‘Californian Votes Really Matter’: What the Election Could Mean for Reproductive Health

Dr. Sophia Yen finds it difficult to talk about the future her daughters could face under a second Trump presidency without tearing up.

Yen, co-founder of an organization specializing in reproductive care, fears their access to such vital care could be further limited if former President Donald Trump wins the election. And she’s not alone.

“How do I get two girls through college?” Yen asked, pointing to the fact that 1 in 4 undergraduate women have reported being sexually assaulted.

Nationwide, she said, reproductive rights have “already gone back. And we need to fix it.”

After the Supreme Court overturned Roe v. Wade in 2022, spurring some states to limit access to abortion, infant mortality rates increased — in Texas, by as much as 13%. Pinning down the maternal mortality rate is harder. According to a recent study from the Commonwealth Fund, women were more at risk of dying at or around childbirth in states with stricter abortion laws. In Texas, the maternal mortality rate rose 56% from 2019 to 2022, while nationally, it ticked up 11%, according to the research nonprofit Gender Equity Policy Institute.

According to a Gallup Poll released this summer, 54% of Americans identify as pro-choice, maintaining “historically high levels” of support for abortion rights since the overturning of Roe v. Wade. And 32% of registered voters said they would only vote for a candidate that shared the same views as them on abortion, up 8 points since 2020.

In an election featuring two candidates with wildly differing views on abortion who are polling extremely closely, Bay Area residents and experts are left to wait and see what the future of healthcare holds.

Even though state laws protect the right to an abortion in California, Yen — who is also a professor at Stanford Medical School — said the stakes are still high for abortion-rights voters in the Bay Area.

“For Californians, we think we’re protected,” she said. “But we’re not.”

What could reproductive health care look like under a second Trump term?

Though the Dobbs decision, which overturned Roe v. Wade, left it to states to regulate abortion, Nancy Cohen of the Gender Equity Policy Institute said, “A national abortion ban is absolutely coming” if Trump is elected a second time.

Project 2025 — a detailed, 900-page policy agenda for the next Republican presidency authored and supported by Trump allies, former and current Trump staffers and his running mate JD Vance — has called for a national database where states would report abortions. Cohen described this proposal as “basically Big Brother.”

Project 2025 also aims to revive parts of the Comstock Act, a law from the late 1800s that bans the mailing of “obscene” items such as contraceptives. (The act faced intense criticism at the time and was restricted in 1930, but it was never fully repealed. Roe v. Wade overruled it, and when Roe v. Wade was overturned, the Biden administration said it would not apply the Comstock Act.)

“States like California and New York that have constitutional protections for abortion rights and reproductive health care in general … those become meaningless,” Cohen said. “Federal law will trump state protection.”

Another Trump term would mean he could appoint more conservative-leaning Supreme Court justices and federal judges. In states like Alabama, Cohen noted, right-leaning judges have increasingly wielded arguments that personhood begins at conception.

“Something like that would outlaw the IUD,” she said.

“A lot of the anti-abortion movement believes that they should also outlaw birth control,” Cohen said. “So we are looking at really terrifying scenarios under a Trump presidency.”

How the Supreme Court still has the final say

Experts predict the future of the judicial branch will also be a political battle, depending on who wins the presidency and the Senate.

For example, if Kamala Harris is elected president but Republicans take control of the Senate, her administration is likely to struggle to get appointments to lower courts confirmed, similar to Barack Obama’s term.

Yen hopes that if there is a Harris presidency, Democrats would “become bold enough to balance the court” — a common call from left-leaning advocates critical of lifetime appointments to the Supreme Court.

This summer, President Joe Biden endorsed the idea of term limits for justices in the country’s highest court. While Harris disavowed “court-packing,” she has called for reforms in the Supreme Court, citing a growing lack of trust in the judicial branch.

“The current people on the Supreme Court are not neutral on reproductive rights, are not neutral on abortion, not neutral on reproductive freedom, and seem to tend towards a theocracy,” Yen said.

