(Bloomberg) -- In overturning Roe v. Wade, the US Supreme Court didn’t so much settle America’s long-running fight over abortion as push the battle to states. The court’s June 2022 ruling in Dobbs v. Jackson Women’s Health Organization repealed constitutional and thus nationwide protections for abortions that had been in place since 1973. That has given conservative governors and legislatures the power they had long sought to limit the medical procedure in their states; access to it now largely depends on where you live.
That has made abortion a potent issue in the Nov. 5 general election. Americans’ thoughts on the issue could be a factor in who winds up in the White House next year: Vice President Kamala Harris, a strong supporter of abortion rights, or former President Donald Trump, who has taken credit for Roe’s demise. In addition, through ballot initiatives in at least ten states, voters will have a direct say on abortion rights where they live.
Why is abortion a major issue in the election?
This is the first presidential election since the Dobbs decision, which a majority of Americans disagreed with, according to polls. Some 25 million women ages 15 to 44 now live in states where there are more restrictions on abortion than before the ruling. The number of voters who listed abortion as their top election issue has grown over the course of this year in swing states, those where both Democratic and Republican candidates have won in recent presidential elections and where polls show similar levels of support for each side in the current race. Overall, the share of US adults who say abortion should be legal in all or most cases has remained relatively steady in recent years — at about 3 out of 5 — according to the Pew Research Center.
How does abortion play in the presidential election?
Harris, the Democratic nominee, supports a nationwide abortion-rights law that would restore the protections provided by Roe. That’s an ambitious goal. Even if the Democrats manage to secure control of both chambers of Congress in November, the Republicans could thwart such legislation in the Senate using a prerogative known as the filibuster, which permits never-ending debate unless a supermajority votes to shut it down. Harris supports eliminating the filibuster to pass an abortion-rights law, but changing Senate rules is difficult.
Harris has used opposition to the Dobbs decision as a cudgel against Trump. The Republican former president has taken credit for the ruling, having appointed the three Supreme Court justices that created a majority for it. He says he wants to leave abortion regulation to the states. In an indication of the heat he’s feeling on the issue, he said Oct. 1 that he would veto a “federal abortion ban,” after previously suggesting he’d support a proposal to restrict the procedure nationwide to the first 15 weeks of a pregnancy.
What have states done since the Dobbs decision?
Thirteen states now prohibit almost all abortions, according to the Guttmacher Institute, a research organization that backs reproductive rights. Another three states significantly restrict abortions after the sixth week of pregnancy; many people don’t know they’re pregnant at that point.
Some states, including Alabama, Texas and Tennessee, ban abortions even in cases of rape and incest, with the only exception being if there’s serious medical risk to the mother. Medical providers could face felony charges, carrying fines and jail sentences, for violating these laws. Some laws go beyond criminalizing abortion to give legal rights to fetuses.
Some of the new state-level restrictions have faced court challenges.
What’s on state ballots for Nov. 5?
Voters in ten states will be asked whether they support establishing a fundamental right to abortion in their state. These states include Arizona and Florida, which have restricted abortion access post-Dobbs. In Nebraska, voters will also consider a separate measure that would prohibit abortions after the first trimester, with exceptions for rape, incest or medical emergency.
Since the Dobbs decision, votes on ballot initiatives in California, Michigan, and Ohio have ended in wins for abortion rights.
How have abortion numbers changed?
In the immediate aftermath of the Dobbs ruling, legal abortions fell in states that restricted the practice and surged in states where it remained broadly legal. There were an estimated 208,040 people in places with severe restrictions that weren’t able to get abortions in those states between April 2022 and March 2024, according to the Society of Family Planning, an abortion and contraceptive advocacy and research group. Yet the average volume of pregnancy terminations across the US for the first three months of 2024 was 3% higher than for the first three months of 2023. Part of the increase may be explained by the rise in telehealth. The number includes medication-induced abortions performed under clinical care but not “self-managed abortions” achieved by obtaining and taking abortion-inducing pills outside traditional US medical channels.
How common is the use of abortion pills?
In 2023, an estimated 63% of terminations happened with the help of pills, according to the Guttmacher Institute. They became easier to receive by mail as a result of rule changes during the pandemic and were thus already the most common way to end a pregnancy in the US when Roe was overturned. One catch: Abortion pills are most effective in the first trimester of pregnancy and are recommended for use only up to 10 or 11 weeks of pregnancy. And five states require patients to have an in-person visit with a physician to access the pills.
The US Supreme Court in June 2024 preserved current levels of access to mifepristone, one of two drugs commonly used to end pregnancies, after a lawsuit had challenged the way the US Food and Drug Administration regulates the drug.
In October 2024, a law took effect in Louisiana that classifies mifepristone and misoprostol, another medication used to end pregnancies, as controlled dangerous substances. That means the drugs need to be stored in a locked box, which doctors say may delay care for miscarriages or postpartum hemorraghing.
What’s happening with abortion clinics?
The number of brick-and-mortar abortion clinics in the US fell by 5% between 2020 and March 2024, according to the Guttmacher Institute. For women in states with no abortion services, the nearest clinic can be hundreds of miles and multiple states away, and the cost of transportation, lodging and care can be prohibitively expensive. Groups that help finance abortions and related expenses received an influx of donations following the Dobbs decision, though some of the biggest organizations have since reduced support as funding has dried up.
--With assistance from Rebecca Greenfield.
(Corrects reference to states with abortion-related ballot initiatives.)
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