We Can’t Give Up on States With Abortion Bans

On my campus and in advocacy spaces, I often find myself in the minority opinion, fighting for the states that so many have left behind. The response to Dobbs cannot be a tactical retreat.

A rally to protest the closure of the last abortion clinic in Missouri on May 30, 2019, in St. Louis. (Jacob Moscovitch / Getty Images)

As the first anniversary of the Dobbs v. Jackson decision approached, I sat in a training session with my student reproductive rights advocacy group, excited to hear from a longtime abortion rights champion on how we could continue strengthening our advocacy efforts as students in a state with a total abortion ban. I was taken aback when this leader advised me and my fellow student advocates to focus less on Missouri. This perspective that in our post-Dobbs landscape, we need to center our efforts solely on investing in abortion access in states where abortion is still legal is an increasingly common one among pro-abortion advocates and providers. It has left states like Missouri behind as the abortion rights movement has been forced into crisis management. 

Since Missouri became the first state to completely ban abortion after Dobbs, activists and providers have been left to address a fragmented reproductive rights landscape. Clinics in Illinois, where abortion is still accessible without restriction, frequently saw Missouri patients even before the fall of Roe, as harsh restrictions and TRAP laws made abortion largely inaccessible to Missourians.

Of course, this influx of out-of-state patients only increased after Dobbs, as anti-abortion state politicians seized the opportunity to restrict access further. Illinois clinics now expect patients from non-bordering states like Florida and Georgia, as state lawmakers continue to chip away at remaining access.

No state is too far gone for substantial pro-abortion political action.

Last summer, while I was interning at Planned Parenthood of the South Florida region, Florida remained an epicenter for access in the South, bringing in patients from neighboring states with more restrictive bans. After the floor created by Roe was demolished, Gov. Ron DeSantis (R) and the Florida legislature targeted abortion access in a larger crusade against human rights.

But Missouri remains emblematic. As we get farther away from the media hype of the Dobbs decision, resources have been stripped from grassroots abortion advocacy efforts in ban states, and working around bans has become the priority. ​​The idea that we shouldn’t give up on Missouri shouldn’t be radical—yet on my campus and in advocacy spaces, I often find myself in the minority opinion, fighting for the states that so many have left behind. 

Though abortion is banned in Missouri, state-level advocacy efforts are more critical than ever. In this year’s legislative session alone, 20 bills were introduced in Missouri targeting access to medical abortion, criminalizing interstate travel, and increasing barriers to access. Funding advocacy efforts in Missouri is essential for the same reasons that funding efforts in abortion safe-haven states are essential: We all still have a lot to lose.

No state is too far gone for substantial pro-abortion political action. Just ask grassroots abortion advocates in states with anti-abortion-led legislatures—like Ohioans who fought hard this year to put a ballot measure ensuring the constitutional right to abortion. Advocates were also crucial in rallying voters last year to defeat anti-abortion ballot initiatives in Kansas and Kentucky and elect a pro-abortion judge in Wisconsin.

Pigeonholing on crisis management efforts alone ensures a crisis future for generations of Missourians to come. We must meet people’s immediate needs and lay the groundwork for a better future.

In the short term, we must invest resources in interstate travel so people in states with restrictive laws can access care. But this is a harm reduction tactic, not a long-term solution.

We also need to help spread knowledge about abortion pills, so people can self-manage their abortions at home. Community support networks are now providing free abortion pills to those living in states with bans, and dozens of companies are now offering abortion pills online for as little as $37, with prompt delivery in all 50 states.

As bad as things are now, our public health crisis can and will continue to worsen as support for grassroots abortion advocacy efforts dwindles. ”Workaround” strategies are essential for meeting the immediate needs of patients in states where adequate reproductive healthcare is inaccessible.

Still, in the long term, we are building an elaborate and unsustainable system of tightropes nationwide so patients can access basic reproductive healthcare. Forcing people needing life-affirming care like abortion to travel out of state is not only inequitable, but physically, emotionally and financially taxing to those needing care. The bodily autonomy we fight for means equitable access to sexual and reproductive healthcare in our communities.

No matter how many clinics are opened in neighboring states, the detrimental impact of the provider drought will persist as long as abortion remains inaccessible in states like Missouri. Already 47 percent of counties in Missouri are considered “maternity care deserts.” Just last month, a rural Missouri hospital closed its maternity care ward due to a growing shortage of providers, and 10 rural hospitals have completely closed in Missouri since 2012, exacerbating the maternity care crisis around the state.

Because of Dobbs, more and more maternity care providers are forced to decide between providing the best possible care with significant personal and legal risk or moving to a state that doesn’t infringe on their medical expertise. The closing of this ward is a looking glass into the future for Missouri families if advocates cede to the anti-abortion narrative that states like ours are too far gone. 

As we work toward a more equitable future where abortion and reproductive healthcare is accessible to everyone regardless of circumstance, we must continue to support workaround efforts that help people get the immediate care they need and support grassroots abortion advocacy efforts in states where abortion has been restricted. 

The response to Dobbs cannot be a tactical retreat. It took years for anti-abortion politicians to chip away and dismantle Roe. It will take years to rebuild past Roe toward homegrown and accessible reproductive healthcare in states like Missouri. 

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Amelia Letson (she/her/hers) is an undergraduate student at Washington University in St. Louis studying political science and women, gender and sexuality studies. She is an advocate for reproductive freedom on her campus and within her community and is currently interning with Abortion Action Missouri.