Dr. Margaret Baum (second from left), chief medical officer for Planned Parenthood Great Rivers, stands with attorneys from the Planned Parenthood Federation of America on the steps of the Jackson County Courthouse in Kansas City, Missouri, on Jan. 12, 2026, the first day of a two-week trial over abortion restrictions. (Photo by Anna Spoerre/Missouri Independent)

The outcome of two trials in the coming weeks could shape what it will look like when voters overturn state abortion bans through future ballot initiatives.

Arizona and Missouri voters in November 2024 struck down their respective near-total abortion bans. Both states added abortion access up to fetal viability as a right in their constitutions, although Arizonans approved the amendment by a much wider margin than Missouri voters.

That was just the beginning of protracted legal battles.

Amy Myrick, senior counsel at the Center for Reproductive Rights, said ballot measures are a powerful and important step in returning abortion access to a state, but success on Election Day doesn’t mean the fight is over.

“State constitutions don’t automatically repeal laws,” Myrick said. “Sometimes, even if the state isn’t doing it, other groups or legislators will jump in to try to retain these restrictions.” 

The trial over Arizona’s abortion restrictions wrapped up this week, Arizona Mirror reported. Maricopa County Superior Court Judge Gregory Como seemed unconvinced of the argument that certain laws around how abortion medication can be prescribed, waiting periods and bans on abortions in cases of fetal abnormalities should remain enforceable.

A similar trial in Missouri will wrap up on Jan. 26 after hours of testimony about more than a dozen abortion restrictions state officials are seeking to preserve. The Republican supermajority state legislature is also putting a countermeasure to reinstate the abortion ban on the ballot in November, paired with a ban on gender-affirming care for minors. 

Arizona and Missouri have what are known by abortion-rights advocates as Targeted Regulation of Abortion Providers, or TRAP, laws passed by legislatures before the U.S. Supreme Court’s Dobbs decision in 2022. Even states without bans, like Connecticut, Maryland and Rhode Island, have statutes in place that the Guttmacher Institute considers TRAP laws. Abortion providers are subject to state licensing and other medical requirements, but as of December, 25 states still have laws that impose additional regulations for clinics, according to Guttmacher, such as facility size and transfer agreement requirements, or admitting privileges at local hospitals within 30 miles.

Officials and legislators usually argue in the statehouse and in court that the extra parameters increase the safety of abortion procedures, but the safety record is strong under existing medical requirements and is safer than childbirth, according to the American College of Obstetricians and Gynecologists. Studies show the risk of maternal death associated with childbirth is about 14 times higher than the risk associated with abortion.

But there are also other laws that advocates say are meant to discourage or frustrate those seeking abortion care, such as mandatory vaginal exams, waiting periods, or a requirement that the same physician must see an abortion medication patient over two subsequent visits. Some of those laws were passed over decades and helped drive abortion providers away, including in Missouri.

As a result, even though Missourians overturned the ban, abortion care remains difficult to obtain, and many are still leaving the state to get it, according to Missouri Independent.

“Because constitutional amendments don’t overturn conflicting laws, people can still experience injuries under these laws,” said Prachi Dave, senior managing legal and policy director at If/When/How, a reproductive rights legal services and advocacy organization. “For example, if a waiting period is interfering with my ability to access the care I am guaranteed under the newly passed amendment, then I would ask a judge to affirm that the law is getting in the way of my right. In doing so, lawsuits give practical effect to constitutional amendments.”

In a Michigan lawsuit led by advocacy groups, a judge ruled in May that a mandatory waiting period was unconstitutional after voters approved an initiative codifying reproductive rights.  

Wendy Heipt, attorney for advocacy organization Legal Voice in Washington, said even if some laws were ruled unconstitutional, they may have to be litigated again because the basis for the unconstitutional argument relied on the Roe v. Wade case that the U.S. Supreme Court overturned almost four years ago.

Heipt frequently works on cases in Idaho, where many lawsuits over the state’s near-total abortion ban have taken place in the past three years. Though still in effect, there is an effort to overturn the ban via ballot in November. 

The initiative is different from those approved in Arizona and Missouri because people in Idaho cannot submit constitutional amendments — only proposed state laws — for ballot consideration directly.

Melanie Folwell, lead organizer of the reproductive rights initiative in Idaho, said even if successful, it’s only one leg of a long race in restoring access. The initiative group, Idahoans United for Women and Families, drafted a bill that would have repealed existing abortion laws, but it was too long and legally complicated for the ballot. Instead, what they’ve come up with for voters is meant to establish a right to reproductive health privacy without undue government interference and override existing laws. 

