Tag Archives: dobbs

Republicans can’t sugarcoat their losses on abortion rights anymore

Originally published in Vox on November 8, 2023.

Even before Tuesday’s elections, many progressives insisted the question of whether protecting abortion rights wins elections was already asked and answered. Democrats made abortion rights the centerpiece of their campaign advertising during the 2022 midterms, a cycle where Democrats outperformed expectations, kept control of the US Senate, and staved off a red wave. Polls last year also found abortion rights to be a significantly motivating issue for both independent and Democratic voters.

Abortion rights ballot measures won in all six states where they appeared in 2022, including states like Montana, Kentucky, and Kansas that otherwise elected Republican candidates. Democrats have been winning in special elections where they ran on abortion rights, and surveys suggested voters have grown even more supportive of abortion rights since the repeal of Roe v. Wade in June 2022.

Anti-abortion groups argued in turn that liberals were mistaking correlation for causation; they maintained that confidence in abortion rights messaging was misplaced, and voters would ultimately punish Democrats for their maximalist positions. They pointed out that Democrats tried and failed to unseat anti-abortion governors in the midterms, and applauded winning federal candidates who “went on offense” on abortion, like Sen. Marco Rubio and Ohio Sen. J.D. Vance. The lost referendums, anti-abortion groups insisted, stemmed largely from Republican leaders failing to campaign hard enough and from being outspent, something they promised to never let happen again.

The polling on abortion rights, meanwhile, could be complicated and seem contradictory: Voters sometimes express support for second- and third-trimester bans while signaling strong opposition to restricting access to abortion.

The 2023 election cycle represented a big test: Were abortion rights activists right? Or were anti-abortion leaders correct that the earlier post-Roe losses stemmed from insufficient investment and mealy-mouthed campaigning?

A decisive 13-point victory for protecting abortion rights in red Ohio, wins for Democrats in the Virginia legislature where GOP candidates campaigned on rolling back abortion access to 15 weeks, and the decisive reelection of Kentucky Democratic Gov. Andy Beshear, who made protecting abortion rights in his red state central to his campaign, provide the clearest evidence to date that voters of all political persuasions do not support the nationwide attack on reproductive freedom and are voting accordingly.

Anti-abortion leaders tested a host of new tactics this cycle — from rebranding abortion bans as “limits” to claiming the Ohio abortion rights ballot measure was really about curtailing parents’ rights. None of them worked. Republican strategists had been banking on November 7 providing them with proof that voters were sick of Democrats talking about abortion. Virginia was supposed to be a proof of concept that would let Republicans run on a “consensus” position on 15-week bans next year while changing the subject to other topics like crime and immigration.

So Tuesday’s results really were a resounding victory for Democrats and abortion rights supporters — but there are still some caveats and reasons for caution in 2024.

How abortion rights won in Ohio

Anti-abortion leaders recognized how important a win in Ohio would be to changing the narrative ahead of 2024. “A win here would show those other states that will have these ballot measures in the years to come, ‘Hey, these battles can be won,’” Peter Range, the executive director of Ohio Right to Life, told the 19th News in October. The anti-abortion movement threw everything they had at the campaign and still fell far short.

Instead, last night 57 percent of Ohio voters cast their ballot in favor of the constitutional amendment to codify abortion access, despite a significant array of obstacles in a solidly Republican state where Republican elected officials had come out uniformly against the measure.

“Generally speaking, ballot measures in Ohio don’t tend to win,” said Jonathan Robinson, the director of research at Catalist, a liberal voter data analytics firm.

Passing affirmative ballot measures is even harder. In the other conservative states where ballot measures won, abortion rights campaigners organized voters against anti-abortion proposals. Political scientists find it can be easier to be on the “no” side of ballot measure campaigns, since voters have a bias toward maintaining the status quo.

“The reality is Ohio is among the tougher states that we have worked in,” said Joey Teitelbaum, a pollster involved with the Ohio abortion rights campaign, who also worked on winning ballot measures in Colorado, Kansas, and Kentucky. “We stayed focused on a broad values-based message that went beyond partisan politics.”

Though polls indicated Ohio voters were broadly supportive of the proposed amendment, abortion rights advocates were dealing with new hurdles, including an expensive August special election that sought to raise the ballot measure threshold to 60 percent, voter roll purges led by the anti-abortion secretary of state, a misleading intervention from the state’s Republican attorney, and vocal campaigning from the state’s Republican Gov. Mike DeWine, who urged Ohioans to vote no in a TV ad.

The Ohio Ballot Board also drafted its own summary language of the proposed ballot measure, using more politically objectionable terms like “unborn child” instead of “fetus” and refusing to state that the amendment would protect not just access to abortion but also to contraception, miscarriage care, fertility treatment, and continuing pregnancy. Researchers know that the specific language that appears on a ballot can have a significant impact on how voters vote, and a poll released in late October found support for the amendment dropped considerably when voters were presented with the edited language.

“I have never encountered such complete opposition by the state government,” said Ashley All, who served as communications director for the winning pro-abortion rights ballot measure campaign in Kansas and has since consulted on other post-Roe ballot referendums.

