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What North Carolina’s abortion ban does — and why it matters

The policy behind North Carolina’s dramatic abortion showdown, explained.

People hold signs supporting abortion rights.
A rally for abortion rights in Charlotte, North Carolina, in 2022.
Alex Slitz/Charlotte Observer/Tribune News Service/Getty Images
Zack Beauchamp is a senior correspondent at Vox, where he covers ideology and challenges to democracy, both at home and abroad. Before coming to Vox in 2014, he edited TP Ideas, a section of Think Progress devoted to the ideas shaping our political world.

On Tuesday, the North Carolina legislature took the hugely consequential step of overriding Democratic Gov. Roy Cooper’s veto of a new 12-week abortion ban. Republicans control a supermajority in both the Senate and the House, which gave them enough votes to override the governor’s veto.

The veto override is only the latest contentious chapter in the partisan fight over abortion since the Supreme Court overruled Roe v. Wade last year in Dobbs v. Jackson.

North Carolina is an unusually critical state for abortion rights: It has become a haven for those seeking abortion in the post-Dobbs South. In the months following the Supreme Court’s ruling, North Carolina saw the single highest increase in abortions of any state in the country — largely due to out-of-staters coming in from nearby states where the procedure is heavily restricted or banned. The new law, which goes into effect July 1, could have a significant impact on abortion access in the United States writ large.

The actual policy mechanisms in the bill are more subtle than you might think. Most abortions — at least 88 percent in North Carolina — take place at or before 12 weeks. To reduce abortions during the period when it remains legal, the bill contains new in-person visit requirements for patients and onerous licensing restrictions on surgical clinics. These likely wouldn’t have the same effect as a full ban but would still make it harder for patients (especially out-of-staters) to access care.

North Carolina Republicans chose this more subtle pathway deliberately: Reporting from the Washington Post shows that the legislative drafting process was shaped by the widespread evidence that strict abortion bans are a political loser for the GOP.

The bill even includes some limited financial support for parents, like paid parental leave for state employees and teachers, to defang the popular Democratic argument that Republicans don’t actually care about the welfare of mothers and their children. It’s a state abortion restriction seemingly designed to counter the post-Dobbs backlash — one that could serve as a model for Republicans elsewhere looking to retreat from more hardline positions if it proves politically effective.

Whether the bill actually works as intended, on both policy and political grounds, it has potentially massive stakes for the entire country.

How North Carolina’s bill restricts abortion

Under current North Carolina law, elective abortion is permitted up through 20 weeks. This is considerably less restrictive than the post-Dobbs bans enacted in several nearby Republican-controlled states.

In neighboring Tennessee, abortion is completely banned (with some very limited exceptions); in Florida and Georgia, it’s prohibited past six weeks (before many people even know they’re pregnant).

As anyone who has been pregnant or known a pregnant person knows, the difference between six and 20 weeks is absolutely massive. Only 40 percent of all abortions nationwide took place before six weeks, whereas nearly all abortions in the United States happen before 20 weeks.

This is why North Carolina has seen such a dramatic surge in abortions since Dobbs; it, together with surprising holdout South Carolina, remains an island where abortion is still accessible in a region where it’s increasingly prohibited.

The new North Carolina law restricts elective abortion through 12 weeks (the first trimester). After that, abortion is prohibited with narrow exceptions: rape and incest through 20 weeks, life-threatening fetal anomalies through 24 weeks, and life of the mother throughout (a notoriously murky exception).

In and of itself, the changing dates represent a rollback in abortion rights — though, given that most abortions happen within the first 12 weeks, one perhaps not as hugely consequential as the six-week bans that have passed in other states. But at least two other components of the bill also create important barriers to abortion access.

First, the bill changes the state’s waiting period law to require an in-person visit.

Under current law, anyone seeking an abortion in North Carolina must begin with a consultation process at least 72 hours before the procedure — but this can be done over the phone, making it comparatively easy for out-of-state patients. The new law now requires the consultation to be done in person, which the bill’s critics say is a significant barrier for out-of-state residents — especially low-income or working-class ones who can’t afford to take time off work.

“This bill is about making it as difficult as possible to obtain an abortion, even in the first trimester,” Amy Bryant, a professor at the University of North Carolina and practicing OB-GYN, said at a rally against the abortion bill.

