Illinois abortion providers are hopeful a wave of upcoming abortion-related ballot measures in other states will favor reproductive rights, but they predict these initiatives are unlikely to immediately quell the crush of out-of-state patients who have been traveling to Illinois following the fall of Roe v. Wade.
On Nov. 5, millions of voters in 10 states will weigh in on how their state regulates abortion, including in parts of the country where the right to terminate a pregnancy has been almost entirely banned or severely restricted after the U.S. Supreme Court overturned Roe in June 2022, ending nearly a half-century of federal abortion rights.
In neighboring Missouri, a ballot measure would enshrine abortion rights in the state constitution up to the point of fetal viability. Missouri prohibited nearly all terminations immediately after Roe was overturned.
In Nebraska, dueling initiatives could expand or restrict the right to terminate a pregnancy: One measure would ensconce abortion rights until viability — or later in cases that risk the health or life of the pregnant person — in the Nebraska Constitution. The other measure would prohibit most abortions past the first trimester. Nebraska now has a 12-week abortion ban, with some exceptions.
Various other abortion-related initiatives will also be decided by voters in New York, Florida, Colorado, Arizona, Maryland, South Dakota, Nevada and Montana.
Dr. Allison Cowett, medical director of the Chicago abortion provider Family Planning Associates, said she’s optimistic voters will generally support abortion rights. In previous ballot measures in seven states — California, Kansas, Kentucky, Michigan, Montana, Ohio and Vermont — voters have favored reproductive health freedoms.
“I do feel hopeful that the ballot measures will send a message that the majority of Americans want abortion to be available close to home,” she said.
But Cowett noted that abortion rights don’t always translate into access to reproductive care. She cautioned that even if voters support pro-reproductive rights measures in these states, that doesn’t mean abortion will actually be available and accessible there, at least in the short term.
She predicts most of these amendments will likely be challenged in court and are unlikely to go into effect “for months, if not years.”
At Family Planning Associates, about 12% of patients were from other states when Roe was the law of the land compared with 30% after the end of federal abortion rights, Cowett said. She doesn’t anticipate the outcome of the ballot initiatives will decrease the throngs of abortion seekers traveling to places like Illinois anytime soon.
“Interestingly I don’t think the ballot initiatives — regardless of the decisions — will have a significant impact on our patient population, at least in the immediate months,” Cowett added. “We believe we will continue to see many, many patients from out of state.”
After the demise of Roe, the number of patients traveling to Illinois for abortion care skyrocketed: Nearly 17,000 abortion seekers came here from other states in 2022, the year Roe was overturned, a 49% increase over the previous year, according to Illinois Department of Public Health data.
In response, several new clinics have opened in Illinois and existing abortion providers have extended their hours or added telehealth and abortion pill by mail services to try and serve the increase in demand.
Illinois has strong reproductive rights protections and has long been considered an island of abortion access amid the largely restrictive Midwest. Nearly 10,000 patients crossed state lines into Illinois to have an abortion in 2020, when Roe was still intact, and the number had increased every year since 2014, state health department data showed.
Dr. Erica Hinz, an Illinois obstetrician-gynecologist and specialist in complex family planning, said ballot measures wouldn’t preclude states from enforcing other abortion restrictions — certain gestational limits, wait periods and burdensome regulations governing abortion clinics — that could still prevent many patients from terminating a pregnancy, leading them to leave their state for care.
“I don’t think they will impact travel to Illinois too much, just because we’re already seeing people from states that have passed ballot amendments,” said Hinz, who works for an Illinois abortion provider and a university hospital.
Even when abortion rights are enshrined in a state constitution, other restrictions that were already in place, or new ones crafted by state legislatures, can still make it difficult or impossible to have an abortion, she explained.
“So while it’s legally accessible, it’s not practically accessible,” Hinz said. “So people are still traveling for care.”
Chicago Abortion Fund Deputy Director Qudsiyyah Shariyf said parental notification laws and restrictions on terminations later in pregnancy can also be barriers for certain abortion seekers, even when pro-reproductive rights ballot measures pass.
“The most marginalized people — young people and folks that are later in pregnancy and need abortions — are essentially being left out or left behind in a lot of these ballot measures,” Shariyf said. “If any abortion is stigmatized all abortion is stigmatized.”
In 2019, the Chicago Abortion Fund supported 824 abortion seekers. In 2023, after the fall of Roe, the nonprofit received more than 12,000 requests for support, which includes procedure funding and travel costs such as lodging, transportation, meals, childcare and other expenses; this was the highest number in its 39-year history and the Chicago Abortion Fund plans to meet another “year of record-breaking need in 2024,” Shariyf said.
