For Katie Quinonez-Alonzo, the executive director of the Women’s Health Center in Charleston, West Virginia, being able to offer abortions to women from her state is personal.
At 22, she had an abortion at that same clinic and she remembers compassion and respect, the physician holding her hand and a recovery room with a heating pad, snacks and ginger ale.
So when West Virginia legislators passed a near total ban on abortions in 2022, she and the center’s board of directors looked across the border to Maryland and opened a second clinic there in a town called Rawlings. Almost a year to the day that the ban was approved, the new clinic saw its first patients for medication abortions, and since then, for procedural abortions up to 16 weeks.
“Abortion bans are not about saving babies or protecting pregnant people,” Quinonez-Alonzo said. “They are about power and control.”
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Now Maryland is one of 10 states with abortion-related measures on the ballot in November, most of which would protect abortion rights. Nine, including those in Maryland and Florida, where a six-week ban took effect in May, would add reproductive freedom to the state constitutions. Nebraskans, meanwhile, are being asked to choose between two competing citizen-initiated changes: recognize a right to an abortion up to viability or ban abortion in the second and third trimesters. (New York would add anti-discrimination protections for pregnancy to its Equal Rights Amendment with language that backers say would protect abortion rights but opponents argue would expand transgender rights for minors.)
Abortion is already legal in Maryland, without restrictions on how far along a pregnancy is, so why enshrine that right in the state’s constitution?
“Constitutional protections are just stronger than statutory protections,” said Greer Donley, an associate professor at the University of Pittsburgh Law School and an expert on abortion.
A future legislature intent on restricting abortion rights would have a more difficult time reversing an amendment in a state constitution than overturning a law, much as it is more difficult to amend the U.S. Constitution, Donley said.
"So I think one motivation is certainly to provide extra protections," she said.
Even with its current law in place, the state is vulnerable to attempts to limit abortions, said Adrienne Jones, the speaker of Maryland’s House of Delegates. In 2022, the state’s General Assembly allocated $3.5 million to train medical professionals other than physicians to perform the procedure, but then-governor Larry Hogan withheld the money. Hogan, now a U.S. Senate candidate, said through a spokesman that he did not believe "non-licensed physicians" should perform abortions.
“We can’t uphold the integrity of reproductive freedom in Maryland when access to reproductive services can be limited with the stroke of a pen,” Jones said.
A constitutional amendment would send a message to women across the country that Maryland will protect their right to make decisions about their bodies and for their families, she said.
“Opening our state to women from West Virginia or Texas who are simply looking for a safe health-care option, represents the respect and freedom all women deserve to make decisions about their own lives,” she said. “I’m looking forward to be able to help them in Maryland.”
Jeffrey Trimbath, the president of the Maryland Family Institute, wants Maryland to be known for its beautiful beaches, not as an abortion destination.
In an open letter to Maryland residents, the institute called the state's abortion laws some of the most extreme in the country and said the amendment demanded "a firm conscientious NO vote." Trimbath knows that most Americans favor abortion rights, but says that groups like his need to do a better job changing minds.
He said the institute believed the amendment to be unnecessary, that it would make what he called common sense restrictions on abortion all but impossible and would undermine parental rights.
“We’re concerned with the broad language of the amendment,” Trimbath said. “We think it’s rife for legal challenge. We’ll be monitoring that very closely.”
In the two years since Roe v. Wade was overturned by the U.S. Supreme Court, legislators in conservative states have raced to pass abortion bans or other restrictions. Twenty states now have full bans in place or limits on abortion earlier than would have been possible under Roe v. Wade. In the rest of the country, abortion remains legal or the protections of abortion rights have increased.
At the ballot box, abortion rights proponents have had the advantage, winning all seven state measures that were voted on in those two years. But that could change this year in Florida in particular.
In 2022, California, Michigan and Vermont enshrined a right to an abortion in their state constitutions, Kansas voted against removing abortion rights protections from the constitution, and Kentucky rejected an amendment specifying that there was no right to an abortion, though a ban remains in place. Montana turned down an initiative that would have required medical interventions to save infants defined by the state as “born alive,” a measure doctors said could result in unnecessary procedures for infants who would not survive.
The following year, Ohio joined the states that had ensured a state constitutional access.
This year, abortion measures will be voted on in Arizona, Colorado, Montana, New York, Nevada and South Dakota, in addition to Maryland, Florida and Nebraska. In some states, the initiatives made it to the ballot only after court rulings and other battles with anti-abortion activists.
Florida’s faces the highest hurdle because 60% of the vote is needed for it to pass. It would protect the right to an abortion up until the viability of a fetus and when necessary to safeguard the mother’s health. A University of North Florida poll in July found 69% of likely voters indicating that they would vote yes on the amendment and 23% saying no. But a more recent poll from The New York Times and Siena College, released on Oct. 8, found the measure falling short, with only 46% of likely voters saying they would vote yes.
