By Carrie Baker for Ms. Magazine.
Broadcast version by Nadia Ramlagan for Kentucky News Connection reporting for the Ms. Magazine-Public News Service Collaboration

Overturning Roe v. Wade in June, the Supreme Court declared that "the authority to regulate abortion is returned to the people and their elected representatives." But with rampant voter suppression and gerrymandering on the rise-greenlit by the Supreme Court-these "elected representatives" often do not fairly represent the people. This makes ballot initiatives an increasingly important avenue for ensuring women's rights against the extremism of ruby red legislatures. Just look at Kansas.

On Aug. 2, Kansas primary voters overwhelmingly rejected a proposed constitutional amendment that would have allowed the Republican-dominated state Legislature to severely restrict access to abortion. The amendment was a response to a 2019 state Supreme Court decision in Hodes & Nauser v. Schmidt, which established that the Kansas Bill of Rights includes a right to abortion. The amendment would have overturned this decision and declared that "the constitution of the state of Kansas ... does not create or secure a right to abortion."

Some 59 percent of voters cast ballots against the proposed amendment in an election with a strong turnout-especially among Democrats and Independents-compared to the 2018 midterm primary. This despite the fact that there were no heavily contested Democratic primary races that would have pulled in their votes, and Independents in Kansas are not allowed to vote in partisan candidate races.

In the November elections, there will be five more ballot measures on abortion across the U.S.-the most on record for any single year.

Constitutional Amendment 2 would amend Kentucky's Bill of Rights to declare that there is no state constitutional right to abortion. Supporters backed the measure to forestall Kentucky courts from making a ruling similar to the Kansas Supreme Court's Hodes decision.

Protect Kentucky Access is leading the campaign against the amendment. "Healthcare and the right to bodily autonomy are basic human rights," said Tamarra Wieder, Kentucky state director of Planned Parenthood Advocates of Indiana and Kentucky. "This constitutional amendment puts tens of thousands of Kentuckians' access to safe, legal abortion at risk, and inserts the government into our individual, personal healthcare decisions. Abortion is healthcare and is a core component of social and economic equality for individuals, their families and their communities."

Another anti-abortion measure will appear on the midterm ballot in Montana, declaring that "infants born alive at any stage of development are legal persons" and punishing healthcare providers with civil penalties and up to 20 years of jail time if they do not provide medical care. Currently, Montana law requires medical care only if an infant is viable.

By contrast, three states have ballot measures that would add explicit protections for abortion to state constitutions. While courts in nine states have ruled that provisions related to privacy or personal autonomy secure the right to abortion, and other states have guaranteed this right through statute, no state currently provides an explicit constitutional protection for abortion. Voters in Vermont, California and Michigan have the opportunity to change that.

In Vermont, voters will decide on Proposal 5, the Right to Personal Reproductive Autonomy Amendment to the Vermont Constitution, which states that "an individual's right to personal reproductive autonomy is central to the liberty and dignity to determine one's own life course." The amendment would prohibit this constitutional right from being "denied or infringed unless justified by a compelling State interest achieved by the least restrictive means."

In California, voters will weigh in on Proposition 1, the Right to Reproductive Freedom Amendment, which would revise the California Constitution to forbid the state from interfering with or denying "an individual's reproductive freedom ... which includes their fundamental right to ... have an abortion and ... contraceptives."

Advocates in Michigan submitted 753,759 signatures to place a measure on the November ballot that would create a state constitutional right to reproductive freedom, defined as "the right to make and effectuate decisions about all matters relating to pregnancy, including but not limited to prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care." The ballot initiative would allow the state to regulate abortion after fetal viability; however, the state could not ban the use of abortion to "protect the life or physical or mental health of the pregnant individual," as determined by an attending healthcare professional.