The outcome of Missouri’s trial could be instructive for Idaho abortion-rights advocates, because the political environments are similar. Idaho has a lengthy list of its own waiting periods for abortion care, mandatory counseling and ultrasound requirements, and elected officials in the Republican-led state have repeatedly signaled their opposition to abortion access, including the attorney general. The legislature also has a Republican supermajority.

And since it can’t be a constitutional amendment, any new law may be more vulnerable to legal challenges. 

“There are things to learn from every one of the states that have reproductive access on the ballot, which is 17 states at this point,” Folwell said. “It is always instructive for us to see what plays out in that state’s legislature, what plays out with their courts.”

Myrick said the legal battles can feel discouraging, but voters shouldn’t let it stop them from using their voices to make their policy preferences known.

“Ballot measures are not the silver bullet. We need a lot of follow-up to make these rights real. And the attempts to keep these restrictions after the voters have spoken are blatantly anti-democratic, but they’re still happening,” Myrick said.

State and federal proposals to regulate and restrict medication abortion are expected to continue in 2026 as abortion opponents claim, without strong evidence, that abortion medication is dangerous to patients and the environment. (Getty Images)

Going into the fourth year without federal abortion rights protections, groups that helped overturn Roe v. Wade are focused on cutting off access to abortion pills. As multiple lawsuits over the abortion drug mifepristone unfold, state and federal proposals to regulate and restrict medication abortion are expected to continue in 2026. Abortion opponents argue that medication abortion, despite its strong safety record, is dangerous to patients and the environment.

Abortion bans are largely unpopular, but heading into a midterm election year, some lawmakers in states with strict abortion bans have already prefiled bills to add new restrictions. Here’s a look at early legislative trends emerging in abortion-related bills recently introduced or prefiled ahead of the new year.

Proposals to restrict abortion pill or study environmental effects

Over the last few years, the national anti-abortion group Students for Life of America has spread unfounded claims that mifepristone pollutes U.S. waterways and drinking water, drafted model legislation to regulate the disposal of medication abortions, and requested environmental studies at the federal and state level. 

In 2025, lawmakers in at least seven states introduced bills to create environmental restrictions for the abortion drug mifepristone or order environmental studies. Bills introduced this year in Texas, Wisconsin and Wyoming would have required testing community water systems for traces of mifepristone. 

Bills in Maine, Montana, Pennsylvania, West Virginia, Wisconsin and Wyoming would have required providers to give patients medical waste kits to collect and return the tissue following a medication abortion. Women commonly flush the tissue associated with medication abortion and miscarriages, which typically occur during the first trimester. 

These bills, except Pennsylvania’s, would have also mandated in-person dispensing of the medication and follow-ups, effectively banning telehealth abortion. 

None of these proposals passed, but they are likely to be reintroduced in 2026 as abortion opponents continue to push for environmental regulation of abortion pills, including at the federal level. 

In June, 25 congressional Republicans sent the U.S. Environmental Protection Agency a letter inquiring about potential avenues for regulating mifepristone, as the New York Times reported. And as Politico recently reported, Students For Life lobbied the agency to add mifepristone to its recently updated list of contaminants that utilities will have to track in drinking water. It’s too late to include a new drug on the list, which is updated every five years. 

But according to Politico, EPA staffers advised anti-abortion activists to use an upcoming public comment period to drum up requests that the agency include active metabolites in mifepristone. The EPA collects nationwide data on the chemicals on this list, which could be used to set future federal limits.  

Fetal wrongful death bills 

In Florida, where abortion is banned at six weeks’ gestation, lawmakers recently advanced HB 289 ahead of the 2026 session, which would allow parents to file wrongful death lawsuits for the loss of a developing fetus and to claim damages for mental pain and loss of support. Its companion bill, SB 164, filed for the third year in a row by Republican Sen. Erin Grall, faces an uphill battle in the Florida Senate, reported the Florida Phoenix, which noted that jurors could be asked to consider the salary the fetus could have earned over its life as part of damages to which parents could be entitled. 

Groups opposing the legislation as far-reaching and likely to increase liability exposure for OB-GYNs who specialize in high-risk pregnancies include the American Civil Liberties Union of Florida, the Florida Justice Reform Institute and the Doctors Company, the nation’s largest physician-owned medical malpractice carrier.

One of the bill’s leading champions, Andrew Shirvell, founder and executive director of Florida Voice for the Unborn, told state House Judiciary Committee members they should continue expanding “civil remedies afforded under Florida law to hold accountable those who continue to take the lives of unborn children illegally in our state.”

