When Wendy Davis wanted to get birth control as a teenager in the 1980s, she went to her local Planned Parenthood in Fort Worth, Texas, with a friend. “There is absolutely no way I would have asked my mother for her permission to do that,” says Davis, the former Texas state senator who famously filibustered an anti-abortion bill for 11 hours in a pair of pink sneakers. “That’s just not something that’s possible for many, many, many teenage girls.” 

Forty years later, with abortion banned in wide swaths of the country, access to reliable contraception is more important than ever. Yet for Texas teens, getting prescription birth control is arguably harder now than it was when Davis was an adolescent. Over the past two years, federal courts—including the notoriously conservative 5th Circuit—have ruled that minors must have parental consent to obtain prescription birth control from Texas clinics subsidized by a federal family planning program known as Title X. Flush with victory, Texas Republicans have made it clear: They have no intention of stopping there. In late July, Attorney General Ken Paxton filed suit to overturn a new federal rule that reaffirmed teens’ ability in other states to get contraception without their parents’ consent. “The Biden Administration continues to prove they will do anything to implement their extremist agenda,” Paxton said in a press release.

To anyone paying even a modicum of attention, the far right’s plans to limit access to birth control have long been hiding in plain sight. When the Supreme Court overturned the federal right to abortion in the Dobbs decision in 2022, Justice Clarence Thomas wrote that the court “should reconsider” other rulings with similar legal principles, including Griswold v. Connecticut, the 1965 decision establishing a right to contraception (and, more fundamentally, a constitutional right to privacy). The ultra-conservative strategists behind Project 2025— including Roger Severino, longtime anti-abortion movement lawyer, and Russell Voght, an avowed Christian nationalist—have spelled out a plan for how a Republican-led White House could gut or rewrite key federal birth-control regulations, building on efforts that began during the first Trump administration. (While Trump has tried to distance himself from Project 2025, even claiming he doesn’t know who wrote it, at least 140 members of Trump’s team, including Severino and Voght, had a hand in drafting it.)

But what has escaped many Americans is that these threats aren’t just terrifying what-if-this-happens scenarios. As the Texas lawsuits show, in some parts of the United States, that scary future has already arrived. States have been passing laws allowing pharmacies to refuse to fill birth control prescriptions based on moral objections, or proposing legislation that unscientifically classifies emergency contraception and IUDs as “abortifacients.” Reproductive Health and Freedom Watch has found that since 2021, at least 21 states have directed a total of $513 million to religiously affiliated crisis pregnancy centers and “alternatives to abortion” programs that actively spread misinformation about birth control and discourage its use.

And though contraception is supported by around 90 percent of voters, when Congress had the chance earlier this year to pass a law protecting access to birth control, Republican senators blocked it, claiming it was unnecessary.

The Biden administration has repeatedly pushed back—most recently, with a new proposed rule under the Affordable Care Act to require private insurance to cover 100 percent of the cost of over-the-counter birth control and offer patients more choices for prescription contraception. In a statement, Vice President Kamala Harris described the move as “the largest expansion of contraception coverage in more than a decade.” But the regulations won’t be finalized until after the presidential election, and the new rules are virtually certain to be challenged in GOP-packed federal courts even if Harris wins. 

And what if she doesn’t?

A new Trump administration and its right-wing allies are expected to escalate attacks on contraception on a multitude of fronts, including appointing extremists to key government positions. Rather than outright bans, we should expect more subtle incursions—regulatory changes, limits on insurance coverage, and funding reductions for family planning, as well as rules like the parental consent requirement for teens, according to reproductive health policy experts interviewed by Mother Jones. “It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing,” says Kelly Baden, vice president for public policy at the Guttmacher Institute. “They’re not. It is much more behind-the-scenes, around the margins. And yet, the impact is still potentially devastating.”

“It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing. They’re not.”

“That’s what happened to abortion,” adds Amanda Stevenson, an assistant professor at the University of Colorado-Boulder who studies the impact of family planning policy. “Death by a thousand cuts.”

Here are four key strategies we can expect under a new Trump administration intent on undermining access to contraception:

Doubling Down on False Claims that Birth Control Causes Abortion

One of the most common attack lines against contraception is the claim that certain methods—notably IUDs and morning-after pills—are abortifacients, which is to say they cause abortion, purportedly by preventing fertilized eggs from implanting in the uterus. In fact, decades of research show that these methods block fertilization from ever happening—by preventing the release of eggs, for instance, or stopping sperm from reaching them. Yet the belief that IUDs and emergency contraception, like Plan B and Ella, end pregnancies rather than preventing them has become distressingly common, thanks in part to rampant misinformation spread by the anti-abortion movement—including appointees in the first Trump administration.

The falsehoods have made their way into Food and Drug Administration policy, with decades-long repercussions for reproductive health. Back in the early 2000s, when the FDA was trying to decide whether Plan B should be sold over the counter, it relied on an advisory committee that included several abortion opponents. Over the objections of their colleagues, those committee members persuaded the agency to include language in Plan B’s packaging that stated the drug “may also work” by preventing implantation. Not until 2022 did the FDA finally update the Plan B label to clarify the drug “does not terminate a pregnancy.” But anti-abortion groups could challenge that update in a second Trump administration.

Meanwhile, since 2015, the “abortifacient claim” has inspired lawmakers in at least seven states to vote to cut off funding for contraception or block bills to protect access to it, USA Today found in a recent investigation. Project 2025 also continues this line of attack, describing Ella as a “potential abortifacient” and proposing to wipe out mandatory insurance coverage for it. Some anti-abortion organizations, including the influential Students for Life, even falsely claim that the daily birth control pill is an abortifacient. As my colleague Kiera Butler has written, it’s all part of a growing right-wing movement to persuade women that hormonal contraception is just plain bad for them. If Trump wins, his appointees are likely to bring those arguments with them to the agencies they oversee, further threatening birth control access.

Rewriting Title X

Attacking government subsidies for contraception has been part of the GOP playbook for decades. A favorite target is Title X, a federal safety-net program that underwrites free reproductive health services—birth control, cervical cancer screenings, and STI screening and treatment, but not abortion—for low-income and uninsured people. Planned Parenthood clinics, a common provider of these services, receive about 20 percent of Title X funds.

No surprise: Texas has led the way in attacking the federal program since 2011, when the legislature slashed state funding for reproductive health care and redirected Title X money to primary care providers. The changes that year—designed to kneecap Planned Parenthood—forced scores of reproductive health clinics to close, and others to reduce hours, charge patients new fees, or ration the most effective (but expensive) forms of contraception, such as IUDs. As a result of the changes, the number of clients served by Texas family planning organizations fell by more than half, and the teen birth rate rose an estimated 3.4 percent. “It shredded the safety net for women’s health care in our state,” says Davis, now a senior adviser to Planned Parenthood Texas Votes. “Tens of thousands of women literally lost the only health care they had ever known, overnight. It was devastating, and slowly, we’ve been building our way back.”

“Tens of thousands of women literally lost the only health care they had ever known, overnight.”

Trump’s first-term appointees, following Texas’ lead, set about dramatically reshaping the entire Title X program. The administration’s “gag rule,” first proposed under Ronald Reagan but never fully implemented, which forbids any clinics that took Title X money from referring patients to abortion providers. It also required them to keep separate books and separate facilities from their abortion services, if they offered them—a logistical nightmare. Some 1,300 reproductive health facilities, including 400 Planned Parenthood clinics, withdrew from the program rather than withhold abortion referrals from patients who wanted them, and roughly 1.6 million patients lost access to federally subsidized birth control. “It was a very difficult time in the program,” says Clare Coleman, president of the National Family Planning & Reproductive Health Association. “Of course, the numbers plummeted.” What happened to the freed-up Title X money? The Trump administration sent some of it to a chain of Christian “crisis pregnancy centers” that refused to provide contraception or even referrals for birth control, as my colleague Stephanie Mencimer found in a 2019 investigation.

When Joe Biden took office, his administration promptly revoked the Trump rule, and the Title X network started rebuilding. But Vice presidential candidate Ohio Sen. JD Vance has already signaled that a second Trump administration would try again to defund Planned Parenthood—code for attacking Title X. Project 2025 urges the next president to “quickly” reissue the gag rule. It also advocates that Title X be “reframed with a focus on better education around fertility awareness”—a less-reliable method of cycle tracking favored by anti-abortion activists and wellness influencers—with grants opened up once again to anti-abortion religious organizations.

In anticipation of a Trump win, Coleman’s organization has been working with reproductive health clinics to prepare for the old gag rule to be reissued and even expanded soon after Inauguration Day. Not only could the next version of the rule pick up on Texas’ efforts to require parental consent for teenagers, Coleman warns Trump appointees are also likely to attack gender-affirming care. (Title X does not explicitly fund such care but some providers offer those services separately, just as they do abortion.) “They may say, if you take Title X, you can’t provide any of that care,” Coleman speculates. “We are quite concerned about them trying to enforce not only a gender binary—because we also do see men in the Title X program—but to recast it as: ‘This is a program about biological sex.’”

That’s if Title X survives at all: House Speaker Mike Johnson’s budget bill in September 2023 would have defunded the program entirely.

Gutting the Affordable Care Act

Before the Obama administration passed the Affordable Care Act, birth control accounted for around a third of women’s out-of-pocket healthcare expenses, according to the National Women’s Law Center. Monthly copays deterred women from getting the Pill, while an IUD could have an up-front cost of $1,000.

The ACA changed all that for over 62 million women. Starting in 2012, the law classified contraception as a form of preventive care and made it mandatory for private insurance to cover a wide range of prescription birth control at no cost to consumers. Last year, responding to the fallout from Dobbs, the Biden administration directed agencies to find ways to strengthen the contraception mandate and make sure insurers follow it; last month’s announcement on coverage of over-the-counter contraception follows that effort.

Fighting the contraception mandate has been one of the key ways conservatives and religious groups have sought to erode access to birth control. In 2014, the Supreme Court’s infamous Hobby Lobby ruling blew a crater in the ACA’s contraception mandate in the name of protecting religious freedom. There had always been a religious exemption for churches and houses of worship. But Hobby Lobby expanded that exemption to include 90 percent of US businesses—letting them deny coverage for birth control in employee insurance plans if the owners had a religious objection.

Trump broadened the exemption even further in his first term, allowing employers to decline to provide birth control based on moral, not just religious, objections. “It opens the door wide for any employer that provides health insurance to pick and choose what kind of contraception they would like to cover,” says Dana Singiser, cofounder of the Contraceptive Access Initiative.

Of course, there’s always the chance that a Republican White House and Congress would wipe out the ACA altogether, as Trump tried to do in 2017. Trump has since made conflicting statements about whether he would try again for a repeal or impose “concepts of a plan” to replace it. In late October, Speaker Johnson promised a “massive reform” of the ACA if Trump is elected.

Even with the ACA still on the books, experts say Trump could do significant damage, bypassing Congress by issuing new regulations or guidance from executive-branch agencies. Project 2025 leans in on this idea, urging the next president to make regulatory moves that would hobble the contraceptive mandate. “It’s not flashy,” says Lauren Wallace, senior counsel for reproductive rights and health at the National Women’s Law Center. “Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

“Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

The Biden administration is currently finalizing a replacement to Trump’s rule allowing moral objections to the contraceptive mandate; it’s safe to say that Trump would block or revoke it. He could also issue other regulations to make the contraceptive mandate “unworkable,” Wallace says. He could give insurers more agency to make rules around which types of birth control they choose to insure or require patients to try certain methods, before covering more expensive ones.

Project 2025’s authors, of course, have their own ideas about which forms of birth control are preferable. Their blueprint urges the next president to require the Department of Health and Human Services to issue new regulations about what is covered by the ACA contraceptive mandate. In: “fertility awareness” methods. Out: male condoms and Ella.

Shrinking Medicaid While Increasing Surveillance

Back to Texas.

Over the past decade or so, at the same time the state was attacking family planning clinics, it found a way to mess with the most common way people pay for birth control: Medicaid. And Davis sees what it did as a potential model for other states should Trump win.

First, the state passed a law banning abortion providers and their affiliates from participating in the state’s Medicaid-funded family planning program. The law conflicted with a federal rule allowing Medicaid patients to choose any “willing” provider. That meant Texas had to apply to the Obama administration for a waiver of the rule. “They got into a standoff,” Davis recalls. “The Obama administration said, ‘We’re going to remove all of your funding if you do this.’ And Texas said, ‘Fine, do it.’”

For the next few years, Texas ran a shrunken version of the program using state funding. Then Trump appeared, installing a National Right to Life Committee lobbyist to oversee national family planning policy. Texas applied for the Medicaid waiver again—and this time, received it. The Trump administration also gave the state permission not to cover emergency contraception in its Medicaid-funded program.