In addition to these abortion-related measures, the general election ballot in Nevada includes an Equal Rights Amendment (ERA) that would add language to the Nevada Constitution that "prohibits the denial or abridgment of rights on account of an individual's race, color, creed, sex, sexual orientation, gender identity or expression, age, disability, ancestry or national origin." State Sen. Pat Spearman (D), a sponsor of the amendment, said, "We've waited long enough for equal rights to be incorporated into our state constitution. ... We must be brave in protecting the weak, the downtrodden, the oppressed. We must be brave in lifting our fellow Nevadans to a place of justice and equality." If the amendment passes, Nevada will become the 27th state to have an ERA in its constitution.

Other noteworthy ballot initiatives include minimum wage amendments in Nevada and Nebraska, a collective bargaining measure in Illinois, a right to healthcare amendment in Oregon, a Medicaid expansion initiative in South Dakota and a New Mexico amendment to direct public money to early childhood programs.

Voters in five states-Alabama, Louisiana, Oregon, Tennessee and Vermont-will decide on ballot measures to repeal language from their state constitutions that allows for enslavement or servitude as punishments for crimes or, in Vermont, for the payment of debts, damages or fines.

If the Kansas primary vote is a sign, these ballot measures could expand women's rights significantly in a number of key states.

Carrie Baker wrote this article for Ms. Magazine.


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By Jade Prévost-Manuel for Yes! Media.
Broadcast version by Farah Siddiqi for Ohio News Connection reporting for the Yes! Media-Public News Service Collaboration

Taylor Young has never wanted to be a mom. From the time the now 27-year-old began dating, she experienced persistent anxiety around the thought of getting pregnant in Ohio, a Republican-controlled state where Young felt her right to abortion was tenuous.

In 2018, she discovered the childfree subreddit, an online forum on Reddit for people who do not have children and do not want them. In that forum, she learned about bilateral salpingectomy, a procedure that removes both fallopian tubes and permanently prevents pregnancy.

"I was 19 or 20, and I knew I probably wouldn't be able to get it," says Young, who didn't meet the minimum age requirement to have a Medicaid-funded sterilization procedure at the time. "But it was something that was kind of in my back pocket."

In 2022, when a document suggesting the U.S. Supreme Court was likely going to overturn Roe v. Wade was leaked, Young, who now met the minimum age requirement, immediately made an appointment with her gynecologist for a bilateral salpingectomy.

After observing the mandatory one-month waiting period, Young received the procedure. "[I had felt like] an animal in a trap," she says. "But when I woke up from that surgery, it was just ... indescribable peace."

Young is one of many people of reproductive age whose health care decisions have been influenced by the overturning of Roe v. Wade, the fundamental ruling protecting the right to abortion in the United States.

In the years since, the rate of permanent sterilization procedures for people between 18 and 30 has jumped, particularly among female-born people. During the 2024 election, abortion rights were a key ballot issue and several states, including Maryland and Colorado, enshrined the right to abortion into their state constitutions.

Political promises to legalize abortion-a critical issue, but one topic in the much larger ecosystem of reproductive health care-have overlooked some of the discussions the country must have to improve reproductive rights for the millions of reproducing people in America. When we take a closer look at the quality of reproductive health care that most people receive, it's clear that simply restoring Roe v. Wade isn't enough.

"The populations with the best reproductive health care outcomes ... have all of [their] basic and human life needs met," says Dr. Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women's Reproductive Justice Agenda, a group that amplifies Black voices to advocate for reproductive equity. "That is why we have some of the worst outcomes when we compare ourselves to other industrialized countries."

Pregnant people in the United States are more likely to die during pregnancy, childbirth, or postpartum than any other high-income nation, even though more than 80% of maternal deaths are preventable. The maternal death rate is double for Black women, who statistically are less likely to have access to high-quality medical care. On average, giving birth in the U.S. can cost more than $18,500.

Cost is a leading prohibitive factor for those who most need to access birth control, abortion, and other reproductive health care. But there are legal barriers to subsidizing reproductive health care services-such as the Hyde Amendment, which bans the use of federal funds for abortion with few exceptions-and in many counties, no one to provide them. An estimated one-third of American counties, for example, do not have a single birthing facility or obstetric clinician to deliver maternal care.

