It’s been three months since seven states passed amendments to add abortion protections to their constitutions, and not as much has changed as clinics had hoped.
In five states that added protections, abortion was already allowed either with no gestational limit or up to fetal viability, which varies by pregnancy but is typically about 24 weeks gestation, according to the American College of Obstetricians and Gynecologists.
In two states, “yes” votes set the stage for potential law reversals: Arizona, where a 15-week ban took effect in September 2022, and Missouri, where a total ban with limited exceptions took effect in June 2022, minutes after the Supreme Court overturned constitutional abortion protections in Dobbs v. Jackson Women’s Health Organization.
The problem is that a state’s constitutional amendment doesn’t automatically override state laws. There are still restrictions in these states and across the nation that impact patient access and threaten clinics’ ability to stay afloat, providers say.
There are still legal technicalities, residual restrictions, and a lack of awareness about the changes, Gabrielle Goodrick, medical director at abortion care clinic Camelback Family Planning in Phoenix, told Healthcare Brew.
“[After the amendment passed], we were on cloud nine,” Goodrick said. “But there’s so many other factors.”
Arizona’s fight continues
Arizona’s amendment took effect following a statewide canvass on Nov. 25, per the state constitution.
Arizona-based providers then filed a lawsuit on Dec. 3 to overturn the state’s 15-week ban, according to the American Civil Liberties Union (ACLU) of Arizona.
The suit is still ongoing, but the day it was filed, state Attorney General Kris Mayes signed a stipulation that says the 15-week ban is “unconstitutional and unenforceable” while the suit plays out. This allowed providers to resume abortions up to fetal viability or past that point if needed to save the mother’s life.
Goodrick said her clinic immediately resumed abortions past the 15-week threshold. She estimates they do at least a dozen a week for patients from all over the country.
But many patients and even some physicians don’t know that abortions past 15 weeks have resumed, Goodrick said. There are also still other restrictions in effect, like a requirement that makes patients wait 24 hours between their initial consultation and abortion.
It’s a rapidly changing and complicated situation that is straining clinics nationwide, she noted.
“We’re seeing patients from Louisiana. We see Floridians. We see Texans every day. People are trying to get the healthcare they can, and we’re trying to help them,” Goodrick said. “But it’s overwhelming. It’s overwhelming to the system that was already overwhelmed before Dobbs.”
Missouri lawsuits rage on
Several states over in Missouri, residents also voted to add abortion protections to the state constitution.
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Missouri’s two Planned Parenthood affiliates and the ACLU of Missouri sued the state on Nov. 6 to overturn its abortion ban and other restrictions, such as a 24-hour waiting period requirement that is similar to Arizona’s.
On Dec. 20, the 16th Judicial Circuit Court of Jackson County in Kansas City temporarily blocked some of Missouri’s existing abortion restrictions—including the ban—from being enforced while the case plays out, but it didn’t block them all.
Hospitals are able to resume abortion care, for example, but there are still requirements in place that prevent Planned Parenthood clinics from providing abortion services, such as making abortion clinics obtain a license from the state, according to a Dec. 21 statement from the local ACLU.
“Unless these discriminatory laws are enjoined, Missourians will continue to be denied full access to the abortion care that is now protected under our state constitution,” read a statement provided to Healthcare Brew from the ACLU and Planned Parenthood affiliates.
Zooming out
And then there’s Florida, South Dakota, and Nebraska. These states did not get enough support for amendments to protect access to abortion, leaving restrictions in place for now.
As of Jan. 6, 12 states have near-total abortion bans in effect with limited exceptions, according to the New York Times tracker. Seven more ban the procedure between six to 18 weeks gestation.
At least 76 independent clinics, like Goodrick’s, have stopped offering abortions or closed altogether since 2022, according to November data from the Abortion Care Network, a national membership and advocacy organization for independent clinics.
Goodrick worries about the financial viability of clinics in other states, but holds on to hope.
“Even not being able to provide care over 15 weeks [gestation] affected our numbers,” she said. “But we survived, and I think in the states where abortion is at least legal for some gestations, they can pivot and provide other care, maybe, and hopefully, things will swing back.”