogate abortion requires the written consent of the surrogate mother and the approval of the competent authority. This approval must comply with the Abortion Act 1971. Additionally, a surrogate mother can decline surrogacy before the embryo has implanted in the uterus.


Violations and Penalties: Violations under this law include: (ii) exploitation of surrogate mothers; (iii) not abandon, exploit or possess the surrogate mother; (iv) selling or importing human embryos or gametes for surrogacy; Penalties for such violations are up to 10 years imprisonment and fines up to Rs.100,000. The bill sets out a number of offenses and penalties for other violations of the bill's provisions.


The bill got passed in Rajya Sabha on 8 Dec 2021.


Surrogacy  is legal in  New Zealand  if it is performed altruistically, where the surrogate donates her services selflessly, without any compensation beyond the coverage of expenses. Commercial surrogacy, where the surrogate is paid in addition to the coverage of expenses, is not legal. There is a lack of specific legislation and regulations dealing with surrogacy, though the recent increase in surrogacy cases has led to a number of amendments. New Zealand is party to the  United Nations   Convention on the Rights of the Child , and ratified it in April 1993. The primary principle of this convention is that the  best interests  of the child are paramount, which must then encompass all surrogacy agreements and regulations. The lack of clear surrogacy legislation in New Zealand has led to many couples engaging in  reproductive tourism  in order to ensure the surrogacy is successful. This has the potential to significantly impact the  human rights  of all of the parties involved. [ 1 ]


New Zealand has no specific surrogacy legislation. However, there are provisions in other acts that relate to surrogacy arrangements. The Human Assisted Reproductive Technology Act 2004 (“HART Act”) is the primary instrument that deals with the legality of surrogacy. The purpose of the HART Act was to create regulations for cases involving  human assisted reproduction , but the lack of specific surrogacy legislation has led to the HART Act encompassing all surrogacy cases within New Zealand.


The HART Act provides that surrogacy arrangements are not, of themselves, illegal, but are not enforceable by or against any person. [ 2 ]  The HART Act also makes it illegal to give or receive valuable  consideration  for participating in or arranging surrogacy, but also provides that there may be exceptions to this, being situations where reasonable and necessary expenses are incurred. [ 3 ]  The provision that surrogacy arrangements are not enforceable against any person seems to offer little protection for any of the parties involved; none of the parties are able to ensure that the agreement is fulfilled. Any dispute regarding a baby born of surrogacy will be resolved by the Family Court, and the judge will make their decision in the best interests of the child. [ 4 ] [ 5 ]


The Guidelines on Surrogacy Arrangements involving Assisted Reproductive Procedures state that the approval of an ethics committee must be obtained before surrogacy agreements are allowed to proceed. [ 6 ]  The Ethics Committee on Assisted Reproductive Technology must determine, among other mandatory considerations and requirements, that:


The Adoption Act 1955 is also relevant to surrogacy, as, under the Act, it is an offence to give or receive any payment or reward in consideration of an adoption or proposed adoption, [ 7 ]  and a child must be adopted by the genetic or intending parents in order for them to have any legal status in relation to the child. [ 8 ] [ 9 ]  The Status of Children Act 1969 further provides that the birth mother, the surrogate, is the child's legal mother irrespective of the genetic origins of the child, and the legal father is the surrogate's partner if he has consented to the surrogacy. [ 10 ]


The lack of specific legislation regarding surrogacy arrangements has led to calls for the law to be reformed, specifically reform to allow commercial surrogacy. [ 11 ]


New Zealand is bound by the international agreements to which it is party, including the  Universal Declaration of Human Rights , the  United Nations   Convention on the Rights of the Child , the  Convention on the Elimination of All Forms of Discrimination against Women  and the  International Covenant on Civil and Political Rights .


The  Convention on the Rights of the Child  provides that ratifying states, of which New Zealand is one, must act in the  best interests  of the child, and that every child has basic rights, including the  right to life [ 12 ]  and the right to be raised by their  parents  within a  family . [ 13 ]


The  Universal Declaration of Human Rights  provides for basic human rights, to which every party in a surrogacy agreement is entitled. While an unborn child does not have the right to life in New Zealand, once the child is born, it is subject to the full rights accorded every person in international law. [ 14 ]


Once a child has been born as a result of a surrogacy agreement the child will then need to be formally adopted by the intended parents. The Adoption Act 1955 governs this and deals with matters such as whose consent is required and who are the legal parents.
If a child was born overseas and was brought to New Zealand a temporary visa must be granted to the child and the habitual residence must then be decided by the court. If the court concludes that the child is a habitual resident of New Zealand the Adoption Act 1955 applies, however if it concludes that it is the resident of another State then the Adoption (Intercountry) Act 1997 will apply to the situation. The Court of Appeal set a test whereby the habitual residence of a child could be decided upon. Broadly, test is to look at the intentions of the parents and where they intended the child to be residence of. [ 15 ]


There has been large debate over whether there have been breaches of human rights in surrogacy cases. It is clear that the right against discrimination is a fundamental human right. On the international scale the Universal Declaration of Human Rights creates such protection and at the domestic level the Human Rights Act 1993, in particular section 21. Same-sex couples have, for a significant number of years, been arguing that they should have the right to enter into surrogacy agreements. In 2013 same-sex marriage was legalised in New Zealand due to an amendment to the Marriage Act 1955. The court has the power to make an adoption order “on the application of 2 spouses jointly in respect of a child” under section 3 of the Adoption Act. There has been much debate as to whether same-sex couples fulfil the definition of “spouse” for the purposes of the Adoption Act however since the legalisation of same-sex marriage the courts have now concluded that they do fall within the required definition. This was affirmed by the family court in the case of In the Matter of C (Adoption) [2008] NZFLR 141. The implication of this appears to be that this argument, pertaining to human rights breaches towards same-sex couples in adoption and surrogacy cases, have been nullified as the courts may now make an adoption orders to same-sex couples.


As New Zealand does not allow commercial surrogacy, many New Zealand couples are choosing to enter into international commercial surrogacy arrangements. [ 16 ]  This involves the birth of a child to a surrogate mother in one country, where the genetic or intending parents are from another country. [ 16 ]  There is no specific legislation in New Zealand that addresses international surrogacy arrangements, thus in all cases where couples arrange for a child to be born overseas and brought back to New Zealand, all New Zealand law will apply. [ 17 ]  These arrangements have significant legal complexities, as well as a high risk of humanitarian problems that may affect the surrogate mother and the child.