Davis predicts that other states will use the same maneuver to sever Planned Parenthood from Medicaid, should Trump return to office. Tennessee, which bans virtually all abortions, and South Carolina, which bans them at six weeks, have already applied for similar waivers. And Missouri recently enacted a law to ban all Medicaid reimbursements for abortion providers and their affiliates—even though the state’s abortion ban means they now only provide services like contraception and cancer screening.

Project 2025 proposes making federal Medicaid family planning funding conditional on states participating in a frighteningly detailed abortion surveillance system. “Because liberal states have now become sanctuaries for abortion tourism,” the blueprint says, “HHS should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders.” The database would include the gestational age at which the abortion was performed, the method, and the reason for it.

The proposal would force states to make an “impossible choice,” says Madeline Morcelle, senior attorney at the National Health Law Program. Participating in that “weaponized program,” she says, “would likely be used to criminalize pregnant people,” particularly immigrants, Black, Indigenous, and other people of color, young people, and people with disabilities. But dropping out would likely mean losing federal funding for vital Medicaid services affecting millions of those same low-income people.

Davis, in Texas, says she knows that predictions about losing access to birth control can sound exaggerated. She’s heard such criticisms before—from people who believed that Roe would never fall. “There are those out there who believe that this is hyperbole,” she says. But as a Texan who has witnessed how what appears radical becomes normalized, she has no illusions about the potential dangers. “I don’t think it’s unlikely at all that as Republicans become more and more extreme, and governed in a more and more extreme way by their rightward flank, that we are going to see these things become a reality.”

Correction, October 31: An earlier version of this story misstated which funds Project 2025 suggests withholding from states that don’t participate in an expanded abortion surveillance program.

When Wendy Davis wanted to get birth control as a teenager in the 1980s, she went to her local Planned Parenthood in Fort Worth, Texas, with a friend. “There is absolutely no way I would have asked my mother for her permission to do that,” says Davis, the former Texas state senator who famously filibustered an anti-abortion bill for 11 hours in a pair of pink sneakers. “That’s just not something that’s possible for many, many, many teenage girls.” 

Forty years later, with abortion banned in wide swaths of the country, access to reliable contraception is more important than ever. Yet for Texas teens, getting prescription birth control is arguably harder now than it was when Davis was an adolescent. Over the past two years, federal courts—including the notoriously conservative Fifth Circuit—have ruled that minors must have parental consent to obtain prescription birth control from Texas clinics subsidized by a federal family planning program known as Title X. Flush with victory, Texas Republicans have made it clear: They have no intention of stopping there. In late July, Attorney General Ken Paxton filed suit to overturn a new federal rule that reaffirmed teens’ ability in other states to get contraception without their parents’ consent. “The Biden Administration continues to prove they will do anything to implement their extremist agenda,” Paxton said in a press release.

To anyone paying even a modicum of attention, the far-right’s plans to limit access to birth control have long been hiding in plain sight. When the Supreme Court overturned the federal right to abortion in the Dobbs decision in 2022, Justice Clarence Thomas wrote that the court “should reconsider” other rulings with similar legal principles, including Griswold v. Connecticut, the 1965 decision establishing a right to contraception (and, more fundamentally, a constitutional right to privacy). The ultra-conservative strategists behind Project 2025— including Roger Severino, longtime anti-abortion movement lawyer, and Russell Voght, an avowed Christian nationalist—have spelled out a plan for how a Republican-led White House could gut or rewrite key federal birth-control regulations, building on efforts that began during the first Trump administration. (While Trump has tried to distance himself from Project 2025, even claiming he doesn’t know who wrote it, at least 140 members of Trump’s team, including Severino and Voght, had a hand in drafting it.)

But what has escaped many Americans is that these threats aren’t just terrifying what-if-this-happens scenarios. As the Texas lawsuits show, in some parts of the US, that scary future has already arrived. States have been passing laws allowing pharmacies to refuse to fill birth control prescriptions based on moral objections, or proposing legislation that unscientifically classifies emergency contraception and IUDs as “abortifacients.” Reproductive Health and Freedom Watch has found that since 2021, at least 21 states have directed a total of $513 million to religiously affiliated crisis pregnancy centers and “alternatives to abortion” programs that actively spread misinformation about birth control and discourage its use.

And though contraception is supported by around 90 percent of voters, when Congress had the chance earlier this year to pass a law protecting access to birth control, Republican senators blocked it, claiming it was unnecessary.

The Biden administration has repeatedly pushed back—most recently, with a new proposed rule under the Affordable Care Act to require private insurance to cover 100 percent of the cost of over-the-counter birth control and offer patients more choices for prescription contraception. In a statement, Vice President Kamala Harris described the move as “the largest expansion of contraception coverage in more than a decade.” But the regulations won’t be finalized until after the presidential election, and the new rules are virtually certain to be challenged in GOP-packed federal courts even if Harris wins. 

And what if she doesn’t?

A new Trump administration and its right-wing allies are expected to escalate attacks on contraception on a multitude of fronts, including appointing extremists to key government positions. Rather than outright bans, we should expect more subtle incursions—regulatory changes, limits on insurance coverage, and funding reductions for family planning, as well as rules like the parental consent requirement for teens, according to reproductive health policy experts interviewed by Mother Jones. “It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing,” says Kelly Baden, vice president for public policy at the Guttmacher Institute. “They’re not. It is much more behind-the-scenes, around the margins. And yet, the impact is still potentially devastating.”

“It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing. They’re not.”

“That’s what happened to abortion,” adds Amanda Stevenson, an assistant professor at the University of Colorado-Boulder who studies the impact of family planning policy. “Death by a thousand cuts.”

Here are four key strategies we can expect under a new Trump administration intent on undermining access to contraception:

Doubling Down on False Claims that Birth Control Causes Abortion

One of the most common attack lines against contraception is the claim that certain methods—notably IUDs and morning-after pills—are abortifacients, which is to say they cause abortion, purportedly by preventing fertilized eggs from implanting in the uterus. In fact, decades of research show that these methods block fertilization from ever happening—by preventing the release of eggs, for instance, or stopping sperm from reaching them. Yet the belief that IUDs and emergency contraception, like Plan B and Ella, end pregnancies rather than preventing them has become distressingly common, thanks in part to rampant misinformation spread by the anti-abortion movement—including appointees in the first Trump administration.

The falsehoods have made their way into Food and Drug Administration policy, with decades-long repercussions for reproductive health. Back in the early 2000s, when the FDA was trying to decide whether Plan B should be sold over the counter, it relied on an advisory committee that included several abortion opponents. Over the objections of their colleagues, those committee members persuaded the agency to include language in Plan B’s packaging that stated the drug “may also work” by preventing implantation. Not until 2022 did the FDA finally update the Plan B label to clarify the drug “does not terminate a pregnancy.” But anti-abortion groups could challenge that update in a second Trump administration.

Meanwhile, since 2015, the “abortifacient claim” has inspired lawmakers in at least seven states to vote to cut off funding for contraception or block bills to protect access to it, USA Today found in a recent investigation. Project 2025 also continues this line of attack, describing Ella as a “potential abortifacient” and proposing to wipe out mandatory insurance coverage for it. Some anti-abortion organizations, including the influential Students for Life, even falsely claim that the daily birth control pill is an abortifacient. As my colleague Kiera Butler has written, it’s all part of a growing right-wing movement to persuade women that hormonal contraception is just plain bad for them. If Trump wins, his appointees are likely to bring those arguments with them to the agencies they oversee, further threatening birth control access.

Rewriting Title X

Attacking government subsidies for contraception has been part of the GOP playbook for decades. A favorite target is Title X, a federal safety-net program that underwrites free reproductive health services—birth control, cervical cancer screenings, and STI screening and treatment, but not abortion—for low-income and uninsured people. Planned Parenthood clinics, a common provider of these services, receive about 20 percent of Title X funds.

No surprise: Texas has led the way in attacking the federal program since 2011, when the legislature slashed state funding for reproductive health care and redirected Title X money to primary care providers. The changes that year—designed to kneecap Planned Parenthood—forced scores of reproductive health clinics to close, and others to reduce hours, charge patients new fees, or ration the most effective (but expensive) forms of contraception, such as IUDs. As a result of the changes, the number of clients served by Texas family planning organizations fell by more than half, and the teen birth rate rose an estimated 3.4 percent. “It shredded the safety net for women’s health care in our state,” says Davis, now a senior adviser to Planned Parenthood Texas Votes. “Tens of thousands of women literally lost the only health care they had ever known, overnight. It was devastating, and slowly, we’ve been building our way back.”

“Tens of thousands of women literally lost the only health care they had ever known, overnight.”

Trump’s first-term appointees, following Texas’ lead, set about dramatically reshaping the entire Title X program. The administration’s “gag rule,” first proposed under Ronald Reagan but never fully implemented, which forbids any clinics that took Title X money from referring patients to abortion providers. It also required them to keep separate books and separate facilities from their abortion services, if they offered them—a logistical nightmare. Some 1,300 reproductive health facilities, including 400 Planned Parenthood clinics, withdrew from the program rather than withhold abortion referrals from patients who wanted them, and roughly 1.6 million patients lost access to federally subsidized birth control. “It was a very difficult time in the program,” says Clare Coleman, president of the National Family Planning & Reproductive Health Association. “Of course, the numbers plummeted.” What happened to the freed-up Title X money? The Trump administration sent some of it to a chain of Christian “crisis pregnancy centers” that refused to provide contraception or even referrals for birth control, as my colleague Stephanie Mencimer found in a 2019 investigation.

When Joe Biden took office, his administration promptly revoked the Trump rule, and the Title X network started rebuilding. But Vice presidential candidate Ohio Sen. JD Vance has already signaled that a second Trump administration would try again to defund Planned Parenthood—code for attacking Title X. Project 2025 urges the next president to “quickly” reissue the gag rule. It also advocates that Title X be “reframed with a focus on better education around fertility awareness”—a less-reliable method of cycle tracking favored by anti-abortion activists and wellness influencers—with grants opened up once again to anti-abortion religious organizations.

In anticipation of a Trump win, Coleman’s organization has been working with reproductive health clinics to prepare for the old gag rule to be reissued and even expanded soon after Inauguration Day. Not only could the next version of the rule pick up on Texas’ efforts to require parental consent for teenagers, Coleman warns Trump appointees are also likely to attack gender-affirming care. (Title X does not explicitly fund such care but some providers offer those services separately, just as they do abortion.) “They may say, if you take Title X, you can’t provide any of that care,” Coleman speculates. “We are quite concerned about them trying to enforce not only a gender binary—because we also do see men in the Title X program—but to recast it as: ‘This is a program about biological sex.’”

That’s if Title X survives at all: House Speaker Mike Johnson’s budget bill in September 2023 would have defunded the program entirely.

Gutting the Affordable Care Act

Before the Obama administration passed the Affordable Care Act, birth control accounted for around a third of women’s out-of-pocket healthcare expenses, according to the National Women’s Law Center. Monthly copays deterred women from getting the Pill, while an IUD could have an up-front cost of $1,000.

The ACA changed all that for over 62 million women. Starting in 2012, the law classified contraception as a form of preventive care and made it mandatory for private insurance to cover a wide range of prescription birth control at no cost to consumers. Last year, responding to the fallout from Dobbs, the Biden administration directed agencies to find ways to strengthen the contraception mandate and make sure insurers follow it; last month’s announcement on coverage of over-the-counter contraception follows that effort.

Fighting the contraception mandate has been one of the key ways conservatives and religious groups have sought to erode access to birth control. In 2014, the Supreme Court’s infamous Hobby Lobby ruling blew a crater in the ACA’s contraception mandate in the name of protecting religious freedom. There had always been a religious exemption for churches and houses of worship. But Hobby Lobby expanded that exemption to include 90 percent of US businesses—letting them deny coverage for birth control in employee insurance plans if the owners had a religious objection.

Trump broadened the exemption even further in his first term, allowing employers to decline to provide birth control based on moral, not just religious, objections. “It opens the door wide for any employer that provides health insurance to pick and choose what kind of contraception they would like to cover,” says Dana Singiser, cofounder of the Contraceptive Access Initiative.

Of course, there’s always the chance that a Republican White House and Congress would wipe out the ACA altogether, as Trump tried to do in 2017. Trump has since made conflicting statements about whether he would try again for a repeal or impose “concepts of a plan” to replace it. In late October, Speaker Johnson promised a “massive reform” of the ACA if Trump is elected.