Second, the new law imposes a new requirement that abortion clinics maintain facilities on par with those of ambulatory surgery centers (ASCs), which are non-hospital outpatient surgery clinics. ASCs are required to adhere to specific rules, including physical layout restrictions, that abortion clinics don’t always meet.

There is no evidence that these restrictions improve outcomes in patients who have abortions; a study of 50,000 abortions found no difference between those performed in ASCs and those performed outside of them.

The ASC rule is the most common restriction found in so-called TRAP laws — short for “targeted regulation on abortion providers.” The idea behind TRAP legislation is to impose financially burdensome requirements on abortion clinics that all but force many of them to shut down. Research by the Guttmacher Institute found that TRAP laws in four states — Arizona, Kentucky, Ohio, and Texas — caused roughly half of all clinics in those states to shut down between 2011 and 2017. And Planned Parenthood has already said that none of its existing clinics in North Carolina meet the state’s ASC standards.

Moreover, the bill passed Tuesday strengthens an existing North Carolina law that prohibits patients from using abortion-inducing drugs like mifepristone at home or elsewhere absent a physician’s supervision. Providing abortion drugs directly to a patient carries a $5,000 fine, as does advertising the sale of any such drugs.

Again, none of these rules are as tight as the bills in nearby states.

But combined, they amount to significant restrictions on abortion access in a state that currently serves as a region-wide haven. It’s hard to estimate how many (safe and legal) abortions would be prevented by this bill’s imposition: North Carolina after Dobbs is a fairly unique case. But it’s fair to say that the number isn’t trivial.

How the GOP is confronting the Dobbs backlash

So why did the North Carolina GOP, famously one of the more radical in the country, opt for this more subtle attempt to restrict abortion rather than a tighter ban? The answer appears to be politics.

According to the Washington Post’s Caroline Kitchener and Rachel Roubein, Republicans drafted the bill in secret and introduced it through a procedurally novel method that circumvented the need for committee debate. The reason, per Kitchener and Roubein, was to avoid political backlash: both to minimize anti-abortion protests and “to prevent far-right legislators from introducing an amendment that would replace the 12-week limit with a six-week ban.”

By restricting input during the bill’s passage, they aimed to circumvent the problem that has plagued state Republican parties since Dobbs: being caught between an activist base demanding six-week-or-tighter restrictions and a mass public that vehemently opposes such restrictions.

The 2022 midterms and subsequent elections, like the Wisconsin Supreme Court contest, proved that abortion is a motivator for Democrats and a powerful wedge issue — one that has seemingly punished Republicans at the ballot box.

North Carolina Republicans were clearly sensitive to these political consequences, and drafted policy with politics in mind. Republican state senators and representatives have repeatedly emphasized, in their public rhetoric, a poll finding that a majority of North Carolinians supported restricting abortion to the first trimester (with exceptions).

Whether this is actually true is open to debate: Another poll found that a clear majority, 57 percent, supported either keeping North Carolina abortion laws the same or making it even easier to access the procedure. And a more recent poll, conducted after the abortion bill’s initial passage, found that 54 percent opposed the new requirements.

These numbers aren’t favorable to Republicans, but they’re far less unfavorable than those on six-week bans or total prohibitions. No matter what, Republicans took a lesser risk than, say, Gov. Ron DeSantis in Florida, who recently signed new restrictions into law. In the internal GOP debate, they have lined up with Donald Trump — who is arguing that abortion is a political loser that Republicans need to deemphasize — rather than DeSantis.

But deemphasizing doesn’t mean ignoring. Instead, it means using other means — like TRAP provisions — to restrict abortions alongside the tighter week requirements they could impose after Dobbs. This approach worked for Republicans for many years while Roe was still law, allowing them to reduce abortion access without suffering much in the way of obvious political consequences. Whether it’s enough for powerful anti-abortion activists, who play a major role in the party’s internal politics, is another matter.

The North Carolina abortion law won’t merely be a test of whether the GOP can reduce abortions both state- and region-wide. It’ll be a test of a different, less blatantly radical approach to post-Dobbs pro-life politics in a state that will likely be competitive in 2024.

Update, May 17, 10:30 am: This piece was originally published May 16 before the North Carolina legislature’s vote to override Gov. Roy Cooper’s veto. It has been updated throughout to account for the legislature’s vote.