While former President Donald Trump’s win of the White House was a blow to many reproductive rights advocates, Election Day some wins when it came to abortion ballot measures. In seven of 10 states, voters chose to protect abortion rights.
However, that doesn’t mean abortion rights will go into effect immediately in these states, experts say.
“People kind of think that abortion access can be like a light switch, like you flip it up because the law allows you to provide abortion care, and suddenly there’s all of these clinics and providers who are able to provide care. You flip it down when abortion is restricted, and those providers are able to just pause but not go anywhere,” said Kimya Forouzan, principal state policy advisor at Guttmacher, a nonpartisan research and policy organization in reproductive health. “That’s just not the case. What we see fairly frequently when there is a change in abortion law is that it just takes a bit of time, if ever, for that infrastructure to be built back up.”
In states with restrictions or bans, many providers have left the state, and it could take a while to restore the workforce.
Where did abortion measures win?
Even though it’s not as easy as flipping a light switch, the seven states that passed ballot measures protecting abortion in the 2024 election were Arizona, Colorado, Maryland, Missouri, Montana, Nevada and New York. Missouri currently has a total abortion ban, but because the ballot measure establishes a fundamental right to abortion prior to viability, the state’s residents can legally challenge that ban. Fetal viability occurs generally during 24–26 weeks of pregnancy.
The ballot measure now allows Missourians to make decisions about abortion, contraception and miscarriage management, among other things.
Arizona, meanwhile, currently bans abortion at 15 weeks or later. Like Missouri, the ballot measure establishes a right to abortion and gives advocates a legal path to challenge the ban.
In Nevada, abortion is banned at 24 weeks and later, and the ballot measure enshrines the right to abortion in the state constitution until viability, as well as after that to protect the mother’s life or physical health.
In the remaining states — Colorado, Maryland, Montana and New York — abortion is currently protected, and the ballot measures succeeded in further safeguarding abortion rights. For example, New York’s measure adds language to the state constitution that prohibits discrimination, including ethnicity, age and disability. Colorado’s measure repeals a previous constitutional amendment that bans the use of state funds for abortion care. The measure in Maryland establishes a right to reproductive freedom, and Montana’s measure protects the right to abortion up to viability.
In another three states —Florida, Nebraska and South Dakota —abortion rights ballots failed. While Florida’s did not pass, the majority of voters (57%) still showed their support of the measure. However, Florida requires a greater than 60% vote to pass.
Nebraska also had a unique case, in which the ballot had both a protective abortion rights measure and an anti-abortion measure. The protective abortion rights measure failed while the anti-abortion measure passed. The anti-abortion measure bans most abortions after the first trimester and enshrines the current 12-week ban in the constitution. However, there were reports that these competing ballot measures may have confused voters.
For one reproductive health advocate, these results were a “bright spot.”
“We know that people in these states and people in the U.S. support abortion, and that abortion is a winning issue,” said Israel Cook, state legislative counsel at the Center for Reproductive Rights, in an interview. “It was very heartening and somewhat expected that these measures passed.”
It’s also worth noting that several of the states that approved abortion ballot measures also sided with Trump in the presidential election, including Missouri, Montana, Arizona and Nevada.
“It really highlights that people are in support of abortion access, even in places like Missouri, where abortion is completely banned, all the way to places like New York, where it’s protected,” Cook added. “Even in states where the measures might have failed, there was still overwhelming support. Look at Florida.”
The ballot measures to fortify women’s access to abortion stems from the overturning of Roe v. Wade. In 2022, through the landmark Dobbs decision, the Court essentially took away the constitutional right to abortion and gave states the ability to make their own policies on abortion. Now, 13 states ban abortion, and many others have restrictions, according to KFF.
There are two ways in which an abortion measure can get on the ballot: legislatively-referred measures that are introduced and approved by lawmakers and citizen-initiated measures that are written by citizen groups and put on the ballot if they get enough signatures. However, the latter approach is not available in all states. Since the overturning of Roe v. Wade, 16 states have voted on abortion measures, including six prior to the 2024 election.