The Ministry for Vulnerable Children has issued country warnings for jurisdictions that potential parents are advised to avoid, which include: [ 17 ]


The increase in international surrogacy arrangements have led to a number of concerns about the human rights of the child, the surrogate mother and the genetic or intended parents. [ 18 ]


When a child is born via an international surrogacy arrangement, under  New Zealand law , the genetic or intending parents will have no legal relationship to the child when it is born; the child's legal parents will be the surrogate mother and her partner. [ 16 ]  This could arguably breach the right to family life, as while the surrogate mother carried and gave birth to the child, she does not necessarily have a familial link. The HART Act provides that children have the right to information about their biological background and genetic origins; this would suggest that the child has the inherent legal right to know their family, irrespective of the lack of legal rights of the genetic parents. [ 19 ]


Under the  Convention on the Rights of the Child  and the  ICCPR , [ 20 ]  a child is entitled to a nationality from birth. [ 21 ]  This right is often violated in practice in international surrogacy arrangements, where the relevant nations refuse to recognise a child born through these arrangements as a national, as the laws in each country are often conflicting in relation to the child's legal parentage and nationality. [ 22 ]  If it is not possible to determine a child's nationality, it will not be able to obtain a passport in order to travel and remedy the statelessness and lack of parentage. [ 16 ]  While the country of the child's birth may recognise the intended or genetic parents as the child's legal parents, New Zealand does not. [ 10 ]  Children born as a result of an international surrogacy arrangement do not meet the requirements for New Zealand citizenship by descent, [ 17 ]  and thus the only way that the intended parents may become the child's legal parents is through adoption. [ 7 ]


Adoption in New Zealand after an international surrogacy arrangement is complex, as New Zealand is signatory and is bound by the  Hague Convention on Protection and Co-operation in Respect to Intercountry Adoption , which was brought into New Zealand law by the Adoption (Intercountry) Act 1997. [ 23 ]  These enactments apply “where a child who is habitually resident in one Contracting State… has been, is being or is to be moved to another Contracting State”. [ 24 ]  While these enactments deal with international adoption and not specifically with international surrogacy, they have been used by the New Zealand courts where the child has already been brought back to New Zealand by the intending parents to go through the adoption process. The  Family Court  has tended to find that intercountry adoption requirements do not apply in such cases, as the child born in an international surrogacy arrangement is intended to have the same  habitual residence  as the intended parents, not where the child was born, which is often the surrogate mother's habitual residence, as they often do not have legally identifiable parents in that location. [ 25 ] [ 26 ]  Further, the Convention on the Rights of the Child states that, in adoptions, the  best interests  of the child are paramount, especially where there is intercountry adoption. [ 27 ]


The Convention on the Rights of the Child also provides that a child shall have the right to know and be cared for by its  parents , [ 21 ]  and it shall not be separated from them. [ 28 ]  In surrogacy arrangements, the intended or genetic parents are arguably the child's parents, not the surrogate mother or her partner. Yet, the law surrounding surrogacy fails to recognise this, and instead provides that the legal parents of the child are the surrogate mother and her partner. This could be an issue where the genetic parents of the child are culturally different to that of the surrogate mother, which is often true of international surrogacy arrangements.


One of the concerns that arises in international surrogacy arrangements is the rights of the surrogate mother, especially when it comes to informed consent and exploitation. It is accepted that in no circumstances should the surrogate mother be forced by the intended parents or anyone else to enter into a surrogacy arrangement. [ 29 ]  In all cases, there should be  informed consent  before the surrogacy arrangement can proceed. Before allowing a child a temporary travel visa to enter New Zealand in order to be adopted, the Ministry of Immigration will consider whether there has been informed consent from the surrogate mother. [ 17 ]  However, it has been widely questioned whether women in impoverished countries can actually give informed consent to surrogacy arrangements. Women in impoverished countries where international surrogacy arrangements usually take place are often uneducated and poor, and therefore may not be able to fully comprehend all of the implications of surrogacy, and therefore, the idea of a high payment may become a form of coercion or undue influence. [ 29 ]


The high prices paid by intending or genetic parents may also lead to unfair requirements being placed on the surrogate mother during the pregnancy, which may interfere with her right to privacy and right to self-determination. [ 29 ]  For example, the intending parents may require that the surrogate mother not travel to certain places or do certain things while she is pregnant, in order to protect the pregnancy and the child.


In 2005, the  New Zealand Law Commission  made recommendations to reform the law related to surrogacy. [ 30 ]  These recommendations were not advanced by successive Governments. Calls to reform to the way surrogacy is regulated have since grown. In September 2019, a 30,000 signature petition was submitted to the House of Representatives calling for an overhaul of the surrogacy process. [ 31 ]  In August 2020, the Law Commission announced that Minister of Justice  Andrew Little  had referred a review of surrogacy laws to the commission as a new project for the 2020/21 year. [ 32 ]  The commission announced the Terms of Reference for that review on 8 March 2020 with the name Te Kōpū Whāngai: He Arotake | Review of Surrogacy. [ 33 ]


Transnational Reproduction: Race, Kinship, and Commercial Surrogacy in India  is a 2016 book by anthropologist Daisy Deomampo. The book analyzes transnational commercial surrogacy, focusing on the practices of doctors, surrogates, parents, and agents in India. The book proposes that the practice of transnational surrogacy reinforces social status distinctions through a shared "racial reproductive imaginary".  Transnational Reproduction  was reviewed in  Medical Anthropology Quarterly ,  Social Anthropology ,  Anthropological Quarterly ,  International Journal of Comparative Sociology , and  Signs .


The first part of the book reports Deomampo's ethnographic study of commissioning parents who live outside of India. The analysis focuses on how commissioning parents understand and explain the differences in power and social status between themselves and the intended Indian surrogate. Deomampo found that parents typically used one of two explanations: either they saw themselves as helping to rescue Indian surrogates, or they saw the surrogacy experience as a straightforward transaction. Later chapters in the book examine the practices of Indian doctors and agents who take advantage of power differences, such as differences in lack of access to information, to control the surrogacy process and the surrogates themselves. [ 1 ]


The book contrasts the experiences of the more powerful, higher status parents, doctors, and agents against the experiences of the Indian surrogates. Deomampo finds that while the women are not uniformly victims, they often make sense of their own situation using the same beliefs and explanations about racial and gender hierarchies that parents, doctors, and agents provide. Deomampo uses the term "racial reproductive imaginary" to describe this set of beliefs and explanations, which place Indian women lower in a racial and gender hierarchy than the parents, agents, and doctors with whom they interact. Deomampo concludes that this common "racial reproductive imaginary" ends up reinforcing existing racial and gender hierarchies. [ 2 ]


Writing for  Anthropological Quarterly , Kim Gutschow recommended the book, praising it as an "insightful account of how transnational surrogacy in India reflects and refracts a broader set of social and health inequalities". [ 3 ]  In  Social Anthropology , Vaibhav Saria linked Deomampo's findings to larger policy questions, calling the book "prescient" for showing "how imaginaries and anxieties of race permeate contemporary conditions of intimate labour". [ 4 ]   Medical Anthropology Quarterly  observed that while some of Deomampo's findings were not entirely new and did not always take existing scholarship in the area into account, the book  "offers new ethnographic insight into transnational assisted reproduction arrangements in India". [ 5 ]


In the  United States ,  abortion  is a divisive issue in  politics  and  culture wars , though a majority of Americans support access to abortion. [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ]  Abortion laws vary widely  from state to state . [ 7 ]


From the  American Revolution  to the mid-19th century abortion was not an issue of significant controversy; most held to the traditional  Protestant Christian  belief that  personhood  began at quickening, sometime between 18 and 21 weeks. It was legal prior to  quickening  in every state under  the common law . [ 8 ] [ 9 ] [ 10 ] [ 11 ]  Connecticut was the first state to regulate abortion in 1821; it outlawed abortion after quickening, the moment in pregnancy when the pregnant woman starts to feel the fetus's movement in the uterus, and forbade the use of poisons to induce one post-quickening. Many states subsequently passed various laws on abortion until the  Supreme Court of the United States  decisions of  Roe v. Wade  and  Doe v. Bolton  decriminalized abortion nationwide in 1973. The  Roe  decision imposed a federally mandated uniform framework for state legislation on the subject. It also established a minimal period during which abortion is legal, with more or fewer restrictions throughout the pregnancy.  Evangelical Christians  were initially generally either supportive or indifferent to  Roe  — citing what they saw as  a lack of biblical condemnation  on the matter, its perceived affirmation of  religious liberty , and furthering of  non-intrusive government  — but by the 1980s began to join anti-abortion Catholics to overturn the decision. [ 12 ] [ 13 ]  That basic framework, modified in  Planned Parenthood v. Casey  (1992), remained nominally in place, although the effective availability of abortion varied significantly from state to state, as many counties had no abortion providers. [ 14 ]   Casey  held that a law could not place legal restrictions imposing an " undue burden " for "the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus." [ 15 ]   In December 2021, the  FDA  legalized  telemedicine  provision of medication abortion pills with delivery by mail, but many states have laws which restrict this option.


