This report contains a correction.
Introduction and summary
Nearly two years after the U.S. Supreme Court overturned1 Roe v. Wade and set abortion rights into legal uncertainty and a state of chaos,2 state governments have been left to mend a patchwork of abortion laws across the country.3 The fate of abortion access and reproductive freedom for women and their families has been thrown into flux4 as state lawmakers—rather than patients and their doctors—decide whether, when, and how a woman can have an abortion. Without federal protections for abortion, many states have severely restricted and banned it,5 often forcing people to travel hundreds of miles6 for care or to carry a pregnancy and give birth.7
Arizona has emerged as one of the latest political battlegrounds in the debate over abortion rights.8 At the moment, Arizona effectively has a 15-week ban on abortion in place, but in April 2024, the Arizona Supreme Court revived an 1864 near-total abortion ban.9 The ruling10 suggested that doctors could be criminalized11 for providing or assisting an abortion, sparking fear and chaos12 for abortion providers and patients across the state. This decision put Arizona on track to become the 15th state13 to completely ban abortion. In early May, Gov. Katie Hobbs (D) signed the legislature’s repeal of the 1864 ban.14 Now, Arizona voters may soon have a say15 in abortion access through a citizen-initiated ballot measure16 that would amend the state constitution to protect abortion17 until fetal viability—generally considered to be 24 weeks gestation—that is on track18 for the November ballot after the campaign submitted signatures in early July. All eyes will be on Arizona in the coming months as citizens lead the charge in determining the fate of abortion access in the state. This report summarizes what is at stake for Arizona if its current ban stays in place and what the ballot measure could change.
Restricting abortion at 15 weeks is not a compromise—all abortion bans are harmful
Every abortion ban is extreme, harmful, and deprives pregnant people of their ability to make their own decisions about their bodies and private health care needs. Arizonans have faced attacks on abortion access for decades.19 Following the overturn of Roe, then-Gov. Doug Ducey (R) in 2022 signed a 15-week abortion ban20 with an exception for medical emergencies.21
Arizona’s current 15-week abortion ban22 is not grounded in medical science or evidence.23 Instead, 15 weeks marks an arbitrary timeline that abortion rights opponents have constructed in order to incrementally restrict24 abortion access. It represents a new political reality25 wherein practicing medicine is not based on scientific evidence,26 and policymakers and judges undermine patients’ autonomy and interfere with health care providers’ duty to provide care. In fact, 96 percent of abortions27 in the United States happen at or before 15 weeks.28 However, there are many reasons why someone may need to seek an abortion later in their pregnancy.
Exceptions and “carve outs” to abortion bans obscure the reality that abortion bans ultimately restrict essential and sometimes lifesaving health care.
Research has long demonstrated that abortion bans of all types29 have harrowing consequences30 for pregnant women and particularly hurt historically marginalized groups31 and those who face systemic racism32 and other forms33 of oppression that compound barriers to obtaining an abortion.34 Exceptions35 and “carve outs” to abortion bans obscure36 the reality that abortion bans ultimately restrict essential and sometimes lifesaving health care37 and are an attempt to control women and pregnant people’s reproductive decisions and futures.38
Furthermore, research shows that the majority of women seeking a second-trimester abortion discover their pregnancy beyond the eight-week mark, and 1 in 5 recognizes the pregnancy only after 20 weeks.39 Gestational limit40 bans disproportionately affect people who discover they are pregnant later on, such as those who have never been pregnant before or who regularly use a contraceptive.41 In short, women denied abortion care because of gestational bans are restricted from accessing an essential health service they did not know they needed at the time. Gestational bans also disproportionately affect women of color and young people, who are more likely to find out they are pregnant later in pregnancy.42 Forcing someone to carry an unwanted pregnancy—no matter the reason—or forcing them to go through burdensome barriers to access care is harmful and a violation of reproductive and bodily autonomy.
Restricting abortion at 15 weeks endangers women of all ages
Banning abortion at any stage makes it harder for people of all ages to access care and can put their lives at risk.43 Abortion bans pose logistical and legal obstacles that can be hard for young people, people with low incomes, and people with pregnancies later in life to overcome. And ultimately, abortion bans deepen these disparities.
The inability to terminate a pregnancy due to a 15-week ban forces many young women to abandon or delay their educational and professional aspirations.
