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The Battle for Abortion Access will be Fought Locally

Image via Neeta Satam/The Washington Post

A year ago, living in a country without the right to an abortion felt more like a conservative pipe dream than a material possibility. Today, it’s our reality. When the Dobbs v. Jackson Women’s Health Organization draft opinion was leaked, reproductive rights advocates told us that people would die, rape victims would be forced to give birth, and low-income people and people of color would bear the brunt of the economic and psychological burden. All of their predictions were right. 

Ohio healthcare providers wrote in affidavits that they have already seen three women commit suicide after being denied abortions. In Texas, women have reported suffering irreversible damage because they were forced to delay medically necessary abortions until their conditions were serious enough to land them in an intensive care unit. An early November report concluded that, in the two months following the Dobbs decision, abortions fell by 10,000. This number potentially represents 10,000 women who were forced to carry pregnancies to term because they had no other options. It inevitably includes minors, survivors of rape, and those without the financial means to support children. In Kentucky alone, there are more than a dozen victimized children under the age of 14 who get abortions every year. 

We don’t have time to wait for nationwide legalization. With the midterm elections flipping the house, a national codification of Roe is no longer a viable strategy for at least the next two years. We have to prioritize survival, which necessitates significant and immediate state and local action. 

While Democrats had banked on Roe v. Wade to keep abortion accessible, Republicans have long been prepared for a state-by-state battle on reproductive rights. They protested at abortion clinics, created crisis pregnancy centers, and pushed the limits of Roe with harsh legislative bans. Since the Dobbs decision, they haven’t let up and are instead intensifying their efforts to prevent abortions. Members of the anti-abortion movement are already drafting legislation that would allow private citizens to sue anyone for traveling out of state for an abortion, drawing upon the legal strategy of Texas’ original ban. Red states are funneling taxpayer money into “crisis pregnancy centers,” purposefully deceptive clinics that claim to protect women’s health while, in reality, using misinformation to dissuade pregnant people from getting abortions. Since Dobbs, some of these centers have been converted into vans that can drive to blue states and intimidate or redirect individuals outside of abortion clinics. 

As red states did everything they could to ban, restrict, and criminalize access to abortions, blue states vowed to be safe havens for abortion seekers. But if women’s stories about being denied abortions tell us anything, it’s that despite incredible efforts by lawmakers, reproductive care providers, and community organizations, Democratic states are losing the fight. Abortion clinics in blue states were already stretched thin prior to Dobbs, but since June, the situation has only gotten worse. For clinics bordering states with restrictions, wait times have increased from five days to weeks or months. 

Long wait times are a significant barrier for low-income people seeking abortions, as extended journeys entail greater upfront expenses and risking job loss. When clinics on borders are overwhelmed, people are forced to travel further for care. Problematically, studies have shown that living 100 miles away from a clinic decreases someone’s likelihood of being able to access an abortion by 20 percent. A quarter of women of childbearing age currently live at least 200 miles away from an abortion clinic. If blue states vow to be safe havens but do nothing to ease barriers for those who can’t access transportation, they are failing to meaningfully address systemic harm to low-income women. It can’t just be about legality anymore; it must be about access.

While blue states have passed laws to codify the right to abortion, few have done anything to prepare for the influx of out-of-state patients. One way they can do so is by creating state-run abortion funds to put government money behind existing feminist organizing. For example, a bill proposed in California would create a fund to help individuals pay for abortions and associated travel costs as well as provide funding to clinics to support individuals without health insurance. 

Additionally, blue states should direct more funding to create and support clinics that border red states in order to reduce the travel time necessary to access abortion care. Other proposed initiatives like expanding telehealth, increasing the production of safe abortion pills, and expanding the number of qualified medical professionals who can perform abortions would further help ease the burden on clinics. 

Advocating for change in red states is also not a lost cause. There are incredible organizations currently operating within red states to provide women with funding for abortions and reproductive and contraceptive care. And in city councils, mayors in some blue cities have already started taking action. In Austin, for example, Mayor Steve Adler passed a resolution that deprioritizes investigations into abortion-related crimes and prohibits city funding from being used to surveil reproductive decisions. 

Some additional measures that cities should take involve blocking data collection from local hospitals; directing hospitals to avoid collecting nonessential reproductive data from patients; and electing progressive prosecutors who will refuse to try abortion cases. There are already district attorneys in Texas who have stated that they will refuse to prosecute people for receiving abortions. City governments in restrictive states can also provide legal advice to obstetricians, gynecologists, and other medical professionals who are now in tenuous positions because lines between legal and illegal are increasingly blurry. Such actions can go a long way toward stopping the criminalization of individuals seeking and providing abortions. 

Reproductive rights are absolutely central to women’s freedom and ability to live. Stripping them puts poor women and women of color who are already being hurt by the defunding of welfare programs, devaluation of care work, the carceral system, and so many other structures in even more precarious positions. As we continue to put pressure on the federal government, it is imperative that blue states and cities do what they can to prevent more people from suffering and dying due to abortion bans.