North Carolina’s history of abortion restrictions—and what comes next

Abortion restrictions passed by the General Assembly in 2013 were widely protested, including in the House chamber during a floor debate in July of that year. (AP Photo/Gerry Broome)

By Michael McElroy

January 22, 2024

On the 51st anniversary of Roe v. Wade, here’s a look at all the times North Carolina’s lawmakers tried to disrupt abortion care.

Five decades ago the US Supreme Court ruled that a woman’s decision to have a baby, or to not have one, belonged only to her. Not to lawmakers. Not to politicians. Not to anyone else.

It was, of course, the crowning moment of a woman’s right to bodily autonomy in a country that so often tried to deny it. 

But that was then. 

Roe v. Wade turns 51 on Monday, but the anniversary, a key date in American history, is overshadowed by the aftermath of its repeal two years ago by a new, conservative Supreme Court.

The ruling threw the issue to the states, creating a chaotic mix of outright bans in some states, firm protections in others, and a confusing mess in several states where doctors now defer to lawyers, and pregnant women face dangerous barriers to the care they need. 

Last year, North Carolina’s Republican-controlled legislature passed a 12-week ban with exceptions for rape, incest, and the physical health of the mother. Gov. Roy Cooper and Democrats opposed the bill, but the Republican supermajority in the legislature overrode Cooper’s veto of the ban. 

Though it was the first salvo in a post-Roe world, this was only the latest chapter in the winding history of abortion rights in North Carolina. The 12-week abortion ban was hardly the first time lawmakers tried to obstruct abortion rights in the state, and it will likely not be the last. High-profile Republicans, including Mark Robinson, the party’s leading candidate for governor, have called for full bans, and far-right conservatives are plotting ways to restrict access to abortion should they take over control of the federal government in 2025.

A month before Roe was repealed in 2022 – but when it was clear it would be and what that would mean – women of all ages poured into cities across the country to tell justices, lawmakers and anyone else who needed to hear it, that No, there was no going back to the way things were.

For many women marching over those weeks, history had crashed violently into the present. 

“We’ve been doing this for 50 years,” a marcher who asked to remain anonymous told Cardinal and Pine at a rally in Raleigh in May of 2022.

Her jaw was clenched. She pointed to the abortion-rights buttons all over her shirt.

“I’m angry that these had to come out of a box again,” she said.

She was angry, she said, because she remembered all too well what things were like before Roe

“I had a friend in high school bleed out from an illegal abortion,” she said. 

The girl was 16.

“I never thought I’d have to do this again,” the woman said.

On the 51st anniversary of Roe v. Wade, here is an abridged history of reproductive rights in North Carolina. But first, some important context:

Abortion bans are dangerous

Abortions are far less dangerous than pregnancy itself. 

A study of North Carolina abortions in 1971, a couple of years before Roe, showed that about 3.5% of the women who got an abortion experienced complications. Most of those cases, the study said, were tied to preexisting conditions. 

In 2023, an estimated 2% of women who had an abortion experienced a complication, whether minor or severe.  

But that is far less than the risks associated with pregnancy itself.

Some 8% of all pregnancies result in severe complications that could threaten the health and life of the mother and child. And a 2021 study by the University of Colorado at Boulder showed that abortion bans increase the risk of maternal death by 21%. For Black women, the risk jumps by 33%.

This is a major part of the backdrop to the debate that has been raging nationally and in North Carolina since the late 1800s. It’s part of why abortion restrictions have no medical basis, why doctors nearly unanimously oppose them, and why voters by large margins reject significant restrictions to abortion access.

And now, a timeline of abortion rights in North Carolina.

Before Roe

1776-1880

  • There are no specific laws against abortion in North Carolina during this time period, but there is a well-established “common law” dating all the way back to England that prohibited abortion in most cases. There are, however, exceptions for rape, incest, and the mental and physical well-being of the mother. 
  • Several court cases in North Carolina in the 1800s help form the foundation of a key argument from anti-abortion advocates: that a person’s rights start at conception. But the cases cited most often by the anti-abortion movement have nothing to do with abortion. The cases and rulings are narrowly and clearly tied only to property, inheritance, wills, and similar matters. 

1881

  • The North Carolina legislature bans abortions once the mother can feel the baby “kicking.”

1965

  • In a bit of a precursor to Roe, the US Supreme Court rules in Griswold v. Connecticut that states cannot prohibit married couples from using contraception. There are rights to privacy in a marriage, the Justices write.

1967

  • The North Carolina legislature passes a law clarifying that abortions are legal only in cases of rape, incest, fetal abnormalities, and if either the physical or mental health of the mother were at risk. (The 12-week abortion ban passed in 2023, by the way, omits threats to the mental health of the mother as an approved exception.) The 1967 law also says that abortions could be performed only in hospitals and by licensed doctors, not by midwives. Three doctors also have to agree an abortion was necessary, but it’s up to them whether to report the abortion to state health officials.

1971

  • The legislature lowers the number of doctors needing to sign off on an abortion to two. They are now, however, required to report all abortions to state officials. 

1972

  • The US Supreme Court extends its right to contraception from married couples to all women.

1973

  • The Supreme Court rules in Roe v. Wade that a woman can decide for herself whether to have an abortion until the fetus can live outside the womb. A doctor has to make that determination, and any restrictions on abortion after that point in pregnancy, the court rules, have to account for the health of the mother. 
  • In response to Roe, NC lawmakers pass a bill banning abortion after 20 weeks. It also allows doctors and nurses to refuse to perform an abortion.