Young people are disproportionately affected
Young people face extraordinary barriers to sexual and reproductive health care; abortion restrictions not only create barriers to care but also have long-term effects on youth outcomes. Around 22 percent of Arizona’s population is under the age of 18. Thirty percent of Arizona voters ages 18 to 29 ranked abortion as the most important issue to them during the 2022 midterm elections.44 Young people already face heightened challenges and barriers45 to accessing abortion services and sexual and reproductive health care in general,46 and these challenges may be further exacerbated with a ban at 15 weeks, coupled with an array of other youth-targeted restrictions.47 Adolescents48 and young women49 are more likely than older women to obtain abortions later in pregnancy because they may take longer to recognize they are pregnant, to find a provider, and to source payment for the procedure.50 According to the U.S. Centers for Disease Control and Prevention, 19.8 percent of adolescents under 15 years old and 9.6 percent of youth ages 15 to 19 obtained an abortion after 13 weeks’ gestation, compared with 6.8 percent to 7.5 percent for women in older age groups.51 For young women, having to carry an unintended pregnancy can severely disrupt their educational and career plans and their future family planning goals.52 The inability to terminate a pregnancy due to a 15-week ban forces53 many young women to abandon or delay their educational and professional aspirations, limiting their future opportunities.54 This is a reality that youth are worried about.55
Restrictions can endanger pregnant women older than 30
Women older than age 30 may be more likely56 to experience pregnancy-related complications, including developmental or chromosomal fetal abnormalities,57 some of which can only be definitively detected at or after the 15-week mark.58 For example, some prenatal genetic screening and diagnostic tests59 for abnormalities are usually recommended to be conducted after 15 weeks; a major ultrasound typically takes place after 20 weeks.60 Abortion restrictions at this stage jeopardize women’s health and well-being because waiting for the recommended prenatal care means they are no longer able to get an abortion should they need it. Furthermore, it would sharply restrict options for the growing number of women with pregnancies over age 30.61 Additionally, other medical conditions such as gestational diabetes, preeclampsia, and other health issues become more prevalent as women get older, posing higher risk for this population.62
Arizona’s pregnancy-related death rate quadrupled between 1999 and 2019.
Restricting abortion at 15 weeks would worsen maternal health outcomes for Arizona women. Arizona ranks ninth worst nationally in maternal mortality, with a maternal mortality rate of 31.4 deaths per 100,000 births63 compared with the national average of 22.3 deaths per 100,000 births.64 Moreover, Arizona’s pregnancy-related death rate quadrupled—from 7.6 deaths to 32.1 deaths per 100,000 births—between 1999 and 2019,65 and the increase was even higher among Black and Native American people,66 who are more likely than white women to die from pregnancy-related causes in Arizona.67
Restricting abortion at 15 weeks worsens care and pregnancy outcomes
The loss of abortion rights and the growing maternal health crisis in the United States means that maternal risk will only increase.68 Pregnancy itself is a health condition that has risks, and Arizonans should have access to the resources, tools, and care they need to have a healthy pregnancy.69 Moreover, women who are denied an abortion are more likely to have health problems during their pregnancy and to experience financial difficulties or live in poverty years later.70
Restrictions obstruct standard medical care and delay lifesaving care
Abortion restrictions jeopardize71 women’s safety and well-being and force72 health care providers into precarious positions.73 Restrictions on abortion delay access to care,74 lead high-risk patients to seek care later on,75 increase strain on emergency health care services,76 and ultimately harm the well-being of patients.77 Increased barriers to abortion not only delay access to care but can also increase costs.78 Complex medical circumstances may necessitate abortions later in pregnancy, and abortion bans at any stage can prevent a person from receiving that essential care.
Abortion is one of the oldest79 medical procedures and is incredibly safe.80 In fact, in-clinic and medication abortion have lower complication rates and are safer than other common medical procedures.81 However, the rate of complications and risks82 associated with abortion does increase later in pregnancy.83
Florida’s 15-week ban endangers women with pregnancy complications
Anya Cook84 was living in Florida during the state’s 15-week ban when she experienced prelabor rupture of membranes—one of the more common complications that women can experience85—in her second trimester. Cook’s medical care hinged on Florida’s 15-week abortion ban, which she had surpassed. When she first arrived at the emergency department losing amniotic fluid, she was turned away because she was not assessed to be “sick enough” to qualify for Florida’s emergency medical exception.86 Because of Florida’s 15-week abortion ban, Cook was unable to receive the care she needed until her life was in danger. She later miscarried in the bathroom of a salon, experiencing excessive bleeding and life-threatening complications.
Abortion care becomes more complex and can worsen maternal morbidity and mortality rates
There are two different forms of abortion: medication abortion and procedural abortion, also known as a surgical abortion.87
To terminate a pregnancy during the first trimester, either a medication abortion or a procedural abortion can be administered.88 Medication abortion using a two-step regimen of mifepristone and misoprostol is used to terminate a pregnancy through 10 weeks gestation (70 days).89 The World Health Organization recommends 12 weeks as the cutoff for self-managing a medication abortion.90
Abortions performed after the first trimester are usually surgical.91 Sometimes, these procedures require a more complex and time-consuming care plan depending on the length of the pregnancy.92 For instance, some surgical abortions occur over the course of two or three days.93 This means that women who cannot get an abortion after the 15-week mark in Arizona may have to travel for more complex and extended care that they could have received in the comfort of their home state. This is further complicated by the fact that women of color and women earning lower wages often have to travel the farthest to get an abortion, as documented in recent Center for American Progress analysis.94
A 15-week abortion ban poses significant risks to women’s health, autonomy, and well-being.95 Overall, Arizona’s 15-week ban threatens women’s health by imposing arbitrary96 restrictions on women’s health care, increasing the risk of maternal mortality and morbidity,97 and exacerbating existing disparities across groups.