How reproductive rights show up in California’s local races

Advocates stress that the stakes of reproductive health in the U.S. do not just lie with the executive office and the Supreme Court. Democrats need just five seats to win control of the House, and whether this happens “really depends on elections in California and New York,” Cohen said.

This summer, when Senate Republicans blocked the Right to Contraception Act, San Francisco Rep. Nancy Pelosi wrote in a statement that GOP resistance “should come as no surprise,” citing the 195 Republicans who voted against the House’s version of the act in 2022. Though eight House Republicans voted in favor of the act, none of them were from California.

The California Republicans who voted against the 2022 act are up for reelection. They include Rep. Ken Calvert, who is facing a challenge from Democrat Will Rollins in Southern California’s Riverside County. (Calvert said he supported competing Republican-backed bills that expanded contraceptive use but kept protections for religious health care providers.)

In the Central Valley, Rep. David Valadao, who co-sponsored the Life at Conception Act in 2022, is running against Democrat Rudy Salas. The anti-abortion incumbent did not co-sponsor the legislation again in 2023.

For Yen, these Democratic challengers “could help us gain control in the House for those that support reproductive rights, voting rights and freedom of religion.”

“For Californians who care about abortion rights and live in one of these districts, it’s very important to look at their record and see a lot of them are obfuscating and outright lying about where they are on this issue,” Cohen said.

And at the local level, anti-abortion candidates for school boards and city councils could potentially also seek to enact “really extreme measures that are out of sync with Californians’ inclusive and pro-rights values,” Cohen said.

“Californian votes really matter.”

California abortion — for residents and visitors

California has stronger protections for reproductive rights than much of the country, especially after voters added the right to an abortion to the state constitution in 2022.

However, reports have shown that people in the state’s rural areas have a hard time accessing care due to the lack of facilities nearby that can perform abortions. Last month, the state sued a Catholic hospital for refusing to perform an emergency abortion. The patient in question, Dr. Anna Nusslock, was rushed to another hospital for a life-saving surgery.

Just last week, the attorney general’s office found that Beverly Hills officials had pressured a landlord to prevent an abortion clinic from opening.

“It is troubling that, even here in California where access to reproductive healthcare is a constitutional right, Beverly Hills officials have taken actions reminiscent of those in extremist red states by illegally interfering with, and ultimately preventing a new reproductive healthcare clinic from opening,” Attorney General Rob Bonta said in a statement.

There is also the influx of out-of-state patients traveling to California for abortion care when access is restricted in their own states, leading to increased wait times and crowded clinics.

The Bay Area “provides care for the millions of women of reproductive age in the region” and out of state, Cohen said.

“But the system is a little stressed,” she said, citing the need for “better coordination” and increased resources across the state.

Dr. Katherine Brown, medical director of the Black Wellness Clinic at UCSF, said she and her colleagues have seen “people from all over the country more than we did before. We have patients coming from places like Texas, Oklahoma, Tennessee.”

“My patients already went through a lot prior to the Dobbs decision. But now, they have to go through a lot more hoops to even get the care that they need,” she said, noting the high costs of such cross-country travel.

“I always wonder about the people that don’t make it,” she added.

What could a Harris presidency look like when it comes to reproductive rights?

As a California prosecutor, Harris had a strong record of protecting abortion rights. She has said that if she were to win the presidency, she would sign a bill reinstating Roe’s protections into law if Congress passes it. Harris could also use her authority to strengthen privacy laws, which could protect people with uteruses from being prosecuted.

Brown said there are opportunities with this election to amend the inequities that have faced some Americans. For example, she said Roe v. Wade was “imperfect” — noting that due to federal law, many people on Medicaid could not have the costs of their abortion covered. (California’s version of the program, Medi-Cal, does cover abortion, however.)

“Access to abortion needs to be a protected right no matter where you are,” she said. “Insurance needs to be able to cover it, no matter what type of insurance you have.”

While she is anxious for Election Day, she said she is also “guardedly hopeful.”

“We have the opportunity to move beyond Roe and find something that’s better,” she said. “That really honors reproductive freedom, reproductive autonomy.”

“So that’s where I find my hope.”