In 2022,  Roe  and  Casey  were overturned in  Dobbs v. Jackson Women's Health Organization , ending protection of abortion rights by the  United States Constitution  and allowing individual states to regulate any aspect of abortion not preempted by federal law. [ 16 ]  Since 1976, the  Republican Party  has generally sought to restrict abortion access based on the stage of pregnancy or to criminalize abortion, whereas the  Democratic Party  has generally defended access to abortion and has made  contraception  easier to obtain. [ 17 ]


The  abortion-rights movement  advocates for patient choice and bodily autonomy, while the  anti-abortion movement  maintains that the fetus has a  right to live . Historically  framed  as a debate between the  pro-choice and pro-life  labels, most Americans agree with some positions of each side. [ 18 ]  Support for abortion gradually increased in the U.S. beginning in the early 1970s, [ 19 ]  and stabilized during the 2010s. [ 20 ] [ 21 ]  The abortion rate has continuously declined from a peak in 1980 of 30 per 1,000 women of childbearing age (15–44) to 11.3 by 2018. [ 22 ]  In 2018, 78% of abortions were performed at 9 weeks or less gestation, and 92% of abortions were performed at 13 weeks or less gestation. [ 22 ]  By 2023,  medication abortions  accounted for 63% of all abortions. [ 23 ]  Almost 25% of women will have had an abortion by age 45, with 20% of 30 year olds having had one. [ 24 ]  In 2019, 60% of women who had abortions were already mothers, and 50% already had two or more children. [ 25 ] [ 26 ]  Increased access to  birth control  has been statistically linked to reductions in the abortion rate. [ 27 ] [ 28 ] [ 29 ]


As of 2024,  Alaska ,  Arizona ,  California ,  Colorado ,  Illinois ,  Kansas ,  Maryland ,  Michigan ,  Minnesota ,  Missouri ,  Montana ,  New York ,  North Dakota ,  Ohio ,  Vermont , and  Wyoming [ e ]  have a right to abortion in their state constitutions, either explicitly or as interpreted by the state supreme court. [ 30 ] [ 31 ]  Other states, such as  Oregon  and  Massachusetts , protect abortion under state law. The state constitutions of  Alabama ,  Arkansas ,  Louisiana ,  Tennessee , and  West Virginia  explicitly contain no right to an abortion, while the state constitution of  Nebraska  prohibits abortion after the first trimester. [ 31 ]


The abortion debate most commonly relates to the  induced abortion  of a pregnancy, which is also how the term "abortion" is used in a legal sense. [ nb 1 ]  The terms "elective abortion" and "voluntary abortion" refer to the interruption of pregnancy, before viability, at the request of the woman but not for medical reasons. [ 35 ]  In medical parlance, "abortion" can refer to a spontaneous  miscarriage  or to an induced miscarriage before the fetus is viable. After viability, doctors call an induced miscarriage a "termination of pregnancy".


Abortion was a fairly common practice in the history of the United States, and was not always controversial. [ 10 ] [ 36 ]  At a time when society was more concerned with the more serious consequence of women becoming pregnant out of wedlock, family affairs were handled out of public view. [ 37 ] [ 36 ]  Abortion did not become a public controversy until the health risk of unsafe abortions by (female) unlicensed practitioners was brought to the public attention in the 19th century. [ 38 ]  James Mohr wrote that even though pre-quickening abortion was legal in the first three decades of the 19th century, only 1 in 25 to 1 in 30 pregnancies ended in abortion. By the 1850s and 1860s, this number had increased to 1 in 5 or 1 in 6. [ 11 ] [ 39 ]  John Keown highlighted some challenges in pinning down the common law view, observing that "evidence of quickening would clearly facilitate prosecution". [ 40 ] [ 41 ]  In the mid-18th century,  Benjamin Franklin  included a recipe for an  abortifacient  in a math textbook. [ 42 ] [ 43 ]  In 1728, Franklin condemned publisher  Samuel Keimer  for publishing an article on abortion. According to biographer  Walter Isaacson , Franklin did not have a strong view on the issue. [ 44 ]  In  The Speech of Polly Baker , Franklin places the blame for abortion and infanticide on the  sexual double standard  against women. He stated: [ 45 ]


Forgive me Gentlemen, if I talk a little extravagantly on these Matters; I am no Divine: But if you, great Men, must be making Laws, do not turn natural and useful Actions into Crimes, by your Prohibitions. Reflect a little on the horrid Consequences of this Law in particular: What Numbers of procur'd Abortions! and how many distress'd Mothers have been driven, by the Terror of Punishment and public Shame, to imbrue, contrary to Nature, their own trembling Hands in the Blood of their helpless Offspring! Nature would have induc'd them to nurse it up with a Parent's Fondness. 'Tis the Law therefore, 'tis the Law itself that is guilty of all these Barbarities and Murders. Repeal it then, Gentlemen; let it be expung'd for ever from your Books: And on the other hand, take into your wise Consideration, the great and growing Number of Batchelors in the Country, many of whom, from the mean Fear of the Expense of a Family, have never sincerely and honourably Courted a Woman in their Lives; and by their Manner of Living, leave unproduced (which I think is little better than Murder) Hundreds of their Posterity to the Thousandth Generation. Is not theirs a greater Offence against the Public Good, than mine? Compel them then, by a Law, either to Marry, or pay double the Fine of Fornication every Year.