Anti-abortion advocates raised millions more dollars than they had in previous ballot measure campaigns, and worked to cast the Ohio amendment as an “anti-parent” measure that would effectively create a new right to gender-affirming surgery for minors. Legal scholars said the fear-mongering about parental consent was unjustified, given Ohio case law and the Republican-controlled state Supreme Court.​

That abortion rights won so decisively against all these odds — and that so many Trump voters proved willing to cross party lines to vote in favor of the amendment — is a sobering result that anti-abortion leaders will struggle to dismiss. For now, the Susan B. Anthony Pro-Life America group is saying it lost because voters incorrectly believed pregnant patients could be denied life-saving medical care. But even in states with exceptions to abortion bans, doctors have been denying or delaying care, fearing funding cuts or criminal prosecution.

How abortion rights won in Virginia

Though Virginians were not casting votes on a ballot measure, it was no secret that the Virginia legislative elections were largely being fought over abortion.

“It almost feels like we’re running a single-issue campaign on this one,” J. Miles Coleman, of the UVA Center for Politics, said last week. Among women voters, who make up more than half of Virginia’s election, 70 percent rated abortion as a “very important” issue, up 47 percent from 2019.

All 140 seats in the Virginia General Assembly were up for grabs, and Democrats not only retained control of the state Senate but flipped control of the Virginia House.

Youngkin and anti-abortion groups bet that if they could win in Virginia by running emphatically on a 15-week abortion ban, something they cast as a “reasonable” and “consensus” position, then they could prove to Republicans nationwide that abortion need not be a political loser for their party. (The ban, which they called a “limit,” also would have exceptions for rape, incest, and the life of the mother.) They also hoped that staking out this position would allow them to more easily change the subject to topics they had advantages on, like crime and the economy.

Prior to the fall of Roe, national polls showed broad support for restricting abortion after 15 weeks, but since the Dobbs decision, voters have been signaling more opposition to the idea. A poll released in mid-October from Christopher Newport University found 54 percent of Virginians opposed the idea of a 15-week ban, and another October survey from the Washington Post-Schar School found 47 percent opposed and 46 percent approved.

Another way to understand the question in Virginia is whether voters would support lawmakers cutting short the window of legal abortion by 12 weeks, since abortion is currently permitted up to 26 weeks and 6 days of a pregnancy in the state.

Voters, though, had good reason to be suspicious Virginia Republicans really would stop at 15 weeks. In Florida, Republicans passed a 15-week ban on abortion in 2022, only to turn around and pass a six-week ban in 2023. Other GOP-led states like South Carolina, Georgia, and Ohio have passed six-week bans.

Multiple videos also emerged of Virginia Republicans admitting they’d likely push for more than they’ve publicly let on. In 2021, an activist secretly recorded Youngkin saying he’d go “on offense” if elected but needed to speak minimally about the topic during campaign season. Two months ago videos surfaced of a House of Delegates candidate saying he’d support a “100 percent” and “total” ban on abortion, and more recently a video of a candidate in a Virginia Senate race showed her saying she’d be interested in pushing beyond a 15-week ban.

A Washington Post-Schar School poll from October found that 51 percent of registered Virginia voters trusted Democrats to handle abortion, compared to 34 percent who trust Republicans.

There are real grounds for abortion rights optimism in 2024

The news out of Ohio is auspicious for those organizing abortion rights ballot measures next year in Arizona, Nevada, Florida, South Dakota, Nebraska, and Colorado. Abortion rights have had a 7-0 winning streak on the ballot since Roe v. Wade was overturned, and Republicans’ fear-mongering rhetoric about parents’ rights and abortion “up until birth” seemed to have failed. While Americans tend to be more uncomfortable with abortions later in pregnancy, voters seem to understand they are extremely rare, and typically associated with fetal anomalies, threats to a mother’s life, and barriers to care that delay access to the procedure.

Evidence continues to mount that voters are willing to cross party lines when it comes to protecting access to reproductive health care. If abortion rights campaigners can continue to frame the issue in a nonpartisan way, their odds of success in the next round of ballot measures look good. Democratic Gov. Andy Beshear’s strong reelection in Kentucky is also an encouraging signal that Democrats can campaign openly on abortion rights in red states and still win.

It’s hard to overstate how much the loss in Virginia complicates’ Republicans’ 2024 campaign plans. Virginia was supposed to show that Republicans could cast Democrats as extremists, proactively pursue reductions in abortion access, and still win, even among Biden-leaning voters. The GOP wanted to show Republicans could “neutralize” the abortion issue, so that swing voters would feel more comfortable voting on other topics they trusted Republicans on. Youngkin insisted voters are “ready to move on and talk about topics besides abortion.”

The fact that Republicans failed so spectacularly doesn’t mean Republicans won’t try this strategy again next year, but it does represent a rather clarifying result — and one that should make GOP strategists pretty nervous, especially given that most voters think Republicans want to ban abortion in all or most cases.

How things could still go poorly for abortion rights in 2024

While things have gone well for abortion rights campaigners thus far, most will admit they were certainly not sure things would play out as they did. And, as anti-abortion leaders are quick to point out, Democrats tried and failed to unseat anti-abortion governors like Brian Kemp in Georgia, Kim Reynolds in Iowa, Mike DeWine in Ohio, and Ron DeSantis in Florida last year, showing that it’s not dispositive that politicians will pay a price for restricting access to abortion.

