PRB

In 2022, the Dobbs decision by the U.S. Supreme Court held that there is no constitutional right to abortion, effectively granting individual state governments the authority to determine the legality of the medical procedure. Since then, state legislators working to protect access to abortion care have been challenged by limited resources and political opposition—but have found allies in the research community.

At a June 9 symposium on the public health effects of state abortion bans,  State Delegates Kayla Young (D-West Virginia), Candi Mundon King (D-Virginia), and Lesley Lopez (D-Maryland) shared their experiences advancing legislation in states with very different policy environments for abortion access. For instance, while in 2025 Maryland guaranteed the right to abortion and passed a law unlocking $25 million in insurance funds for abortion care, West Virginia lawmakers face near-total opposition to abortion protections.

The lawmakers emphasized the importance of forming trusted partnerships with researchers to advance evidence-based policies during limited legislative sessions. All three state legislators are members of the State Innovation Exchange’s Reproductive Freedom Leadership Council, which is the nation’s only network of state legislators championing reproductive health, rights, and justice.

“We all have our different styles in the way we want to communicate, but just giving a little piece of data and then some narrative around it to help explain the context is important,” Young said. “The more granular you can get with that data, the more useful it is to us.”

Navigating Political Obstacles With Limited Resources

A fundamental challenge lies in the different operating structures of state legislatures. West Virginia has no permanent staff for legislators, and all work takes place during a 60-day session with shared resources. Virginia has one staff person serving 80,000 constituents, while Maryland has more structured committee assignments. Different structures—and levels of support—have pushed lawmakers to rely heavily on external research partnerships and advocacy organizations for policy development and real-time guidance during floor debates, the lawmakers shared at the symposium.

The political landscape adds another layer of complexity. In West Virginia, Democratic lawmakers are in the minority, with only nine Democrats to 91 Republicans. Virginia operates under divided government with a Democratic legislature and Republican governor who has vetoed reproductive rights legislation. Maryland, despite its Democratic supermajority, still faces internal party disagreements on how to address reproductive health issues, Lopez noted.

The lawmakers reported navigating increasingly sophisticated opposition that includes so-called crisis pregnancy centers receiving millions in state funding, anti-abortion medical providers in areas with limited health care options, and emerging tactics like using land use policies to restrict clinic locations. The potential criminalization of pregnancy outcomes (such as spontaneous miscarriages) creates additional legal gray areas that lawmakers must address while being careful not to inadvertently lay the groundwork for fetal personhood laws.

Strategies, Successes, and Ongoing Battles

Despite these challenges, the lawmakers reported some success advancing reproductive health policy. Maryland’s HB 930 demonstrates how existing federal provisions can be leveraged for significant impact, Lopez said. The first-of-its kind law activated a previously overlooked section of the Affordable Care Act requiring insurance carriers to collect $1 per month per subscriber for abortion care, unlocking $25 million in  dedicated funds with an additional $3 million generated annually.

Without coordination from researchers and advocates, Lopez said, “we would have not had 38 other organizations who support reproductive rights in Maryland and across the country come up to support us and provide testimony in that bill.”

Research partnerships have also emerged as crucial for policy success. The lawmakers emphasized the need for trusted sources, such as Johns Hopkins University and the University of Virginia, particularly when confronting misinformation during legislative debates. They noted a preference for quick, easy-to-reference research delivered in multiple formats, including:

• One-page summaries for quick reference.
• Detailed reports for deeper analysis.
• Real-time fact-checking during floor debates via text message from advocacy partners.

In addition, humanization of reproductive health efforts is a critical strategy. Virginia’s “momnibus” initiative passed 12 of 18 maternal health bills by connecting abortion access to broader women’s health concerns, including expanding postpartum care, providing mobile health clinics for rural communities, and treating substance abuse issues. This approach helped lawmakers frame reproductive rights as comprehensive healthcare rather than isolated political issues, King said.

“Yes, this is about abortion, but it’s about abortion ‘plus,’” she said. “And it’s connected to how lack of access to abortion, to contraceptives, to any reproductive care is damaging the lives of women.”

“We need to look at all of the total life experience of women, seeking health care, bringing life into this world,” King added.

Financial arguments resonate across party lines, particularly in conservative states. Delegate Young says that “any sort of research on financial implications of how we could save money, doing things in any capacity is helpful to get Republicans on board.”

Following this strategy, West Virginia successfully expanded postpartum Medicaid coverage from 60 days to one year by demonstrating cost savings. The state also nearly passed midwife regulation by appealing to insurance companies and healthcare providers who saw economic benefits.

However, significant obstacles persist, the lawmakers noted. Crisis pregnancy centers are providing misleading information, and patients often have to travel hundreds of miles to receive quality care. A growing number of states are using land use policies to restrict clinic locations and using child protection laws and services against pregnant women, particularly those who are poor, have substance use disorders, or are women of color.

Criminalization of pregnancy outcomes creates dangerous legal precedents, the lawmakers said. West Virginia recently prosecuted a case involving miscarriage remains, while Georgia’s Adriana Smith case illustrates how abortion bans can affect grieving families. Thirty-plus states now allow pregnancy to supersede advance directives, further eroding women’s autonomy, they noted.

The experiences of these lawmakers highlight the critical need for multi-state coordination and resource and data sharing among reproductive rights advocates. For instance, Maryland’s success with HB 930 could be replicated in other states with similar insurance structures.

“I’m just incredibly thankful for the role of partners in this and people who have really dedicated their lives to being researchers and studied the nitty gritty of 908-page bills,” said Lopez.

Dr. Feinian Chen, who directs the Hopkins Population Center, concluded, “the challenges we face require all of us at the table working together to chart a more informed and inclusive path forward.”