In 1716, New York passed an ordinance prohibiting midwives from providing abortion. [ 46 ]  Founding Father and Second President of the United States  John Adams  praised the Spartan lawgiver  Lycurgus  for refusing his sister-in-law from having an abortion even though it prevented him from assuming power. [ 46 ]  Early U.S. statutes did not prohibit early-term abortions: for the most part, abortion was not a crime until  quickening , and most exceptions to this in practice were penalties imposed on practitioners if a woman under their care died as a consequence of the procedure. [ 47 ]  Within the context of a  sex scandal , [ 48 ]  Connecticut became the first state to regulate abortion by statute in 1821. Many states subsequently passed various abortion laws. In 1829,  New York  made post-quickening abortions a  felony  and pre-quickening abortions a  misdemeanor . [ 49 ]  This was followed by 10 of the 26 states creating similar restrictions within the next few decades, [ 50 ]  in particular by the 1860s and 1870s. [ 38 ]  The first laws related to abortion were made to protect women from real or perceived risks, and those more restrictive penalized only the provider. [ 51 ]  Criminalization did not end the practice of abortion; unlicensed doctors and midwives continued to perform them. Most of the women receiving abortions from unlicensed practitioners were poor. Women's safety continued to be a concern, especially after the highly publicized death of  Mary Rogers . Wealthier women could pay willing physicians to broadly interpret health exceptions in their favor. Euphemistic advertisements for abortifacients offered an assortment of herbal remedies. [ 47 ]  Abortions increased during  World War II  as the need for female labor outweighed other concerns and bribes were often accepted in exchange for lax enforcement. Regulations were tightened after the war to encourage a return to traditional family life, until a reform movement started in the 1950s drawing attention to the public health issue of illegal abortions, and a consensus grew in the medical community that physicians should make decisions about when health exceptions apply. [ 52 ]


A number of other factors likely played a role in the rise of anti-abortion laws. As in Europe, abortion techniques advanced starting in the 17th century, and the  conservatism  of most in the medical profession with regards to sexual matters prevented the wide expansion of abortion techniques. [ 38 ] [ 53 ]   Physicians , who were the leading advocates of abortion criminalization laws, appear to have been motivated at least in part by advances in medical knowledge. Science had discovered that  fertilization  inaugurated a more or less continuous process of development, which produced a new human being. Quickening was found to be not more or less crucial in the process of  gestation  than any other step. Many physicians concluded that if society considered it unjustifiable to terminate pregnancy after the fetus had quickened, and if quickening was a relatively unimportant step in the gestation process, then it was just as wrong to terminate a pregnancy before quickening as after quickening. [ 54 ]  Patricia Cline Cohen, a professor emeritus at the University of California, Santa Barbara, said that these laws had come about not because society saw abortion as a crime but from a small group of doctors who had taken it upon themselves to prove to the rest of the county that pre-quickening abortion should be seen as a crime. The doctors used flawed math to convince the  American Medical Association  to accept that pre-quickening abortion should also be outlawed, leading to the raft of state laws banning abortion in the latter half of the 19th century. [ 55 ]  Doctors were also influenced by practical reasons to advocate anti-abortion laws. For one, abortion providers were usually female midwives without formal training or education. In an age where the leading doctors in the nation were attempting to standardize the medical profession, these unlicensed practitioners were considered a nuisance to public health. [ 38 ] [ 56 ]


Despite campaigns to end the practice of abortion, abortifacient advertising was highly effective and abortion was commonly practiced, with the help of a  midwife  or other women, [ 8 ]  in the mid-19th century, [ 57 ] [ 58 ]  although they were not always safe. [ 59 ]  While the precise abortion rate was not known, James Mohr's 1978 book  Abortion in America  documented multiple recorded estimates by 19th-century physicians, [ 38 ]  which suggested that between around 15% and 35% of all pregnancies ended in abortion during that period. [ 60 ]  This era also saw a marked shift in the people who were obtaining abortions. Before the start of the 19th century, most abortions were sought by unmarried women, who had become pregnant  out of wedlock  and for which there was much less compassion compared to married women who got an abortion; many of them were wealthy and paid well. [ 38 ]  Out of 54 abortion cases published in American medical journals between 1839 and 1880, over half were sought by married women, and well over 60% of the married women already had at least one child. [ 61 ]


The sense that married women were now frequently obtaining abortions worried many conservative physicians, who were almost exclusively men. In the  Reconstruction era , much of the blame was placed on the burgeoning  women's rights movement . Although the medical profession expressed hostility toward  feminism , many feminists of the era were also opposed to abortion. [ 38 ] [ 62 ] [ 63 ]  In  The Revolution , a newspaper operated by  Elizabeth Cady Stanton  and  Susan B. Anthony , an 1869 opinion piece was published arguing that instead of merely attempting to pass a law against abortion, the root cause must also be addressed. [ 63 ] [ 64 ]  The writer stated that simply passing an anti-abortion law would be "only mowing off the top of the noxious weed, while the root remains. ... No matter what the motive, love of ease, or a desire to save from suffering the unborn innocent, the woman is awfully guilty who commits the deed. It will burden her conscience in life, it will burden her soul in death; But oh! thrice guilty is he who drove her to the desperation which impelled her to the crime." [ 65 ]  To many feminists of this era, abortion was regarded as an undesirable necessity forced upon women by thoughtless men. [ 66 ]  The  free love  wing of the feminist movement refused to advocate for abortion and treated the practice as an example of the hideous extremes to which modern marriage was driving women. [ 67 ]   Marital rape  and the seduction of unmarried women were societal ills, which feminists believed caused the need to abort, as men did not respect women's right to  abstinence . [ 67 ]  Feminist opposition to abortion was much less prevalent by the 20th century, and it was feminists and physicians who came to question anti-abortion laws and raise public interest in the 1960s. [ 38 ]


Physicians, one of the most famous and consequential being  Horatio Storer , remained the loudest voice in the anti-abortion debate, and they carried their agenda to state legislatures around the country, advocating not only anti-abortion laws but also laws against birth control on  racist  and  pseudoscientific  grounds; [ 68 ]  religious groups were not particularly active within this movement, [ 69 ]  which presaged the modern debate over women's body rights. [ 70 ]  Although many of these laws indicated the woman as a co-criminal, she was rarely prosecuted. [ 38 ]  A campaign was launched against the movement and the use and availability of  contraceptives . Criminalization of abortion accelerated from the late 1860s through the efforts of concerned legislators, doctors, and the  American Medical Association  influenced by Storer, [ 71 ] [ 72 ]  and were facilitated by the press. [ 38 ]  In 1873,  Anthony Comstock  created the  New York Society for the Suppression of Vice , an institution dedicated to supervising the  morality  of the public. Later that year, Comstock successfully influenced the  United States Congress  to pass the  Comstock Law , which made it illegal to deliver through the U.S. mail any "obscene, lewd, or lascivious" material. It also prohibited producing or publishing information pertaining to the procurement of abortion,  birth control , and  venereal disease , including to medical students. [ 73 ]  The production, publication, importation, and distribution of such materials was suppressed under the Comstock Law as being obscene, and similar prohibitions were passed by 24 of the 37 states. [ 74 ]


By 1900, abortion was normally a felony in every state. Some states included provisions allowing for abortion in limited circumstances, generally to protect the woman's health or to terminate pregnancies arising from rape or incest. [ 75 ]  Most Americans did not view abortion as a crime, and abortions continued to occur and became increasingly available. [ 76 ]  The  American Birth Control League  was founded by  Margaret Sanger  in 1921; it would become Planned Parenthood Federation of America in 1942. [ 77 ] [ 78 ]  By the 1930s, licensed physicians performed an estimated 800,000 abortions a year. [ 79 ]


In 1988, 17 year old  Becky Bell  died from an infection after an unsafe abortion. She lived in Indiana where parental consent was required to have a safe and legal abortion.  Laurence H. Tribe  wrote in  Abortion: The Clash of Absolutes  that Bell's best friend said that Becky "couldn't bear telling" her parents and considered other alternatives like an out-of-state abortion. [ 80 ]  It's not known if Becky attempted the abortion by herself but it was not done safely and she died from an infection. Her parents publicly campaigned against parental consent laws after her death. [ 81 ]


