The Court took a middle path: it declined to overrule Roe entirely, but it restructured abortion doctrine.

First, the Court reaffirmed abortion as a protected liberty interest under substantive due process and emphasized reliance interests—women’s ability to participate equally in society had developed around the availability of reproductive choice.

Second, the Court criticized the trimester framework as too rigid and as improperly limiting the state’s ability to express respect for potential life throughout pregnancy. The Court concluded that the state may encourage childbirth over abortion and may regulate abortion before viability, so long as it does not impose an undue burden.

Applying the undue burden test, the Court evaluated each provision:

• Informed consent + 24-hour waiting period: upheld. The Court treated these as permissible regulation intended to ensure deliberation and informed decision-making.

• Parental consent with judicial bypass: upheld. The Court accepted this as consistent with prior doctrine allowing special rules for minors.

• Spousal notification: struck down. The Court concluded this created a substantial obstacle for many women, particularly those facing domestic abuse or coercion, and thus imposed an undue burden.

• Reporting and recordkeeping requirements: largely upheld as legitimate regulatory measures not imposing a substantial obstacle.

In future cases, Casey became the controlling abortion framework for decades, shifting the constitutional inquiry away from Roe’s trimester categories and toward the undue burden test. It also strengthened the focus on viability as the key boundary for prohibitions.