Even with the ACA still on the books, experts say Trump could do significant damage, bypassing Congress by issuing new regulations or guidance from executive-branch agencies. Project 2025 leans in on this idea, urging the next president to make regulatory moves that would hobble the contraceptive mandate. “It’s not flashy,” says Lauren Wallace, senior counsel for reproductive rights and health at the National Women’s Law Center. “Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

“Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

The Biden administration is currently finalizing a replacement to Trump’s rule allowing moral objections to the contraceptive mandate; it’s safe to say that Trump would block or revoke it. He could also issue other regulations to make the contraceptive mandate “unworkable,” Wallace says. He could give insurers more agency to make rules around which types of birth control they choose to insure or require patients to try certain methods, before covering more expensive ones.

Project 2025’s authors, of course, have their own ideas about which forms of birth control are preferable. Their blueprint urges the next president to require the Department of Health and Human Services to issue new regulations about what is covered by the ACA contraceptive mandate. In: “fertility awareness” methods. Out: male condoms and Ella.

Shrinking Medicaid While Increasing Surveillance

Back to Texas.

Over the past decade or so, at the same time the state was attacking family planning clinics, it found a way to mess with the most common way people pay for birth control: Medicaid. And Davis sees what it did as a potential model for other states should Trump win.

First, the state passed a law banning abortion providers and their affiliates from participating in the state’s Medicaid-funded family planning program. The law conflicted with a federal rule allowing Medicaid patients to choose any “willing” provider. That meant Texas had to apply to the Obama administration for a waiver of the rule. “They got into a standoff,” Davis recalls. “The Obama administration said, ‘We’re going to remove all of your funding if you do this.’ And Texas said, ‘Fine, do it.’”

For the next few years, Texas ran a shrunken version of the program using state funding. Then Trump appeared, installing a National Right to Life Committee lobbyist to oversee national family planning policy. Texas applied for the Medicaid waiver again—and this time, received it. The Trump administration also gave the state permission not to cover emergency contraception in its Medicaid-funded program.

Davis predicts that other states will use the same maneuver to sever Planned Parenthood from Medicaid, should Trump return to office. Tennessee, which bans virtually all abortions, and South Carolina, which bans them at six weeks, have already applied for similar waivers. And Missouri recently enacted a law to ban all Medicaid reimbursements for abortion providers and their affiliates—even though the state’s abortion ban means they now only provide services like contraception and cancer screening.

Project 2025 proposes making Medicaid and other federal health funding conditional on states participating in a frighteningly detailed abortion surveillance system. “Because liberal states have now become sanctuaries for abortion tourism,” the blueprint says, “HHS should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders.” The database would include the gestational age at which the abortion was performed, the method, and the reason for it.

The proposal would force states to make an “impossible choice,” says Madeline Morcelle, senior attorney at the National Health Law Center. Participating in that “weaponized program,” she says, “would likely be used to criminalize pregnant people,” particularly immigrants, Black, Indigenous, and other people of color, young people, and people with disabilities. But dropping out would likely mean losing federal funding for vital Medicaid services affecting millions of those same low-income people.

Davis, in Texas, says she knows that predictions about losing access to birth control can sound exaggerated. She’s heard such criticisms before—from people who believed that Roe would never fall. “There are those out there who believe that this is hyperbole,” she says. But as a Texan who has witnessed how what appears radical becomes normalized, she has no illusions about the potential dangers. “I don’t think it’s unlikely at all that as Republicans become more and more extreme, and governed in a more and more extreme way by their rightward flank, that we are going to see these things become a reality.”

Two years after the US Supreme Court ended the federal right to abortion, tens of millions of Americans will go to the polls this November hoping to protect access to the procedure—whether their lawmakers like it or not. Ten states— some already with robust protections, others with near-total bans—have measures on their ballots to enshrine abortion rights in their constitutions. The expected outpouring of voters, including in key swing states, could help determine control of the White House, Congress, state legislatures, and state supreme courts.

Reproductive freedom has proved to be one of the strongest currents shaping the outcome of American elections since 2022. So far, voters in seven states have reacted to the end of Roe v. Wade by passing ballot measures aimed at restoring, and even expanding, Roe’s protections. In a few of those states, the voter-initiative process empowered the public to bypass GOP-dominated legislatures and supersede decades-old restrictions. Reproductive rights organizers are hoping to continue that winning streak on November 5. 

But faced with the broad appeal of abortion initiatives in GOP-led states such as Ohio, Republican officials have gone to sometimes extreme lengths to undermine the latest measures. In Florida, for example, Gov. Ron DeSantis has waged a multifront war on Amendment 4, threatening television stations that air ads favoring the measure and issuing a 348-page report accusing the Floridians Protecting Freedom campaign of “widespread petition fraud.” 

While most of this year’s measures have a common objective—protecting reproductive access—they take very different approaches to reaching that goal. Here is a rundown of what’s on the November ballot, which we will update as election results become available. 

Arizona

In anticipation of the end of Roe, Arizona Republicans passed a 15-week abortion ban in early 2022. But they also left in place an 1864 statute that outlawed nearly all abortions and threatened providers with jail time—a “zombie” law that was moot as long as Roe was in effect. This past April, the Arizona Supreme Court revived that Civil-War era ban by a 4–2 vote. The GOP-controlled legislature quickly repealed the old law, but many Arizonans were outraged at what the court had done, and the campaign to put Proposition 139 on the November ballot exploded. Prop 139 would enshrine a fundamental right to abortion in the Arizona Constitution and prohibit the state from restricting or banning abortion until the point of fetal viability—about 24 weeks. Abortions would be allowed later in pregnancy to save the mother’s life or to protect her physical or mental health. The amendment would also protect anyone who helps another person obtain an abortion.

A coalition of reproductive rights groups certified more than 575,000 signatures this past summer—the most ever validated for a citizens initiative in the state’s history, supporters said. In a New York Times/Siena College poll in late September, Prop 139 was ahead among likely voters by a resounding 58 percent. If it passes, Prop 139 could be used to challenge almost 40 abortion laws on Arizona’s books, including the existing 15-week ban, a prohibition on telehealth abortions, and a parental consent requirement for teenagers.

Colorado

Long before the Dobbs decision, Colorado legislators passed numerous laws safeguarding access to abortion. But after Dobbs, reproductive health advocates in the state concluded that even the strongest statutes weren’t strong enough—Colorado needed to enshrine those protections in its constitution. The measure they put on the November ballot, Amendment 79, wouldn’t just establish a right to abortion; it would repeal a 40-year-old constitutional provision that prohibited the use of state dollars to fund abortion. Sponsored by a coalition called Coloradans for Protecting Reproductive Freedom, the measure needs 55 percent of votes to pass. 

Surrounded by states with bans or heavily restrictive laws, Colorado is a crucial abortion access point for the West. With no gestational limits, the state is also a haven for anyone seeking an abortion later in pregnancy, as it is home to one of four clinics in the US that offer third-trimester procedures. Repealing the ban on state funding would allow Colorado to use its state Medicaid dollars to pay for abortions, making the procedure more accessible for low-income patients.

Florida

Florida’s Amendment 4 would enshrine in the state’s constitution the freedom to seek an abortion before fetal viability, and after viability if a medical provider determines that the procedure is necessary to preserve a patient’s health.

Gov. DeSantis and his GOP administration have done everything they can to sabotage the amendment—including sending “election police” to the homes of people who signed the petitions.

If the measure passes, it would dramatically improve access to reproductive care in Florida, which since May has banned abortions after six weeks of pregnancy. Before that, the state permitted abortions up to 15 weeks, and before Dobbs, until 24 weeks. The impact of the Florida vote will be felt throughout the Southeast: Tennessee, Alabama, Arkansas, Mississippi, and Kentucky all have near-total abortion bans; Georgia and South Carolina have six-week bans, and North Carolina’s 12-week ban is made more burdensome by a 72-hour waiting period. 

The stakes for passage are high, and so are the barriers. Over the last several election cycles, Florida has turned out more conservative voters than liberal ones. While reproductive rights are popular across the political spectrum, the state has a 60 percent threshold to approve constitutional amendments; the other red states that have passed abortion-protective measures since Dobbs—Kansas, Kentucky, Ohio—only required simple majorities. Meanwhile, Gov. DeSantis and his GOP administration have done everything they can to sabotage the amendment—including sending “election police” to the homes of people who signed the petitions, ostensibly to root out fraud. If the measure passes, DeSantis and his allies are widely expected to fight just as hard to overturn the results.

Maryland

Maryland’s Question 1, which was placed on the November ballot by the state legislature, does not mention “abortion”—much to the chagrin of supporters and opponents alike. Instead, the amendment broadly establishes the constitutional right to “reproductive freedom,” including the freedom to decide whether to continue or end a pregnancy. It needs a simple majority to pass.

Maryland already has some of the least restrictive abortion laws in the country: There is no gestational limit, state Medicaid covers the procedure, and a shield law protects patients who travel from states with abortion bans. This has made the state a critical access point for abortion seekers further along in pregnancy, as well as people traveling from the South. Abortion protections are widely popular in the state; in a recent poll by the University of Maryland, Baltimore County, 69 percent of respondents said they plan to vote for Question 1.

Missouri

Missouri’s near-total abortion ban took effect mere minutes after the Supreme Court overturned Roe v. Wade in 2022—making it the first state in the nation to broadly prohibit abortion. Abortion-rights advocates soon set about crafting a ballot initiative to end the ban, inspired by wins in other states. Now, with Amendment 3, voters will decide whether they want the right to “reproductive freedom”—defined as the ability to make and carry out one’s own decisions about contraception, abortion, and healthcare during pregnancy. If approved by a simple majority, the amendment would set up a legal battle to overturn the current ban and challenge the many other Missouri laws that regulated abortion providers nearly out of existence even when Roe was still in effect.

Amendment 3’s proponents, a coalition known as Missourians for Constitutional Freedom, have traveled a rocky road just to get the measure before voters. They’ve overcome blatant obstruction by top state GOP officials, multiple legal challenges, and deep internal divisions over whether the initiative should allow the state to ban abortions after fetal viability. The final text protects abortion rights until viability, and permits later abortions if needed to protect the life or health of the pregnant person.

Montana

Constitutional Initiative 128 establishes the right to make and carry out decisions about one’s own pregnancy, including abortion. If passed, it would allow the state to regulate abortion after fetal viability, so long as those restrictions don’t prevent abortions that health care providers deem medically necessary. The amendment, which requires more than 50 percent of the vote, would also prevent the government from criminalizing patients and anyone who helps a person exercise her abortion rights.

If top Republican state officials had it their way, the measure would not even be on the ballot. State courts intervened at multiple points; the Montana Supreme Court overruled Attorney General Austin Knudsen’s initial rejection of the proposed amendment, nixed Knudsen’s drafted ballot language saying the amendment “may increase the number of taxpayer-funded abortions,” and threatened Secretary of State Christi Jacobsen with a contempt charge because she refused to hand over the sample ballot petition to the campaign behind the amendment, Montanans Securing Reproductive Rights. After abortion rights supporters submitted nearly double the required 60,000 signatures, Jacobsen even tried changing the rules to throw out the signatures of inactive registered voters, until a district court ordered her to stop.

Thanks to the state supreme court, abortion is currently legal in Montana until fetal viability, despite the best efforts of Republican state legislators to restrict access. Montanans have already brushed off one GOP attempt to stigmatize abortion; in November 2022, 52 percent of voters rejected a legislature-initiated statute that would have made it a felony for doctors to not provide care to infants born alive after induced labor, a cesarean section or an “attempted abortion.” (The law wasn’t necessary since Montana, like every other state, already makes infanticide a crime.)

Nebraska

Nebraska voters will see dueling abortion amendments on their November ballots. Initiative 434 restricts abortion rights, banning the procedure after 12 weeks of pregnancy with limited exceptions. That’s essentially the same law already on the state’s books—but the measure would enshrine it as a constitutional amendment, making it much harder to repeal. And because the amendment doesn’t protect abortion before the 12-week mark, state politicians could always go further and pass a complete ban, as Republican Gov. Jim Pillen has pledged to do.

By contrast, Initiative 439 expands abortion rights, creating a “fundamental right to abortion until fetal viability, or when needed to protect the life or health of the pregnant patient.” In practice, the amendment would roughly double the length of time for pregnant people in Nebraska to get an abortion. Crucially, it would block lawmakers from passing a total ban.

If the double initiatives sound confusing, well, that’s the point. Anti-abortion activists have repeatedly tried to muddy the waters about which ballot initiative is which, as Rachel Cohen at Vox has reported. They’ve also tried to get the pro-abortion initiative thrown off the ballot on a technicality, but the Nebraska Supreme Court shot them down.

Given the confusion, it is possible that both measures could pass. In that case, the one with the most votes wins.