“In the midterms, yes, abortion mattered in certain places, and democracy issues mattered on certain races. But not all of them,” Ashley All told Vox. “Florida voted exactly as Florida does. Political observers and pundits want to make blanket statements about how things will impact an election, but everyone who works on campaigns knows it doesn’t work like that.”

Another concern is that Youngkin’s prediction was just premature and that voters will in fact grow more tired of hearing about attacks on abortion rights the further out from Dobbs the country gets. Republicans bet wrongly on that happening in 2022 and 2023, but experts admit it’s hard to know what will be animating voters a year from now, especially given how exhausted the electorate seems to be these days.

“Generally people seem a little burnt out,” said Robinson, of Catalist. “The level of political donations for Democrats and Republicans is down a lot, which suggests a sag in interest in politics. Interest in the Republican presidential primary is really low.” Though turnout on November 7 was high, the abortion rights measure in Ohio received nearly as many votes as Republican Sen. J.D. Vance did in 2022.

Reproductive rights campaigners also say the public should not underestimate how tough a fight they faced this year in Ohio compared to the previous six ballot measure campaigns in 2022. Anti-abortion politicians are likely to continue their efforts to curb access to the ballot, and invest heavily in TV and digital advertising aimed at confusing voters. This year abortion rights activists benefited from Ohio being the only ballot measure campaign in the country, helping them to raise three times as much money as their opponents, with most money coming from out of state.

Next year, when there are more expensive ballot measures competing for both media attention and political donations, on top of a surely consuming presidential contest and a bevy of congressional and gubernatorial elections, advocates say the fundraising landscape for abortion rights referendums may be much more difficult.

The anti-abortion movement insists everything is really fine

Originally published at Vox on August 24, 2023.
—–

The anti-abortion movement is at a political crossroads.

Last year, abortion rights won in all six states with abortion ballot measures, including in red states like Kentucky and Montana that otherwise elected Republican candidates. Earlier this month, activists suffered yet another defeat when Ohio voters cast ballots decisively against a referendum that would have made it harder for constitutional amendments, including an upcoming vote this November on abortion rights, to pass in the future. Abortion was not on the ballot, but anti-abortion groups campaigned heavily in favor of the Ohio measure, and they lost.

Even the Republican presidential primary, which the anti-abortion movement had been planning to dominate, has been something of a mixed bag, and there are signs that the movement’s influence is wavering. During Wednesday night’s GOP debate, Fox News moderator Martha MacCallum argued that “abortion has been a losing issue for Republicans since the Dobbs decision.” A recent New York Times/Siena poll shows that more than a third of Republican primary voters think abortion should be legal all or most of the time, and in a CBS poll this week, most didn’t think it was very important for Republican candidates to talk during the debate about their plans to restrict abortion.

Some candidates, including former Vice President Mike Pence, are still eagerly courting support from the movement, but others appear less willing to take their campaign cues from those anti-abortion organizations.

Donald Trump, for example, has resisted calls from the leading activist group, Susan B. Anthony Pro-Life America, to endorse a national 15-week ban on abortion. He’s also refused to say if he supports the type of six-week abortion ban that Gov. Ron DeSantis signed in Florida. Trump would say, however, that “many people within the pro-life movement feel that that was too harsh.”

And when DeSantis was dismissive of federal abortion restrictions in late July, saying he believed the anti-abortion movement would see more success from states and local communities, SBA Pro-Life America criticized his stance as “unacceptable.” DeSantis’s campaign didn’t seem to care, countering that the governor “does not kowtow to D.C. interest groups.”

Does that mean the anti-abortion movement is planning to rethink its own aggressive post-Roe strategy of trying to limit abortion as much as possible in as many places as possible? For now, the answer is broadly no. Instead, leaders argue that any losses they’ve suffered over the last year have not been because their agenda is unpopular, but because it hasn’t been pursued boldly and strategically enough. If anything, they say, winning will require an even stronger commitment to restricting abortion.

GOP presidential candidates are divided on federal abortion bans

Leading groups opposing abortion rights are divided on what they want to hear from federal candidates.

SBA Pro-Life America has said it will not support anyone who does not express at least a commitment to restricting abortion at the federal level after 15 weeks. Meanwhile Students for Life made clear that they oppose such a 15-week litmus test, given that more than 90 percent of abortions occur within the first 13 weeks. Instead, they asked each candidate to lay out their proactive vision for a post-Roe America, and emphasized that their own blueprint includes granting legal protections to unborn children, defunding Planned Parenthood, banning the distribution of medication abortion by mail, and reimposing other restrictions on abortion pills that were relaxed under the Biden administration.

During the first GOP primary debate, however, most candidates declined to do any of these things, and appeared divided on whether the federal government should limit abortion at all. DeSantis dodged a question on whether he’d support a six-week ban, former South Carolina Gov. Nikki Haley stressed the fact that there’s little chance of getting something through Congress, and North Dakota Gov. Doug Burgum claimed a federal ban would violate the 10th Amendment of the US Constitution. Of the eight candidates on stage, only Pence and South Carolina Sen. Tim Scott backed a 15-week restriction.

