Anti-abortion politicians and activists are coalescing around early gestational limits that providers say could deny care to up to 90% of patients
(Bloomberg) — Republican-led state legislatures are increasingly road-testing restrictive abortion rules that fall just short of total bans, to see how far they can limit reproductive health-care without generating political backlash.
States such as Florida and Georgia have passed laws banning abortions after six weeks, before many people realize they are pregnant. Others are trying out slightly longer gestational limits. North Carolina’s Senate Republicans earlier this month advanced a bill that would restrict abortion after 12 weeks, while Arizona has a 15-week ban in effect.
After years of hewing to a strong anti-abortion platform, Republicans are treading more carefully as they run into a different political reality since the end of Roe. When given the choice at the ballot box in the last year, voters have turned out to support abortion protections and delivered a series of losses to Republicans in key political contests where reproductive health was an issue.
While the majority of the Republican base supports extreme restrictions and bans, a January Gallup poll of Americans showed that 17% want less strict abortion laws, an increase from just 2% in 2021. Among Independents, 44% want less strict laws, up from less than 20% before Roe was overturned.
“In these purple states, we’re going to see a drip drip — incremental changes that will satisfy the base, but not cause a backlash,” said Alex Patton, a Republican strategist and pollster based in Florida. Ultimately, laws that pass without much pushback could not only inform other state legislation but offer a road-map for a national strategy, which has yet to emerge among federal lawmakers.
Even without a total ban, abortions fall sharply in states when gestational limits are imposed.
After Georgia’s six-week ban took effect, legal abortions performed in the state fell 55%, according to a Society of Family Planning report. At one clinic in Jacksonville, a coastal city that’s home to almost 1 million Floridians, staff said that if the state’s Supreme Court allows the six-week limit to go into effect they could soon be turning away nine out of 10 potential patients.
“It’s been really confusing for our staff and our patients because things change so quickly and so drastically,” said Kelly Flynn, president and chief executive officer of A Woman’s Choice of Jacksonville. Less than 10% of patients come in before the six-week mark, Flynn said, which passes before many people find out they’re pregnant.
In Ohio, a six-week limit went into effect for three months last year before a judge blocked the law. (The ban could go back into effect any time, depending on how it moves through the courts.)
That first night, staff at Preterm, a Cleveland clinic whose doors have been open since 1974, stayed until about 11pm to call patients past the six-week restriction and tell them they could no longer see them. In the immediate aftermath, the number of patients dropped to 30% to 40% of the typical 400 people it would see each month, according to Sri Thakkilapati, interim executive director at Preterm.
“I worry about the people that we see and what will happen to them when we’re not here,” she said.
Ohio clinics had to cancel the appointments of minors, victims of sexual assault and patients who couldn’t receive cancer treatment until they’d had an abortion, according to court papers.
Across the state, providers saw over 1,500 fewer patients in July and August, though numbers have almost returned to their levels under Roe, since the ban was blocked by a judge.
Testing Waters
The political right in the US hasn’t found a cohesive approach to abortion.
Almost a year after the end of Roe, near total bans are in effect in 13 deep-red states. But extreme restrictions in South Carolina and Nebraska — both controlled by Republicans — failed to pass in recent weeks. Nebraska legislators had proposed a six-week ban with some exceptions; in South Carolina, legislators wanted a near-total ban, with exceptions for rape and incest.
Republican hopefuls for the 2024 election have floated divergent policies. Florida Governor Ron DeSantis, who is widely expected to run, signed the bill restricting abortions after six weeks. Former South Carolina Governor Nikki Haley called for a “national consensus,” though she is yet to detail what she believes that consensus should be. Haley also urged her party to acknowledge the limits of federal action on the abortion debate.
Former President Donald Trump has blamed the party’s disappointing midterm election results on GOP candidates’ hardline on abortion, particularly those who are against exceptions for rape or incest.
And though the staunchly anti-abortion group SBA Pro-Life America — which was closely aligned with Trump when he president — still wants a national ban, the group told Bloomberg News in April that it’s now open to a 15-week limit with exceptions for rape, incest or if the life of the mother is in danger. It’s threatened to oppose any Republican candidate who doesn’t support the same, at a minimum.
“It’s going to be part of the 2024 election cycle and beyond,” said US Senator Lindsey Graham, a South Carolina Republican, during an April 26 hearing on the post-Dobbs landscape. Graham recently reiterated calls for a 15-week nationwide abortion ban.
Polling data show a disconnect between lawmakers’ actions and what most Americans want. A University of North Florida poll of 1,500 people in February and March found that 75% of Floridians oppose a six-week ban. Of 550 Republican respondents, 61% said the same. Even 40% of Republicans believe abortion should be available in the first 12 weeks of pregnancy, according to an NPR poll. The other 60% want near-total or total bans.
Meanwhile, the specter of additional restrictions is motivating pro-abortion voters to back reproductive rights in elections.
In Kentucky last year, voters struck down a measure that would have amended the state constitution to say there is no right to abortion. In Montana, an anti-abortion ballot measure was defeated in November. And after the most expensive judicial election in US history, a flip of the Wisconsin Supreme Court in April has given Democrats an opening to undo decades of Republican policies on abortion access.
“What’s on the ballot does determine turnout and who comes out to vote,” said the Republican strategist, Patton. “I’m not going to give the Democrats strategies, but that’s probably a pretty good one.”
Patchwork Effects
The patchwork of state laws has created vast abortion deserts, which will only widen as more restrictions go into effect.
Florida’s clinics, particularly in the north and west, have been popular destinations for people from nearby, more restrictive states — like Alabama, Mississippi and Tennessee. The monthly average number of terminations in the state from July to December was 19% higher than in the weeks before Roe was overturned.
Two clinics in Tallahassee, just 75 miles or so from the state border with Alabama, are now the nearest abortion providers for more than 1.5 million women, according to a dashboard from Caitlin Myers, a researcher at Middlebury College.
“It is a lot to ask of these patients and it’s unfair that they don’t have this type of care within a reasonable radius,” said Flynn, who oversees clinics in North Carolina in addition to the Florida facility.
At his three abortion clinics in Ohio, abortion provider David Burkons is seeing patients from as far away as Texas, and patient numbers are running ahead of last year. But most of his 31-person staff are part-time and have other jobs: it’s hard for him to hire full-time employees when he doesn’t know if his business will be open in a few months.
“Even though we’re busy, we’re doing gratifying work, we can’t really make any plans for the future,” he said.
Last summer, during the months when the state’s six-week ban was in place, Burkons looked at real estate for potential clinics in Michigan or Pennsylvania. He would consider it again if the law is reinstated.
“I’m certainly looking into it, but I’m 76 years old,” he said. “I would rather stay closer to home, and I think patients would rather stay closer to home, too.”
–With assistance from Ella Ceron.
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