Sarah Garza Resnick, chief executive officer of the pro-abortion rights political committee Personal PAC, added that in states where abortion has been banned or severely restricted, it’s often difficult for clinics that closed or ceased offering abortion to resume terminations quickly, even if the law changes; she noted that some abortion providers leave the state or shut down and never reestablish care.
“So even when these ballot initiatives pass, it’s wonderful. But then I think voters are going to be left thinking, ‘well why still can I not get access to abortion?’” she said. “And I think people are kind of losing that thread, the difference between rights and access and equitable access to a right. Rights are wonderful. But if only wealthy people have access to those rights, is that really a right?”
Resnick said ballot measures can serve as “a tool in the tool kit,” but they’re not enough to truly change the national reproductive rights landscape.
Illinois abortion opponents don’t foresee these ballot initiatives reducing out-of-state abortions here either, regardless of their outcome.
Matt Yonke, communications director for the Chicago-based Pro-Life Action League, said he believes “the American people don’t ‘like’ abortion, but they’re deeply uncomfortable with the idea of it being banned outright.”
“When it’s posed as an all or nothing proposition — which is how the pro-abortion campaigns are posing it — they prefer that some abortion remain legal,” he said.
Yonke added that he believes most Americans support “common sense” abortion restrictions.
“When we talk to people during our pro-life activism on the street, most people say there should be some limits, whether on gestational age or things like parental involvement for minors,” he said. “Based on what I see when I interact with the public, I think most people have a sense that throwing away these tiny lives is definitely suboptimal, but they can’t see other answers to solve the problems that lead women to choose abortion so they believe it should remain legal in some form.”
But Yonke doesn’t anticipate these out-of-state ballot measures will have much impact on Illinois.
“As a lifelong Illinoisan, I’m disgusted that we’re already known as the abortion destination for the surrounding states that have stronger protections for children in the womb,” he said. “Sadly, I imagine we’ll continue to fill that role.”
Illinois Right to Life Executive Director Jaclyn Cornell added that “the abortion industry will continue to use states with the least restrictions as a way to make up for their bottom line against states who have chosen to respect the lives and rights of the most vulnerable.”
The ballot initiatives come as abortion remains a central issue in the heated U.S. presidential race.
Democratic candidate Vice President Kamala Harris has said working to restore abortion protections would be among her top priorities in office.
“Ours is a fight for the future, and it is a fight for freedom — for freedom, like the fundamental freedom of a woman to make decisions about her own body and not have her government tell her what to do,” Harris said during a recent campaign event in Georgia.
She went on to describe how her Republican opponent, former President Donald Trump, “hand-selected three members of the United States Supreme Court with the intention that they would undo the protections of Roe v. Wade, and they did as he intended.”
“And now, in America, one in three women lives in a state with a Trump abortion ban,” she added.
In a statement on the day Roe was overturned, Trump credited the ruling to the conservative justices he nominated to the high court.
“Today’s decision, which is the biggest WIN for LIFE in a generation, along with other decisions that have been announced recently, were only made possible because I delivered everything as promised, including nominating and getting three highly respected and strong Constitutionalists confirmed to the United States Supreme Court,” he said at the time.
In early October, however, Trump said he would veto a federal abortion ban, adding that the matter of abortion rights should be decided by states.
Yonke of the Pro-Life Action League said he’s discouraged, though not shocked, by Trump’s approach to abortion this election.
“I never had any illusions that his pro-life stance was more than pragmatic, so I’m not surprised that he’s turned away from it since he did what was asked of him in his first term,” he said.
Cornell of Illinois Right to Life said there’s a vast difference between the way Harris and Trump view abortion, noting that Trump’s first term in office “did a lot for the pro-life movement.”
She also lamented that the Harris-Tim Walz “ticket is the most pro-abortion platform this country has ever experienced.”
Resnick of Personal PAC believes Trump hasn’t actually softened his stance on reproductive rights, calling the former president’s statements on the campaign trail “just a change in verbiage.”
“We are at a precipice of unleashing, if Donald Trump became our president again … a horror onto this country and onto the women of this country that we have never seen,” she said.
Resnick added that she trusts Harris and Walz to defend reproductive rights.
“I know they will do everything in their power to protect women and pregnant people so that we can get the health care that we need and deserve,” she said.
The Associated Press contributed.