Another bill, HB 663, would allow a family member to sue someone for providing or attempting to provide an abortion up to two years after the fact with up to $100,000 in damages, even if the woman consented or if the abortion was performed in another state or country where the procedure is legal.

Attempts to overturn or skirt abortion rights ballot measures 

Even though Missouri voters in 2024 approved an amendment to protect abortion rights in the state constitution, broad access has not returned to the state. Between January and October, there were only 80 in-clinic abortion procedures in Missouri, according to state data, with an additional 79 abortions in hospitals and identified as medical emergencies.

A trial in January could determine whether Missouri’s anti-abortion laws violate the voter-approved amendment. Meanwhile, Republican lawmakers have put a new constitutional amendment on the 2026 ballot that would ban nearly all abortions in the state with limited exceptions.   

In 2023, Ohio voters approved a constitutional amendment protecting abortion rights through fetal viability, and prohibiting the state from interfering with or penalizing someone for exercising that right. But Republicans have been advancing anti-abortion bills to create restrictions that make accessing abortion more difficult without directly flouting the amendment. 

During this legislative session, which ends Dec. 31, state Sen. Kyle Koehler introduced SB 309, which could add steps to accessing medication abortion and would require doctors to deliver a state-mandated script about the dangers of mifepristone. It would also allow patients, their parents if they’re underage, or the father of the fetus  to sue if they feel the patient was uninformed when taking the pill.

In November, the Ohio House passed HB 485, which would require students in fifth through 12th grade to watch either a “Meet Baby Oliva” fetal development video created by the national anti-abortion group Live Action, or a similar video. Live Action’s video has been criticized by reproductive health advocates for not being fully medically accurate or comprehensive. Similar bills have been introduced in dozens of states this year, and have been enacted in Idaho, Indiana, Iowa, Kansas, North Dakota and Tennessee. 

Abortion records privacy

Privacy concerns around reproductive health in the post-Roe era persist nationally. Lawmakers in states that protect abortion rights continue to try to shore up medical and data privacy protections for abortion, which is almost completely illegal in more than a dozen states. 

In Indiana, where the legislative session began in December, Sen. La Keisha Jackson introduced SB 109. Under the measure, a health care provider’s report about an abortion submitted to the Indiana health department as a medical record would be confidential and not subject to disclosure as a public record. In a state lawsuit brought by two OB-GYNs from Indianapolis, an appeals court in December upheld the privacy of these records, known as terminated pregnancy reports.

In Washington state, Democratic lawmakers are still drafting legislation that would regulate license plate readers following reports that authorities in Texas searched thousands of cameras, as far as Washington and Illinois, to find a woman they believed had a self-administered medication abortion. 

Calling for forced vasectomies for convicted rapists

State abortion restrictions typically hold health providers liable, but women have been jailed or prosecuted for their pregnancy outcomes. One Democratic lawmaker in Alabama, where abortion is banned throughout pregnancy except to save the pregnant person’s life, has introduced legislation that comes with steep penalties for men convicted of rape or incest that resulted in pregnancy. 

Democratic Rep. Juandalynn Givan’s prefiled HB 46 would authorize abortion to preserve the health of the mother or if the pregnancy resulted from rape or incest. It would also require men convicted of rape or incest to pay for the abortion, and undergo either vasectomy or castration, as determined by the court. As the Alabama Reflector reported, the bill is unlikely to be considered, but for Givan it’s really about starting a broader conversation of bodily autonomy. 

“We have already set a double standard,” Givan said. “Have you seen a bill crafted that tells a man what he cannot … do with his body? You have not, outside of the standard laws that speaks to rape and incest, and we already know that that is definitely a crime.”

Anticipated federal policy decisions during Trump’s second year 

In his first year back in office, President Donald Trump rescinded many of the Biden-era policies intended to expand abortion access, including the previous administration’s interpretation that the Emergency Medical Treatment and Labor Act covers abortions necessary to save a pregnant person’s life even in a state that has banned abortion.

More major federal policy decisions around abortion are anticipated in 2026. The Food and Drug Administration agreed to review mifepristone’s safety, but abortion opponents recently called for FDA Commissioner Martin Makary to be fired, accusing him of slow-walking the review until after the midterm elections in November. 

Just a few months before that, in July, a controversial Medicaid policy effectively defunding Planned Parenthood clinics and other nonprofit clinics that provide abortions, is slated to expire. Whether Republicans will renew the funding restriction or let it lapse — allowing the nation’s largest network of reproductive health clinics to continue serving Medicaid patients for services unrelated to abortion — remains to be seen.