Nevada

Nevada, one of the swingiest states in the 2024 election, has its own version of the Equal Rights Amendment, passed by voters in 2022. But it didn’t explicitly mention protections for abortion. Question 6 constitutionally enshrines the right to abortion until fetal viability or for the health or life of the mother, as determined on a case-by-case basis by health care providers. Any pre-viability restrictions must be directly related to promoting the health of the pregnant person and “consistent with accepted clinical standards of practice.” This year’s vote is just the first step in a multiyear process; assuming a simple majority of voters approve it, the measure must be passed again in 2026 to become part of the constitution.

Thanks to a law passed in 1973, abortion has been legal in Nevada until 24 weeks. Because voters passed a referendum on that law in 1990, it can only be changed by a direct ballot measure. Protections for abortion are very popular in Nevada; a University of Maryland poll conducted over the summer found that about 70 percent of state voters oppose criminalizing abortion at any stage of pregnancy. The campaign behind the amendment, Nevadans for Reproductive Freedom, has raised nearly $10 million since January, according to campaign finance reports; the Coalition for Parents and Children PAC, which successfully sued to block an initial version of the amendment that covered reproductive healthcare more broadly, hasn’t raised or spent any money.

New York

New York’s Proposal 1 may not include the word “abortion,” but it would create first-in-the-nation protections for the rights of pregnant people.

The proposal is a broad version of the Equal Rights Amendment, the long-running feminist effort to guarantee women’s rights in state and federal constitutions. Right now, New York’s constitution only forbids government discrimination on the basis of race and religion. Prop 1 adds more protected categories to that list: disability, age, ethnicity, national origin, and sex, including sexual orientation, gender identity, and gender expression. Those types of discrimination are already banned under state law, but by enshrining protections in the constitution, Prop 1 would make them harder for legislators to attack in the future—for example, if New York politics keep trending rightward.

Here’s where abortion comes in: The amendment also bans discrimination based on “pregnancy status, pregnancy outcomes, and reproductive health care and autonomy.” Not only does that definition go farther than any other state, it leaves little room for judges to interpret in ways that might limit abortion access, according to Katharine Bodde, of the New York Civil Liberties Union.

Yet while New York Democrats initially viewed Prop 1 as a surefire way to boost voter turnout, their right-wing opponents have seized on transphobic messaging to great effect—making this blue-state fight unexpectedly close.

South Dakota

South Dakota’s current abortion ban is one of the most extreme in the country, with all abortions banned except when needed to save a pregnant person’s life. Amendment G, backed by a group called Dakotans for Health, would replace that law with a trimester-based system allowing increasing restrictions on abortion as a pregnancy progresses.  

In the first trimester, the state would be banned from interfering with “a woman’s abortion decision and its effectuation.” In the second trimester, the state could restrict abortion in ways “reasonably related to the physical health of the pregnant woman.” Third-trimester abortions could be banned, except when necessary to preserve a pregnant person’s life or health. The amendment needs a simple majority to pass.

Planned Parenthood and other abortion-rights groups aren’t supporting Amendment G, which they’ve said doesn’t go far enough. But the conservative Republicans who dominate state politics are still so terrified of the measure that they passed an emergency law to let voters revoke their petition signatures—then opponents of the measure led a phone banking effort to dupe signers into pulling their support. Why are state Republicans spooked? “If you can do it in South Dakota, it will strike fear into the hearts of every red-state legislature in the country,” Dakotans for Health co-founder Adam Weiland told the American Prospect.

Madison Pauly, Abby Vesoulis, Julianne McShane, and Nina Martin contributed reporting. This is a developing story. Check back for updates.

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Top image photo credits: Octavio Jones/AFP/Getty; RJ Sangosti/The Denver Post/Getty; William Campbell/Getty; Rachel Aston/Las Vegas Review-Journal/Getty; Getty(3)

In late August, on the fringes of a press conference outside New York City Hall, a man wearing a “Kill your local pedophile” T-shirt and a “Babies Lives Matter” pin screamed at a transgender woman who had shown up to protest the speeches. “Is it a boy or a girl?” the man yelled at the protester, gripping a rainbow Trump flag in his fists. “She shaves her armpits, so it must be a man,” he spat, cursing and hurling epithets. 

On the podium, the transphobic messaging was less vile but no less overt. Speakers were urging the small crowd to vote against Proposal 1, a measure on the November ballot that would strengthen protections for abortion in New York state—and much more. Prop 1 is a statewide version of the Equal Rights Amendment (ERA), the 101-year-old feminist effort to guarantee equal rights for women in the US Constitution. While the federal ERA has been largely stalled since the 1970s, many states have adopted their own versions. New York’s constitution, however, currently bans discrimination based only on race and religion, not sex. That could change if voters accept Prop 1’s expansive vision of equality, which includes protections for segments of the population that historically have been marginalized and demonized, including LGBTQ people.

In a year in which support for abortion rights could determine control of statehouses, Congress, and the presidency, Prop 1 seemed like a shoo-in, especially in the blue state of New York. Yet with a little over a month before the election, the effort to pass the New York ERA has been stumbling. An opposition campaign, calling itself the Coalition to Protect Kids, has fixated on the amendment’s protections for trans people, exaggerating its impact on women’s sports and pushing misleading claims about its effects on parental rights. “By solidifying new constitutional rights based on gender identity, Prop 1 is sacrificing the rights of girls,” Amaya Perez, the New York chapter leader of Gays Against Groomers, a right-wing group known for pushing extremist anti-LBGTQ narratives, said at the press conference. 

Those tactics appear to be working. Leaked polling from the pro-Prop 1 campaign shows that voters find the opposition’s messages extremely persuasive. Months ago, Democrats saw the amendment as a means of motivating liberal turnout in November. Now, state Democratic politics are in a precarious state following the indictment of New York Mayor Eric Adams, and Republican candidates are turning the tables, using opposition to Prop 1 as a rallying cry for their own voters.

“They’re trying to use [trans rights] as a wedge issue,” says Faris Ilyas, policy counsel at the New Pride Agenda, an LGBTQ rights group supporting Prop 1. “Even in New York, it’s a working strategy. We’re a little bit scared of what might happen in November.”

It’s an old trick in conservative politics to argue that equal rights are bad for women. The federal ERA, which says equal rights cannot be denied “on account of sex,” was first drafted by leaders of the women’s suffrage movement in 1923 and introduced in every session of Congress for the next five decades. After it finally passed both the House and Senate in 1972, the next step was to go to the states: An amendment must be ratified by three-quarters of state legislatures before it can be added to the US Constitution. But conservative lawyer Phyllis Schlafly mounted a successful guerrilla campaign claiming the amendment would erase all differences between men and women in the law, thus forcing women into military combat, permitting same-sex marriage, and allowing men to use women’s restrooms. The ERA failed to reach the ratification threshold within the seven-year deadline, though efforts to revive and certify it continue.

Even without the ERA, Schlafly’s predictions have more or less come true: The culture already was shifting toward the kinds of gender equality the amendment attempted to codify. Yet her arguments still hold power. Warnings about mixed-gender bathrooms were used to defeat Houston’s Equal Rights Ordinance in 2015—around the same time conservative legal and political organizations, including the Schlafly-founded Eagle Forum, began whipping up the contemporary anti-trans panic, starting with bills restricting trans students’ bathroom access.

The version of the ERA that will appear on New York ballots doesn’t include the word “abortion,” but it was designed first and foremost to protect the right to choose. The effort started in 2019, when Democrats took control of the state Senate for the first time in a decade. They swiftly passed the Reproductive Health Act, removing abortion from New York’s criminal code—where it had been largely forgotten during the Roe v. Wade era—and protecting access to the procedure through 24 weeks’ gestation. (The new law also allowed abortion later in pregnancy if the fetus was not viable or if the pregnant person’s life or health was in danger.) But soon after, state Sen. Liz Krueger of Manhattan, who had spent a decade shepherding the new law, decided the work wasn’t done. “I realized, nope, not good enough,” Krueger says. “We’ve got to actually start to open up our constitution and modernize it.”

With the confirmation of Justice Brett Kavanaugh to the US Supreme Court in 2018, anti-abortion strategists finally had the far-right majority they needed to overturn Roe. “We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law,” Krueger says. If New York enshrined abortion rights in the state constitution, she figured, those protections would be harder to repeal if the political winds eventually shifted.

So Krueger and Assembly Member Rebecca Seawright, also from Manhattan, convened scholars and reproductive law experts to craft an amendment. Rather than simply writing protections for abortion seekers into the constitution, they decided to swing for the fences: a measure modeled on the federal ERA but even broader. In addition to existing protections for race, color, and religion, Prop 1 would ban government discrimination based on disability, age, ethnicity, national origin, and sex—including sexual orientation, gender identity, and gender expression. The resulting amendment, now known as Prop 1, would make New York’s anti-discrimination protections the “most extensive” in the nation, says Ting Ting Cheng, director of the ERA Project at Columbia Law School, who consulted with the drafters. 

“We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law.”

There are nine other abortion rights ballot initiatives across the country this year, but when it comes to reproductive rights, New York’s ERA is unique. While most of the other measures essentially restore Roe, New York’s approaches abortion “as a matter of gender equality,” says Katharine Bodde, policy co-director of the New York Civil Liberties Union, one of the amendment’s chief backers. To accomplish this, it explicitly says discrimination based on pregnancy status, pregnancy outcomes, and reproductive health care and autonomy count as “sex discrimination” and are forbidden. The idea is to leave little room for judges to interpret the ERA in ways that wouldn’t protect abortion rights or pregnant people in the future. After all, courts have wide latitude to interpret ambiguous language, and they sometimes reconsider their old interpretations—as the US Supreme Court did when it reversed Roe. This past spring, Florida’s Supreme Court overturned a prior decision that said the state constitution protected abortion—after being stacked with judges appointed by Republican Gov. Ron DeSantis. And the Iowa Supreme Court has upheld a six-week abortion ban despite the state’s ERA, which broadly enshrines gender equality but doesn’t get into specifics. “We’re taking no chances in New York with courts interpreting ‘sex discrimination’ narrowly,” Bodde says. 

That scares abortion opponents. New York’s Catholic bishops told their 35,000 mailing list subscribers in September that Prop 1 would “permanently legalize abortion without restriction” and “render impossible any change to the law if the hearts and minds of New Yorkers were ever to shift toward protecting the child in the womb.”

Prop 1 follows an ERA in Nevada two years ago, which passed with 58 percent of the vote after being pitched to the state’s fiercely independent residents as a means of protecting individual liberty. The Nevada ERA overcame opposition from anti-abortion forces—including the religious-right legal firm Alliance Defending Freedom—which predicted that the measure would void Nevada’s ban on Medicaid coverage for abortion. (It was right.) Next up: An expansive ERA is slated for the 2026 ballot in Minnesota, and another is on the table in Oregon. “It’s incremental,” Cheng says. “Every state that does something new, it creates a new bar or a new precedent for other states to go beyond that.”

These amendments work in two ways. First, they harden the state’s existing constellation of anti-discrimination laws by adding them to the state constitution. And second, they give individuals strong constitutional grounds to challenge discrimination by the government. In New York, Prop 1’s  protections for different “pregnancy outcomes” might be used to defend women from criminal prosecution after self-managed abortions or losing a pregnancy in a car accident—both of which have happened in New York, says Dana Sussman, senior vice president of Pregnancy Justice, a nonprofit legal advocacy group. And it might be used to challenge state hospitals that drug test pregnant women, sometimes without their knowledge or consent—policies that can lead to child protection cases and family separation.

Other activists hope the ERA could be used to overturn the state’s 24-week gestational limit, which forces some New Yorkers to travel out of state if—for one of the many reasons women can face delays in accessing care—they need a later abortion. Randi Gregory, vice president of political and legislative affairs at the National Institute for Reproductive Health Action Fund, believes Prop 1 would protect abortion rights “at all trimesters.” “We hope that it will be a framework for other states,” Gregory adds. “We’re really excited to be running an expansive and proactive amendment.”

But that’s only if they can get it passed—a task that looks increasingly daunting.

The coalition behind Prop 1 made big promises in June 2023, after New York Democrats’ embarrassing showing in the 2022 election. Their losses had helped flip control of the US House of Representatives back to the GOP, while former US Rep. Lee Zeldin, an anti-abortion Republican, came within 6 points of winning the governorship.

State Democrats evidently had an excitement problem—one they hoped the ERA could solve. Gov. Kathy Hochul and Sen. Kirsten Gillibrand told the New York Times that they wanted to use the amendment to motivate 2024 turnout. Progressive groups formed New Yorkers for Equal Rights, a committee that pledged to spend $20 million ginning up enthusiasm.