Most of the other measures need only greater than 50% of the vote to pass, except Colorado which requires 55%.
The administration of Florida Gov. Ron DeSantis is fighting the amendment, in ways some critics have said is unethical. Detectives have visited the homes of residents who signed petitions to qualify the referendum and the state Agency for Health Care Administration charged that the measure “threatens women’s safety.” It published a webpage last month with a headline reading, “Florida is Protecting Life - Don’t Let the Fearmongers Lie to You”
DeSantis defended the website at a press conference, saying it was only providing information about Florida's law.
Legal attempts to block ballot initiatives are not limited to abortion measures, argued Peter Northcott, the National Right to Life director of state strategies.
"It makes sense that amending the constitution is not a process that just happens overnight and so there have been legal measures that have been put in place to ensure the integrity of a ballot initiative," he said. "I don’t think that that’s unique to ballot initiatives on this issue."
But Laura Goodhue, the executive director of Florida Alliance of Planned Parenthood Affiliates, see the state's efforts as intimidation.
“It’s yet again an example of government interfering in the will of Floridians,” Goodhue said. “We collected 1.4 million petitions. What’s more democratic than citizens petitioning their government?"
Under Florida's new restrictions, Planned Parenthood has seen a decrease in the number of women it has been able to provide abortions for because they are learning that they are pregnant beyond the six-week limit, she said. At the same time it has become more difficult for women to travel to other states for abortions because of the numbers, she said.
It is not a partisan issue, she said. The patients are both Democrats and Republicans.
"It’s been life changing, traumatic, horrific." she said.
There are exceptions, although whether they are workable depends on whom you ask. The law allows for abortions at up to 15 weeks for pregnancies that are a result of rape, incest or human trafficking, but women must provide documentation such as a police report, which Goodhue said are typically impossible to obtain in a timely way. Abortions also are permitted to save the life of the woman and in the case of fatal fetal abnormalities if before the third trimester.
A 2024 survey on women’s health by the Kaiser Family Foundation found that three in four of women of reproductive age in Florida believe abortion should be legal in all or most cases. That includes 86% of Democrats and 51% of Republicans.
“Abortion access is something that is overwhelmingly supported by the public,” said Candace Gibson, the director of state policy for the Guttmacher Institute. The ballot measures are one of the few avenues people have to protect that access, she said.
"People have seen the success in the prior ballot measures," she said. "We have a half dozen states where people went out and supported abortion access and so I think for many advocates this is a viable tool to protect the right."
And discrepancies between a state’s law and a constitutional amendment could later provide an opening for advocates to push to expand rights, Donley said, if for example a law bans abortion after fetal viability but an amendment does not.
Across the country, about two-thirds of women or 67% support a nationwide right to abortion, including both Democrats, at 79%, and Republicans, at 49%. More than half of women, 57%, oppose a nationwide ban at 15 weeks and even more, 69% oppose leaving the decision of whether abortion should be legal to states.
As a state bordering ones where the procedure is more restricted, Maryland draws women traveling for abortions. The Guttmacher Institute estimates that of the 39,000 clinician-provided abortions performed in Maryland in 2023, 4,000 were for women who came from other states. Most came from neighboring states, including 990 women from Pennsylvania, 800 from West Virginia and 1,260 from Virginia.
In Maryland and elsewhere, supporters of abortion rights have been outraising their opponents by significant margins. Only in Nebraska are the totals close.
As of this month, supporters of abortion rights have raised nearly eight times as much as groups that are working against the amendments. The campaign in Florida is costing the most but it remains the most difficult to pass.
"The amount of money that is being spent on these ballot measures is breathtaking and I think is a big factor in what’s driving the results we’ve seen thus far and will certainly be a factor come November," Northcott said.
As of September, the Women's Health Center in Maryland has provided abortion care to 200 patients, with half of them coming from West Virginia. Another 100 or so patients have received sexual and reproductive health care such as annual exams, birth control, breast and cervical cancer screenings, Pap smears and breast exams as well as gender affirming hormone therapy, Quinonez-Alonzo said.
"I know personally how crucial this health care is and the fact that it is politicized in the manner that it is, it's truly heartbreaking," said Quinonez-Alonzo, who had an earlier abortion at 17.
Her first came when she was in what she described as a controlling, mentally abusive relationship before she had a chance to go to college; the second when she had just graduated and had just started dating her then-boyfriend and now husband. That time she was not treated kindly by the staff, she said.
“It is imperative that states that are leading the way like Maryland enshrine abortion rights into the state constitution,” Quinonez-Alonzo said. “Abortion is a human right. It is an essential part of routine, safe reproductive health.”
Trimbath said his organization knew that Maryland, with its higher support for abortion rights than other more conservative states, could be more resistant to its message.
"Maryland is not like Alabama, it's not like Oklahoma," he said. "We knew that this would pose a challenge for us as pro-life Marylanders."