Rosie Jimenez  died from sepsis in 1977 following an abortion procedure at the home of a midwife who was not licensed to perform abortions. She did not go to a licensed physician because the  Hyde Amendment  barring public Medicaid funding for abortions had gone into effect after surviving a statutory challenge in  Beal v. Doe  and an  Equal Protection  challenge in  Maher v. Roe . [ 82 ] [ 83 ] [ 84 ]


Dr. Abu Hayat was convicted by a Manhattan Court in 1993 for performing an illegal third trimester abortion at his clinic in  Alphabet City . The doctor began the  dilation and evacuation  procedure which was not legal in the third trimester. The baby was born alive before the procedure could be completed. She was missing an arm that had been severed during the D&E. [ 85 ]


He cited  Roe v. Wade  when he appealed his conviction for assaulting the baby based on an argument that the baby had not yet been born when he attempted the procedure. [ 85 ]


Another patient was forced to leave the clinic halfway through a procedure after Dr. Hayat demanded more money that her husband could not afford to pay. The patient nearly died and was treated at a local hospital for severe infection caused by pieces of dismembered fetus being left in her uterus. [ 86 ] [ 87 ]  17 year old Sophie McCoy died in 1990 from an infected uterine perforation after receiving an abortion at Dr. Hayat's clinic. [ 88 ]


Inequality in access to safe and legal abortions persists to this day whereby many women cannot afford to obtain a legal abortion; in such cases, women may turn to  illegal abortion . [ 89 ] [ 90 ]


In the early 1960s, a controversy centered around children's television host Sherri Finkbine that helped bring abortion and abortion law more directly into the American public eye. Living in the area of  Phoenix, Arizona , Finkbine had had four healthy children; during her pregnancy with her fifth child, she discovered the child might have severe deformities when born. [ 91 ]  This was likely because Finkbine had been taking sleeping pills that she was unaware contained  thalidomide , a drug that increases the risk of fetal deformities during pregnancy. [ 92 ]  Though Finkbine wanted an abortion, the  abortion laws  of Arizona only allowed abortions if a pregnancy posed a threat to the woman's life. The situation gained public attention after Finkbine shared the story with a reporter from  The Arizona Republic , who disclosed her identity in spite of her requests for anonymity. On August 18, 1962, Finkbine traveled to  Sweden  to obtain a legal abortion, where it was confirmed that the fetus had severe deformities. [ 93 ]


In 1964,  Gerri Santoro  of Connecticut died trying to obtain an illegal abortion, and her photo became the symbol of an  abortion-rights movement . Some women's rights activist groups developed their own skills to provide abortions to women who could not obtain them elsewhere. As an example, in Chicago, a group known as " Jane " operated a floating abortion clinic throughout much of the 1960s. Women seeking the procedure would call a designated number and be given instructions on how to find "Jane". [ 94 ]


In 1965, the  U.S. Supreme Court  case  Griswold v. Connecticut  struck down one of the remaining contraception  Comstock laws  in  Connecticut  and  Massachusetts . [ 95 ]  However,  Griswold  only applied to marital relationships, allowing married couples to buy and use contraceptives without government restriction. It took until 1972, with  Eisenstadt v. Baird , to extend the precedent of  Griswold  to unmarried persons as well. [ 96 ]  Following the  Griswold  case, the  American College of Obstetricians and Gynecologists  (ACOG) issued a medical bulletin accepting a recommendation from six years earlier that clarified that "conception is the implantation of a fertilized ovum", [ 97 ]  and consequently  birth control  methods that prevented implantation became classified as  contraceptives , not  abortifacients .


In 1967,  Colorado  became the first state to decriminalize abortion in cases of rape, incest, or in which pregnancy would lead to permanent physical  disability  of the woman. Similar laws were passed in  California ,  Oregon , and  North Carolina . In 1970,  Hawaii  became the first state to legalize abortions on the request of the woman, [ 98 ]  and New York repealed its 1830 law and allowed abortions up to the 24th week of pregnancy. Similar laws were soon passed in  Alaska  and  Washington . In 1970, Washington held a referendum on legalizing early pregnancy abortions, becoming the first state to legalize abortion through a vote of the people. [ 99 ]  A law in  Washington, D.C. , which allowed abortion to protect the life or health of the woman, was challenged in the Supreme Court in 1971 in  United States v. Vuitch . The court upheld the law, deeming that "health" meant "psychological and physical well-being", essentially allowing abortion in Washington, D.C. By the end of 1972, 13 states had a law similar to that of Colorado, while  Mississippi  allowed abortion in cases of rape or incest only and  Alabama  and  Massachusetts  allowed abortions only in cases where the woman's physical health was endangered. In order to obtain abortions during this period, women would often travel from a state where abortion was illegal to one where it was legal. The legal position prior to  Roe v. Wade  was that abortion was illegal in 30 states and legal under certain circumstances in 20 states. [ 100 ]


In the late 1960s, a number of organizations were formed to mobilize opinion both against and for the legalization of abortion. In 1966, the  National Conference of Catholic Bishops  assigned Monsignor  James T. McHugh  to document efforts to reform abortion laws, and anti-abortion groups began forming in various states in 1967. In 1968, McHugh led an advisory group which became the  National Right to Life Committee . [ 101 ] [ 102 ]  The forerunner of the  NARAL Pro-Choice America  was formed in 1969 to oppose restrictions on abortion and expand access to abortion. [ 103 ]  Following  Roe v. Wade , in late 1973, NARAL became the National Abortion Rights Action League.


Prior to  Roe v. Wade , 30 states prohibited abortion without exception, 16 states banned abortion except in certain special circumstances (e.g. rape, incest, and health threat to mother), 3 states allowed residents to obtain abortions, and New York allowed abortions generally. [ 104 ]  Early that year, on January 22, 1973, the  U.S. Supreme Court  in  Roe v. Wade  invalidated all of these laws, and set guidelines for the availability of abortion. The decision returned abortion to its liberalized pre-1820 status. [ 38 ]   Roe  established that the  right of privacy  of a woman to obtain an abortion "must be considered against important state interests in regulation". [ 105 ]   Roe  also established a trimester framework, defined as the end of the first  pregnancy trimester  (12 weeks), as the threshold for state interest, such that states were prohibited from banning abortion in the first trimester but allowed to impose increasing restrictions or outright bans later in pregnancy. [ 105 ]


In deciding  Roe v. Wade , the Court ruled that a  Texas  statute forbidding abortion except when necessary to save the life of the mother was unconstitutional. The Court arrived at its decision by concluding that the issue of abortion and abortion rights falls under the  right of privacy in the United States  (e.g. federal constitutionally-protected right), in the sense of the right of a person not to be encroached by the state. In its opinion, it listed several landmark cases where the court had previously found a right to privacy implied by the Constitution. The Court did not recognize a right to abortion in all cases, saying: "State regulation protective of fetal life after viability thus has both logical and biological justifications. If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother." [ 107 ]


The Court held that a right to privacy existed and included the right to have an abortion. The court found that a mother had a right to abortion until viability, a point to be determined by the abortion doctor. After viability a woman can obtain an abortion for health reasons, which the Court defined broadly to include psychological well-being. A central issue in the  Roe  case and in the wider abortion debate in general is whether human life or personhood begins at conception, birth, or at some point in between. The Court declined to make an attempt at resolving this issue, writing: "We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man's knowledge, is not in a position to speculate as to the answer." Instead, it chose to point out that historically, under English and American  common law  and statutes, "the unborn have never been recognized ... as persons in the whole sense", and thus the fetuses are not legally entitled to the protection afforded by the right to life specifically enumerated in the Fourteenth Amendment. Rather than asserting that human life begins at any specific point, the Court declared that the state has a "compelling interest" in protecting "potential life" at the point of viability. [ 107 ]


