Abortion Refusal

This safeguard indicates the religious liberty protections available for health-care providers (individuals and institutions) with respect to abortion procedures. States exhibit variation in who has the right to refuse, from what negative consequences the entity is safeguarded, and whether there are limitations to those safeguards. This safeguard also includes an item measuring whether states protect employees of a facility in which an abortion may be performed from being required to handle or dispose of aborted remains if that individual objects to such procedures for religious reasons.

Since Roe v. Wade (1973) was overturned by Dobbs v. Jackson Women’s Health Organization (2022), previously existing abortion bans went into effect or states have passed new laws banning abortion. As of January 1, 2026, thirteen states effectively ban all abortions (with a few exceptions, such as to save the life of a mother). Thus, if abortion is completely illegal in a state, protections ensuring that individuals and institutions can’t be forced to perform them aren’t necessary (with the exception of performing an abortion to save the life of the mother). A state may have adopted an abortion ban for reasons unrelated to religion, but if a state's law has the unintended consequence of protecting religious liberty, the state receives credit for doing so. For more details, see the report and the errata and revisions page.

*A special note on public hospitals: Court cases in three states—Alaska, Minnesota, and New Jersey—have effectively eliminated state protections in abortion for public hospitals in these states. That is, these judicial rulings supersede the abortion refusal statutes cited here where they apply to public hospitals.