Summary:
- North Carolina has been a battleground for abortion rights since SB 20 in 2023 restricted access.
- With abortions banned after 12 weeks, barring exceptions, North Carolina is a moderately restrictive state.
- The restrictions predominantly fall on marginalized populations, with the conflicts over access and privacy still ongoing.
Since the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade, North Carolina has become a critical battleground in the fight for reproductive rights. Our state’s response has been marked by significant legislative changes, advocacy efforts, and ongoing debates about the future of abortion access. This evolving landscape highlights how North Carolina serves as a key example of the broader national struggle over reproductive autonomy, where political power, grassroots activism, and public opinion continue to clash in defining the scope of women’s rights.
Current Legal Landscape
In May 2023, North Carolina enacted Senate Bill 20 (SB 20), officially titled the Care for Women, Children, and Families Act, over the veto of former Governor Roy Cooper. The act significantly restricts access to abortion in the state, banning most abortions after twelve weeks of pregnancy, with exceptions allowed for rape and incest, life-threatening medical emergencies, and life-limiting fetal anomalies.
SB 20 also imposes a 72-hour waiting period before an abortion can be performed, during which patients must receive in-person, state-directed counseling, which creates substantial logistical and financial hurdles for many patients.
Under the prior regime, North Carolina’s Women’s Right to Know Act (House Bill 854, Session Law 2011-405, amended 2015) explicitly allowed the informed consent counseling required by N.C Gen. Stat. § 90‑21.82 to be delivered “by telephone or in person,” permitting real-time phone counseling as an alternative to an in-person visit. These provisions applied equally to surgical and medication abortions and included a 72-hour delay after counseling before the procedure could occur.
However, Senate Bill 20 (Sessions Law 2013-14), effective July 1, 2023, amended Article 1L of Chapter 90, including § 90‑21.82, to remove all telecounseling language, requiring that the state-directed counseling now be given solely in person. This is why individuals now often face two or three clinic trips – one for the mandatory counseling visit, one for the receipt of medication, and often a third for follow-up, which drastically increases the barriers to accessing care.
Compared to other states, North Carolina is in the middle ground concerning Abortion access. It is more restrictive than states like California and New York, where abortion remains widely accessible into the second and third trimesters. However, SB 20 is less extreme than laws in other states like Texas and Alabama, where abortion is banned after roughly six weeks, often with no exceptions for rape or incest. Still, North Carolina’s layered procedural and access barriers, including the waiting period, counseling mandates, and clinic restrictions, significantly delay and discourage care. Thus, it disproportionately impacts low-income individuals, rural patients, and communities of color.
These restrictions have led to a significant decrease in abortion access within the state, prompting some residents to seek services in neighboring states with less stringent laws. States like Virginia, Maryland, and Washington, D.C. maintain more permissive abortion laws, allowing procedures later into pregnancy and without mandatory waiting periods or in-person counseling. In contrast, nearby states such as South Carolina and Georgia enforce six-week bans, making North Carolina a limited-access hub by comparison. As a result, out-of-state travel for abortion care has surged across the region.
Impact on Communities
The tightened regulations disproportionately affect marginalized populations, including people of color, low-income individuals, and those in rural communities. These groups often face additional barriers such as limited transportation, lack of nearby clinics, and financial constraints.
For example, the Hispanic community in North Carolina has been particularly impacted. Organizations like El Pueblo have highlighted how these restrictions exacerbate existing disparities in health care access.
In response to these challenges, advocacy groups have mobilized to protect and expand reproductive rights. Pro-choice North Carolina and the ACLU of North Carolina are working to provide resources, support, and education to those affected by the new laws.
Health care providers and professionals have also stepped into advocacy roles. Nurses and doctors are voicing concerns about the impact of restrictive laws on patient care and are advocating for policies that prioritize health and autonomy. Many have also highlighted the financial constraints these laws impose on patients, especially those who must travel out of state, take time off work, and cover additional expenses. These barriers disproportionately affect low-income communities the most.
State Government Actions
Former Governor Roy Cooper had taken steps to safeguard reproductive rights in North Carolina. In January 2025, he issued Executive Order No. 8, which aims to protect access to reproductive healthcare services and the privacy of patients and providers. The order directs state agencies to coordinate efforts to ensure that individuals seeking or providing lawful reproductive healthcare are not subjected to criminal or civil penalties.
Building on this, Governor Josh Stein reaffirmed these protections with his own Executive Order in January 2025, further directing state agencies to shield patients and providers from out-of-state investigations related to legal reproductive care in North Carolina. He also ordered reviews of state data practices to enhance patient privacy and tasked DHHS with ensuring access to contraceptives and accurate public information on reproductive services.
What’s Next?
The future of reproductive rights in North Carolina remains uncertain. Legislative efforts continue to evolve, and advocacy groups are preparing for potential further restrictions. At the same time, there is a concerted push to protect and expand access through legal challenges, public awareness campaigns, and support networks.
As the state navigates this complex landscape, the actions of policymakers, healthcare providers, and community advocates will play a crucial role in shaping the accessibility and legality of reproductive healthcare in North Carolina.