Under  Roe v. Wade , state governments may not prohibit  late terminations of pregnancy  when "necessary to preserve the life or health of the mother", even if it would cause the demise of a viable fetus. [ 108 ]  This rule was clarified by the 1973 judicial decision  Doe v. Bolton , which specifies "that the medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient". [ 109 ] [ 110 ] [ 111 ]  It is by this provision for the mother's mental health that women in the U.S. legally choose abortion after viability when screenings reveal abnormalities that do not cause a baby to die shortly after birth. [ 112 ] [ 113 ] [ 114 ] [ 115 ]


In the 1992 case of  Planned Parenthood v. Casey , the Court abandoned  Roe's  strict trimester framework but maintained its central holding that women have a right to choose to have an abortion before viability. [ 116 ]   Roe  had held that statutes regulating abortion must be subject to " strict scrutiny "—the traditional Supreme Court test for impositions upon fundamental  Constitutional  rights.  Casey  instead adopted the lower,  undue burden  standard for evaluating state abortion restrictions, [ 116 ]  but re-emphasized the right to abortion as grounded in the general sense of liberty and privacy protected under the constitution: "Constitutional protection of the woman's decision to terminate her pregnancy derives from the  Due Process Clause  of the  Fourteenth Amendment to the United States Constitution . It declares that no state shall "deprive any person of life, liberty, or property, without due process of law." The controlling word in the cases before us is 'liberty'." [ 117 ]


The Supreme Court continues to make decisions on this subject. On April 18, 2007, it issued a ruling in the case of  Gonzales v. Carhart , involving a federal law entitled the  Partial-Birth Abortion Ban Act of 2003  which President  George W. Bush  had signed into law. The law banned  intact dilation and extraction , which opponents of abortion rights referred to as "partial-birth abortion", and stipulated that anyone breaking the law would get a prison sentence up to 2.5 years. The United States Supreme Court upheld the 2003 ban by a narrow majority of 5–4, marking the first time the Court has allowed a ban on any type of abortion since 1973. The opinion, which came from justice Anthony Kennedy, was joined by Justices  Antonin Scalia ,  Clarence Thomas , and the two recent appointees,  Samuel Alito  and Chief Justice  John Roberts .


In the case of  Whole Woman's Health v. Hellerstedt , the Supreme Court in a 5–3 decision on June 27, 2016, swept away forms of state restrictions on the way abortion clinics can function. The Texas legislature enacted in 2013 restrictions on the delivery of abortions services that, it was argued by its opponents, created an undue burden for women seeking an abortion by requiring abortion doctors to have difficult-to-obtain "admitting privileges" at a local hospital and by requiring clinics to have costly hospital-grade facilities. The Court supported this argument and struck down these two provisions "facially" from  the law at issue —that is, the very words of the provisions were invalid, no matter how they might be applied in any practical situation. According to the Supreme Court, the task of judging whether a law puts an unconstitutional burden on a woman's right to abortion belongs with the courts, and not the legislatures. [ 118 ]


The Supreme Court ruled similarly in  June Medical Services, LLC v. Russo  on June 29, 2020, in a 5–4 decision that a Louisiana state law, modeled after the Texas law at the center of  Whole Woman's Health , was unconstitutional. [ 119 ]  Like Texas' law,  the Louisiana law required certain measures for abortion clinics that, if having gone into effect, would have closed five of the six clinics in the state. The case in Louisiana was put on hold pending the result of  Whole Woman's Health , and was retried based on the Supreme Court's decision. While the District Court ruled the law unconstitutional, the Fifth Circuit found that unlike the Texas law, the burden of the Louisiana law passed the tests outlined in  Whole Woman's Health , and thus the law was constitutional. The Supreme Court issued an order to suspend enforcement of the law pending further review, and agreed to hear the case in full in October 2019. It was the first abortion-related case to be heard by President  Donald Trump 's appointees to the Court,  Neil Gorsuch  and  Brett Kavanaugh . [ 120 ]  The Supreme Court found the Louisiana law unconstitutional for the same reasons as the Texas one, reversing the Fifth Circuit. The judgment was supported by Chief Justice  John Roberts  who had dissented on  Whole Woman's Health  but joined in judgment as to upholding the court's respect for the past judgment in that case. [ 119 ]


The Supreme Court granted  certiorari  to  Dobbs v. Jackson Women's Health Organization  in May 2021, a case that challenges the impact of  Roe v. Wade  in blocking enforcement of a 2018  Mississippi  law (the  Gestational Age Act ) that had banned any abortions after the first 15 weeks. [ 121 ]  Oral arguments to  Dobbs  were held in December 2021, and a decision was expected by the end of the 2021–22 Supreme Court term. On September 1, 2021,  Texas  passed the  Texas Heartbeat Act , one of the most restrictive abortion laws in the nation, banning most procedures after six weeks. [ 122 ]  On May 2, 2022, a leaked draft majority opinion for  Dobbs , written by  Samuel Alito , set to overturn  Roe  was reported by  Politico . [ 123 ]


On June 24, 2022, the Supreme Court overruled both  Roe  and  Planned Parenthood v. Casey  in the  Dobbs  case on  originalist  grounds that a right to abortion cannot be found in the U.S. Constitution.  John Roberts , the  Chief Justice of the United States , concurred in the decision to uphold the law at question as constitutional, by a 6–3 vote, and did not support overruling both  Roe  and  Casey . [ 124 ] [ 125 ]  This enabled  trigger laws , which had been passed in 13 states, [ 126 ] [ 127 ] [ 128 ]  to effectively ban abortions in those states. [ 129 ] [ 130 ]


Abortion-related initiatives were placed on the  2022 ballot  in six states, as  2022 California Proposition 1 ,  2022 Michigan Proposal 3 , and  2022 Vermont Proposal 5  enshrined the right to an abortion in state constitutions, while the  2022 Kansas abortion referendum ,  2022 Kentucky Amendment 2 , and  Montana Legislative Referendum No. 131  rejected restrictions on abortion. [ 131 ]  Voters in Ohio defeated  August 2023 Ohio Issue 1  intended to make changes to the state's constitution more difficult, ahead of  November 2023 Ohio Issue 1 , which added the right to an abortion to the  Ohio constitution . [ 132 ]


FDA v. Alliance for Hippocratic Medicine  brought into question the  Food and Drug Administration  (FDA)'s approval and rules around  mifepristone , after lower courts had deemed the FDA's approval unlawful. [ 133 ]  In Arizona, the state Supreme Court ruled in  Planned Parenthood Arizona v. Mayes  that instead of a 15-week ban on abortion passed by the state in 2022, that the state should follow a 1902 law, based on a pre-ratification 1864 law, that disallowed nearly any abortion except in the case of a medical emergency, [ 134 ]  though the state government repealed the 1902 law in May 2024 to allow the 2022 law to take precedence. [ 135 ]  Some Republicans, including allies of presidential candidate Donald Trump, have pushed  Project 2025 , a sweeping government reform plan that includes banning abortions at a federal level as well as access to medical abortions drugs. [ 136 ]  Democrats used the pushback against these Republican and conservative anti-abortion goals as a point of campaigning for the election. [ 137 ]


Although all states allow abortion to prevent the woman's imminent death, 5 woman have died to pregnancy related issues in Texas alone due to doctors refusing to execute abortions because of the states abortion law despite the de jure legal circumstances. [ 138 ] [ 139 ]


Abortion-related issues were a topic in the  2024 United States elections , including these referendums:  2024 Arizona Proposition 139 ,  2024 Colorado Amendment 79 ,  2024 Florida Amendment 4 ,  2024 Montana Initiative 128 ,  2024 Maryland Question 1 ,  2024 Missouri Amendment 3 ,  2024 New York Proposal 1 ,  2024 Nebraska Initiative 439 ,  2024 Nevada Question 6 , and  2024 South Dakota Amendment G .


