Ballot measures supporting abortion rights come with financial and emotional costs

Since the U.S. Supreme Court overturned Roe v. Wade in June 2022, voters in a number of states have turned to the ballot initiative process to protect reproductive rights, at great financial and emotional cost.

From 1973, when Roe was decided, to the court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, abortion rights were protected nationwide by the Constitution. In 2016, as Donald Trump ran for president, he promised to put Supreme Court justices on the bench who would overturn Roe and let the states decide for themselves whether to ban abortion.

Trump kept that promise, appointing three justices who joined the conservative majority in overruling Roe. Since then Trump has frequently said that everyone, regardless of party, wanted abortion rights to be left up to the states to decide, writing in a social media post on Aug. 22: “Everybody, Democrats, Republicans, Liberals, and Conservatives, wanted Roe v. Wade TERMINATED, and brought back to the States. … Now the people are voting, which is the way it was supposed to be.”

Polling has shown that two-thirds of Americans disagree with the Dobbs ruling and that most voters in a majority of states want abortion to be legal in all or most cases. Still, several state legislatures have passed harsh restrictions and bans.

In response, in 2022 and 2023, voters in California, Michigan, Ohio, and Vermont approved state constitutional amendments to protect reproductive rights. Voters in Kansas, Kentucky, and Montana rejected proposals to restrict abortion in those states. In total, abortion rights advocates reported spending a total of more than $132 million on those seven ballot campaigns. 

This year, voters in at least 10 states are set to cast ballots containing measures that would protect reproductive rights: Arizona, Colorado, Florida, Maryland, Missouri, Montana, Nebraska, Nevada, New York, and South Dakota. Nebraska will consider two opposing abortion ballot measures: one that would enshrine a 12-week abortion ban in the state constitution and another that would guarantee the right to an abortion in the state constitution. 

The Arkansas Supreme Court rejected a pro-abortion rights ballot measure in that state on a technicality relating to how the signatures were gathered. 

To date, backers of reproductive rights proposals have spent more than $57 million in those 11 states to get the measures on the ballot and persuade voters to approve them.

Data shows that having to defend your rights at the polls can be stigmatizing and emotionally damaging. 

Psychologist and educator Lenore Walker studies violence against women and children. She discussed the concept of “invalidation trauma,” a term in psychology for a person’s feeling that they don’t matter or what they care about doesn’t matter, a traumatic response that she says she’s seeing more often in patients recently.

“There’s a lot of emotional cost, especially anger, in the injustice of having to do this all over again,” Walker said, adding that she herself fought for the right to abortion in the 1970s before Roe v. Wade was the law of the land. 

Jacob Goldsmith, founder and clinical psychologist at Generations Psychotherapy in Evanston, Illinois, said seeing their rights rolled back can deeply impact people’s mental health.

“If we’re talking about people for whom reproductive health is a personal issue, even if they’re not taking this personally, there’s still this sort of existential, What the hell country do we live in now?” he said. “It feels like this violates something very baked-in and fundamental, and I think maybe put another way, I think for a lot of people, not going forward feels bad enough. Going backward is a different kind of injury.” 

Nearly half of states lack direct access to citizen-led ballot measures. Additionally, if Trump were reelected and followed the directives of Project 2025, a roadmap for a second Trump term written by many of his close allies, measures to protect the right to abortion, even in states where it is enshrined in the constitution, could be overruled. 

Kiersten Iwai is the executive director of Forward Montana, one of the four organizations that make up the citizen-led initiative Montanans Securing Reproductive Rights, together with the ACLU of Montana, the Fairness Project, and Planned Parenthood Advocates of Montana.

“Fighting for abortion rights is expensive, but the cost of doing nothing is greater. Anti-abortion extremists have made it clear that they won’t stop until they’ve banned abortion completely,” Iwai said. “They will lie and use desperate tactics to deceive voters. Now is the time to fight back and show that the majority of Montanans (and Americans) want to protect abortion access.”