This Week in Abortion: Ballot Initiatives, the Morning After
A collection of good reads, events from the week, and policy insights on reproductive health.
Welcome back to This Week in Abortion - Your weekly substack roundup of good reads, news updates, and policy insights on abortion.
Hope you are staying warm and safe out there! We’ve got plenty to read this week, so take your time.
Ballot Initiatives, the Morning After
In recent years, Missouri, Ohio, and Arizona passed ballot measures enshrining abortion rights in their constitutions. All three states previously had bans in place, including an all-out ban in Missouri, ~6-week ban in Ohio, and a ~15-week ban in Arizona.
Today, I’m checking in on MO, OH, and AZ, where anti-abortion legislatures remain determined to limit care and the fight for meaningful access continues. Bottom line, ballot measures may be the only option to force relief in certain states, but there is no substitute for legislative politics and advocacy.
In the Weeds
Missouri
In Missouri, implementation of the November amendment has been slow and fraught. After a December ruling partially struck down the state’s ban, three clinics have reopened. But, services remain limited—for example, the Planned Parenthood in Columbia, MO, only performs abortions up to 13 weeks. Only a handful of patients have actually received abortion services. So far no one in the state is approved to distribute pills for a medicated abortion, and they may never be.
Lawmakers, meanwhile, are working to reverse the amendment through a ballot initiative in 2026 and pursuing restrictions like "born alive" legislation, tax incentives for anti-abortion organizations, and a uniquely twisted attempt to “create a registry of pregnant girls and women, “at risk” of abortion.”
Ohio
Ohio's six-week ban was struck down following Issue 1's passage in 2023. The state reported a modest increase in abortion procedures that same year, but that appears to be it, which is curious considering Ohio borders states with all out bans.Maybe one reason for this is that appeals continue to leave providers in regulatory limbo.
Like Missouri, anti-access legislators are seeking to restrict care through indirect measures, such as tax credits for crisis pregnancy centers and redefining "dependents" as starting at conception, which could alter financial frameworks and reproductive rights policies.
Arizona
Arizona voters nullified the state's 15-week ban and its outdated 1864 law with Proposition 139.
Unlike Ohio and Missouri, the state has pro-access executives, which is at least helpful in stopping its legislature’s anti-access agenda. Essentially the two sides are in a stalemate, the legislature has refused to repeal burdensome regulations and the Governor has vetoed new restrictions. The Attorney General has also said she won’t enforce restrictions, but many operators continue to work under the assumption that they are in place, afterall who knows what a future AG will hold them to.
Viability
The ballot measures in all three states below allow for the legislature to regulate abortion after viability. That could prove to be a problem. Viability is generally defined as the ability for a fetus to survive outside the womb after birth without “extraordinary” medical intervention. In Roe that estimate was between 24-28 weeks of gestation. But it’s not a hard and fast rule. These days, even in pro-access spaces, you now see that period moved up to 20-24 weeks. This vagueness leaves a lot of room for legislators to make trouble.
Think about it this way: you take a law that declares egg + sperm equals a whole independent person, mix in a tax credit that starts at conception, a dash of civil liability that changes the narrative around what is “extraordinary” intervention. Suddenly, you have someone in court arguing that the legal definition of viability is conception. They might not get all the way there, but in MO, OH, and AZ, not to mention in Montana - another state that passed a ballot initiative last year- that is what some legislators are trying to do, in direct opposition to the will of the voters.
Ballot Measure Backlash
The success of pro-access and other “progressive” ballot measures in recent years, including pro-access efforts, has sparked a wave of backlash. For example, a bill passed in Florida this week requires future initiative sponsors to put up a $1 million bond and creates other barriers. You’ll recall that a pro-access ballot measure approved by a majority of voters just failed to pass because Florida requires approval by 60% of voters.
As legislators continue to dilute measures that have passed and put up roadblocks to future action, it all comes back to the same thing. Ballot measures are a potential tool in the box, but they are not a magic potion.
Good Reads
Seventeen states want to end an abortion privacy rule. A federal judge is questioning HIPAA itself. [News from the States]
Fetal Personhood Bills Are Flooding State Legislatures [The Cut]
New threats to abortion rights hit Puerto Rico as advocates share how to fight back [Prism]
rePROs’ 50-State Report Card: The Looming Storm and How the New Administration is Primed to Make the Human Rights Crisis Worse
Federal News
Trump Administration Freezes Critical Title X Funding for 16 Organizations [Time Magazine] Jessica Valenti points out this is just as much about contraception as it is about abortion.
Justices skeptical of S.C.'s efforts to stop suit over Planned Parenthood exclusion (Law Dork) The case stems from South Carolina’s disqualification of Planned Parenthood from its Medicaid program.
Oz opposes abortion, trans care in letter to GOP senator [Roll Call]
The States
Alabama
👍Alabama can’t prosecute groups who help women travel to get an abortion, federal judge says. [Associated Press]
Connecticut
👍CT weighs stronger protections for doctors providing abortion, gender-affirming care [CT Mirror]
Georgia
👏👏👏Charges dropped against US woman found unconscious after miscarriage [Guardian]
Illinois
👎Rockford Pregnancy Care Center, Diocese of Springfield sue state of Illinois [Rockford Register Star]
Maryland
👍Legislation creating new abortion grants to governor’s desk [Maryland Matters]
New York
👍NY county clerk refuses to file Texas’ fine for doctor accused of prescribing abortion pills [Associated Press]
Nevada
👎Nevada can enforce dormant 1985 law requiring parental notification of abortion, judge rules [Associated Press]
New Hampshire
👎NH House votes to criminalize helping minors receive abortions — but avoids the word abortion [New Hampshire Bulletin]
South Carolina
👎The State Senate approved a bill to create tax credits for crisis pregnancy centers. It’s likely headed for passage in the House. But at least the debate about it brought up some questions. Ultrasounds, pregnancy tests and parenting classes: SC funding for pregnancy centers questioned [South Carolina Daily Gazette]
Tennessee
👎‘Fatal fetal anomalies’ bill fails in Tennessee legislature [Tennessee Lookout]
Virginia
👍👎Youngkin signs bill to protect reproductive and sexual health data, amends right to contraception [Virginia Mercury]
West Virginia
👎Senate passes bill targeting abortion medication sent to West Virginia residents. [West Virginia Watch] It’s a good bet this bill, which makes it a felony to distribute abortion drugs, will become a law in the next few months.