Yet while some GOP political consultants quietly worry about electoral backlash to abortion bans that voters consider too extreme, anti-abortion groups have urged candidates to stay the course, and to champion the post-Roe successes the movement has achieved so far.

“A year after Dobbs, 25 states have put pro-life protections into law — half the country,” SBA Pro-Life America stated after the Ohio election. Rejecting the idea that abortion rights were helpful to Democrats in 2022, they touted the midterm wins of Florida Sen. Marco Rubio, North Carolina Sen. Ted Budd, and Ohio Sen. J.D. Vance. Catherine Glenn Foster, president of Americans United for Life, offered a similar rosy post-midterms reflection, noting that public officials who backed or enforced abortion restrictions were reelected in nearly 20 states. “Democrats didn’t crack state governor, state attorney general, or state house seats in red states that have enforced abortion limits since [Dobbs],” she argued.

The movement against abortion rights isn’t admitting defeat

While the attempt to make it harder to pass ballot measures — known as Issue 1 — lost by 14 percentage points in Ohio, anti-abortion groups say that does not mean they’ll face a similar fate when abortion is actually on the ballot in November. The proposed Ohio amendment would restore the right to an abortion up to the point of fetal viability, and permit abortions beyond that point if a patient’s doctor deems it necessary to protect their life or health.

In their post-mortem memo, SBA Pro-Life America said they lost for two reasons: they didn’t start their campaign against Issue 1 early enough, and some voters were motivated to vote no because of concerns about democracy and other policies, like the minimum wage or legalizing marijuana. The group claims it does not see support for abortion rights as a key reason for Issue 1’s failure.

Anti-abortion groups have also blasted Republican elected officials and business leaders for not campaigning hard enough. “The silence of the establishment and business community in Ohio left a vacuum that was too large to overcome,” SBA Pro-Life America argued. “So long as the Republicans and their supporters take the ostrich strategy and bury their heads in the sand, they will lose again and again.”

Terry Schilling, leader of the conservative American Principles Project, likewise slammed GOP donors for not spending heavily enough on the Ohio election, and he blamed Republican presidential candidates and national party leaders for downplaying its importance. Another national anti-abortion group, Students for Life, made similar arguments, noting that being outspent by opponents almost 5 to 1 “certainly helped create the confusion about what was at stake.”

While groups supporting abortion rights frame the Ohio results as a clear-cut victory for their cause, election analysts caution we don’t yet fully understand who voted for Issue 1 and why, and it is possible that voters who cast their ballot against the Issue 1 referendum in August will also vote against expanding abortion restrictions in November.

Students for Life has recently launched a “3-step plan” for defeating the abortion rights amendment, largely by mobilizing youth voters. The group is arguing that voters in states like Kansas are experiencing “buyer’s remorse” for approving a state constitutional amendment for abortion rights last year, and they claim they’ll dissuade Ohioans from making the same mistake. When asked for evidence of such remorse, spokesperson Kristi Hamrick told Vox it’s based on her group’s “lived experience [and] talking with people on the ground.”

Early polls on the November amendment bode well for abortion rights supporters; one from June found nearly 60 percent of Ohioans support the idea of an amendment for reproductive freedom. But political researchers say it’s generally harder for affirmative ballot measures to pass, given what’s known as a “status quo bias.” To pass the Ohio amendment, advocates may copy the playbook from Michigan, where abortion rights activists framed their winning 2022 ballot measure around the idea of restoring the rights of Roe v. Wade — bringing back the reality Americans had known for five decades. Opponents, meanwhile, will claim activists are trying to radically expand rights.

Anti-abortion leaders are already running with this strategy, claiming that Ohio’s proposed abortion rights amendment’s language is so broad that it would create a new right to gender-affirming surgery, and therefore invalidate the state’s requirement for parental consent.

In its post-mortem memo, SBA Pro-Life America argued that advocates in Ohio must stick with “a simple message,” framing the upcoming referendum as “an attempt by ACLU to eliminate parental rights and legalize abortion on demand in the Ohio constitution.” The amendment would only permit abortions past the point of fetal viability to protect a patient’s life or health, but SBA Pro-Life America is urging advocates to claim it will “legalize unrestricted access to abortion until the moment of birth, paid for by Ohio taxpayers.”

Anti-abortion groups note that the ACLU has long opposed parental consent laws, and an ACLU Ohio lawyer in February said existing laws that conflict with a constitutional amendment “should not be enforced.” Still, Ohio case law generally requires parental consent for youth medical care, and the amendment could only affect parental consent laws if someone were to successfully challenge the rules in court as unconstitutional. Given that Ohio’s state Supreme Court is controlled by Republicans, legal experts think a more sweeping interpretation of the abortion rights measure is unlikely. Andrew Everett, an ACLU spokesperson, told Vox in July they “have no plans to challenge parental consent laws in Ohio.”

Even the most unapologetic anti-abortion groups recognize they need to work on the movement’s image

While leading national groups insist there’s no real proof candidates should back away from abortion restrictions, activists are talking more about the need to speak more compassionately to the needs of mothers and children — driven partly by media coverage showing pregnant women and new mothers have suffered under new anti-abortion laws.