So, what might reproductive health care look like in a reimagined America that puts equity first? There's already a framework for it: reproductive justice, a critical feminist framework that advocates for the right to have children, the right not to have them, and the right to raise children in a safe environment.

A Quest for Overall Well-Being

In 1994, a group of Black women activists coined the term "reproductive justice" to achieve, as Loretta J. Ross writes, "the complete physical, mental, spiritual, political, social, and economic well-being of women and girls, based on the full achievement and protection of women's human rights."

While reproductive justice promotes equitable reproductive health care for everyone, the idea was born out of the struggles that people of color-particularly Black women-have faced in the United States since slavery, when they were forced to bear children to work on plantations.

The framework acknowledges that Black women face poorer reproductive health outcomes-and aims to do something about it. "The reproductive justice framework analyzes how the ability of any woman to determine her own reproductive destiny is linked directly to the conditions in her community-and these conditions are not just a matter of individual choice and access," Ross writes. "Reproductive justice addresses the social reality of inequality-specifically, the inequality of opportunities that we have to control our reproductive destiny."

There is a modern-day implicit bias in health care, says Davis Moss, that women as a whole can't be trusted to make their own decisions about their bodies. For example, Black women commonly report that health care providers are not offering them the full range of contraceptive options.

"The subjugation, the control, all that has happened ever since the country was born," says Davis Moss. "We've seen that happen over the years in our health care system, in segregated hospitals, all the way up to modern day in clinical care encounters."

Though Young's bilateral salpingectomy, which can cost thousands of dollars without insurance, was fully covered by Ohio Medicaid, cost remains a prohibitive factor for many people accessing reproductive health care in the United States.

Take contraception, for example. A 2022 KFF Women's Health Survey, which interviewed more than 5,000 female-born participants, looked at how cost influences contraceptive choice. Researchers found that a quarter of those surveyed with insurance had to pay at least part of their birth control costs out of pocket. "Any time you have to make a choice about day-to-day expenses and a copay... you know, living expenses, keeping food on the table... that is going to have an impact [on health]," says Davis Moss.

The survey also found that of those who were in their reproductive years, one in five women who were uninsured had to stop using a contraceptive method because they couldn't afford it. That data is supported by a Commonwealth Fund survey of women in several high-income nations, which found that women of reproductive age in the U.S. were the most likely to skip or delay necessary care due to cost.

Solutions for the Future

In 2023, In Our Own Voice and more than 50 other Black women's organizations published the Black Reproductive Policy Agenda, a playbook on how to improve reproductive justice for birthing people at the policy level.

The report makes more than a dozen policy recommendations that Davis Moss calls "proactive, comprehensive, and life-saving." Among them are making prescription birth control free, requiring states to provide maternity and newborn care for at least one year (the time frame in which most maternal deaths occur), and increasing access to doulas and midwives who advocate for patients.

Passing acts like the Equal Access to Abortion Coverage in Health Insurance Act would require the federal government to provide funding for abortion services. "That in and of itself directly impacts a large percentage of Black women of child-bearing age [who] are on Medicaid and Medicare," says Davis Moss.

For people struggling to pay for contraception, with or without health insurance, the cost of an in-person abortion-the median price is $600-is somewhat unthinkable. Medication abortion, however, can be cheaper and more accessible. Such is the promise of telehealth abortion, a virtual way to connect with a doctor, receive a prescription, and take abortion pills in a supportive environment.

Increasingly more women in the United States are finding themselves living in maternity care and reproductive health care deserts-areas where there is limited or nonexistent access to prenatal, postnatal, maternity, contraceptive, or abortion services. Telemedicine can provide a range of services for people living in these areas at a fraction of the cost-the median price of a telehealth medication abortion is $150.

"Telehealth does a lot to remove barriers to access to health care," says Dr. Ushma Upadhyay, a public health scientist at UC San Francisco who researches the impacts of telehealth abortion. "People who live in rural areas, young people, people who report facing food insecurity... in our research, they are the most likely to have said that telehealth enabled them to have an abortion."

