What’s going on with abortion? Most of the action is happening in the states.

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Talk about abortion dominated the 2024 election. Kamala Harris promised to restore Roe v. Wade‘s protections and warned that Donald Trump would ban abortion nationwide. Yet since Trump took office, abortion policy has largely taken a back seat, with no new federal laws or major policy changes restricting access.

But things are happening at the state level. In some ways, it’s pretty much as the Supreme Court’s 2022 decision overturning Roe predicted: Blue states are expanding abortion access and red states are restricting it. Yet legal disputes between states also suggest that the implications of Roe‘s demise remain unsettled nearly three years later.

“This is still uncharted territory,” said Ingrid Duran, who tracks state-level abortion-related bills for the National Right to Life Committee, an antiabortion group. Today’s newsletter explains four broad ways in which state abortion laws are changing that you might have missed.

After Roe fell, Republican-controlled states passed abortion bans that would punish doctors — with fines, loss of their medical license, even prison — for violating them. But some of those laws were written ambiguously. Women suffered illness, risked infertility, or died after doctors, fearing legal penalties even in medical emergencies, delayed or denied pregnancy-related care.

Antiabortion activists like Duran argue that such cases reflect “a misinformation campaign” from the laws’ opponents. Yet last week, the Texas Senate unanimously passed legislation aimed at clarifying when doctors can perform abortions under the state‘s strict ban.

Texas isn’t alone. Kentucky Republicans enacted a bill in March that listed emergencies in which doctors can legally terminate pregnancies, overriding the Democratic governor’s veto. And last fall, South Dakota released a video meant to clarify emergency exemptions, although some physicians say the rules are still too ambiguous and such medical decisions should be left to doctors.

The 2024 election revealed a surprising pattern: Red states that voted for Trump also voted for ballot measures to protect abortion access. Some Republicans are now trying to undo or preempt their own voters’ efforts to protect abortion.

Last November, about 52 percent of Missouri voters backed an amendment to the state constitution protecting abortion access until fetal viability (about 24 weeks of pregnancy), reversing that state‘s near-total ban. But Republicans lawmakers are now working to overwrite it by placing a new amendment on the ballot.

Their proposal would once again ban almost all abortions in Missouri. Yet the summary language that would appear on the ballot doesn’t explicitly mention a ban, instead asking Missourians if they support “women’s safety during abortions” and allowing “abortions for medical emergencies, fetal anomalies, rape, and incest.” If the state senate approves the measure, it could appear on ballots next year.

Other Republican-dominated states seem to be trying to prevent future abortion-related ballot measures from ever passing. Some Idaho GOP lawmakers favor requiring more signatures for initiatives to appear on the ballot. In South Dakota, some Republicans want to raise the threshold to pass a ballot measure from a simple majority to 60 percent.

Most abortions in the US today happen not via a medical procedure, but by using medication that doctors prescribe. Women can get them at a pharmacy or through the mail to take at home. “That access is really important,” said Anna Bernstein of the Guttmacher Institute, a research organization that supports abortion rights, “especially in areas where brick-and-mortar clinics aren’t accessible.”

Peer-reviewed studies have repeatedly found that the pills, called mifepristone and misoprostol, are safe and effective. The FDA approved mifepristone a quarter century ago, and the Supreme Court preserved access to it last year. Yet some Republicans claim that the pills are dangerous.

According to Guttmacher, 28 states restrict access to the pills. Attorneys general from Idaho, Kansas, and Missouri are suing the FDA to further limit access, including by barring patients from getting mifepristone via telehealth. The administration is set to file a brief in that case today.

Abortion pills have also triggered unresolved legal wrangling between states.

In January, Louisiana accused a New York-based doctor of breaking its abortion ban by prescribing pills to a Louisiana patient. But New York is one of several states — including Massachusetts — with “shield laws,” which protect providers who prescribe and mail abortion pills into states with abortion bans. New York has refused to extradite the doctor.

The impasse will likely lead to court battles testing the shield laws’ legality, which could eventually reach the Supreme Court.

Under Republicans this year, the federal government has so far played a limited role on abortion. The Trump administration has rolled back modest Biden-era efforts to protect access, and Republicans’ narrow majorities make it unlikely that Congress will pass a nationwide abortion ban. Some lawmakers want to strip Medicaid funding from Planned Parenthood in a party-line bill, but a similar effort failed during Trump’s first term.