SBA Pro-Life America urged lawmakers to support legislation that requires child support payments to begin when a fetus is in the womb, and to expand the child tax credit and parental leave support. Students for Life similarly emphasized the need to better support pregnant moms and parents on campuses. Route Fifty reported that at least four states have approved new tax exemptions for pregnant people and anti-abortion centers, and nearly a dozen more are considering them.

A few dissenting voices in the anti-abortion movement have recently urged more compromise. Schilling, of the American Principles Project, said candidates should stick with 15-week bans that allow for exceptions for rape, incest, and protecting the life of the mother. “Abortion limits need to be reasonable and popular,” he told Politico. “15 weeks, build a genuine culture of life, revisit,” echoed Duncan Braid, a staffer at the conservative think tank American Compass.

But for now these are minority voices, and the anti-abortion movement is broadly urging lawmakers to get bolder, lest they meet the same electoral fate as failed Republican Senate candidates Mehmet Oz in Pennsylvania and Adam Laxalt in Nevada — who SBA Pro-Life America claim ran from abortion in their midterm races and subsequently lost. “Going on offense is essential for any candidate who wants to win in 2024,” said the group’s president, Marjorie Dannenfelser, at the conclusion of Wednesday’s debate.

Republicans’ abortion bans are nothing like those in Europe

Originally published in Vox.com on June 6, 2023.
—–

Republicans scrambling to address mounting backlash to abortion bans have landed on what they hope they can market as a moderate political compromise: limiting abortion after 12 weeks of pregnancy.

Over the last month, Republicans in North Carolina and Nebraska have passed 12-week abortion bans, a dramatic reduction in access for states that previously allowed abortion up until 20 weeks and 22 weeks, respectively.

North Carolina’s ban would permit abortion for rape victims through 20 weeks, for life-threatening fetal anomalies through 24 weeks, and to protect the life of the mother throughout. Nebraska’s new ban would permit exceptions for rape and to save the life of the mother, but not for fatal fetal anomalies. (Health of pregnant person exceptions have been notoriously confusing for doctors in practice, who fear criminal sanctions for violating the vague statutes.)

Republican politicians are casting these new 12-week bans as “mainstream,” comparing them to even more extreme GOP-led states that have banned virtually all abortion, and pointing to other countries, particularly in Europe, that also impose gestational age limits at 12 weeks.

The rhetorical strategy of invoking other countries to justify banning abortion will sound familiar to those who followed the overturn of Roe v. Wade. In that case, Dobbs v. Jackson, Mississippi lawmakers defended their 15-week abortion ban by pointing out that most European countries have even earlier restrictions.

In the Dobbs Supreme Court hearing itself, Justice John G. Roberts claimed the proposed 15-week ban mirrors “the standard that the vast majority of other countries have.” In his majority opinion, Justice Samuel Alito cited a study published by a leading anti-abortion group that argued the US was out of step with the rest of the world in terms of abortion after 20 weeks.

The study, published by the think tank arm of the Susan B. Anthony Pro-Life America, said 47 out of 50 European nations limit “elective” abortion before 15 weeks, meaning before then doctors are not required to attest to a particular justification for the abortion.

But differences between the US and European countries are more complex than that simple comparison suggests. In practice, abortion limits in the United States are far more restrictive than what exists in most of the Western world, including in nations with gestational age limits at 12 weeks, like Germany, Denmark, Belgium, and Italy.

This distinction between “elective” abortions (or “abortion on demand,” as it’s more provocatively called) and “therapeutic” abortions, which are done for medical reasons, might seem like a key distinction between the US and Europe. But in practice, the line is much blurrier. All abortions are ultimately elective — no one is forced to end a pregnancy, even if a doctor recommends it. Plenty of elective abortions are done for therapeutic reasons.

Moreover, European countries that have 12-week limits on “elective” abortions still make it fairly easy for women to get abortions later on, with relatively broad exceptions for mental health or socioeconomic circumstances. Republicans have aggressively fought against similar exceptions, and in particular have worked to bar consideration of mental health risk — even the risk of suicide if a pregnancy continues — as a factor.

And in other ways, European countries make it easier to get an abortion than in even relatively permissive jurisdictions in the United States. Across Europe, abortion services are covered under national health insurance, meaning the cost of accessing care is a far lower barrier for pregnant people facing time constraints.

By contrast, in the US, cost is one of the biggest hurdles to ending a pregnancy. Even though more than 90 percent of abortions occur within the first 13 weeks, roughly 75 percent of all US abortion patients are low-income according to 2014 numbers, and researchers find Americans needing care in the second trimester tend to be those with less education, Black women, and women who have experienced “multiple disruptive events” in the past year, such as losing a job.

Republican lawmakers are also bucking international trends in working to aggressively restrict access to telehealth abortion care and medication abortion generally — which allows patients, especially those who live in remote and rural areas, to get the abortion services they seek on a faster timeline. Both North Carolina and Nebraska have fully banned abortion via telehealth, despite research affirming its safety and efficacy.

