Tennessee: the laboratory for anti-abortion and anti-trans laws

In Tennessee, two of the most significant legislative offensives in contemporary United States converge: the one against the right to abortion and the one against the rights of transgender people. This is not a geographic coincidence. The state produced the case that the Supreme Court used to uphold bans on gender-affirming care for minors (United States v. Skrmetti, June 2025) [1], and a few months later, hosted the proposal to classify abortion as homicide with a possible death penalty (House Bill 570, February 2026) [2]. Behind both fronts operate the same political actors, the same organizations, and the same legal logic. Here is the complete map.

Senate Bill 1: the ban on trans healthcare

On March 2, 2023, Governor Bill Lee signed Senate Bill 1 (SB 1), the law that bans gender-affirming care for minors in Tennessee [1]. The bill had passed the state Senate with 26 votes in favor and 6 against, and the House with 77 votes in favor and 16 against.

What it bans

SB 1 prohibits healthcare professionals from prescribing, administering, or dispensing puberty blockers and hormone therapy to any minor for the purpose of enabling them to identify with an identity inconsistent with their biological sex [1]. The ban extends to telemedicine. Minors already in treatment before July 1, 2023 were required to completely discontinue care by March 31, 2024.

The penalties

Minors cannot be prosecuted. Healthcare professionals who violate the law face penalties of up to $25,000 and disciplinary measures, including license revocation. Parents can be sued civilly.

The Skrmetti case

SB 1 became the most important court case in recent years regarding trans rights. The Biden administration challenged the law, arguing that it violated the Equal Protection Clause of the 14th Amendment. The case went through the Sixth Circuit Court of Appeals, which in September 2023, by a vote of 2 to 1, overturned the district court’s injunction and upheld the ban’s constitutionality. Chief Judge Jeffrey Sutton wrote the majority opinion, applying “rational basis review” — the lowest standard of scrutiny.

On June 18, 2025, the Supreme Court decided United States v. Skrmetti by a vote of 6 to 3 [1][13]. Chief Justice Roberts wrote the majority opinion, establishing that Tennessee’s ban does not classify on the basis of sex or transgender status, and that the two classifications used by the law — age and medical use — do not require heightened scrutiny. Justices Sotomayor, Kagan, and Jackson signed the dissent.

The ruling had immediate consequences on a national scale. Before Skrmetti, bans in several states were blocked by court injunctions. After the decision, bans on gender-affirming care in 25 of the 27 states that had enacted them became fully enforceable [13]. Tennessee had produced the legislative model and the court case that legitimized it.

HB 570: abortion as homicide

In February 2026, Republican Representative Jody Barrett (Dickson district) introduced an amendment to House Bill 570, with the corresponding Senate Bill 738, proposing to extend the protections of the Tennessee criminal code to “unborn children” [2][3].

What it proposes

The amendment classifies abortion as “homicide of an unborn child” under the fetal homicide provisions already existing in the state criminal code. Under this classification, an abortion or attempted abortion could be treated by courts as homicide or assault [2][3]. The prescribed penalties would be those for first-degree murder: life imprisonment, life without parole, and in the most serious cases, the death penalty [2][3].

The text explicitly excludes miscarriage and situations in which life-saving procedures are adopted for the mother or the embryo. It does not provide other exceptions.

The scope

The proposal does not target only the woman who has an abortion. Anyone who assists a person in obtaining an abortion — including physicians — could be criminally prosecuted [3]. Representative Monty Fritts, co-sponsor and candidate for governor, stated: “Murder is murder” [2].

Current status

Senator Mark Pody (Lebanon district), sponsor of the Senate version, withdrew his support for the measure in February 2026, stating he could not proceed with the amendment that would penalize women [3]. As of March 2026, the proposal has not been formally scheduled for committee discussion.

The abortion trigger ban

The HB 570 proposal exists within a context where abortion is already completely banned in Tennessee. The total ban currently in effect was not born in 2026: it was prepared in 2019 and went into effect on August 25, 2022, sixty days after the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling, which eliminated the federal right to abortion [4][5].

The law’s structure

The ban applies at all stages of pregnancy, from fertilization. It does not provide exceptions for rape, incest, or lethal fetal anomalies [5]. The only exception concerns cases in which abortion is necessary to “prevent the death of the pregnant person or the serious risk of substantial and irreversible impairment of a major bodily function” [4][5].

The most contested feature of the law is its structure as an “affirmative defense.” This structure means that the medical exception does not function as a preventive exemption: the physician who performs an abortion is first charged, and only subsequently can invoke medical necessity as a defense in court [5]. The burden of proof falls entirely on the physician, who must demonstrate by a “preponderance of the evidence” that the abortion was necessary. In other words, the physician must first face arrest, indictment, and trial before being able to assert their defense.

