A political earthquake shook Kansas on Tuesday. Voters in the deep-red state turned out in droves to reject a measure that would have taken abortion protection out of the state constitution. With more than 90 percent of the vote reported, the “no” vote (which would preserve abortion access) led by nearly 20 points as of Wednesday morning.
President Biden put out a rare statement on a state referendum, praising the turnout and result. “Voters in Kansas turned out in record numbers to reject extreme efforts to amend the state constitution to take away a woman’s right to choose and open the door for a state-wide ban,” he said. “This vote makes clear what we know: the majority of Americans agree that women should have access to abortion and should have the right to make their own health care decisions.” He urged Congress to “listen to the will of the American people and restore the protections of Roe as federal law.”
This is the first concrete evidence of a major backlash against the Supreme Court’s Dobbs decision. Forced-birth advocates in Kansas thought that by putting the measure on a primary ballot, for which turnout is historically lower, conservative voters could dominate. Instead, they drove Democrats and a lot of pro-choice independents and Republicans who might not otherwise vote to the polls.
Republicans in other states should pay attention to Tuesday’s results. They have been zealously passing bans in states such as Kentucky and Louisiana, and severely restricting access in others such as Florida. There is still time for lawmakers in some states to heed the warning from Kansas.
Indiana, for example, is on the precipice of outlawing abortion from the moment of conception, except if needed to prevent “substantial impairment” to a woman’s life. Victims of rape or incest would have to get abortions within the first trimester (before many women know they are pregnant) or face the trauma of a forced pregnancy and labor. That will add to the tide of women desperately traveling to states such as Illinois (or Kansas) to get care.
I spoke recently with Jennifer Pepper, chief executive of CHOICES — Memphis Center for Reproductive Health, who has been planning to move her clinic since the Supreme Court took up the Dobbs case last year. While her facilities will still provide services for those within six weeks of pregnancy, when there is no fetal heartbeat, the vast majority of her patients will have to go elsewhere for care. That could be as far as Carbondale, Ill., where she is starting a clinic from scratch.
counterpointThe democratic lessons of Kansas’s pro-choice upset
Carbondale might become a central location, the place farthest south that can provide abortion services according to medical standards, if the entire South moves to ban abortions (a likely scenario). “There were 11,000 abortions in Tennessee alone last year,” Pepper says. It will simply not be possible to accommodate all the patients stranded in states that force women to remain pregnant.
Nevertheless, Pepper says services there will be initially limited to medical abortions (generally available for up to 11 weeks). For procedural abortions, patients will have to be directed to travel to farther locations. Her clinic is becoming increasingly involved with patients’ logistical needs. That might entail helping patients with transportation and accommodations. Abortion funds can help defray the cost, but the ordeal of arranging travel, accommodations and in some cases, child care for kids at home, means further delays and later abortions, perhaps beyond the 11-week cutoff for medical abortions. (The irony is these laws are shifting what would have been early abortion to later-term abortions.)
As Kansas voters seem to have recognized, the impact of these bans on women’s lives can be devastating. While abortion advocates often highlight the adverse physical, economic and social consequences from forced-birth laws, there might also be substantial damage to women’s mental health.
Katherine Wisner, a practicing psychiatrist specializing in abortion cases, tells me that there are many instances in which mental health disorders might warrant an abortion. Patients with anxiety disorders, depression and other serious conditions might not want to risk aggravating or relapsing during a pregnancy or postpartum period (which is common). Wisner tells me, “The rates of postpartum disorders I found in [a 2013] study will increase with the stress of lack of reproductive choice.” These bans, she expects, will “leave a slew of victims in their wake.” And worse, this comes at a time when we are already experiencing a massive shortage of mental health services.
In the wake of Kansas, states should also consider how abortion bans affect the medical profession. Wisner emphasizes that the mental health toll on doctors and other medical personnel, already stressed to the breaking point with covid, will increase as their caseloads rise dramatically in abortion-safe states. In red states, they’ll be forced to weigh the needs of patients against their own risk of prosecution. She expects “burnout” to escalate.
Kansas, however, provides an alternative outcome to the parade of disasters. Voters there have sounded a wake-up call for lawmakers to consider not only the unpopularity of bans but also the wave of suffering they will unleash. The Kansas vote should prompt states to pause before joining the forced-birth movement.