Across the globe, the clear trend has been to expand access to abortion, decriminalize the procedure, and loosen restrictions. While restrictive policies, including earlier gestational limits, still present barriers for international abortion care, per the Center for Reproductive Rights, nearly 60 countries have liberalized their laws and policies on abortion since 1994. Only four — the US, El Salvador, Nicaragua, and Poland — have further restricted rights.

Even with earlier gestational limits, abortion in Europe is broadly affordable and accessible. This is not the paradigm Republicans are proposing in the United States. They are fighting to keep abortion expensive, particularly for low-income patients who rely on Medicaid; to limit the reasons like mental health for which patients can access legal abortion; and to restrict access to care, all while imposing bans on telemedicine, ramping up criminal penalties for providers, and shortening the legal timeline for pregnant people to raise funds, arrange travel, and book mandatory medical appointments.

Understanding international abortion access in practice

Republicans have been eager to point to countries that restrict “elective” abortion after 12 weeks to justify the supposedly mainstream nature of their new bans. But in 21 countries across Europe, the cost of abortion care is fully paid for by federal governments, making first-trimester abortions simply easier to do. Abortions in the US can easily exceed $500 out of pocket, and only 17 states currently cover abortion under their Medicaid programs, which they must do with state funds, not federal dollars, as Congress prohibits it.

Another difference is that abortion exceptions for “health of the pregnant woman” in Europe take into account mental health, too. In Germany, for example, while abortion is permitted upon request throughout the first 12 weeks, someone can seek legal abortion through 22 weeks if it would help them “avert the danger of grave impairment to [their] physical or mental health.”

In Britain, which allows legal abortion up to 24 weeks, it’s similarly clarified that a pregnant person can access care if it’s determined that ending the pregnancy would cause less damage to the patient’s physical or mental health than continuing to carry.

“This is always granted [by doctors] under the correct assumption that continuing a pregnancy is always more dangerous than terminating, and that continuing an unwanted pregnancy is always detrimental to a person’s mental health,” said Maria Lewandowska, a reproductive and sexual health researcher at London School of Hygiene and Tropical Medicine.

Any doctor can provide this authorization, she said, and in practice, patients often get approval directly from doctors at abortion clinics. Advocates in the UK have been encouraging the government to authorize nurses and midwives to grant this permission, too.

Some countries don’t explicitly state “mental health” in their statute, but recognize that maternal health includes psychological health. The author of France’s 1975 abortion law clarified during legislative hearings that “the very term ‘health’ covers, it seems to me, the mental aspect as well as the physical aspect.” The World Health Organization’s definition of “health” includes “mental health.” In Canada, leaders make no formal distinction between physical and mental health, which Joyce Arthur, executive director of the Abortion Rights Coalition of Canada, says allows providers to “better integrate abortion care into the broader health care system.”

Meanwhile, research on the psychological harm associated with carrying unwanted pregnancies continues to mount. The Turnaway Study, a longitudinal study on the effects of unwanted pregnancy on patients’ lives, found that the mental health of women able to end unwanted pregnancies was significantly better than that of women forced to carry to term. Another report published in 2022 found that suicide is a leading cause of death for pregnant people during pregnancy and the first year following it.

Anti-abortion activists in the US, for their part, continue to dismiss these studies. “Having an abortion will not mitigate mental health issues,” said Laura Echevarria, a spokesperson for the National Right to Life Committee, which has lobbied state legislatures to exclude mental health.

In addition to providing exceptions for mental health and paying for abortion care, pregnant people in European countries can also seek legal abortion beyond their country’s 12- or 14-week limit for broad socioeconomic reasons, like feeling too young or too old to have children, feeling consumed by existing children, being a single parent, or lacking a stable housing or financial situation. The Center for Reproductive Rights counts at least 16 European countries that permit abortion on socioeconomic grounds.

In Denmark, for example, though the country has a 12-week ban on paper, it’s considered relatively feasible for residents to get approval for abortion beyond that. In 2021, 803 pregnant people applied to get an abortion in Denmark beyond 12 weeks, and 750 were approved.

Thousands of pregnant women living in countries with 12-week abortion bans travel internationally to end their pregnancies

Even with broader grounds for legal exceptions and greater financial assistance available in countries with earlier gestational age limits, first-trimester bans in Europe still force thousands of pregnant people to travel internationally every year to end their unwanted pregnancies. (A French parliamentary report from 2020 estimated that as many as 4,000 French women traveled abroad for abortion annually due to gestational limits. In 2022, French legislators extended their limit to 14 weeks.)

One study published in March looked at people who traveled from countries like Austria, Bulgaria, France, Germany, and Italy to the Netherlands or England for later abortion care. Over half of the pregnant people surveyed hadn’t learned they were even pregnant until they were at least 14 weeks along, when they had already surpassed the limits in their home countries.

The reasons participants cited for not knowing they were pregnant hold strong relevance for pregnant people in the US living in states with new 12- or six-week bans. The participants all said they would have preferred earlier abortion care but didn’t know they were pregnant due to reasons like irregular periods, lack of clear pregnancy signs, misinformation by doctors about contraception, or their gestational age.