Restricting abortion at 15 weeks makes it harder for doctors to practice
The overturn of Roe has created a landscape of mass confusion and chaos across the United States.98 With the ever-changing legal landscape and outpouring of misinformation, doctors and other health care providers face increasingly difficult decisions on if, how, and when they can provide abortion care. The precarity of abortion laws means doctors are practicing in an untenable and dangerous climate.99
Bans influence where doctors and health care professionals choose to work
There are numerous stories100 of health care professionals making the difficult decision to leave their state or to change their career trajectory because the state in which they practice has an abortion restriction.101 Additionally, states with abortion restrictions102 are beginning to see a decrease in students applying to residency programs and medical schools.103 Doctors are not willing to risk their professional livelihoods and careers, which are threatened by criminalization that comes with possible fines, fees, jail time, and medical license revocation.104
Medical providers flee states with abortion bans
Medical students and physicians in North Carolina, Tennessee, Florida, Arizona, Idaho, Nebraska, Texas, Ohio, Utah, and beyond have expressed hesitancy in practicing in these states because of abortion bans.105 Medical students have even withdrawn applications and others have left their practices for states with more protections in place.106 Reporting suggests that physicians have decided to leave their home states primarily due “to the impact abortion bans have had on their ability to practice medicine and provide the best care possible for patients.”107 For example, Dr. Isabella Rosario Blum considered a family medicine residency program in Arizona, but a mentor advised her not to stay in Arizona if she wanted to be trained to provide abortions.108 She began her residency in Washington state instead. There are countless stories109 of abortion bans taking a toll on medical providers and creating a “chilling effect”110 for OB-GYNs concerned about the criminalization of abortion care.111
A spotlight on Arizona
With the overturn of Roe v. Wade, states such as Arizona have become battlegrounds for abortion access. The erosion of federal protections for abortion underscores the urgent need for state-level action to safeguard reproductive rights.
Access to abortion is a matter of reproductive justice and equity. By removing barriers to care and expanding options for women facing unplanned pregnancies, Arizona can address systemic inequalities and promote equitable access to comprehensive and essential reproductive health care services.
A timeline of abortion access in Arizona
- Gov. Doug Ducey signs S.B. 1164 into law, restricting physicians from providing abortion care beyond 15 weeks with limited exceptions for medical emergencies.
- A Pima County Superior Court judge grants the motion and reinstates the total abortion ban, forcing all abortion providers to stop services in the state.
- An appellate court temporarily blocks the total abortion ban in Arizona, allowing abortion providers to practice again in the state.
- The Supreme Court of Arizona issues a decision in Planned Parenthood Arizona v. Mayes, allowing the state to enforce the 1864 abortion ban against health care providers.
- The Arizona House passes H.B. 2677 to repeal the 1864 abortion ban.
- The Arizona Senate passes the bill to repeal the 1864 abortion ban.
- Gov. Katie Hobbs signs the repeal of the 1864 abortion ban, which would go into effect 90 days after the state legislative session ends.
- The Supreme Court of Arizona grants a motion filed by Attorney General Kris Mayes to delay enforcement of the 1864 abortion ban until September 26, preventing the state from enforcing the 1864 ban before its repeal takes effect.
- The state legislative session ends.
Conclusion
Since the 2022 Dobbs v. Jackson Women’s Health decision, voters in seven states112—California, Kansas, Kentucky, Michigan, Montana, Ohio, and Vermont—have considered constitutional amendments regarding abortion. In each of those states, voters sided with abortion access. In November 2024, Arizona voters will have the chance to enshrine abortion rights in their state constitution.113 The Arizona constitutional amendment would ensure that Arizonans have the right to access abortion care up until fetal viability, which is generally considered 24 weeks.114*
Furthermore, polls indicate that a majority of Americans115 support access to abortion, particularly in the early stages of pregnancy.116 The majority of Arizona voters have said they support making abortion a constitutional right in the state.117 With this initiative, Arizona voters will have a say in the future of abortion access in the state. Extending the window for guaranteed access to abortion up to 24 weeks reflects public sentiment among Arizonans and would be an improvement from the state’s current 15-week abortion ban. Every person deserves to be able to access essential comprehensive reproductive health care when they need it, and that includes abortion care. This initiative represents a step forward for abortion rights in the state.
Acknowledgments
The author would like to thank Amina Khalique and Bela Salas-Betsch for their contributions to this article.
* Correction, July 26, 2024: This report has been updated to avoid unintentionally connecting gestational bans based on capacity for fetal pain and medical organizations’ support for restoring Arizonan’s right to access abortion care up until fetal viability.