Yet in early September, Politico reported that the committee had raised less than $3 million to counter an opposition that had proven surprisingly well-organized and effective. Suddenly, Democrats were afraid of how Prop 1 might affect their candidates in tight races. In the ensuing scramble, Hochul announced $1 million for TV ads and direct mail and issued a statement: “It’s critical voters know that an abortion amendment is on the ballot in New York this year,” she said. “New Yorkers deserve the freedom to control their own lives and health care decisions, including the right to abortion regardless of who’s in office.”

The opposition campaign, the Coalition to Protect Kids, is largely funded by an upstate anti-abortion activist, Carol Crossed, who is vice president of Feminists Choosing Life of New York. Yet it has leaned heavily on anti-trans rhetoric, arguing the amendment would increase trans people’s access to girls’ sports, women’s bathrooms, and gender-affirming medical care—and that these things would be dangerous. “Anti-abortion extremists are pushing a harmful and cruel agenda,” says Sasha Ahuja, campaign director for New Yorkers for Equal Rights. “They’re lying about a small handful of innocent kids to divide New Yorkers and distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

“They’re lying . . . [to] distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

According to New York politics magazine City & State, internal polling shared with ERA proponents in late August found that 64 percent of voters would definitely, likely, or lean toward voting yes on the amendment when presented with its ballot language. But support plummeted by 24 percentage points after voters heard an attack message focused on girls’ sports, transgender protections, and immigration. (Another blatant lie spread by opponents is that Prop 1 would allow undocumented immigrants to vote.)

Ilyas believes the anti-trans messaging gains credence because many voters don’t have personal experience or relationships with trans people. “When you don’t know a trans person, you have this well-funded messaging at you, and people that you trust are saying the same exact thing and reiterating it, it makes sense for even the average New Yorker who’s middle of the road to believe it,” Ilyas says.

Anti-trans attacks have become a go-to strategy for conservative groups fighting abortion rights ballot initiatives. Opponents to Ohio’s abortion rights measure last year claimed it would permit minors to undergo gender-affirming surgery “without parents’ knowledge or consent” and dubbed it an “anti-parent amendment.” (Such surgeries for minors are very rare, and consent from parents or guardians is required.) In Missouri, a last-ditch lawsuit in September tried to block an abortion rights measure from this fall’s ballot by arguing that it might affect laws around single-sex bathrooms and that the voter petition should have disclosed that. (The state Supreme Court didn’t buy it.)

In New York, Prop 1 supporters have repeatedly pointed out that the amendment says nothing directly about trans participation in sports. In fact, trans inclusion in sports is already New York’s status quo, thanks to existing anti-discrimination laws and a state policy allowing trans students to participate on sports teams matching their gender identity. But like Phyllis Schlafly, Prop 1’s opponents love a dire warning: Lawn signs saying, “Save Girls Sports, Vote No Prop 1,” have become a regular sight in some areas. Republican politicians have been picking up on the theme, including Zeldin, the former congressman, and Gina Arena, a GOP candidate for the state Senate from the lower Hudson Valley.

On Long Island, Nassau County Executive Bruce Blakeman and the Republican-dominated county legislature passed a law this past summer blocking permits for women’s sports teams that include trans women, preventing them from using more than 100 county-run parks and athletics facilities. In response, the New York Civil Liberties Union sued the county on behalf of a women’s roller derby league, citing existing New York civil and human rights laws that forbid discrimination based on gender identity, sex, and disability. If the ERA was in the state constitution, lawyers for the league would doubtless argue that Nassau County had violated it as well. “Transgender athletes have been competing and allowed to compete in the state for a really long time now,” Cheng says. “That’s not going to change because of the ERA.”

“Transgender athletes have been competing and allowed to compete in the state for a really long time now. That’s not going to change because of the ERA.”

Still, uncertainty around which laws the ERA might challenge has been a boon to opponents. On its website, the Coalition to Protect Kids claims that banning age discrimination, for instance, would gut laws governing the drinking age, statutory rape, and parental consent for minors to receive medical treatments—especially gender-affirming care. Bodde dismisses these arguments as “misinformation” meant to “stir fear.” Courts have been clear that constitutional rights apply differently to minors and adults, she says, even despite laws forbidding age discrimination. “The state has long been able to create different rules when it comes to young people, whether that’s ensuring a certain age before people can learn how to drive or vote or purchase alcohol.”

But fear and confusion are powerful tools. Prop 1’s opponents have dubbed the ERA the “Parent Replacement Act.” On social media, the Coalition to Protect Kids has repeatedly cited the American College of Pediatricians, a misleadingly named fringe group of anti-LGBTQ doctors whose frequent declarations against gender-affirming care run counter to the conclusions of dozens of major medical associations. Sometimes the claims slip into self-parody: “If Prop One passes…children will mutilate themselves without the benefit of parental guidance,” reads a mailer sent to voters by the New York Republican State Committee. 

For Ilyas, who is transmasculine, the extremist rhetoric feels very personal—and deeply worrisome. “People don’t think that it could happen in New York, just because it’s New York,” Ilyas says. “These people do exist in New York, and they just maybe haven’t had an outlet.”

In late August, on the fringes of a press conference outside New York City Hall, a man wearing a “Kill your local pedophile” T-shirt and a “Babies Lives Matter” pin screamed at a transgender woman who had shown up to protest the speeches. “Is it a boy or a girl?” the man yelled at the protester, gripping a rainbow Trump flag in his fists. “She shaves her armpits, so it must be a man,” he spat, cursing and hurling epithets. 

On the podium, the transphobic messaging was less vile but no less overt. Speakers were urging the small crowd to vote against Proposal 1, a measure on the November ballot that would strengthen protections for abortion in New York state—and much more. Prop 1 is a statewide version of the Equal Rights Amendment (ERA), the 101-year-old feminist effort to guarantee equal rights for women in the US Constitution. While the federal ERA has been largely stalled since the 1970s, many states have adopted their own versions. New York’s constitution, however, currently bans discrimination based only on race and religion, not sex. That could change if voters accept Prop 1’s expansive vision of equality, which includes protections for segments of the population that historically have been marginalized and demonized, including LGBTQ people.

In a year in which support for abortion rights could determine control of statehouses, Congress, and the presidency, Prop 1 seemed like a shoo-in, especially in the blue state of New York. Yet with a little over a month before the election, the effort to pass the New York ERA has been stumbling. An opposition campaign, calling itself the Coalition to Protect Kids, has fixated on the amendment’s protections for trans people, exaggerating its impact on women’s sports and pushing misleading claims about its effects on parental rights. “By solidifying new constitutional rights based on gender identity, Prop 1 is sacrificing the rights of girls,” Amaya Perez, the New York chapter leader of Gays Against Groomers, a right-wing group known for pushing extremist anti-LBGTQ narratives, said at the press conference. 

Those tactics appear to be working. Leaked polling from the pro-Prop 1 campaign shows that voters find the opposition’s messages extremely persuasive. Months ago, Democrats saw the amendment as a means of motivating liberal turnout in November. Now, state Democratic politics are in a precarious state following the indictment of New York Mayor Eric Adams, and Republican candidates are turning the tables, using opposition to Prop 1 as a rallying cry for their own voters.

“They’re trying to use [trans rights] as a wedge issue,” says Faris Ilyas, policy counsel at the New Pride Agenda, an LGBTQ rights group supporting Prop 1. “Even in New York, it’s a working strategy. We’re a little bit scared of what might happen in November.”

It’s an old trick in conservative politics to argue that equal rights are bad for women. The federal ERA, which says equal rights cannot be denied “on account of sex,” was first drafted by leaders of the women’s suffrage movement in 1923 and introduced in every session of Congress for the next five decades. After it finally passed both the House and Senate in 1972, the next step was to go to the states: An amendment must be ratified by three-quarters of state legislatures before it can be added to the US Constitution. But conservative lawyer Phyllis Schlafly mounted a successful guerrilla campaign claiming the amendment would erase all differences between men and women in the law, thus forcing women into military combat, permitting same-sex marriage, and allowing men to use women’s restrooms. The ERA failed to reach the ratification threshold within the seven-year deadline, though efforts to revive and certify it continue.

Even without the ERA, Schlafly’s predictions have more or less come true: The culture already was shifting toward the kinds of gender equality the amendment attempted to codify. Yet her arguments still hold power. Warnings about mixed-gender bathrooms were used to defeat Houston’s Equal Rights Ordinance in 2015—around the same time conservative legal and political organizations, including the Schlafly-founded Eagle Forum, began whipping up the contemporary anti-trans panic, starting with bills restricting trans students’ bathroom access.

The version of the ERA that will appear on New York ballots doesn’t include the word “abortion,” but it was designed first and foremost to protect the right to choose. The effort started in 2019, when Democrats took control of the state Senate for the first time in a decade. They swiftly passed the Reproductive Health Act, removing abortion from New York’s criminal code—where it had been largely forgotten during the Roe v. Wade era—and protecting access to the procedure through 24 weeks’ gestation. (The new law also allowed abortion later in pregnancy if the fetus was not viable or if the pregnant person’s life or health was in danger.) But soon after, state Sen. Liz Krueger of Manhattan, who had spent a decade shepherding the new law, decided the work wasn’t done. “I realized, nope, not good enough,” Krueger says. “We’ve got to actually start to open up our constitution and modernize it.”

With the confirmation of Justice Brett Kavanaugh to the US Supreme Court in 2018, anti-abortion strategists finally had the far-right majority they needed to overturn Roe. “We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law,” Krueger says. If New York enshrined abortion rights in the state constitution, she figured, those protections would be harder to repeal if the political winds eventually shifted.

So Krueger and Assembly Member Rebecca Seawright, also from Manhattan, convened scholars and reproductive law experts to craft an amendment. Rather than simply writing protections for abortion seekers into the constitution, they decided to swing for the fences: a measure modeled on the federal ERA but even broader. In addition to existing protections for race, color, and religion, Prop 1 would ban government discrimination based on disability, age, ethnicity, national origin, and sex—including sexual orientation, gender identity, and gender expression. The resulting amendment, now known as Prop 1, would make New York’s anti-discrimination protections the “most extensive” in the nation, says Ting Ting Cheng, director of the ERA Project at Columbia Law School, who consulted with the drafters. 

“We were basically a pro-choice blue state with people not really understanding how at risk we were from bad law.”

There are nine other abortion rights ballot initiatives across the country this year, but when it comes to reproductive rights, New York’s ERA is unique. While most of the other measures essentially restore Roe, New York’s approaches abortion “as a matter of gender equality,” says Katharine Bodde, policy co-director of the New York Civil Liberties Union, one of the amendment’s chief backers. To accomplish this, it explicitly says discrimination based on pregnancy status, pregnancy outcomes, and reproductive health care and autonomy count as “sex discrimination” and are forbidden. The idea is to leave little room for judges to interpret the ERA in ways that wouldn’t protect abortion rights or pregnant people in the future. After all, courts have wide latitude to interpret ambiguous language, and they sometimes reconsider their old interpretations—as the US Supreme Court did when it reversed Roe. This past spring, Florida’s Supreme Court overturned a prior decision that said the state constitution protected abortion—after being stacked with judges appointed by Republican Gov. Ron DeSantis. And the Iowa Supreme Court has upheld a six-week abortion ban despite the state’s ERA, which broadly enshrines gender equality but doesn’t get into specifics. “We’re taking no chances in New York with courts interpreting ‘sex discrimination’ narrowly,” Bodde says. 

That scares abortion opponents. New York’s Catholic bishops told their 35,000 mailing list subscribers in September that Prop 1 would “permanently legalize abortion without restriction” and “render impossible any change to the law if the hearts and minds of New Yorkers were ever to shift toward protecting the child in the womb.”

Prop 1 follows an ERA in Nevada two years ago, which passed with 58 percent of the vote after being pitched to the state’s fiercely independent residents as a means of protecting individual liberty. The Nevada ERA overcame opposition from anti-abortion forces—including the religious-right legal firm Alliance Defending Freedom—which predicted that the measure would void Nevada’s ban on Medicaid coverage for abortion. (It was right.) Next up: An expansive ERA is slated for the 2026 ballot in Minnesota, and another is on the table in Oregon. “It’s incremental,” Cheng says. “Every state that does something new, it creates a new bar or a new precedent for other states to go beyond that.”

These amendments work in two ways. First, they harden the state’s existing constellation of anti-discrimination laws by adding them to the state constitution. And second, they give individuals strong constitutional grounds to challenge discrimination by the government. In New York, Prop 1’s  protections for different “pregnancy outcomes” might be used to defend women from criminal prosecution after self-managed abortions or losing a pregnancy in a car accident—both of which have happened in New York, says Dana Sussman, senior vice president of Pregnancy Justice, a nonprofit legal advocacy group. And it might be used to challenge state hospitals that drug test pregnant women, sometimes without their knowledge or consent—policies that can lead to child protection cases and family separation.

