While the Republican Party retook the White House and US Senate in the 2024 elections this week, a number of state ballot measures protecting reproductive freedom were also successful. Brittany R. Leach writes that the passing of these ballot initiatives in otherwise conservative states and counties would seem to vindicate the Reproductive Justice approach to reproductive freedom which links these rights and health to economic and social justice.

Though the 2024 election proved devastating for feminists and other progressives hoping to finally elect the first woman President of the United States, state-level ballot initiatives on abortion and other forms of reproductive healthcare provide a faint but unmistakable reason for hope. Abortion rights referendums prevailed in Arizona, Missouri, Nevada, Montana, Colorado, New York, and Maryland. This development is particularly vital in Missouri, where abortion was previously banned throughout pregnancy, without exceptions for rape or incest, unless necessary to save the pregnant person from death or serious injury. In Illinois, a non-binding initiative expanding health insurance coverage for assisted reproduction treatments like in-vitro fertilization (IVF) passed with 73 percent of the vote. Only three states bucked the trend; South Dakota and Florida rejected state constitutional amendments protecting reproductive freedom, and Nebraska rejected a similar amendment while codifying the state’s strict twelve-week abortion ban.

Abortion rights expanded in many Trump-supporting states

This outcome is somewhat puzzling. In some states, the same electorate that expanded abortion rights also delivered majorities for President Trump—whose judicial appointments swung the political balance of the US Supreme Court to the Right, resulting in the Dobbs v. Jackson decision that abolished federal abortion rights—and other Republican candidates who vehemently opposed reproductive rights. For instance, Missouri voters added a “fundamental right to reproductive freedom” to their state constitution by passing Amendment 3, but they re-elected anti-abortion Josh Hawley (R-MO) to the Senate. Hawley is a self-described “Christian nationalist” who opposed Amendment 3, repeatedly voted against IVF, and voted against legislation to protect contraceptive access and the rights of pregnant workers. Were voters persuaded by his last-minute efforts to moderate his stance on reproductive politics? Did they prioritize other issues? Were they misled by misinformation? Unwilling to accept a woman of color in the Oval Office? For now, it is difficult to determine.

However, especially given the apparent role of economic concerns in driving support for Trump, these ballot initiatives seem to vindicate the Reproductive Justice approach to abortion and other reproductive freedoms. Developed by Black feminists in the US, Reproductive Justice links reproductive rights and health to economic and social justice more broadly. This intersectional framework is feminist, anti-racist, and pro-LGBTQ+. It demands universal healthcare, sex education, contraception, accessible and affordable abortion, birthing justice, economic support for poor and working-class families, safe and affordable housing, decolonization, environmental justice, an end to gendered violence, and much more. As explained by Loretta Ross and Rickie Solinger, Reproductive Justice defends three equally-important rights: the right to have a child, the right not to have a child, and the right to parent in a safe and healthy environment. Unlike traditional Pro-Choice approaches that defend abortion rights as negative rights that can be separated from a larger progressive agenda, Reproductive Justice insists on connecting abortion and contraception with equal access to IVF, gender-affirming care, freedom from forced/coerced sterilization, and ending family separation.

“Our Future: March for Abortion Access” (CC BY 2.0) by Fibonacci Blue

Connecting reproductive rights to economic justice

Like our neighbors in Missouri who broke with their conservative loyalties when offered a chance to directly benefit from the abortion rights referendum, the election results in my own region illustrate the potential power of Reproductive Justice. Although Illinois has been a Democratic stronghold in Presidential elections since 1992, the Southern region of the state is rural and conservative. In nearby Marion County, where Harris lost with 24 percent of the vote (to Trump’s 73 percent), 56 percent supported the ballot initiative expanding coverage for IVF and other pregnancy-related healthcare benefits. Reproductive Justice is popular, even in otherwise conservative states and counties.

The Reproductive Justice strategy of connecting abortion rights to economic justice has also succeeded in Latin America, where national and regional meetings of feminist activists converged around a regional agenda and action plan that grew into the Green Wave. As Argentine feminist scholar and activist Verónica Gago explains, Latin American feminists built movements that were both “massive” and “radical” by developing a grassroots politics that integrated women’s experiences of reproductive oppression, economic precarity, and gendered violence. Importantly, Latin American feminists did not wait for policy change; they took direct action to ensure safe abortion access using abortion pills. Using a variety of tactics, moving inside and outside institutions as-needed, these activists pursued the “social decriminalization” of abortion (i.e. de-stigmatization and increased de facto access to safe abortions). Legalization followed.

In the US, there may be additional barriers to ensuring widespread access to abortion medications. For instance, Louisiana recently re-classified abortion medications as controlled substances, restricting them like opiates or other addictive drugs. Yet, even on this point, there is reason for cautious optimism. The conservative US Supreme Court has (so far) proved surprisingly reluctant to uphold challenges to abortion pill access. Some liberal states are passing laws to protect abortion providers and facilitate telemedicine abortions for out-of-state patients. The Food and Drug Administration (FDA) relaxed restrictions on mail-order abortion pills during the pandemic and recently made these more permissive pandemic-era rules permanent. In the post-Dobbs environment, medication abortions are rising despite state abortion bans.

While national abortion policy could grow more hostile after the 2024 election, the abortion referendum results suggest that this is a losing issue for Republicans in most states. Notably, several “pro-life” candidates for national office—including Donald Trump and Missouri Senator Josh Hawley—backed off on supporting a federal abortion ban in the lead-up to the election. Perhaps more importantly, a recent book by Sydney Calkin provides strong evidence that enforcing abortion bans will be practically impossible given the widespread availability of abortion pills from reliable grey-market sources. The struggle for reproductive justice in the United States is far from over.

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