While European passports make travel to other EU countries relatively easy, pregnant people then have to shoulder the cost of travel and the abortion, as national governments only fund abortion care for their own residents. Feminist activists help fundraise for pan-European surgical abortion, as well as the distribution of medication abortion to regions where it’s illegal, but second-trimester abortions for non-Dutch residents can cost up to 1,100 euros. Abortion travel also delays care, which increases a pregnant person’s health risks.

Twelve-week bans in the US won’t end the need for abortion care in the second trimester, because there will always be women who lack the knowledge that they’re pregnant before then. But if Republicans wanted to reduce the need for abortion after 12 weeks, they could back straightforward policies to make the procedure more accessible and affordable.

How abortion rights advocates won every ballot measure this year

Originally published in Vox on November 11, 2022.
—-

Americans voiced their preference for abortion rights on Tuesday, casting votes in support of reproductive freedom everywhere they appeared on the ballot: Kentucky, Michigan, Vermont, Montana, and California.

Counting a pivotal ballot measure Kansas voters weighed in on in August, reproductive rights have been on the ballot in six states since the Supreme Court overturned Roe v. Wade in June. Each time, abortion rights supporters have won.

While Democratic candidates running on abortion access also did extremely well in their contests this week, the vote tallies indicate that the ballot initiatives were often able to draw even more support than the Democratic candidates, garnering votes from individuals who otherwise cast ballots for Republicans, libertarians, or no candidate at all.

“Organizers communicated in a nonpartisan way and that was key,” said Ashley All, who served as communications director for the pro-choice coalition in Kansas. “Their messaging around personal liberty and reproductive freedom and protecting the constitutional rights of women to make the decisions for themselves resonated because it’s shared American values.”

The organizers also succeeded in winning over voters who may personally oppose abortion or have reservations about it. While a majority of Americans say they believe Roe v. Wade should be upheld, roughly one-third of those backing legal abortion do not personally support it. And many who support abortion rights believe it should only be legal in cases of rape or a threat to a woman’s life.

Ethan Winter, the research and strategy director for Families United for Freedom, an abortion rights political action committee, emphasized that the ballot measure campaigns all leaned heavily on persuasion tactics.

“Montana is a heavily Republican state, Kentucky is a heavily Republican state,” he told Vox. “All of these victories depend on Republicans voting for you, on people who self-identify as ‘pro-life’ voting for you.” In Kansas, where Trump won handily in 2020 and registered Republicans outnumber Democrats almost two to one, the pro-choice side won by a nearly 20-point margin. Even California’s measure codifying abortion rights in the state constitution passed this week with roughly 6 percent more support than other Democrats currently have on the statewide ballot.

Abortion rights organizers say they hope their successes this year across diverse states inspires other leaders to follow suit. How to get issues on the ballot varies from state to state; in some cases citizens can collect signatures, while in others lawmakers have to approve turning issues over to voters. In Michigan, activists collected more than 750,000 signatures to get their abortion rights measure on the November ballot. In Montana, Kentucky, and Kansas, by contrast, Republican lawmakers had voted to place their anti-abortion measures on the ballot.

“Our resounding victory now provides a model for the future of coalition-based reproductive ballot initiatives all across the country,” declared Nicole Wells Stallworth, the executive director for Planned Parenthood Advocates of Michigan, in a press conference on Wednesday.

“I’m hoping other states are looking at the outcomes of last night,” Jodi Hicks, the head of Planned Parenthood Affiliates of California, told Vox. “And looking at what they too can do and really start polling, message-testing, and laying the groundwork.”

Voters don’t like big status quo disruptions, and overturning Roe was just that

This past summer when Kansas voters went to cast their ballots, advocates for abortion rights were cautiously optimistic they’d have one advantage on their side: status quo bias.

Americans tend not to like big, disruptive changes, which is why political science researchers believe they observe a “status quo bias” when people weigh in on ballot initiatives. Voters often reject measures they perceive as introducing major change.

Anti-abortion politicians in Kansas had proposed an amendment to the Kansas constitution that would have overruled a Kansas Supreme Court decision affirming Kansans’ right to end a pregnancy. Passing the amendment would have given state lawmakers the power to ignore this ruling and legislate a total abortion ban in the wake of the Dobbs decision.

Activists in Kansas, in other words, could frame the amendment as an effort to take away rights Kansans currently enjoyed under their state constitution, something they called extremist, radical, and disruptive. This general electoral instinct to avoid major shifts to the status quo, organizers believe, helped them defeat the amendment in August.

While the abortion ballot choices on Tuesday weren’t quite as straightforward as asking voters whether they want to remove an existing state constitutional protection, organizers did lean on “status quo bias” messaging in their respective campaigns. In Michigan, for example, though Proposition 3 was an affirmative amendment to codify reproductive freedom in Michigan’s constitution, activists framed their language around the idea of restoring the rights of Roe v. Wade, of bringing back the reality Americans had known for five decades.

In Kentucky activists similarly emphasized a theme of restoration. “We focused our messaging on restoring access and making sure things do not go any further in the extremist direction,” explained Rachel Sweet, who led the Kentucky coalition organizing to defeat the anti-abortion amendment.

Abortion rights organizers used state-specific messaging to win

Activists and researchers experimented with different messages and messengers to win their ballot initiative campaigns, deploying themes that were specific to the histories and values of each state.

