When the US supreme court upended the federal right to abortion enshrined in Roe v Wade, the immediate task before Democrats seemed simple: keep abortion legal in as many states as possible.
But over a year since Roe’s demise, some leaders in the reproductive rights movements worry that Democrats have tunnel vision, focusing their messaging and resources entirely on the legal tug-of-war over abortion bans in the midwest and south.
“Voters want to understand: what are you going to do to make things better? They don’t want to just hear, oh, we’re not going to ban abortion. That’s important, but that’s not good enough,” said Andrea Miller, president of the National Institute for Reproductive Health, which supports abortion rights.
Miller said the fight to keep abortion legal is just one frontier in the larger battle for reproductive healthcare. She spent the past year pushing blue states to pass legislation that makes abortion easily accessible, affordable and without stigma for patients and providers.
In recent months, Maryland has emerged as an example of how Democratic lawmakers can take proactive steps to bolster abortion access, even in states where the procedure is and will probably remain legal.
Maryland is one of just eight states that require private insurers to cover abortion care with no cost-sharing.
In April 2022, in anticipation of the supreme court ruling on abortion, Maryland Democrats passed a bill that allows nurse practitioners, physician’s assistants, and other medical health professionals to supervise abortions.
“Before, we would only allow doctors to do it, even though nurse practitioners, midwives, all these other medical professionals are able to handle the similar things like miscarriages and deliveries,” said the Maryland house delegate Joseline Peña-Melnyk, one of the bill’s sponsors.
The law also directs the state to invest $3.5m a year for abortion-care training.
If Roe fell, Maryland’s solidly Democratic legislature could ward off any attempts at criminalizing abortion patients or providers. But keeping abortion legal was not good enough. Peña-Melnyk and her colleagues wanted to ensure that Maryland’s abortion clinics would have the capacity to deal with an inevitable surge of out-of-state patients.
“This case ending Roe didn’t come out of nowhere, we saw it coming, so when the legislative session started in 2022, we started preparing,” Peña-Melnyk said.
She said Maryland’s investment in reproductive healthcare helped prepare the state for the coming months, when West Virginia, Ohio and other neighbors enacted a dizzying web of abortion restrictions.
The push to bolster abortion resources in Maryland is part of what attracted Dr Anne Banfield to the state.
Dr Banfield spent over a decade of her career as an OB-GYN at a rural hospital in West Virginia. She relocated to Maryland in spring 2022, just after a leaked draft opinion revealed that the supreme court was poised to upend abortion rights.
“When I was in West Virginia, there was this constant hum in the background of, oh, what are the politicians going to do next,” she said. “You don’t realize how much that negatively impacts your overall outlook until the pressure is gone.”
One year after Banfield moved, Maryland’s governor, Wes Moore, signed a new set of protections for abortion providers and patients, including a measure that shields the state’s doctors from legal liability if they provide an abortion to out-of-state patients.
“Listen, we are a rural hospital, it is a place that typically has challenges recruiting providers,” Banfield said.
But in the past few months, Banfield said she has been able to hire recent graduates from top residency programs.
“I can look at these candidates and say, this is a place where you can come and practice full-spectrum reproductive healthcare,” she said. “Here is a place where you will be protected.”
States without affirmative protections for patients and providers could see increased “brain drain”, with doctors like Banfield relocating to places like Maryland. Reproductive health workers are increasingly wary of states that do not proactively push to make abortion more affordable and freely accessible, beyond basic questions about legality.
Hanan Jabril, a full-spectrum doula and abortion rights organizer in Wisconsin, is preparing to apply to medical school in hopes of becoming an OB-GYN.
“Where I’m applying, where I want to end up, it’s something I’ve been thinking about for years, and the political climate of different states is a huge part of that decision,” said Jabril. “States like Wisconsin are just hemorrhaging residents in OB-GYN especially, because the work is being criminalized by these bans.”
When Roe was overturned last year, an 1849 law banning abortion went back into effect in Wisconsin. The 19th-century ban is currently facing a legal challenge that is expected to land before the Wisconsin supreme court.
Jabril was part of a coalition of progressive organizers that helped elect a liberal justice to the state supreme court in April. With a liberal majority on the court, Wisconsin is poised to overturn the state’s 1849 law.
But Jabril said that overturning the ban on abortion wasn’t good enough.
“It’s important, but I think people forget that this fight didn’t start last year,” they said.
Jabril said there were cost barriers to accessing abortion that have long predated the overturn of Roe. Because of the Hyde amendment, passed in 1977, states are banned from using federal Medicaid dollars to pay for abortions, with very narrow exceptions.
Of the 32 states following the Hyde amendment, just four states help pay for abortion in cases where a pregnancy could cause long-lasting damage to a patient’s physical health.
Jabril wants to train and practice medicine in a state like Maryland or Illinois, which has voluntarily opted to use state dollars to cover all or most medically necessary abortion.
“People don’t realize how much more there is to abortion access than just, the law says it’s OK,” said Jabril. “If you can’t pay for it, or if there’s no provider within driving distance, then abortion is still not accessible.”