1977

  • The General Assembly passes a law that bars minors in most cases from getting an abortion. 
  • Congress attaches the Hyde Amendment to a spending bill, baring the federal government from paying for abortion care. It’s a huge move that prevents Medicaid recipients, federal employees, members of the military, and even residents of Washington D.C. from having abortion care covered by their insurance. The amendment includes no exceptions for life of the mother, rape or incest. That doesn’t come until nearly 20 years later.

1978

  • Gov. Jim Hunt of North Carolina, a Democrat, creates a state abortion fund for low-income residents, eventually budgeting more than $1 million a year to help people access abortion care for any reason in the first 20 weeks of pregnancy. 

1992

1995

  • The General Assembly limits access to the state abortion fund only to abortions in the case of rape, incest, and medical threat to the mother. Plaintiffs file a lawsuit against lawmakers, but the North Carolina Supreme Court eventually upholds the law.
  • Lawmakers change state law to allow minors to get an abortion, but only with a parent’s permission. If that’s impossible, minors have to go before a judge and they will decide if the minor can have the abortion or not.

2011

  • This is a big year. The Tea Party wave in 2010 helps tip control of the General Assembly to Republicans, and while Democrats controlled the legislature when it passed restrictions before 2011, from here on out, all other restrictions—including some severe ones—are the darlings of far-right Republicans.
  • Republicans pass a sprawling bill they called “The Women’s Right to Know Act.” It requires anyone wanting an abortion to get an in-person consultation with a doctor, who then has to read from a script several medically unnecessary facts about pregnancy and give misleading information about the (minimal) risks of getting an abortion. Gov. Bev Perdue, a Democrat, vetoes the bill, but Republicans override it. The law also makes the patient wait 24 hours after the consultation before they can have the procedure. (This provision did not apply to emergencies.)
  • The law also requires the patient to undergo an invasive vaginal ultrasound four hours before the procedure. Doctors are also required to show the patient the ultrasound images, describe the dimensions of the fetus, and offer a chance to listen to the heartbeat. The ACLU files an immediate lawsuit challenging the law and a federal judge blocks this provision before it goes into effect. The court, and later an appeals court, rules it unconstitutional, finding that it violates Casey’s “undue burdens” statute. 
  • The legislature also ends the state abortion fund this year. 

2013

  • Despite substantial opposition and protests, Republicans behind closed doors pass abortion restrictions by adding them to a bill about motorcycle helmets without notifying the public. The “motorcycle vagina” bill, as it became known, adds stringent new regulations of abortion clinics, including standards intended for larger surgical centers. The bill also prohibits city and county health plans, or any insurance plans purchased through the Affordable Care Act, from covering abortions in the state. Lawmakers also expand the state refusal laws to cover any healthcare provider who doesn’t want to take part in an abortion.

2014

  • A federal court blocks the 2011 provision requiring doctors to read the medically misleading script to patients seeking an abortion.

2015

  • Lawmakers pass several more laws with new restrictions, banning any abortion provider from getting any state money for any reason; extending the period that a patient had to wait between the consultation and the procedure from 24 to 72 hours. The new laws require doctors to report in-depth details to the state health department of any abortion performed after 16 weeks of pregnancy. Lawmakers also limit the exceptions after the 20-week ban to include only serious physical threats to the life of the mother. 

2019

  • A federal judge rules that the entire 20-week abortion ban, the one enacted all the way back in 1973, is unconstitutional because it set a specific time frame rather than, as Roe required, deferring to individual doctors on a judgment of viability. Abortions become legal until between the 24th and 28th week.

2022

  • The judge who ruled NC’s 20-week ban unconstitutional reinstates it since Roe is now moot.

2023

  • Dr. Beverly Gray, one of the doctors who filed the successful suit against the 20-week ban, sues to block key provisions of the bill. In October, a federal judge temporarily blocks them, ruling that they are likely unconstitutional. The provisions, the judge agrees, are vague and medically unnecessary. 

2024

  • The same judge hears arguments in a separate case accusing the state of overstepping its authority by imposing regulations to the drug mifepristone that surpass those set by the US Food and Drug Administration.

What’s next?

All of these entries, even before the Supreme Court took away Roe’s protections, share a common theme: Far-right Republicans will never stop trying to take away abortion rights. 

The state’s 12-week abortion ban might be one of the least severe bans in the South, but Republicans leadership made it clear after it passed that they would try to go further if they won more seats in the 2024 election. The first abortion bill they introduced in 2023 was a ban at conception. It didn’t get a vote because even some Republicans thought a complete ban was going too far.

But if Robinson wins the governor’s race in 2024, he has said he would push the legislature to follow through on a complete ban.

“Let’s say I was the governor and I had a willing legislature,” Robinson said in a radio interview last year. “We could pass a bill that says you can’t have an abortion in North Carolina for any reason.”

And if Republicans flip enough legislative seats in the 2024 election, they won’t need to worry about the members of their party who resisted the more severe ban.

In addition to the governor’s race, Rep. Dan Bishop, another Republican who has called for a full ban, is running for state attorney general, an important position with oversight of abortion regulations and laws. 

The threat does not die on North Carolina’s borders, either.

Donald Trump and anti-abortion Republicans could pursue a full ban if they regain control of Congress and the White House. Far-right conservatives have crafted an expansive blueprint that lays out in detail how they intend to leverage virtually every arm, tool, and agency of the federal government to attack abortion access—including by banning and criminalizing access to abortion medication.

Project 2025, as the plan has been called, also calls for cutting off funding to hospitals that perform abortions, even to save the life of the mother. 

Anti-abortion measures, however, are widely unpopular nationwide, and the issue was a huge factor in the 2023 elections as voters in Virginia, Ohio, and Kentucky protected abortion rights and beat back Republican efforts to gain full control over state governments. 

It will be North Carolina’s turn in 2024.

Author

  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.

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