State Reproductive Health Care Policy Trends in 2024: Everything You Need to Know

Last year was the first full year of state legislative sessions since the Dobbs decision, making it one of the most active years for reproductive health policy. In 2023, 39 states enacted legislation related to reproductive health. Reproductive rights and abortion continue to be a major topic of debate across the country, however, this year we are seeing a change in how it is being addressed, especially since this is a major election year.

Reproductive Rights on the Ballot in 2024

Currently, proponents in 12 states are attempting to get reproductive rights on the ballot this fall. Initiatives in Arkansas, Arizona, Colorado, Missouri, Nebraska, and South Dakota are currently collecting signatures to get measures before voters this year through citizen-led initiatives. Initiatives in Iowa, Maine, and Pennsylvania are going through the legislative referral process and require a vote from lawmakers to get onto the ballot. In Maryland and New York, legislators already certified measures for the 2024 ballot through this process. In New York, voters will decide whether to adopt the equal rights amendment which includes protections for pregnancy outcomes and reproductive healthcare, and in Maryland, voters will decide whether to enshrine the right to reproductive freedom in the state constitution. 

Ballot initiatives have also been facing legal challenges. In Florida, the Department of State has indicated that a measure to protect the right to abortion in the state constitution has reached the signature threshold. However, the measure faces a challenge from Florida Attorney General Ashley Moody (R) who claims the ballot summary language is misleading. The Florida Supreme Court heard arguments on this legal challenge on February 7. Similarly, a ballot initiative to create a right to abortion in Montana was blocked from moving to the signature-collecting phase of the initiative process after Montana Attorney General Austin Knudsen (R) determined the measure was “legally insufficient.” The group behind the measure has petitioned the state supreme court to overturn this decision. 

Abortion Back Before the U.S. Supreme Court

As noted above, the courts are playing a key role in the ballot initiative process, and their role in the reproductive health policy space doesn't stop there. Several state abortion laws are being challenged in courts, and as a result, abortion restrictions are currently on hold in Montana, Wyoming, Iowa, and Wisconsin. 

Abortion is also headed back to the U.S. Supreme Court. The Court has agreed to hear a case centered around Idaho’s strict abortion ban and the federal Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals with emergency departments to provide stabilizing care to patients with a medical emergency. In their decision to hear the case, the Justices also removed an injunction that prevented enforcement of the state’s abortion ban in cases of medical emergencies. In addition, the Court is scheduled to hear arguments in FDA v. Alliance for Hippocratic Medicine on March 26, 2024. The case challenges FDA approval of mifepristone, one of the drugs used in a two-drug regimen for medication abortions. Both of these cases will have a large impact on how abortion is legislated in the states.   

“Abortion Trafficking” Legislation 

While the courts and elections have been the major focus of reproductive health policy so far this year, we are also tracking a notable trend in state legislatures. “Abortion trafficking” legislation has been introduced in Tennessee, Mississippi, and Oklahoma. The bills would criminalize taking a minor to obtain an abortion without parental consent, even in states where abortion is legal. The bills are similar to a first-of-its-kind law passed last year in Idaho, which is currently on hold after a federal judge granted a temporary restraining order against the law in November.