But even with the advent of telehealth, both Upadhyay and Davis Moss say addressing racism is essential to establishing an equitable reproductive future. That's one of the reasons the Black Reproductive Policy Agenda recommends funding anti-Black racism programs as a part of its agenda.

"This is the reason those 12 Black women 30 years ago said 'You can't only focus on abortion,'" says Davis Moss. "It's impossible to have one without the other."

After getting a bilateral salpingectomy, Young feels relieved. Yet she still worries about what will happen with Medicaid and the Affordable Care Act-the resources she relies on to help her afford care for chronic health issues-under the Trump administration, and what that means for others seeking care.

"Thinking about if other women don't have access, that breaks my heart, and from the abortion side [...] it's too much to bear," she says, emotion tugging at her voice. "I feel relieved I got [the procedure] done when I did. I feel safe."


Jade Prévost-Manuel wrote this article for Yes! Media.


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With a few days left in the 2025 legislative session, Republican lawmakers pushed through a bill they say should reassure doctors they can rely on their medical judgment when treating pregnancy complications, despite the state's abortion ban.

But some Kentucky doctors said the wording of House Bill 90, in an effort to clarify the ban, is "junk language," which confuses them even more than current law.

Tamarra Weider, Kentucky state director for Planned Parenthood Alliance Advocates, said dozens of health care providers have signed onto a letter asking Gov. Andy Beshear to veto it.

"I think it's also important to note that House Bill 90 changes the definition of medical emergency in Kentucky law," Weider pointed out. "The current law gives providers the authority to make decisions in emergencies but this bill would allow judges to decide whether care was truly necessary."

Some Kentucky OB/GYNs said the state's abortion ban is forcing them to violate their oath as physicians and causing "devastating consequences" for patients. Two House Republicans brought forth the language, which was supported largely along party lines. Supporters said the bill will help save lives.

Weider noted physicians accused of violating Kentucky's abortion ban can be charged with a Class D felony and imprisoned, if convicted.

"I think that this is going to continue to chill doctors, continue to chill hospitals, and their lawyers and administrators," Weider emphasized. "Because it puts forward more confusion, more ambiguity."

The legislation said, "no action that requires separating a pregnant woman from her unborn child shall be performed, except the following, when performed by a physician based upon his or her reasonable medical judgment." Doctors said the use of "reasonable medical judgment" still does not protect providers from legal action.

This story is based on original reporting by Sarah Ladd for the Kentucky Lantern.


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The 2022 U.S. Supreme Court decision to overturn federal abortion protections continues to be felt.

New research now suggests states where bans have been enacted, including South Dakota, will see fewer workers because of the moves.

The Institute for Women's Policy Research is out with a new study including survey data from 10,000 adults. The authors said one in five respondents planning to have children within the next decade has moved -- or knows someone who has -- to another state because of reproductive care restrictions in their current location.

Melissa Mahoney, senior research economist at the institute, said it shows ban states will likely see some of their workforce talent flow elsewhere.

"The labor markets in states that protect abortion tend to be more welcoming for women with higher wages, greater access to health insurance, also stronger labor force participation," Mahoney outlined.

The findings mirror results from a similar study issued earlier this year by the National Bureau of Economic Research.

After the Dobbs ruling, when conservative states began enacting bans, officials such as former Gov. Kristi Noem pledged their support for pregnant women and children. Some policy analysts argued Noem's record often fell short in that area.

Mahoney pointed out their research indicates it is not just a problem for state policymakers. She noted businesses should also be worried about a "talent drain," with survey respondents wanting them to prioritize care access.

"Many, in addition, are asking more of their employers in terms of reproductive health care benefits, in terms of speaking out against abortion restrictions in their states," Mahoney observed.

According to the findings, 57% of respondents said they are more likely to apply for or accept a job with reproductive health care benefits as part of the offer. And in South Dakota, 65% of adults think employers should provide financial assistance for child care.


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