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Two years after the U.S. Supreme Court upended 50 years of abortion law with its Dobbs decision, Maryland has reaffirmed its position as an abortion-friendly state while other states have restricted or banned the procedure outright.
Providers in Maryland say they have seen an increase in patients, including an influx from states with restrictive laws. Voters will consider an amendment to the Maryland Constitution this fall that would guarantee reproductive rights, and the question of abortion is expected to have an outsized role in the race for the state鈥檚 Senate seat.
But advocates realize that even in , the landscape could shift at any time 鈥� perhaps as early as this week when the Supreme Court is expected to rule on whether federal law overrules state law on emergency abortions.
鈥淚鈥檓 waiting, kind of like ,鈥楬ere comes the next blow.鈥� You just kind of sit and wait for the next thing,鈥� said Sharon Blugis, executive director for Reproductive Justice Maryland.
It鈥檚 a far cry from some states that all but banned abortions after the court handed down Dobbs v. Jackson Women鈥檚 Health on June 24, 2022. That ruling reversed Roe v. Wade, the 1973 decision that recognized a federal right to an abortion, and said that abortion law should be left to the states.
What has emerged is a patchwork of laws that vary state-to-state. On the two-year anniversary of the Dobbs, Planned Parenthood of Maryland President and CEO Karen J. Nelson thinks it鈥檚 a 鈥済ood day to reflect鈥� on where the nation is on abortion access.
鈥淲here you live should not determine what kind of health care that you receive. And we have created a very large inequity across this country in providing care for those who need it,鈥� she said.
Refuge for out-of-state abortions
The Guttmacher Institute, which provides nationwide abortion analysis, estimates that in 2023 there were a total of 38,590 clinician-provided abortions performed in Maryland, more than 4,000 for patients who came from other states.
Nelson said that in the first year post-Dobbs, Planned Parenthood clinics across Maryland saw a 40% uptick in patients compared to the previous year. And across their network, they continue to see out-of-state abortion patients.
鈥淲e see, just in Planned Parenthood, 13% of our patients are from out of state,鈥� she said. 鈥淪ome of it is what you would expect, that neighboring states and especially West Virginia, where there鈥檚 a total ban. But then you have a lot of people coming from Texas.
鈥淭he numbers that are increasing the most are the Florida folks,鈥� Nelson said. 鈥淲here we just saw, in the past, maybe one or two patients from Florida a month, that is increasing exponentially right now.鈥�
In April, the Florida Supreme Court allowed a controversial ban on abortions after six weeks to take six-week abortion ban to . Nelson believes that the six-week ban, which took effect in May, is contributing to the influx of patients from Florida to Maryland Planned Parenthood facilities.
The that the following number of patients left their home state to seek abortion services in Maryland in 2023:聽Texas: 170, Louisiana: 100, Florida: 130, Georgia: 230, South Carolina: 120, North Carolina: 310, Virginia: 1,290, West Virginia: 820, and Pennsylvania: 1,010
鈥楬olding our breath鈥� on U.S. Supreme Court cases
Last week, the U.S. Supreme Court dismissed a case that could have called mifepristone, a drug commonly used in medication abortions, saying that the anti-abortion doctors and organizations who brought the case did not have standing to do so.
The case called into question the safety of mifepristone after the Food and Drug Administration relaxed regulations in 2016 to make it easier for the drug to be prescribed and taken.
Abortion-rights activists cautiously celebrated the ruling, but expect that new cases challenging the drug would arise in the future. Anti-abortion organizations also expect to see future challenges.
鈥淭he justices did not rule on the substance of the case at all. They ruled on the issue of standing,鈥� said Jeffrey S. Trimbath, president of the Maryland Family Institute.
鈥淎nd it will come back. The substance of it will be decided. This just wasn鈥檛 the right vehicle. You win, some you lose some,鈥� he said.
Now both anti-abortion organizations and reproductive rights advocates have turned their attention to an upcoming U.S. Supreme Court decision that could allow emergency rooms to refuse even in the case of severe, life-threatening pregnancy complications.
Moyle v U.S. challenges the federal Emergency Medical Treatment and Labor Act, shortened to EMTALA, a 1986 law that ensures 鈥減ublic access to emergency services regardless of ability to pay,鈥� according to the Centers for Medicare and Medicaid Services (CMS).
In July 2022, CMS sent a letter to hospitals across the United States stating that EMTALA preempts state laws that ban or severely restrict abortion in cases where an emergency abortion is necessary to 鈥渟tabilize鈥� patient鈥檚 medical condition. Under EMTALA, doctors can perform abortions in such circumstances, the letter said.
But the state of the federal government over what it called the Biden administration鈥檚 effort to 鈥渢ransform every emergency room in the country into a walk-in abortion clinic.鈥� That case is currently in the 5th U.S. Circuit Court of Appeals.
The Supreme Court is expected to rule this week on another challenge to EMTALA, from Idaho. , it was the Biden administration that sued the state, for abortion laws that are too narrow for doctors to perform an abortion to stabilize a patient if needed, as EMTALA requires.
In Maryland, advocates worry that separating emergency abortions from EMTALA could give the state鈥檚 religiously affiliated hospitals and emergency rooms the ability to refuse to provide emergency abortions.
鈥淲e鈥檙e focused on the coming decision on EMTALA, but I think we鈥檙e kind of holding our breath on that one, I don鈥檛 have a lot of faith on what鈥檚 going to come down,鈥� Blugis said.
Abortion on the ballot
The abortion question also plays a role in the race for the state鈥檚 available U.S. Senate seat, as former Republican Gov. Larry Hogan Maryland鈥檚 largely Democratic voters that he supports Roe-style abortion protections.
Meanwhile, his Democratic opponent, Prince George鈥檚 County Executive Angela Alsobrooks, is trying to convince voters not to trust Hogan鈥檚 stance on the matter.
In addition, Marylanders will get to decide if the state constitution should enshrine the right to receive an abortion and determine other reproductive decisions.
In 2023, the General Assembly voted to put the 鈥淩ight to Reproductive Freedom鈥� amendment on the 2024 ballot. The change would protect 鈥渢he ability to make and effectuate decisions to prevent, continue, or end one鈥檚 own pregnancy.鈥�
Blugis said that her main priority is to collaborate with other reproductive health clinics and advocates to push an information campaign about the ballot question, urging voters to approve the constitutional amendment.
Anti-abortion groups are urging Marylanders to reject the ballot initiative, saying that the measure would eliminate health and safety regulations and argues that the amendment threatens a parent鈥檚 right to make medical decisions for their kids.
Blugis says the amendment is an opportunity to for Marylanders to defend reproductive freedom in the state as the rest of the nation turns into a patchwork of laws and regulations on abortion access.
But some are not as confident.
In 2021, Layla Houshmand, was eight weeks pregnant when she experienced a medical emergency. Doctors would not provide treatment for that condition while she was pregnant for fear of . But even in pre-Dobbs Maryland, she said she struggled to secure an abortion.
Houshmand, now 37, worries that state guarantees for reproductive freedom would provide little protection if anti-abortion politicians at the federal level limit abortion access.
鈥淲e鈥檒l take what we can get. It鈥檚 a positive thing. I鈥檒l vote in favor of it,鈥� she said of the Maryland constitutional amendment. But with the possibility of an anti-abortion Congress that could push fetal personhood laws, 鈥渁ll of that might not matter.鈥�
鈥淥nce you have embryos having the same kinds of 鈥� rights as living, breathing people, the game鈥檚 over,鈥� Houshmand said. 鈥淚t doesn鈥檛 matter what your state law is.鈥�
