Sanctuaries, islands, and deserts: A typology of regionalized abortion policy

This paper elaborates a typology of regionalized abortion policy based on a comparative case study of Italy and the United States. Italy originally legalized abortion in 1978 and has seen little effort to modify the law since. Contrastingly, the United States' abortion landscape has been in near constant flux since 1974, when, in Roe v. Wade, the Supreme Court recognized a constitutional right to abortion. This became even more unstable in 2022 when the Supreme Court overruled Roe in Dobbs v. Jackson Women's Health and held there is no constitutional right to abortion. Despite their differences in national abortion policy, both Italy and the US have regionalized the implementation of their abortion policies. Italy's law is national, but implementation is interpreted differently at the regional level. Since Dobbs, US states have proposed and passed many laws about abortion, creating even greater regional variation than before. We propose a typology of regionalized abortion access: "Sanctuaries" where abortion is most protected and available; "Islands" with liberal policies that are surrounded by more restrictive territories; and "Deserts" with minimal abortion access. Through qualitative analysis of policies, political activities, and firsthand accounts by abortion providers and advocates working in places of each type, we then highlight the long-term implications of each of these components of the typology, analyzing the ways that they impact abortion providers and patients.