In Montana, for example, organizers looked to capture the deep sense of pride voters have in their state’s right to privacy. “Montanans of every ideology here are deeply proud of our constitution which enshrines the right to privacy,” said Hillary-Anne Crosby, a spokesperson for the coalition organizing to defeat Montana’s anti-abortion ballot measure. “This amendment really came down to private medical decisions.”

Montana’s referendum — known as LR 131 — was spurred by a bill Republican lawmakers passed last year asking voters to affirm that an embryo or fetus is a legal person with the right to medical care if it survives an abortion or delivery. Under the law, health care providers could face up to 20 years in prison and a $50,000 fine if they failed to provide such care.

While Republican lawmakers framed the measure as a moral choice for anyone opposed to abortion, reproductive rights advocates argued that the proposal itself had little to do with abortion and everything to do with palliative care and compassion for bereft parents.

That’s because infanticide is already illegal in Montana, and the idea that infants were being killed after an abortion is intentionally misleading, part of a longstanding effort by anti-abortion leaders to depict “botched abortions” that they say can result in live births.

Under current Montana law, if an infant has a fatal prognosis parents can spend those final and few moments holding their dying child and saying goodbye. Under LR 131, a doctor would have been obligated to take the infant away to attempt medical treatment, even if they knew nothing would work.

In mobilizing support against the referendum, advocates chose to de-emphasize abortion, often not mentioning the word at all. They ran ads featuring neonatologists, obstetricians and pediatricians, and grieving parents who said elected officials wanted to politicize their tragedies. Leaning in on status quo bias, doctors gave media interviews explaining how the proposed amendment would threaten the existing rights of parents and criminalize “the current practice of medicine.”

“We’re not trying to pull the wool over anyone’s eyes, we’ve been clear that one of the values of Compassion for Montana Families is uplifting and empowering reproductive and sexual health care,” Crosby told Vox. “But we felt abortion language was a misleading, deceptive thing to be talking about, and we wanted to accurately reflect what the bill in question would mean.”

This doesn’t mean Montana advocates aren’t celebrating the outcome as a victory for reproductive rights. “Conservatives tried to make abortion a boogeyman and people didn’t buy it,” Crosby added.

Vermont organizers also emphasized, in their campaign messaging, doing things “the Vermont way” — referring to the state’s independent and nonpartisan ethos.

“Vermont is sometimes seen as this very liberal place because of Bernie Sanders or whatever, but historically Vermont has held a Republican majority as well as the governor’s seat, and Vermonters regularly split their tickets,” said Lucy Leriche, a spokesperson for the abortion rights coalition in Vermont.

Vermont, unlike most other states, also enjoyed 50 years of unlimited and unrestricted reproductive freedom. While states were permitted under Roe v. Wade to restrict pregnancies after viability (typically around 24 weeks in a pregnancy) Vermont lawmakers never did.

“The [anti-abortion] side is very quick to talk about all the bad things that would happen if you don’t restrict abortion rights, but in Vermont we never had any restrictions, so those arguments really do fall flat,” Leriche told Vox. “They don’t stick because we know better.” The measure to codify reproductive rights in Vermont’s constitution passed on Tuesday with 77 percent of the vote.

Abortion rights activists haven’t historically focused on state ballot measures

Shoring up abortion rights on the state level was not something reproductive health advocates prioritized when Roe v. Wade provided a nationwide constitutional protection. Anti-abortion activists would occasionally push state ballot measures, often in deep red states, but fighting them at the polls seemed less critical than challenging them in court for violating Roe.

“Ballot measures are a space where there hasn’t been a ton of money on the pro-choice side and I think Families United for Freedom is indicative of more money moving in, and what I hope to be a larger trend,” said Winter. Families United for Freedom raised about $2 million this cycle, contributing $600,000 in Kansas, $275,000 in Kentucky, $500,000 in Michigan and $275,000 in Montana. Rachael Bedard, the PAC’s executive director, told Vox that they partnered with and supported local grassroots organizations, providing them with polling and media support, and avoided “a super-imposed national strategy.”

Sweet, who managed the campaigns in both Kentucky and Kansas, told Vox that their success was driven by the expertise of these local grassroots leaders. “We also had a lot of volunteers who have never knocked doors for a candidate, and they don’t consider themselves super politically active,” Sweet said. “But they are concerned and motivated by this one issue.”

One key research point Families United for Freedom found is that even among voters who supported the overturn of Roe v. Wade, a majority of them want abortion to be legal to save the life of the mother and in the case of rape and incest. Even in a hypothetical scenario in which abortion was illegal, the group found, 16 percent of those who said they approve of the Dobbs decision wouldn’t want the woman who had an abortion to face penalties.

“In other words,” Bedard said, “they disapprove of abortion but less than they disapprove of criminalization.” Winning on these abortion ballot measures, Bedard said, means creating the space for someone to continue living their life as a “pro-life” person, while emphasizing that doesn’t extend to making their neighbor’s choice for them.

“We need to let voters have their own personal feelings about abortion, but invite them to join us in the fundamental belief that women should make the decisions for themselves,” added Ashley All, who joined Families United for Freedom after defeating the Kansas ballot measure. “That is pro-choice and that is a way to really bridge the gap.”