The fight for abortion rights: what to know going into 2024

More than a year after the U.S. Supreme Court overturned Roe v Wade, the dust from the landmark decision's collapse has still not settled.

It was a dramatic year with consequences Supporters and opponents of abortion rights are now engaged in a state-by-state skirmish for abortion rights. They are sparring in state legislatures, courtrooms, voting booths and hospitals, with each side racking up wins and losses.

With presidential elections and another major Supreme Court case on the horizon, the coming year promises to be just as eventful. Here's what you need to know about the fight against abortion in 2023 – and what it means for 2024.

Abortion rights advocates continue to win at the ballot box

In 2022, Republicans underperformed in the midterm elections and abortion rights activists won a series of ballot measures to preserve abortion rights, even in conservative states. This year, activists have continued their winning streak – and they hope to repeat their successes in 2024.

In November, Ohio became the first reliably red state since Roe to refuse to vote in favor of proactively enshrining abortion rights in the state constitution, while Virginia Democrats successfully fended off Republicans' attempt to retake the state legislature by campaigning for a fifteen-week abortion ban. .

For activists and Democrats, these victories were proof that abortion is an election-winning issue — and potentially one that can attract voters from both sides of the ideological spectrum. Activists are already pushing abortion-related 2024 ballot measures in about a dozen states, including swing states like Arizona and Nevada.

The number of abortions is increasing

After abortion clinics in the South and Midwest were forced to close, patients overwhelmed the nation's remaining clinics. In the first year after Roe's death, the average number of abortions in the U.S. increased rather than decreased each month. Clinics and their advocates are now struggling to keep up. “What is actually happening is complete disruption,” one expert told the Guardian.

There is also a gaping hole in the data, and there was one released in October by the Society of Family Planning: This does not include abortions performed at home, a practice known as “self-managed abortion.” Medical experts generally agree that it is safe to perform a self-abortion using pills early in pregnancy. Roe's topple. But while there is evidence that self-managed abortion is on the rise, the lack of concrete data on the practice reflects a growing problem in the post-Roe United States: As abortion moves further into the shadows of American life, we become less likely to talk about it know. It.

The legal battle over the abortion ban continues

The abortion ban continued to spread across the country in 2023, with nearly total bans taking effect in Indiana, North Dakota, and South Carolina. South Carolina and Nebraska have now passed laws banning abortion after 12 weeks of pregnancy. A total of 24 states or territories have now banned abortion before viability, or about 24 weeks of pregnancy, which would have been illegal under Roe.

Lawsuits over abortion restrictions are still ongoing in many of these states, and lawsuits have been frozen in states like Wyoming and Iowa. Abortion providers in Wisconsin found themselves in a unique position this year: after a judge ruled that an 1849 law that had been interpreted to ban abortions instead only banned foeticide and did not apply to what she called “consensual abortions.” the providers implement it. the procedure – even though the ban is technically still on the books.

Lawsuits could force other hardcore anti-abortion states to relax their bans in 2024 to clarify exceptions when abortions are allowed in medical emergencies. While Tennessee and Texas have included limited exceptions in their abortion laws, abortion rights advocates have still filed lawsuits in those two states, as well as in Idaho, challenging the language. A Texas mother of two filed a lawsuit seeking an emergency abortion while she was still pregnant. (She ultimately fled the state for the procedure.)

Theoretically, people in medical emergencies should be able to access the procedure, even in states where bans are in place — but doctors say these bans are actually so vaguely worded that they prevent doctors from helping sick patients. This summer, one of these lawsuits prompted women to testify in a Texas court about their experiences with abortion denials. It was the first time since Roe fell, if not the first time since Roe itself was decided, that women did so.

Abortion pills are in danger

The most common abortion method, abortion pills, is at the mercy of deeply conservative courts in 2024.

In April, a conservative judge in Texas ruled to suspend FDA approval a major abortion pill, mifepristone, in response to a lawsuit filed by a coalition of right-wing groups to make determination the pill the next target in their post-Roe campaign against abortion. A federal appeals court quickly reversed that decision and decided to keep the pill. mifepristone, available, but places significant restrictions on its use. The Supreme Court then intervened and ruled that the FDA's rules surrounding mifepristone must remain the same while the lawsuit plays out.

The Biden administration and a mifepristone manufacturer did so in September asked the Supreme Court to formally hear arguments in the case. The judges agreed in December.

Although the justices have indicated they will only rule on the restrictions imposed by the appeals court, and not on the overall legality of mifepristone, the case could still have enormous ramifications. Rolling back the FDA's rules could allow future lawsuits against other politicized medicines, such as gender-affirming care, HIV drugs or vaccines. Moreover, the Supreme Court is likely to rule in the summer of 2024 – just months before the presidential election.

Mifepristone is used in more than half of the country's abortions. If access to the drug is curtailed, many abortion clinics have said they will switch to using doses of another drug, misoprostol, to perform abortions, but abortions with misoprostol alone are less effective and associated with more complications.

Doctors flee states with abortion bans

With abortion bans endangering their patients and threatening to send doctors to prison, doctors are fleeing states where the procedure is banned. After Idaho banned abortion, at least 13 reproductive health doctors left the state and at least two rural labor and delivery units closed. Doctors in Tennessee, Texas, North CarolinaOhio and Florida also told reporters that they are leaving or planning to leave states with abortion bans.

OB-GYNs are already scarce in the United States. According to the American College of Obstetricians and Gynecologists, about half of U.S. counties do not have a practicing gynecologist. U.S. maternal mortality rates are also worsening, especially among Black and Indigenous people, at a time when the United States already has the highest maternal mortality rate among industrialized nations.

Doctors are now even afraid to train in states with abortion bans. Applications for OB-GYN residencies in states with near-total bans fell by more than 10% the year after Roe's death, according to data from the Association of American Medical Colleges. Applications for U.S. gynecology residencies fell by about 5% overall – indicating that fewer physicians are planning to become gynecologists.