Other activists hope the ERA could be used to overturn the state’s 24-week gestational limit, which forces some New Yorkers to travel out of state if—for one of the many reasons women can face delays in accessing care—they need a later abortion. Randi Gregory, vice president of political and legislative affairs at the National Institute for Reproductive Health Action Fund, believes Prop 1 would protect abortion rights “at all trimesters.” “We hope that it will be a framework for other states,” Gregory adds. “We’re really excited to be running an expansive and proactive amendment.”

But that’s only if they can get it passed—a task that looks increasingly daunting.

The coalition behind Prop 1 made big promises in June 2023, after New York Democrats’ embarrassing showing in the 2022 election. Their losses had helped flip control of the US House of Representatives back to the GOP, while former US Rep. Lee Zeldin, an anti-abortion Republican, came within 6 points of winning the governorship.

State Democrats evidently had an excitement problem—one they hoped the ERA could solve. Gov. Kathy Hochul and Sen. Kirsten Gillibrand told the New York Times that they wanted to use the amendment to motivate 2024 turnout. Progressive groups formed New Yorkers for Equal Rights, a committee that pledged to spend $20 million ginning up enthusiasm.

Yet in early September, Politico reported that the committee had raised less than $3 million to counter an opposition that had proven surprisingly well-organized and effective. Suddenly, Democrats were afraid of how Prop 1 might affect their candidates in tight races. In the ensuing scramble, Hochul announced $1 million for TV ads and direct mail and issued a statement: “It’s critical voters know that an abortion amendment is on the ballot in New York this year,” she said. “New Yorkers deserve the freedom to control their own lives and health care decisions, including the right to abortion regardless of who’s in office.”

The opposition campaign, the Coalition to Protect Kids, is largely funded by an upstate anti-abortion activist, Carol Crossed, who is vice president of Feminists Choosing Life of New York. Yet it has leaned heavily on anti-trans rhetoric, arguing the amendment would increase trans people’s access to girls’ sports, women’s bathrooms, and gender-affirming medical care—and that these things would be dangerous. “Anti-abortion extremists are pushing a harmful and cruel agenda,” says Sasha Ahuja, campaign director for New Yorkers for Equal Rights. “They’re lying about a small handful of innocent kids to divide New Yorkers and distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

“They’re lying . . . [to] distract us from what this amendment is actually about: protecting the right to abortion, guaranteeing our personal freedoms, and protecting all of us against government discrimination.”

According to New York politics magazine City & State, internal polling shared with ERA proponents in late August found that 64 percent of voters would definitely, likely, or lean toward voting yes on the amendment when presented with its ballot language. But support plummeted by 24 percentage points after voters heard an attack message focused on girls’ sports, transgender protections, and immigration. (Another blatant lie spread by opponents is that Prop 1 would allow undocumented immigrants to vote.)

Ilyas believes the anti-trans messaging gains credence because many voters don’t have personal experience or relationships with trans people. “When you don’t know a trans person, you have this well-funded messaging at you, and people that you trust are saying the same exact thing and reiterating it, it makes sense for even the average New Yorker who’s middle of the road to believe it,” Ilyas says.

Anti-trans attacks have become a go-to strategy for conservative groups fighting abortion rights ballot initiatives. Opponents to Ohio’s abortion rights measure last year claimed it would permit minors to undergo gender-affirming surgery “without parents’ knowledge or consent” and dubbed it an “anti-parent amendment.” (Such surgeries for minors are very rare, and consent from parents or guardians is required.) In Missouri, a last-ditch lawsuit in September tried to block an abortion rights measure from this fall’s ballot by arguing that it might affect laws around single-sex bathrooms and that the voter petition should have disclosed that. (The state Supreme Court didn’t buy it.)

In New York, Prop 1 supporters have repeatedly pointed out that the amendment says nothing directly about trans participation in sports. In fact, trans inclusion in sports is already New York’s status quo, thanks to existing anti-discrimination laws and a state policy allowing trans students to participate on sports teams matching their gender identity. But like Phyllis Schlafly, Prop 1’s opponents love a dire warning: Lawn signs saying, “Save Girls Sports, Vote No Prop 1,” have become a regular sight in some areas. Republican politicians have been picking up on the theme, including Zeldin, the former congressman, and Gina Arena, a GOP candidate for the state Senate from the lower Hudson Valley.

On Long Island, Nassau County Executive Bruce Blakeman and the Republican-dominated county legislature passed a law this past summer blocking permits for women’s sports teams that include trans women, preventing them from using more than 100 county-run parks and athletics facilities. In response, the New York Civil Liberties Union sued the county on behalf of a women’s roller derby league, citing existing New York civil and human rights laws that forbid discrimination based on gender identity, sex, and disability. If the ERA was in the state constitution, lawyers for the league would doubtless argue that Nassau County had violated it as well. “Transgender athletes have been competing and allowed to compete in the state for a really long time now,” Cheng says. “That’s not going to change because of the ERA.”

“Transgender athletes have been competing and allowed to compete in the state for a really long time now. That’s not going to change because of the ERA.”

Still, uncertainty around which laws the ERA might challenge has been a boon to opponents. On its website, the Coalition to Protect Kids claims that banning age discrimination, for instance, would gut laws governing the drinking age, statutory rape, and parental consent for minors to receive medical treatments—especially gender-affirming care. Bodde dismisses these arguments as “misinformation” meant to “stir fear.” Courts have been clear that constitutional rights apply differently to minors and adults, she says, even despite laws forbidding age discrimination. “The state has long been able to create different rules when it comes to young people, whether that’s ensuring a certain age before people can learn how to drive or vote or purchase alcohol.”

But fear and confusion are powerful tools. Prop 1’s opponents have dubbed the ERA the “Parent Replacement Act.” On social media, the Coalition to Protect Kids has repeatedly cited the American College of Pediatricians, a misleadingly named fringe group of anti-LGBTQ doctors whose frequent declarations against gender-affirming care run counter to the conclusions of dozens of major medical associations. Sometimes the claims slip into self-parody: “If Prop One passes…children will mutilate themselves without the benefit of parental guidance,” reads a mailer sent to voters by the New York Republican State Committee. 

For Ilyas, who is transmasculine, the extremist rhetoric feels very personal—and deeply worrisome. “People don’t think that it could happen in New York, just because it’s New York,” Ilyas says. “These people do exist in New York, and they just maybe haven’t had an outlet.”

Vice President Kamala Harris has lost no time blaming former President Donald Trump for the death of a single mother in Georgia after hospital doctors, working under the constraints of an abortion ban, delayed treating her catastrophic infection.

The story of Amber Nicole Thurman’s death in August 2022—and its connection to the six-week abortion ban enacted in Georgia the month before she died—was first reported by ProPublica’s Kavitha Surana. While doctors, patients, and reproductive justice advocates have long warned that abortion bans were causing profound disruptions and delays in healthcare for pregnant women, Thurman’s is the first death to come to public attention.

“This young mother should be alive, raising her son, and pursuing her dream of attending nursing school,” Harris said in a statement reported by the Associated Press. “Women are bleeding out in parking lots, turned away from emergency rooms, losing their ability to ever have children again. Survivors of rape and incest are being told they cannot make decisions about what happens next to their bodies. And now women are dying.”

“This young mother should be alive, raising her son, and pursuing her dream of attending nursing school.”

“These are the consequences of Donald Trump’s actions,” Harris added.

Later on Tuesday, during a interview moderated by the National Association of Black Journalists and WHYY public radio station in Philadelphia, Harris once again drew a link between Thurman’s death and Trump. “Over 20 states have passed what I call ‘Trump abortion bans,’ because I understand how we got here,” Harris told an audience of journalism students from historically Black colleges and universities. “The former president handpicked three members of the United States Supreme Court with the intention they would undo the protections of Roe v. Wade. They did as he intended, and in state after state, laws have been passed criminalizing health care providers.”

The doctors who delayed Thurman’s care were operating under these laws, Harris pointed out. “It appears the people who should have given her health care were afraid they’d be criminalized after the Dobbs decision came down,” she said.

According to ProPublica, Georgia’s ban on abortions after six weeks affected Thurman in multiple ways. When Thurman discovered she was pregnant with twins in July 2022, she was just over the gestational limit. Because the 28-year-old medical assistant could not get an abortion near where she lived, she had to drive four hours with a friend to North Carolina. Then, stuck in traffic, she missed her appointment for a surgical abortion using a technique called dilation and curettage (D&C), so the clinic instead gave her medication to end her pregnancy and sent her home. The distance meant that days later, when Thurman began experiencing a rare complication from the medication abortion—her body hadn’t expelled all the fetal tissue, putting her at risk of a dangerous infection—she couldn’t go back to the provider for a free D&C. Only when her condition deteriorated did she end up going to a hospital outside Atlanta.

There, her blood pressure falling and organs failing, Thurman was diagnosed with “acute severe sepsis.” But physicians waited 20 hours to operate. The hospital and doctors did not respond to ProPublica’s requests for comment. But the delays mirror many other stories about abortion bans leading to dangerous disruptions in pregnancy care since the Supreme Court overturned Roe. Physicians afraid of being prosecuted have raised alarms about the laws’ hard-to-interpret exceptions: How close to death does a pregnant patient have to be in order for them to perform emergency abortion?

Thurman ultimately died in the operating room. A Georgia state committee tasked with reviewing maternal deaths found that the delay in providing the D&C had a “large” impact on her death, and they deemed it “preventable,” according to ProPublica.

Harris’ attention to Thurman’s story is no surprise given her reputation as a forceful defender of abortion rights on the campaign trail and in her debate against Trump. But her attention to pregnancy-related deaths—which are far more common in the United States than in other high-income countries—dates back years. In the Senate, Harris focused on reducing maternal mortality for Black women like Thurman, who are 2.6 times more likely to die of pregnancy-related causes than white women, according to 2022 CDC data. In 2018, she sponsored a resolution recognizing “Black Maternal Health Week” and introduced the Maternal CARE Act to create a grant program to address racial bias in obstetrics and gynecology. As vice president, she pushed efforts to expand postpartum Medicaid coverage from 60 days to 12 months.

“For years, I have worked to make sure our country treats maternal mortality as the national crisis it is,” Harris wrote in 2022, prefacing a 50-point plan to use government agencies to lower maternal deaths. “I am proud to lead our Administration’s efforts to address this issue.”

Reproductive justice advocates have been warning for more than two years that the end of Roe v. Wade would lead to surge in maternal mortality among patients denied abortion care—and that the increase was likely to be greatest among low-income women of color. Now, a new report by ProPublica has uncovered the first such verified death. A 28-year-old medical assistant and Black single mother in Georgia died from a severe infection after a hospital delayed a routine medical procedure that had been outlawed under that state’s six-week abortion ban.

Amber Nicole Thurman’s death, in August 2022, was officially deemed “preventable” by a state committee tasked with reviewing pregnancy-related deaths. Thurman’s case is the first time a preventable abortion-related death has come to public attention since the Supreme Court overturned Roe, ProPublica‘s Kavitha Surana reported.

Now, “we actually have the substantiated proof of something we already knew—that abortion bans kill people.”

Now, “we actually have the substantiated proof of something we already knew—that abortion bans kill people,” said Mini Timmaraju, president of the abortion-rights group Reproductive Freedom for All, during a call with media. “It cannot go on.”

Thurman is almost certainly not the only person to have died as a consequence of an abortion ban, even if her case is the first to be officially confirmed. As ProPublica noted, that’s because investigations of maternal deaths often don’t happen until years later:

Committees like the one in Georgia, set up in each state, often operate with a two-year lag behind the cases they examine, meaning that experts are only now beginning to delve into deaths that took place after the Supreme Court overturned the federal right to abortion.

Earlier this year, the New Yorker reported on the story of Yeniifer Alvarez-Estrada Glick, a 29-year-old woman in Texas who died in July 2022 from complications of a high-risk pregnancy. In that case, medical records did “not suggest any discussion of the fact that an abortion could have alleviated the additional strain that the pregnancy placed on her heart,” the New Yorker reported.

According to ProPublica, Thurman had decided to get an abortion after learning she was pregnant with twins. But the very day she passed the six-week mark of her pregnancy, Georgia implemented a ban forbidding abortion after six weeks’ gestation—as the Supreme Court allowed states to do when it overturned Roe earlier that summer. So Thurman traveled four hours to an abortion clinic in North Carolina, where abortions were then allowed past 20 weeks. There she was given mifepristone and misoprostol, a two-drug regimen used to end pregnancies.