The violation is classified as a Class C felony, punishable by up to 15 years in prison [5].

The impact: the data

In 2023, more than 10,500 women residing in Tennessee traveled to other states to obtain an abortion, according to data collected by the Guttmacher Institute. The majority reached Illinois; others traveled as far as Virginia, North Carolina, and California [4].

In 2024, the number of Tennessee residents who traveled out of state for an abortion was 10,020. Added to this figure are approximately 5,840 patients who terminated pregnancies through medications obtained via telemedicine appointments with healthcare providers in states with “shield laws” that protect physicians from legal proceedings originating in other states.

The case Blackmon v. State of Tennessee, filed by the Center for Reproductive Rights in September 2023, tested the adequacy of the medical exceptions [4]. Five plaintiffs — including two women who were denied necessary medical care and two physicians unable to provide the indicated treatment — challenged the law’s vagueness. Nicole Blackmon, the lead plaintiff, was denied an abortion at fifteen weeks of pregnancy despite a diagnosis indicating the fetus would not survive and that her pre-existing health conditions increased her risk of stroke. She had a miscarriage at thirty-one weeks.

In October 2024, the court temporarily blocked Tennessee’s ban for patients with emergency medical conditions, ruling that the law’s exceptions are “vague and confusing” [4]. In October 2025, the court confirmed the case could proceed even after legislative amendments, calling the new definition of exceptions “circular.”

Tennessee’s other anti-trans laws

Senate Bill 1 is not an isolated case. Tennessee has produced a series of restrictive laws targeting transgender people that, taken together, compose one of the most restrictive legislative frameworks in the country.

The drag show ban (2023)

On March 2, 2023 — the same day he signed SB 1 — Governor Lee signed the Tennessee Adult Entertainment Act, the first law in the United States to place restrictions on drag shows [6]. The law banned “adult cabaret” performances on public property or in any place where they could be seen by minors. The first violation was classified as a misdemeanor; subsequent violations as a felony, punishable by up to six years in prison.

On June 3, 2023, federal Judge Thomas Parker — appointed by Donald Trump — declared the law unconstitutional in a 70-page ruling, establishing that the text was “unconstitutionally vague and substantially overbroad” and that it encouraged “discriminatory enforcement” in violation of the First Amendment [6].

The story did not end there. The Sixth Circuit Court of Appeals subsequently overturned the district court ruling, reinstating the ban [7].

The school reporting mandate (2024)

In May 2024, Governor Lee signed a law requiring all school employees — including teachers — to report to school administration if a student asks to be called by a name or pronouns different from those corresponding to the sex listed on their birth certificate [8]. The administration must then inform the parents. The law provides for the possibility of civil action against non-compliant schools.

This measure adds to a 2023 law (Public Chapter 448) that protects teachers from legal action and disciplinary measures if they use pronouns that do not correspond to the student’s gender identity.

Other measures

The framework includes additional provisions: a ban on transgender students using school bathrooms corresponding to their gender identity; a ban on trans athletes participating in women’s sports (with four successive laws); the ability for foster and adoptive parents to refuse to affirm a minor’s sexual orientation or gender identity (SB 1738, signed in April 2024); and, in 2025, a proposal to classify as a felony assisting a minor in obtaining gender-affirming care.

In 2025, the Trans Legislation Tracker counted 30 anti-trans bill proposals in Tennessee. The Human Rights Campaign classified the state as one of the worst in the country for LGBTQ+ rights.

The political actors

The composition of the legislature

After the 2024 elections, the Tennessee Senate has 27 Republicans and 6 Democrats. The House has 75 Republicans and 24 Democrats [14]. This is a veto-proof supermajority in both chambers: Republicans can pass any law without the support of a single Democrat and can override any governor’s veto. Tennessee is one of 19 states where Republicans hold a veto-proof supermajority in both branches of the legislature [14].

Governor Bill Lee, a Republican, has signed every anti-trans and anti-abortion law passed by the legislature during his term. In March 2023, he signed on the same day both the gender-affirming care ban (SB 1) and the drag show ban.

The national organizations

Tennessee’s laws are not solely the product of local politics. The Alliance Defending Freedom (ADF), classified by the Southern Poverty Law Center as an anti-LGBTQ organization, played a documented role in drafting the state’s legislation [9][10].

ADF contributed to drafting the Mississippi 15-week gestational law that became the Dobbs v. Jackson case before the Supreme Court — the 2022 ruling that eliminated the federal right to abortion [15]. The same organization provided legal support and legislative templates for gender-affirming care bans, including Tennessee’s [9][10].

The Heritage Foundation, through its Project 2025, and the Family Policy Alliance collaborated with ADF on the “Promise to America’s Children” initiative, which opposes the Equality Act and provides state legislators with model legislation on topics ranging from abortion to restrictions on trans people [9][10].