Gerardo Flores  was convicted of two counts of capital murder in 2005 under Texas' fetal homicide law. His girlfriend Erica Basoria testified that she had asked him to step on her stomach because her attempts to induce miscarriage on herself had been unsuccessful. [ 140 ]  Flores said he initially refused but she would not relent until he agreed. Flores admitted to police that he "accidentally, probably" hit Basoria in the face during a fight on the night of the miscarriage. Basoria told police that he was not abusive. [ 141 ]  Texas' fetal homicide law did not allow charges against the mother because she had a right to terminate pregnancy, so only Flores was charged. [ 142 ]


In 2019 a woman in Alabama was indicted after she was shot in the stomach for intentionally causing the death of "unborn baby Jones by initiating a fight knowing she was five months pregnant". The charges were later dropped. [ 143 ] [ 144 ]


Medical abortion  via  mifepristone  and  misoprostol  was approved for abortion in the United States by the FDA in September 2000. [ 145 ]  As of 2007 [update] , it was legal and available in all 50 states, Washington, D.C.,  Guam , and  Puerto Rico . [ 146 ]  It was a prescription drug, and required that it could only be distributed to the public through specially qualified licensed physicians. [ 147 ]


In the midst of the COVID-19 pandemic on December 16, 2021, in light of the difficulties in accessing in-person healthcare services, the FDA approved the distribution of mifepristone via mail. [ 148 ]  In states where abortion is banned or restricted, women are able to obtain pills through ordering from overseas online pharmacies, purchasing from pharmacies in Mexico, from services such as  Aid Access , [ 149 ]  or through a network of U.S.-Mexico border organizations that includes Red Necesito Abortar,  Las Libres  [ es ] , and  Marea Verde . [ 150 ] [ 151 ] [ 152 ] [ 153 ] [ 154 ]


In January 2023, the U.S. Department of Justice stated that USPS mailing of pills for medication abortion, even into states where abortion services are restricted, does not violate federal law. [ 155 ]  In 2023, online access to abortion medication by mail delivered by the US Postal Service is currently available to citizens of all states. [ 156 ]


In light of the  Dobbs  decision, the  Alliance Defending Freedom  launched a lawsuit in November 2022 in the  Northern District of Texas  under Judge  Matthew J. Kacsmaryk  to seek to overturn the FDA's original approval of mifepristone. The Alliance argued that the FDA had ignored some studies that showed the medication to have harmful side effects, while the current federal administration under Joe Biden, the manufacturers of the drugs, and several doctors vouched for the safety of the drugs and argued that the plaintiffs lacked standing. Judge Kacsmaryk ruled for the Alliance on April 7, 2023, reversing the FDA's approval and banning mifepristone across the United States after seven days. [ 157 ]  A district judge in a separate lawsuit,  Thomas O. Rice  of the  Eastern District of Washington , ruled that the FDA should not reverse access to mifepristone in 16 states. [ 158 ]  Kacsmaryk's ruling was partially reversed by a panel on the  Fifth Circuit Court of Appeals , leaving mifepristone on the market but reverting efforts made by the FDA to liberalize its use over seven years. [ 159 ]  The case was appealed to the Supreme Court, and on June 13, 2024, the court ruled that the Alliance Defending Freedom lacked standing to bring the suit. [ 160 ]


Beyond limitations pertaining to abortion in the context of federal funding, there is little federal legislation protecting or penalizing abortion in the United States. [ 161 ]  Abortion is left to each individual state. The  Partial-Birth Abortion Ban Act  of 2003 (codified at  18 U.S.C. § 1531 ),  Freedom of Access to Clinic Entrances Act  of 1994 (codified at  18 U.S.C. § 248 ), and  Comstock Act  of 1873 (codified at  18 U.S.C. 552 ,  18 U.S.C. 1461 ,  18 U.S.C. 1462 , and  18 U.S.C.1463 )  are some of the few pieces of existing federal law that provide substantive criminal provisions either protecting or penalizing abortion. The provisions in the Partial Birth Abortion Ban Act and the Freedom of Access to Clinic Entrances Act cover activity affecting  interstate or foreign commerce , whereas the provisions of the Comstock Act cover activity using the  mail or postal system . The Comstock Act is particularly punitive as a violation is considered a predicate offense for purposes of the  Racketeer Influenced and Corrupt Organizations Act, or R.I.C.O. . [ 162 ]


Since 1995, led by congressional  Republicans , the  U.S. House of Representatives  and  U.S. Senate  have moved several times to pass measures banning the procedure of  intact dilation and extraction , commonly known as  partial birth abortion . Such measures passed twice by wide margins, but  President   Bill Clinton   vetoed  those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Congressional supporters of the bill argue that a health exception would render the bill unenforceable, since the  Doe v. Bolton  decision defined "health" in vague terms, justifying any motive for obtaining an abortion. Congress was unsuccessful with subsequent attempts to override the vetoes.


The  Born-Alive Infants Protection Act  (BAIPA) was enacted August 5, 2002, by an Act of Congress and signed into law by George W. Bush. It asserts the human rights of infants born after a failed attempt to induce abortion. A "born-alive infant" is specified as a "person, human being, child, individual". "Born alive" is defined as the complete expulsion of an infant at any stage of development that has a heartbeat, pulsation of the umbilical cord, breath, or voluntary muscle movement, no matter if the umbilical cord has been cut or if the expulsion of the infant was natural, induced labor, cesarean section, or induced abortion. The  Born-Alive Abortion Survivors Protection Act  is a proposed piece of legislation that would result in criminal penalties for any practitioner who denies a born-alive infant care.


On October 2, 2003, with a vote of 281–142, the House approved the  Partial-Birth Abortion Ban Act  to ban intact dilation and extraction, with an exemption in cases of fatal threats to the woman. Through this legislation, a doctor could face up to two years in prison and civil lawsuits for performing such a procedure. A woman undergoing the procedure could not be prosecuted under the measure. On October 21, 2003, the United States Senate passed the bill by a vote of 64–34, with a number of Democrats joining in support. The bill was signed by President  George W. Bush  on November 5, 2003, but a federal judge blocked its enforcement in several states just a few hours after it became public law. The Supreme Court upheld the nationwide ban on the procedure in the case  Gonzales v. Carhart  on April 18, 2007, signaling a substantial change in the Court's approach to abortion law. [ 163 ]  The 5–4 ruling said the  Partial Birth Abortion Ban Act  does not conflict with previous decisions regarding abortion.