Yet both proponents and opponents of abortion access think there‘s more the federal government could do. Besides the pending mifepristone case, Guttmacher’s Bernstein argues that the administration’s efforts to freeze federal grants — and the other Medicaid cuts that congressional Republicans are weighing — would hamper abortion access.

“Even without an abortion ban through Congress, there‘s a lot of ways that they can really decimate access,” Bernstein said. “ We expect this administration to continue to use all avenues that they can.”

🧩 8 Across: Bring on board | ☔ 53º Showers

Boston and Massachusetts

• Speaker’s sweetener: The state house‘s bill about how to spend “millionaire tax” revenue includes funding for a Quincy parking garage, frustrating supporters who say it should fund education and infrastructure.
• Backfiring? Cambridge requires new building developments to dedicate 20 percent of units to affordable housing. Developers say it makes projects too costly to build.
• Luck of the draw: The NHL Draft lottery begins tonight. Here‘s what will determine which pick the Bruins get.
• A place to call home: Asian Americans in Malden, who make up more than a quarter of the city, have no community center of their own. They soon will.
• Trouble brewing: A Starbucks will replace a Dunkin’ on Capitol Hill. Massachusetts members of Congress reacted as you’d expect.
• Remembrance: A celebration of Kitty Dukakis’s life will take place on Sunday at Brookline High School. Dukakis, the state‘s former first lady, died at 88 in March.

Trump administration

• JFK award: Former vice president Mike Pence, receiving the Kennedy Library’s Profile in Courage award for certifying the 2020 election results despite Trump’s pressure, acknowledged differences with Trump on tariffs and Ukraine.
• Shuttered island: Trump wants to reopen Alcatraz, the infamous San Francisco Bay prison that is now a museum. (NBC Bay Area)
• ‘Brutta figura’: Catholics criticized Trump for posting an AI-generated image of himself as the pope. Vice President JD Vance, who is Catholic, defended it. (ABC)
• Climate of fear: ICE has arrested immigrants inside and outside courthouses, making many afraid to appear in court as victims, witnesses, or defendants.
• Tough job market: The economic uncertainty Trump’s policies have caused has left graduating students struggling to make decisions about their futures.
• Trade barriers: China is Massachusetts’ largest foreign market for exported goods. Trump’s tariffs have left state manufacturers in limbo.
• Baby boom: The administration wants women to have more kids. These women say they would if they could afford it.

The World

• Foiled: Brazilian police arrested two people who allegedly planned to attack LGBTQ+ people at a Lady Gaga concert in Rio de Janeiro. (AP)
• Popemobile of peace: Per Pope Francis’ wishes, his popemobile will become a mobile health unit for children in Gaza. (Vatican News)
• Israel-Hamas war: Israel’s security cabinet unanimously approved a plan to broaden its offensive in Gaza. An army official warned that doing so could endanger Hamas-held hostages. (Times of Israel)

By Teresa Hanafin

🗓️ Free things to do: A Cinco de Mayo party at Downtown Crossing, sketching in the Seaport, meditation in the Public Garden, Lilac Sunday at the Arnold Arboretum, and more.

🇲🇽 Speaking of Cinco de Mayo: Americans love this Mexican holiday, but precious few have any idea what’s being celebrated. (Tucson Sentinel)

🍩 Dunking on Dunkin’: As Dunkin’ turns 75, Kara Baskin ranks the best — and worst — of its menu.

💃 Met Gala tonight: It’s the fashion world’s biggest night out, a spectacle in which celebrities wear bizarre clothes (last year somebody wore sand) and the rest of us gawk. (CNN)

🤧 A Miss Conduct classic: In the season of sneezes, how many times is too many to wish someone “God bless you”?

💰 Windfall: When a California prison dentist retired last year, he walked away with $1.2 million in unused vacation days. In fact, the state owes at least $5.6 billion to state employees who haven’t retired yet. (LA Times)

✉️ Calling all readers: Do you regularly use Strava, Letterboxd, StoryGraph, or other niche social media sites? The Globe wants to hear from you.

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This newsletter was edited by Teresa Hanafin and produced by Diamond Naga Siu and Ryan Orlecki.

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