A few days after she took the pills, Thurman’s pain became excruciating, and she was bleeding through a pad every hour. Complications from abortion pills are rare, but sometimes patients require a procedure called dilation and curettage, or D&C, to remove remaining fetal tissue from the uterus that could lead to life-threatening sepsis. The North Carolina clinic would have performed the D&C for free if Thurman lived closer, ProPublica said. Instead, after vomiting blood and passing out at home, Thurman was brought to the hospital in the Atlanta suburbs, where doctors noted signs of an infection. According to ProPublica,

The standard treatment of sepsis is to start antibiotics and immediately seek and remove the source of the infection. For a septic abortion, that would include removing any remaining tissue from the uterus. One of the hospital network’s own practices describes a D&C as a “fairly common, minor surgical procedure” to be used after a miscarriage to remove fetal tissue.

But because D&Cs can be used to perform abortions, physicians operating under an abortion ban can be slow to provide them even for miscarriages and other emergency situations, as illustrated in a recent report on post-Roe disruptions to pregnancy care in Louisiana. Not until 2 p.m. the day after Thruman entered the hospital was she brought for surgery. She died in the operating room. The Georgia maternal mortality review committee found that if a D&C had been performed earlier, there was a “good chance” her death could have been prevented, ProPublica reports.

“These devastating bans did not only block Amber, and many others, from accessing abortion care in her state, they also delayed the routine life-saving care she later needed, leaving her to suffer and die,” Timmaraju said during the press call on Monday.

While every state abortion ban contains exceptions to save the life of the pregnant person, uncertainty among medical providers over exactly when doctors can step in without fear of being prosecuted has led to delays in medical care for pregnant woman across the country, with devastating consequences.

On the call with reporters, leaders of reproductive justice organizations pointed to the way bans and delays in emergency medical care for pregnant people disproportionately impact Black women. Black women are about 2.6 times more likely to die from a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention.

“Reproductive justice is not just about abortion access, but also about the broader right to quality, comprehensive, full-range, culturally humble care, life saving health care for all of us,” said KR Redman, executive director of SPARK, a reproductive justice group in Georgia. “Amber’s case is just an example of the ongoing systemic negligence that continues to claim the lives of Black folks.”

More than two years since the overturn of Roe v Wade, legal battles over abortion laws are as chaotic as ever. But occasionally, the challenges playing out state by state result in a string of good news for abortion rights. That was the case this week, with a cluster of court decisions that will expand abortion access in Nevada and North Dakota, and allow Missouri and Nebraska voters to weigh in on the issue in November.

On Thursday, District Court Judge Bruce Romanick in Bismarck, North Dakota, issued a powerful opinion siding with abortion providers who challenged a state law that had deemed their practice a felony.

In his order, which takes effect in two weeks, Rominick ruled that the North Dakota constitution’s protections for life, liberty, and the right to pursue happiness include the right to choose abortion. “A woman’s choice of whether or not to carry a pregnancy to term shapes the very nature and future course of her life, on nearly every possible level,” he wrote. “The Court finds that such a choice, at least pre-viability, must belong to the individual woman and not to the government.” He also struck down the ban for its vagueness, concluding that, at present, North Dakota doctors could be prosecuted if other physicians second-guessed their decision to provide an emergency abortion.

Virtually all abortions have been illegal in North Dakota since April 2023, when Republican Gov. Doug Burgum signed a ban with exceptions only to save the life of the pregnant person, or for rape and incest survivors within the first six weeks of pregnancy. North Dakota’s only abortion clinic moved across the state line to Minnesota in 2022, soon after the Supreme Court overturned Roe v. Wade, meaning most people seeking to end a pregnancy will have to leave the state.

But Romnick’s decision should make it easier for doctors to provide emergency abortions to patients with severe pregnancy complications—care that that is often withheld in abortion-ban states, with dire consequences. “It is now much safer to be pregnant in North Dakota,” Center for Reproductive Rights lawyer Meetra Mehdizadeh said in a statement on Friday.

Also on Thursday, a Nevada court order requiring the state Medicaid program to cover abortion became final after the state government declined to appeal an earlier ruling. Nevada will become the 18th state to allow Medicaid funds to cover abortion, the Associated Press reported.

That ruling is the result of a challenge brought under Nevada’s Equal Rights Amendment, which added language banning sex discrimination, along with many other types of discrimination, to the state constitution. Voters there supported the ERA by a nearly 18-point margin in 2022.

In their lawsuit, a Nevada abortion fund and the ACLU argued that the ban on Medicaid coverage amounted to sex discrimination because it denied low-income Nevadans who can become pregnant the ability to make decisions about their future. Back in March, a Clark County District Judge Erika Ballou had agreed—though her decision didn’t become final until this week.

”There was a time when we got it wrong and when women did not have a voice,” one judge wrote. “This does not need to continue for all time.”

“The court made clear that the state cannot withhold coverage for essential, sex-linked health care from low-income Nevadans,” ACLU Reproductive Freedom Project staff attorney Rebecca Chan explained in a statement. “As a result of this decision, Nevadans who have Medicaid as their health insurance will no longer need to fear that they will be forced to carry a pregnancy against their will.”

In November, voters in New York will decide whether to enshrine an ERA of their own—one of 10 states with abortion-related initiatives slated for the 2024 ballot. Yet initiatives in two of those states were in jeopardy until courts came to their rescue this week. On Tuesday, the Missouri Supreme Court threw out a last-minute claim arguing that the text of an abortion-rights initiative petition had omitted details required by state law; it ordered the anti-abortion secretary of state to certify the initiative for the ballot.

On Friday, the Nebraska Supreme Court ruled that dueling initiatives can appear on the ballot in that state, where current law bans abortion after 12 weeks. One of the initiatives, titled “Protect the Right to Abortion,” would create a state constitutional right for Nebraskans to get an abortion prior to “viability” (the hard-to-pinpoint moment in pregnancy when a fetus is able to survive outside the uterus). The other, titled “Protect Women and Children” would enshrine the current 12-week abortion ban in the state constitution.

If both pass, the one with the most votes prevails. But anti-abortion advocates had tried to kill the pro-abortion rights measure altogether by arguing that by regulating abortion before and after viability differently, it dealt with more than one subject, according to the Nebraska Examiner. Friday’s state Supreme Court ruling tossed that challenge, and ensures the vote on both questions will proceed.

Now, with 52 days left before voters will decide whether to add abortion protections to their state constitutions, the opinion from North Dakota’s Judge Rominick could offer some guidance.

“If we can learn anything from examining the history and prior traditions surrounding women’s rights, women’s health, and abortion in North Dakota, the Court hopes that we would learn this: that there was a time when we got it wrong and when women did not have a voice,” Rominick wrote. “This does not need to continue for all time, and the sentiments of the past, alone, need not rule the present for all time.”

When Project 2025 staffer and former Trump White House personnel chief John McEntee tried to score points on social media on Thursday by denying that women were “bleeding out” due to abortion bans, he probably didn’t expect them to reply to him directly.

“Can someone track down the women Kamala Harris said are bleeding out in parking lots because Roe v. Wade was overturned?” McEntee asked in a TikTok video filmed at a restaurant as he dipped fried food into sauce.

“Don’t hold your breath,” he added, smirking.

“I’m right here,” replied Carmen Broesder, a mother living in Idaho, which enacted a trigger law after the fall of Roe, a making it a felony for doctors to provide an abortion unless it was necessary “to prevent the death of the pregnant woman.”

In a TikTok video of her own, Broesder recalled how hospital staff turned her away from the ER three times during an excruciating 19-day miscarriage. She said she was repeatedly denied a procedure to remove tissue from the uterus—a procedure known as dilation and curettage (D&C) that is also used in abortions—and that they gave her just one dose of pain medication in 19 days. “I blacked out in my hallway due to blood loss,” she recounted.

@geekynerdbitchcarmen

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In June, the Supreme Court gave Idaho hospitals the green light to perform emergency abortions to protect pregnant people’s health, as well as their life—but the ruling is temporary while the lower courts reconsider the issue. But the problem isn’t confined to Idaho. In Oklahoma, Jaci Statton developed heavy bleeding, dizziness, and weakness from a molar pregnancy, a condition in which a fertilized egg does not develop into a fetus. For more than a week, she told NPR, doctors denied her treatment, and she was transferred to three different hospitals. Ultimately, she had to drive three hours to an abortion clinic in Kansas to get an D&C.

“The record shows that, as a matter of medical reality, such cases exist,” Justice Elena Kagan wrote in a concurring opinion in the Idaho case. “Hospitals in Idaho have had to airlift medically fragile women to other States to receive abortions needed to prevent serious harms to their health. Those transfers measure the difference between the life-threatening conditions Idaho will allow hospitals to treat and the health-threatening conditions it will not.” 

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life.”

According to Rolling Stone, Broesder’s severe blood loss during her miscarriage caused erratic blood pressure and a stress response that led her to be diagnosed with a heart condition she said could lead to a heart attack if she gets too excited or upset. “I have to deal with these side effects for the rest of my life because of abortion laws,” Broesder said in her video.

Broesder’s experience is a clear illustration of what Vice President Kamala Harris was talking about when she responded to former president Donald Trump’s bizarre claim during the debate that “every legal scholar” wanted Roe v. Wade overturned. “Pregnant women who want to carry a pregnancy to term, suffering from a miscarriage, being denied care in an emergency room because the health care providers are afraid they might go to jail, and she is bleeding out in a car in the parking lot—she didn’t want that,” Harris said. “Her husband didn’t want that.”

McEntee, the founder of a conservative-only dating app, has a large following on TikTok, where he posts snarky and often offensive quips about race and gender designed to tickle his MAGA audience. But his video garnered thousands of first-person responses, many telling stories about severe medical complications after pregnant people were denied care.

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life,” one commenter said.

“My daughter. Nearly lost her life after she miscarried triplets that didn’t expel her body & 3 hospitals wouldn’t remove them,” another replied.

“I’ve been anemic on and off since my weeks-long miscarriage,” wrote yet another commenter. “Three hospitals refused to give me a DNC or pill protocol. Unimaginable pain and distress.”

And so it goes, on and on, for more than 19,000 comments as of Saturday.

More than two years since the overturn of Roe v Wade, legal battles over abortion laws are as chaotic as ever. But occasionally, the challenges playing out state by state result in a string of good news for abortion rights. That was the case this week, with a cluster of court decisions that will expand abortion access in Nevada and North Dakota, and allow Missouri and Nebraska voters to weigh in on the issue in November.

On Thursday, District Court Judge Bruce Romanick in Bismarck, North Dakota, issued a powerful opinion siding with abortion providers who challenged a state law that had deemed their practice a felony.

In his order, which takes effect in two weeks, Rominick ruled that the North Dakota constitution’s protections for life, liberty, and the right to pursue happiness include the right to choose abortion. “A woman’s choice of whether or not to carry a pregnancy to term shapes the very nature and future course of her life, on nearly every possible level,” he wrote. “The Court finds that such a choice, at least pre-viability, must belong to the individual woman and not to the government.” He also struck down the ban for its vagueness, concluding that, at present, North Dakota doctors could be prosecuted if other physicians second-guessed their decision to provide an emergency abortion.

Virtually all abortions have been illegal in North Dakota since April 2023, when Republican Gov. Doug Burgum signed a ban with exceptions only to save the life of the pregnant person, or for rape and incest survivors within the first six weeks of pregnancy. North Dakota’s only abortion clinic moved across the state line to Minnesota in 2022, soon after the Supreme Court overturned Roe v. Wade, meaning most people seeking to end a pregnancy will have to leave the state.

But Romnick’s decision should make it easier for doctors to provide emergency abortions to patients with severe pregnancy complications—care that that is often withheld in abortion-ban states, with dire consequences. “It is now much safer to be pregnant in North Dakota,” Center for Reproductive Rights lawyer Meetra Mehdizadeh said in a statement on Friday.

Also on Thursday, a Nevada court order requiring the state Medicaid program to cover abortion became final after the state government declined to appeal an earlier ruling. Nevada will become the 18th state to allow Medicaid funds to cover abortion, the Associated Press reported.

That ruling is the result of a challenge brought under Nevada’s Equal Rights Amendment, which added language banning sex discrimination, along with many other types of discrimination, to the state constitution. Voters there supported the ERA by a nearly 18-point margin in 2022.

In their lawsuit, a Nevada abortion fund and the ACLU argued that the ban on Medicaid coverage amounted to sex discrimination because it denied low-income Nevadans who can become pregnant the ability to make decisions about their future. Back in March, a Clark County District Judge Erika Ballou had agreed—though her decision didn’t become final until this week.

”There was a time when we got it wrong and when women did not have a voice,” one judge wrote. “This does not need to continue for all time.”