While the abortion ballot measures passed in most states this year, one physician in family medicine and urgent care is still concerned about the differing laws in different states and how they could exacerbate disparities that already exist. She was happy to see that some states did provide protections for abortion, but was disappointed that it wasn’t across the board.
“I always go back to just thinking about that patient, that person that I may see, or my colleagues, and the thought that wherever they live could determine if they’re able to access the care they need,” said Dr. Bayo Curry-Winchell, founder of Beyond Clinical Walls and medical director of urgent care clinics at Saint Mary’s Regional Medical Center. “For me, when we talk about reproductive health, it really is overall health. I worry about those patients who are in those states that will not have access to full care based on the label or association of abortion, because it’s so much more than that.”
Curry-Winchell gave the example of chemotherapy, which may be limited for women of childbearing age in places with abortion bans because they could induce an abortion for a pregnancy the person may not even know about.
What’s ahead
Although the majority of these measures passed, they won’t go into effect immediately. Different states have different effective dates and some require the governor to certify the ballot initiative, according to Forouzan of Guttmacher. She said that most of the states are waiting for the effective date. And when the ballot initiative does go into effect, it revises the state constitution. However, it doesn’t automatically repeal the abortion restrictions or bans that are in place.
“The constitution is affirming of abortion rights, but when you look at the state’s statutory code, there might still be restrictions,” she said. “What often happens is that litigation is brought by advocates in the state to also just get rid of those bans or restrictions that are on the books, so it’s clear that abortion is protected in the state.”
In addition, states that shift from an abortion ban to protecting abortion face workforce challenges. Forouzan gave the example of North Dakota, which had a total ban that was recently blocked.
“Unfortunately, because there was a total ban in place, there are no longer any abortion providers in the state, even though it is technically legal in the state,” she said. “I don’t want to underscore how important that decision was. [For] people who are in a hospital-facing, emergency situation, it’s a lot easier for them to get care. That’s very, very important, but there are no abortion providers for folks who are not in emergency medical situations anymore in the state.”
With the 2024 results, Missouri could be facing a similar dilemma, according to Laurie Sobel, associate director for Women’s Health Policy at KFF, a nonprofit health policy research, polling and news organization. With the ban, many professionals in the field may have moved to providing other medical services or have left the state.
Some physicians may also be concerned that the law is just going to change again. Sobel noted that there were restrictions on abortion in Missouri before the ban. For example, it has restrictions requiring that pregnant people go through a 72-hour waiting period, and that both parents, a legal guardian or a judge consent to a minor’s abortion, according to the Center for Reproductive Rights.
“It’s not just the complete ban that will be litigated,” Sobel stated. “Potentially, there’ll be other restrictions that will also be litigated, because what everyone forgets is that there were restrictions before the ban. All of it would need to be overturned, not just the ban itself. Many providers might be waiting to see where the dust settles before they just move back and set up shop again. Because it’s obviously an investment of resources, time and their livelihoods. It is definitely not like turning a light switch on.”
Curry-Winchell also expressed concern about the future pipeline and representation of doctors, who may avoid going into specialties like OB-GYN or family medicine because of the restrictions and bans in some states.
“As a Black female physician, I represent less than 3% of physicians in the U.S., although the overall Black population is greater than 14%,” she said. “What’s to come from that? Because we do know representation is a huge piece of being able to help with better outcomes, just overall help with trust.”
There are also economic effects of strict abortion laws. For example, New Mexico has begun putting billboards in Texas to recruit doctors to New Mexico so they can safely practice. And if physicians depart there is a direct and indirect impact on the community, to the tune of about $1 million plus a year per physician.
As for future ballot initiatives, the only states left with bans that haven’t had citizen-initiated measures since Dobbs are Arkansas and Oklahoma.
“The game is only in Oklahoma and Arkansas at the moment. … Every other state that has a ban or early gestational limit does not allow for citizen-initiated process, so there’s no way for the citizens to overrule their legislative actions,” Sobel said.
Photo: Fokusiert, Getty Images