According to a Human Rights Campaign analysis, ADF drafted at least 130 legislative proposals in 34 states in 2022 alone, of which more than 30 were enacted [10]. The Tennessee Lookout documented how the Heritage Foundation, Family Policy Alliance, and ADF are “among the most active national organizations supporting anti-LGBTQ legislative proposals in Tennessee” [9].

The strategy: why Tennessee

The choice of Tennessee as the epicenter of these legislative battles is not random. Several structural factors make the state the ideal testing ground for laws destined to become national models.

The supermajority

With 75 seats out of 99 in the House and 27 out of 33 in the Senate, Tennessee Republicans do not need to negotiate with the opposition [14]. They do not even need to worry about a governor’s veto: the numerical margin allows them to override it. This eliminates every procedural obstacle to passing new laws, transforming the state legislature into a legislative assembly line.

The Sixth Circuit

Tennessee falls under the jurisdiction of the Sixth Circuit Court of Appeals, which also covers Kentucky, Michigan, Ohio, and part of Virginia. This circuit has proven the most favorable to conservative causes regarding trans rights. It was the Sixth Circuit that overturned the injunction against SB 1, applying rational basis review and creating the circuit split that led the Supreme Court to grant certiorari in the Skrmetti case [1]. It was the same circuit that reinstated the drag show ban after the district court declared it unconstitutional [7]. It is the same court that upheld Tennessee’s ban on sex changes on birth certificates (Gore v. Lee).

The strategy is clear: pass a law in Tennessee, have it upheld by the Sixth Circuit, then present it to the Supreme Court as a “test case” with a favorable precedent already established on appeal.

The legislative laboratory

The concept of the state as a “legislative laboratory” — the idea that states can experiment with policies that are then adopted at the national level — has a long history in American jurisprudence. In Tennessee’s case, the mechanism works precisely: the state passes a law, national organizations monitor its judicial trajectory, and if the precedent is favorable, they replicate the model in other states [10]. Tennessee’s SB 1 became the model for gender-affirming care bans in at least a dozen other states.

Bodily autonomy: the common thread

Analysis of Tennessee’s laws reveals a common legal logic that crosses both abortion restrictions and gender-affirming care restrictions: the state claims the power to decide what an individual can do with their own body in the medical sphere.

The Dobbs-Skrmetti chain

The connection between the two agendas is not merely political. It is legal. The 2022 Dobbs ruling eliminated the federal right to abortion by revitalizing the 1974 Geduldig v. Aiello precedent, which had established that pregnancy-related restrictions do not constitute sex discrimination [11][12]. In the 2025 Skrmetti ruling, the majority of the Court applied the same logic: the ban on gender-affirming care does not discriminate on the basis of sex because it applies to all minors regardless of the sex assigned at birth [1][11].

The Center for Reproductive Rights observed that “both abortion and gender-affirming care are rooted in the promise of the 14th Amendment that personal decisions regarding our bodies should be made without government intrusion” [12]. With Dobbs and Skrmetti, the Supreme Court has narrowed the legal space for this promise on both fronts.

The same playbook

The analysis by Ms. Magazine documented how “the same conservative playbook that overturned Roe is now being used for trans healthcare” [15]. The strategies are parallel: initial restrictions targeting minors (parental consent laws for abortion, bans on trans care for minors); construction of a court case through favorable circuits; arrival at the Supreme Court with an already consolidated precedent; subsequent extension of restrictions.

In the case of abortion, the path went from gradual restrictions (mandatory waiting periods, clinic closures, gestational limits) to a total ban after Dobbs. In the case of trans care, the path is following the same trajectory: from the ban on minors, discussions now include extensions up to age 26 in states like Oklahoma and Texas.

Success that breeds more success

The mechanism is cumulative. Legislative and judicial success on one front legitimizes and accelerates the other. After Dobbs, the number of anti-trans bill proposals increased from 174 in 2022 to 604 in 2023. After Skrmetti, Tennessee produced the proposal to classify abortion as homicide with the death penalty [2]. This is not casual correlation: the same organizations manage both campaigns, and every court victory expands the political space for the next measure.

Tennessee is the point where these two threads intertwine most tightly. SB 1 became the Skrmetti case. The abortion trigger ban generated the HB 570 proposal. The same organizations — ADF, Heritage Foundation, Family Policy Alliance — operate on both fronts [9][10]. The same legislature, with the same supermajority, passes both categories of laws.

The data are these: a total abortion ban without exceptions for rape or incest; a ban on gender-affirming care upheld by the Supreme Court; a proposal for the death penalty for those who have abortions; more than 30 anti-trans bill proposals in 2025 alone; a supermajority that does not need to negotiate with anyone. Tennessee is not simply a conservative state. It is the place where the next frontier of restrictions on bodily autonomy in the United States is being tested.