Second Trump term has Mass. abortion advocates on edge

November 25, 2024

By JENNIFER SMITH

Since the fall of Roe v. Wade started to look certain, Massachusetts hustled to shore up abortion access. Now facing a second Donald Trump administration, advocates and officials alike are bracing for possible assaults on the Bay State’s ability to offer services not only to its own residents but to the thousands who have turned to Massachusetts for abortions in the past two years.

Trump has attempted to distance himself from the conservative Project 2025 and the idea of a national abortion ban – claiming he intends to leave the subject “to the states” – but congressional Republicans are pushing for a ban after 15 weeks and abortion opponents are laying out roadmaps for stricter potential bans.

“I don't believe them for one second,” Rebecca Hart Holder, president of Reproductive Equity Now, said on The Codcast. "The goal is a federal abortion ban. ‘Leave it to the states’ is a nice talking point from Justice Alito. If we're to leave it to the states – which I don't believe we should, I believe that there should be a national right to abortion – but if we're really going to leave it to the states, then they should leave Massachusetts alone and let us do the important work that we need to do to protect access to care.”

Polling last year, conducted for CommonWealth Beacon, asked whether the state’s abortion laws are a competitive advantage in attracting people to Massachusetts. Some 58 percent of poll respondents said they agreed, while 25 percent disagreed. Almost three-quarters of those surveyed said they support health providers in the state providing abortion services to people from out of state.

And people have taken Massachusetts up on its offer. In just the first four months after the Dobbs decision overturning Roe, out-of-state abortions rose by about 37 percent, according to a Brigham and Women’s Hospital study of 45,797 abortion care records between January 2018 and October 2022. The researchers evaluated data from Planned Parenthood, which accounts for half of all abortions in Massachusetts. 

The demand continued to rise, with 6,115 out-of-state patients turning to Massachusetts doctors for abortion care in 2023 according to a WBUR analysis. This is up from 920 out-of-state patients in 2022. Most received prescriptions for abortion medications via telehealth, and less than one in three patients traveled to the Bay State to get abortions.

Holder expects the demand for abortion services in Massachusetts will rise. So far, she said, clinics have been able to accommodate patients traveling from out of state.

“If that continues to increase, I think we need to take a hard look and continually be talking to independent providers, to Planned Parenthood, to the hospitals who are providing care later in pregnancy, to make sure that they can continue to handle it,” she said. “But the Legislature has shown an appetite to help fund those providers. So I feel really confident that that will continue.”

Massachusetts’ fiscal year 2025 budget includes $2 million for grants to support improvements in reproductive health access. After the Dobbs decision, lawmakers passed a first-of-its-kind “shield law” protecting providers by refusing to cooperate with out-of-state actions to punish medical professionals who provide services to people in other states where abortions are restricted or banned.

Massachusetts has worked to shore up its abortion infrastructure, but Holder notes the state could be vulnerable if the federal posture toward abortion becomes more hostile.

Project 2025, a 900-page policy document from the Heritage Foundation involving more than 100 people who worked in the first Trump administration, targets abortion in several ways that trouble Holder.

The document proposes reversing the FDA’s approval of mifepristone, one of two drugs used in medication abortion, and using the 19th century Comstock Act to ban abortion medications, equipment, or materials from being sent through the US Postal Service.

“I'm not planning for best case scenarios right now, and I don't think we are living in a best case scenario world,” Holder said. “What the Trump campaign did in connection with the Heritage Foundation was to give us their game plan with Project 2025. We understand what it is they want to do. They want a federal abortion ban. It is not sufficient to have overturned Roe because that does not control access in all 50 states.”

Even as voters across the country have acted to protect abortion access through state referendums and constitutional amendments, abortion is not the only reproductive planning option in the sightline. Efforts to guarantee access to contraceptives, Holder notes, have been marked by partisan polarization. 

“I think we have to be very, very clear-eyed about the fact that the end game is not abortion,” Holder said. “The end game goes far beyond abortion. It is actually about women's position in society, and the way you prevent women from being equal is preventing them from controlling their reproductive destiny.”

For more with Rebecca Hart Holder – on the role of the courts, implications for sexual education curricula, and threats to contraceptive access – listen to The Codcast on Apple Podcasts, Spotify, or wherever you listen to podcasts.