The judicial interpretation of the  U.S. Constitution  regarding abortion, following the  Supreme Court of the United States 's 1973 landmark decision in  Roe v. Wade , and subsequent companion decisions, is that abortion is legal but may be restricted by the states to varying degrees. States have passed laws to restrict late-term abortions, require parental notification for minors, and mandate the disclosure of abortion risk information to patients prior to the procedure. [ 164 ]


The official report of the U.S. Senate Judiciary Committee, issued in 1983 after extensive hearings on the  Human Life Amendment  (proposed by Senators  Orrin Hatch  and  Thomas Eagleton ), stated: "Thus, the [Judiciary] Committee observes that no significant legal barriers of any kind whatsoever exist today in the United States for a mother to obtain an abortion for any reason during any stage of her pregnancy." [ 165 ]


One aspect of the legal abortion regime now in place has been determining when the  fetus  is " viable " outside the womb as a measure of when the "life" of the fetus is its own (and therefore subject to being protected by the state). In the majority opinion delivered by the court in  Roe v. Wade , viability was defined as "potentially able to live outside the mother's womb, albeit with artificial aid. Viability is usually placed at about  seven months  (28 weeks) but may occur earlier, even at 24 weeks". When the court ruled in 1973, the then-current medical technology suggested that viability could occur as early as 24 weeks. Advances over the past three decades allow survival of some babies born at 22 weeks. [ 166 ]


As of 2006 [update] , the youngest child to survive a premature birth in the United States was a girl born at Kapiolani Medical Center in  Honolulu ,  Hawaii , at 21 weeks and 3 days gestation. [ 167 ]  Because of the split between federal and state law, legal access to abortion continues to vary by state. Geographic availability varies dramatically, with 87 percent of U.S. counties having no abortion provider. [ 168 ]  Moreover, due to the  Hyde Amendment , many  Medicaid  state programs do not cover abortions; as of 2022, 17 states including  California ,  Illinois , and  New York  offer or require such coverage. [ 169 ]


The legality of abortion is frequently a major issue in nomination battles for the U.S. Supreme Court. Nominees typically remain silent on the issue during their hearings, as the issue may come before them as judges. [ 170 ]


The  Unborn Victims of Violence Act , commonly known as  Laci  and Conner's Law, was passed by Congress and signed into law by President Bush on April 1, 2004, allowing two charges to be filed against someone who kills a pregnant mother (one for the mother and one for the fetus). It specifically bans charges against the mother and/or doctor relating to abortion procedures. Nevertheless, it has generated much controversy among pro-abortion rights advocates who view it as a potential step in the direction of banning abortion.


In 2021, the  Women's Health Protection Act , which would codify abortion rights into federal law, was introduced by  Judy Chu . [ 171 ]  The bill passed the  U.S. House of Representatives  but was rejected by the  U.S. Senate . [ 172 ]


After the  Dobbs  decision,  Merrick Garland , the  U.S. Attorney General , asserted that under federal law, states do not have the right to restrict access to FDA-approved abortion pills, but Louisiana passed a law to ban mailing them. [ 173 ]
Legal experts cited as a potentially persuasive precedent the 2014 district decision in  Zogenix v. Patrick , in which the court ruled that under the doctrine of  federal preemption , Massachusetts could not ban the opioid  Zohydro  because it had been approved by the FDA. [ 174 ] [ 175 ]


On September 13, 2022, Republican senator  Lindsey Graham , who had previously stated that abortion should be left up to each state, [ 176 ]  introduced legislation that would ban abortion nationwide after 15 weeks of pregnancy with exceptions for rape, incest, and the life of the patient, named the  Protecting Pain-Capable Unborn Children from Late-Term Abortions Act . [ 177 ] [ 178 ] [ 179 ]  This law would require states to ban abortion after 15 weeks, but it would not require states with stricter bans to allow it up to that point. [ 180 ]  Despite the view that it "gets the United States in line with other developed nations", it leaves out the fact that none of those nations ban abortion. Graham had previously introduced the  Pain-Capable Unborn Child Protection Act , which set the period at 20 weeks. [ 181 ]


Currently, 13 states have criminal penalties for performing abortions, regardless of  gestational age . [ 182 ]  The penalties in states that have made abortion illegal vary, as outlined below.


This chart lists only the penalties authorized specifically by the state laws which explicitly restrict (or ban) abortions.  The chart does not address the risk of being prosecuted for violating any other law because of the abortion. The jurisprudence surrounding this question – whether laws such as "fetal-personhood laws", [ 183 ]  or laws originally intended to protect pregnant women and their pregnancies from external aggressors, can now also be used to prosecute women who obtain abortions, or who terminate their own pregnancies, deliberately or unintentionally [ 184 ]  – is unsettled, variable, and, in some states, unclear. [ 185 ]
States with criminal penalties that are blocked by a court, have yet to take effect, or are unenforced are denoted by a grey background.


Prior to 2021, abortion was legal in all U.S. states, [ 219 ]  and every state had at least one abortion clinic. [ 220 ] [ 221 ]   Abortion is a controversial political issue, and regular attempts to restrict it occur in most states. Two such cases, originating in  Texas  and  Louisiana , led to the Supreme Court cases of  Whole Woman's Health v. Hellerstedt  (2016) and  June Medical Services, LLC v. Russo  (2020) in which several Texas and Louisiana restrictions were struck down. [ 222 ] [ 223 ]


The issue of  minors and abortion  is regulated at the state level, and 37 states require some parental involvement, either in the form of  parental consent  or in the form of parental notification. In certain situations, the parental restrictions can be overridden by a court. [ 224 ]  Mandatory waiting periods, mandatory ultrasounds and scripted counseling are common abortion regulations. Abortion laws are generally stricter in conservative  Southern states  than they are in other parts of the country.


In 2019, New York passed the  Reproductive Health Act  (RHA), which repealed a pre- Roe  provision that banned third-trimester abortions except in cases where the continuation of the pregnancy endangered a pregnant woman's life. [ 225 ] [ 226 ]


Abortion in the Northern Mariana Islands , a United States Commonwealth territory, is illegal. [ 227 ] [ 228 ] [ 229 ]


Alabama House Republicans passed a law on April 30, 2019, that will criminalize most abortion if it goes into effect. [ 230 ]  Dubbed the " Human Life Protection Act ", it offers only two exceptions: serious health risk to the mother or a lethal fetal anomaly. Amendments that would have added cases of rape or incest to the list of exceptions were rejected [ 231 ]  It will also make the procedure a  Class A felony . [ 232 ]  Twenty-five male Alabama senators voted to pass the law on May 13. [ 233 ]  The next day, Alabama governor  Kay Ivey  signed the bill into law, primarily as a symbolic gesture in hopes of challenging  Roe v. Wade  in the Supreme Court. [ 234 ] [ 235 ]


Since Alabama introduced the first modern anti-abortion legislation in April 2019, five other states have also adopted abortion laws including Mississippi, Kentucky, Ohio, Georgia and most recently Louisiana on May 30, 2019. [ 236 ]


In May 2019, the U.S. Supreme Court upheld an Indiana state law that requires fetuses which were aborted be buried or cremated. [ 237 ]  In a December 2019 case, the court declined to review a lower court decision which upheld a Kentucky law requiring doctors to perform ultrasounds and show fetal images to patients before abortions. [ 238 ]