by Catesby Holmes

Tomorrow, Americans will vote in the first general election since the US Supreme Court overturned Roe v. Wade, the decision that had protected abortion rights throughout the country since 1973.

In June 2022, ruling on the Dobbs v Jackson Women’s Health Organization case, the court declared: “The Constitution does not confer a right to abortion.” Since then, 22 of 50 US states have either completely banned abortions or restricted them to the earliest stages of pregnancy – often before many patients know they are pregnant at all. Fourteen states have outlawed the abortion pill mifepristone.

In the southern state of Georgia, which banned abortions beyond six weeks of pregnancy, at least two women have died from a rare complication of the abortion pill in which not all fetal tissue is expelled – one because a lifesaving abortion surgery was delayed, another because she was too afraid to seek medical care. Just this week, the investigative journalism site ProPublica identified two more women who died in Texas from after treatment for miscarriage was delayed.

“There’s a lot at stake,” said Rachel Rebouché, a health law scholar at Temple University’s Beasley School of Law. She said the two presidential candidates have “starkly different” views on reproductive rights.

Harris, a Democrat, champions abortion rights more unabashedly than perhaps any past US presidential candidate. As California’s attorney general, she co-sponsored a 2015 law requiring so-called “crisis pregnancy centers” — which are intended to dissuade people from terminating pregnancies — to inform patients that they can get an abortion elsewhere, which the Supreme Court later struck down. As a US senator from 2017 to 2021, Harris backed a doomed bill that would have made abortion legal nationwide.

A Harris administration would “use its federal powers to try to walk back the Dobbs decision and all the tragedy that we’ve witnessed in the wake of Dobbs, and be thinking about how we might get a federal right that restores abortion rights,” Rebouché said. 

Photo: Gage Skidmore, CC BY-SA 2.0

As president, Donald Trump appointed the three Supreme Court justices who provided the court with the majority required to overturn Roe v Wade, and a second Trump administration could impose more abortion restrictions. A small but vocal faction of the Republican Party, mainly Christian conservatives, want abortion to be outlawed nationwide. Trump has insisted he does not support a federal abortion ban, seeking to distance himself from an extreme stance he saw as an election loser. Yet in a presidential debate in September, he refused to say whether he’d veto such a ban if it passed Congress. His vice-presidential running mate, JD Vance, has said he supports a “national minimum standard”, a kind of Republican rebranding for what would in all likelihood amount to an abortion ban. 

Despite appearances, abortion has broad popular support in the US. Two-thirds of Americans are in favour of abortion access, and in all six states that have put abortion on the ballot since the Dobbs decision in state elections, residents have resoundingly voted to keep the procedure legal. By driving abortion supporters to the polls in droves, abortion ballot initiatives also benefited Democratic candidates in the 2022 congressional midterm elections.

“I think we’re going to see a similar thing in 2024,” said Alauna Safarpour, a political scientist at Gettysburg University who studies voter participation. 

This time, 12 more states have put abortion rights on the ballot. They include Florida, a Republican stronghold that recently imposed a six-week abortion ban, and several swing states. 

“Arizona and Nevada, of the swing states, are where I could see abortion mattering the most,” Sarfapour said. 

In the crucial swing state of Pennsylvania, Safarpour said, voters are being barraged with ads focused on drawing a sharp contrast between the candidates’ views on abortion. And in North Carolina, the governor’s race pits a Republican anti-abortion zealot against the state’s pro-abortion Democratic attorney general.

Photo: Gage Skidmore, CC BY-SA 2.0

Even in the post-Dobbs era, when state legislatures wield extraordinary control over abortion access, the next president will still have significant power to expand or restrict reproductive rights. Depending on whether Congress tips rightward or leftward in November, the next president could be asked to sign or veto a national abortion ban – or, potentially, or a bill protecting abortion nationwide.

The president also shapes reproductive rights indirectly, as Americans learned during the Trump administration. 

As well as guaranteeing the end of Roe v Wade, the Trump administration also barred medical providers that participate in the federal family planning program Title X from discussing abortion with their patients. Title X, created by the Republican President Richard Nixon in the 1970s, subsidises women’s health clinics to provide free or low-cost contraception, pregnancy testing, infertility services, breast cancer screenings, and other reproductive health care. Trump’s abortion gag rule drove roughly 900 clinics to drop out of the Title X network, sacrificing millions of dollars in funding to continue providing comprehensive reproductive care. The program’s patient rolls fell from 3.9 million people in 2018 to 1.5 million in 2020, according to the Kaiser Family Health Foundation, though the Covid-19 pandemic is likely to have contributed to that drop.

Biden reversed Trump’s changes to Title X soon after taking office in 2021 and rushed $6.6 million in emergency funds to clinics in dire need of help. Even so, for some cash-starved clinics, the end of Roe was the end of the road. Dozens of women’s health clinics have closed their doors since 2022.

“It’s not just abortion that’s fallen. It’s the whole system,” said University of Tennessee at Knoxville professor Gretchen Ely, who studies reproductive health deserts in the South. “Abortion is just health care. It’s a segment of health care that’s been politicized for the political gain of one party, but it’s just reproductive health care.” 

Ely believes the past three years have demonstrated that fact for many Americans. In this year’s election, she said, “people are finally saying some of the quiet parts out loud.”

– Catesby Holmes is a freelance journalist who lives in Brooklyn. Her writing has been published in Slate, Wired, Bloomberg, The Week, and the Boston Globe, among other publications.

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