“The court made clear that the state cannot withhold coverage for essential, sex-linked health care from low-income Nevadans,” ACLU Reproductive Freedom Project staff attorney Rebecca Chan explained in a statement. “As a result of this decision, Nevadans who have Medicaid as their health insurance will no longer need to fear that they will be forced to carry a pregnancy against their will.”

In November, voters in New York will decide whether to enshrine an ERA of their own—one of 10 states with abortion-related initiatives slated for the 2024 ballot. Yet initiatives in two of those states were in jeopardy until courts came to their rescue this week. On Tuesday, the Missouri Supreme Court threw out a last-minute claim arguing that the text of an abortion-rights initiative petition had omitted details required by state law; it ordered the anti-abortion secretary of state to certify the initiative for the ballot.

On Friday, the Nebraska Supreme Court ruled that dueling initiatives can appear on the ballot in that state, where current law bans abortion after 12 weeks. One of the initiatives, titled “Protect the Right to Abortion,” would create a state constitutional right for Nebraskans to get an abortion prior to “viability” (the hard-to-pinpoint moment in pregnancy when a fetus is able to survive outside the uterus). The other, titled “Protect Women and Children” would enshrine the current 12-week abortion ban in the state constitution.

If both pass, the one with the most votes prevails. But anti-abortion advocates had tried to kill the pro-abortion rights measure altogether by arguing that by regulating abortion before and after viability differently, it dealt with more than one subject, according to the Nebraska Examiner. Friday’s state Supreme Court ruling tossed that challenge, and ensures the vote on both questions will proceed.

Now, with 52 days left before voters will decide whether to add abortion protections to their state constitutions, the opinion from North Dakota’s Judge Rominick could offer some guidance.

“If we can learn anything from examining the history and prior traditions surrounding women’s rights, women’s health, and abortion in North Dakota, the Court hopes that we would learn this: that there was a time when we got it wrong and when women did not have a voice,” Rominick wrote. “This does not need to continue for all time, and the sentiments of the past, alone, need not rule the present for all time.”

When Project 2025 staffer and former Trump White House personnel chief John McEntee tried to score points on social media on Thursday by denying that women were “bleeding out” due to abortion bans, he probably didn’t expect them to reply to him directly.

“Can someone track down the women Kamala Harris said are bleeding out in parking lots because Roe v. Wade was overturned?” McEntee asked in a TikTok video filmed at a restaurant as he dipped fried food into sauce.

“Don’t hold your breath,” he added, smirking.

“I’m right here,” replied Carmen Broesder, a mother living in Idaho, which enacted a trigger law after the fall of Roe, a making it a felony for doctors to provide an abortion unless it was necessary “to prevent the death of the pregnant woman.”

In a TikTok video of her own, Broesder recalled how hospital staff turned her away from the ER three times during an excruciating 19-day miscarriage. She said she was repeatedly denied a procedure to remove tissue from the uterus—a procedure known as dilation and curettage (D&C) that is also used in abortions—and that they gave her just one dose of pain medication in 19 days. “I blacked out in my hallway due to blood loss,” she recounted.

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In June, the Supreme Court gave Idaho hospitals the green light to perform emergency abortions to protect pregnant people’s health, as well as their life—but the ruling is temporary while the lower courts reconsider the issue. But the problem isn’t confined to Idaho. In Oklahoma, Jaci Statton developed heavy bleeding, dizziness, and weakness from a molar pregnancy, a condition in which a fertilized egg does not develop into a fetus. For more than a week, she told NPR, doctors denied her treatment, and she was transferred to three different hospitals. Ultimately, she had to drive three hours to an abortion clinic in Kansas to get an D&C.

“The record shows that, as a matter of medical reality, such cases exist,” Justice Elena Kagan wrote in a concurring opinion in the Idaho case. “Hospitals in Idaho have had to airlift medically fragile women to other States to receive abortions needed to prevent serious harms to their health. Those transfers measure the difference between the life-threatening conditions Idaho will allow hospitals to treat and the health-threatening conditions it will not.” 

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life.”

According to Rolling Stone, Broesder’s severe blood loss during her miscarriage caused erratic blood pressure and a stress response that led her to be diagnosed with a heart condition she said could lead to a heart attack if she gets too excited or upset. “I have to deal with these side effects for the rest of my life because of abortion laws,” Broesder said in her video.

Broesder’s experience is a clear illustration of what Vice President Kamala Harris was talking about when she responded to former president Donald Trump’s bizarre claim during the debate that “every legal scholar” wanted Roe v. Wade overturned. “Pregnant women who want to carry a pregnancy to term, suffering from a miscarriage, being denied care in an emergency room because the health care providers are afraid they might go to jail, and she is bleeding out in a car in the parking lot—she didn’t want that,” Harris said. “Her husband didn’t want that.”

McEntee, the founder of a conservative-only dating app, has a large following on TikTok, where he posts snarky and often offensive quips about race and gender designed to tickle his MAGA audience. But his video garnered thousands of first-person responses, many telling stories about severe medical complications after pregnant people were denied care.

“I was told when I had a possible ectopic pregnancy that I would have to ‘wait until it made me septic’ to get the surgery to save my life,” one commenter said.

“My daughter. Nearly lost her life after she miscarried triplets that didn’t expel her body & 3 hospitals wouldn’t remove them,” another replied.

“I’ve been anemic on and off since my weeks-long miscarriage,” wrote yet another commenter. “Three hospitals refused to give me a DNC or pill protocol. Unimaginable pain and distress.”

And so it goes, on and on, for more than 19,000 comments as of Saturday.

Reproductive rights advocates in Missouri have beaten back a last-ditch effort by Republican officials to stop voters from having their say on abortion in November. On Tuesday afternoon, the Missouri Supreme Court ordered that a proposed amendment to enshrine abortion rights in the state constitution will remain on this year’s ballot.

The ruling ensures that Missourians will have the opportunity to vote on Amendment 3, which would establish a right to “reproductive freedom”—defined as the ability to make and carry out one’s own decisions about contraception, abortion, and healthcare during pregnancy. If approved, the amendment will set a high legal bar for how the state can regulate abortion prior to “viability”—the difficult-to-pinpoint moment when a fetus becomes likely to survive outside the uterus. After viability, the measure would let the state ban abortion, with exceptions to protect the life and health of the pregnant patient.

The decision caps a roller-coaster of a year for Missouri reproductive-rights advocates, who faced hurdle after hurdle to get the measure on the November ballot. Supporters gathered more than 380,000 signatures this spring, circumventing a legislature dominated by hard-line abortion foes who passed the state’s current, near-total abortion ban. A St. Louis University/YouGov poll of 900 likely voters in mid-August found that 52 percent supported Amendment 3 and 34 percent opposed it.

“Today’s decision is a victory for both direct democracy and reproductive freedom in Missouri,” Rachel Sweet, campaign manager for Missourians for Constitutional Freedom, the group behind the amendment, said in a statement. “This fight was not just about this amendment—it was about defending the integrity of the initiative petition process and ensuring that Missourians can shape their future directly.”

Ballot initiatives have become a central part of the strategy to restore and expand abortion rights in the post-Roe v. Wade era. They’re also key to Democrats’ efforts to turn out voters in battleground states in this year’s tight presidential election. Abortion rights are popular, even in solidly red states; the pro-choice side has won all seven abortion-related measures on state ballots since 2022.

That’s led Republican officials in GOP-dominated states including Arkansas, Florida, and Nebraska to pull out all the stops this year to prevent abortion-rights measures from getting to the ballot in the first place—filing lawsuits, delaying or invalidating petitions, and spreading misinformation.

In Missouri, Tuesday’s ruling comes in response to a last-minute lawsuit by two Republican state lawmakers, Rep. Hannah Kelly and Sen. Mary Elizabeth Coleman, working with anti-abortion activists and lawyers from the Thomas More Society, a law firm aligned with conservative Catholics. They argued that Missouri Secretary of State Jay Ashcroft should never have certified Amendment 3 because it did not specify which state laws it would repeal. (Missouri law requires initiative petitions to “include all sections of existing law or of the constitution which would be repealed by the measure.”) In a court filing, they claimed that the Amendment 3 campaign “defrauded potential signers” and that the measure “would have far-reaching effects,” including on Missouri’s rules on human cloning and single-sex bathrooms.

Amendment supporters responded that no state laws would be automatically repealed. Instead, advocates would have to file lawsuits challenging anti-abortion laws, with judges making the final decisions about which ones violate the new constitutional amendment. “This is another example of someone flailing, trying to gum the works of a campaign that has serious momentum,” said Mallory Schwartz, executive director of Abortion Action Missouri, part of the pro-Amendment 3 coalition. “What they’re really doing is trying to deny people access to direct democracy.” 

The Missouri Supreme Court’s decision overturns a surprise ruling by Cole County Circuit Judge Christopher Limbaugh last Friday evening declaring that the vote on the amendment should be canceled—though he left time for an appeal. Judge Limbaugh, a cousin of the late conservative talk radio host Rush Limbaugh, was appointed to the bench by his former boss, Republican Gov. Mike Parson, barely five weeks ago.

Ashcroft defended his certification in a hearing before Limbaugh. But following the Friday ruling, Ashcroft sent the abortion-rights campaign a letter announcing that he was decertifying Amendment 3 himself. “On further review in light of the circuit court’s judgment, I have determined the amendment is deficient,” he wrote.

In its Tuesday ruling, the Missouri Supreme Court ordered Ashcroft to recertify Amendment 3 for the ballot, ruling that the deadline for him to issue a certification decision had passed.

For Ashcroft and other Missouri Republicans, the decision is yet another rebuke in a long and exhausting campaign to keep the amendment off the ballot. In at least four previous lawsuits, Missouri courts have slapped down state officials’ attempts to interfere with the amendment.

First, state Attorney General Andrew Bailey, who is running for reelection, held up the initiative for months by pushing a baseless theory that the initiative could cost the state billions in federal Medicaid funding and declining to rubber-stamp a cost estimate prepared by the state’s auditor. After a legal battle, the Missouri Supreme Court ordered Bailey to stop stonewalling.

Then last fall, Kelly and Coleman—the same legislators behind the latest lawsuit—seized on Bailey’s phony theory about Medicaid funding and sued the state auditor over his cost estimate. They too were slapped down by the courts, which found the cost estimate “fair and sufficient.”

Meanwhile, Ashcroft—an outspoken abortion opponent whose job requires him to craft neutral summaries of ballot initiatives—issued summaries claiming the measure would permit “dangerous, unregulated, and unrestricted abortion.” Last October, an appeals court ruled those summaries were “replete with politically partisan language.” A circuit court judge completely rewrote them.

But Ashcroft didn’t learn his lesson. Last month, on the same day he certified the amendment for the ballot, he issued “fair ballot language” to be posted at polling places that made a slew of false claims, including that the measure would prohibit legal recourse against “anyone who performs an abortion and hurts or kills the pregnant women.” Last Thursday, Cole County Circuit Judge Cotton Walker threw out Ashcroft’s description, calling it “unfair, insufficient, inaccurate and misleading.”

Tuesday’s Supreme Court ruling is a crucial win for the fight to expand abortion rights in Missouri, which has some of the most restrictive laws in the country. Even before the Supreme Court overturned Roe v. Wade, only one clinic remained open in the state, providing fewer than 100 abortions annually. Hours after the fall of Roe, state officials invoked a dormant law making it a felony to provide abortion in virtually all cases.

Missouri isn’t the only place where state officials have been making last-ditch efforts to block or blunt voter referendums on abortion. On Monday, the Nebraska Supreme Court heard arguments in a trio of lawsuits over dueling amendments—one to protect abortion until viability and another to ban abortion after the first trimester. Arguments focused on whether the protective amendment violates a state rule requiring ballot measures to only cover a single subject, according to the Nebraska Examiner.

Last month in Arkansas, the state Supreme Court threw out thousands of signatures in favor of an abortion-rights measure, ruling that organizers had failed to file training certifications for their paid canvassers in the proper format, the Associated Press reported. The decision affirmed state officials’ move to disqualify the measure from the ballot.

In Florida, the state Attorney General lost a lawsuit arguing that an amendment to protect abortion rights until viability was “too complicated” for voters to understand. But last month, the state Supreme Court approved a fiscal impact statement for Amendment 4 written with the help of the Heritage Foundation, the conservative group behind Project 2025. Meanwhile, the state’s Agency for Health Care Administration unveiled a website on Thursday full of false claims about the initiative, as my colleague Julianne McShane reported. And the Florida Department of State is reportedly investigating 36,000 voter signatures submitted by amendment organizers.

As it stands on Tuesday, ten states will vote on abortion-related measures on the ballot come November. Missouri is one of two where voters could overturn a near-total abortion ban.

Sophie Hurwitz contributed reporting.