BOZEMAN, Mont. — It’s an unseasonably warm afternoon in Bozeman, and Jackie Johnston has at least two dozen doors to knock on before she calls it a day.
Johnston is a longtime Democrat, and she has canvassed for multiple candidates over the years. But she began knocking on doors to talk about abortion rights for a personal reason: her daughter’s ectopic pregnancy three years ago.
A few months later, a Supreme Court decision would end national abortion protections, triggering bans, legislative battles, and a string of voter referendums about abortion rights. Johnston is out drumming up support for a measure to protect the right to abortion in her state’s constitution. Montana is home to only a handful of abortion providers, but has quickly become a safe haven for abortion care in the rural West, raising the stakes as voters head to the polls.
Advocates, led by groups like Montanans Securing Reproductive Rights and Forward Montana, are optimistic: They collected double the necessary signatures to get the initiative on November’s ballot, and other states have seen these measures succeed.
“We knew that the vast majority of Montanans support abortion access,” said Kiersten Iwai, executive director of Forward Montana, one of the groups that gathered signatures. Iwai spoke to STAT in Forward’s downtown Bozeman office, a former lawyer’s practice in a nondescript tan building that shares a parking lot with an auto parts store. “Who gets to make decisions about something really personal, pregnancy and abortion? Especially in Montana, we don’t want anyone, much less the government, telling us that.”
But while voters are consistently backing abortion rights in referendums, they aren’t always choosing the Democrats who support them. Montana’s Democratic senator, Jon Tester, is falling behind anti-abortion Republican candidate Tim Sheehy in the polls. The Democratic candidate for governor is also badly lagging incumbent Republican Greg Gianforte.
The Senate race could establish which party takes the Senate majority next year. A Tester loss could hamstring any Democratic effort to pass laws on reproductive health, even if Vice President Harris prevails over former President Trump nationally.
Tester has focused on reproductive rights in his campaign at every opportunity. A political ad that ran this September warned Sheehy “wants to take away the freedoms to choose what happens with your body.” At a “grab a beer with Jon Tester” rally in Butte this month, Tester called for the country to reinstate Roe v. Wade, to applause from the crowd. Days later, he appeared at another rally with the president of national group Reproductive Freedom for All.
Johnston aims to visit at least 20 houses this afternoon, in a leafy neighborhood blocks away from a state university. At one house, a woman shares that she and her mother have each had an abortion, but the rest of their family does not know and she cannot imagine ever telling them. Across the street, Johnston began telling her daughter’s story to a group of college students before one, a young man, interrupted. He doesn’t want to hear anymore, he said; his brother had a child at 19 years old and is grateful every day.
“But he had a choice, and so did my daughter,” Johnston says before carrying on to the next house.
That happens a lot — people sharing their own experiences with abortion, pregnancy, and health care, Johnston told STAT. One house, one doorbell, can open up whole new conversations with strangers.
Montana is one of 10 states bringing abortion rights to voters in November’s election, the latest in a stream of ballot measures since the Supreme Court overturned Roe v. Wade in 2022. In the two years since the court’s Dobbs decision, 21 states have enacted abortion restrictions and effective bans; more liberal states formalized abortion protections and positioned themselves as safe havens for traveling patients.
The year that Roe fell, Montanans voted down a referendum on a so-called born-alive measure — which would have required doctors to provide care in the extremely rare case that a fetus survives an abortion. Advocates then began mustering the support to codify abortion rights in the state constitution.
Every time that Americans have voted on abortion in the wake of the Supreme Court decision, they’ve favored access over restrictions. Republican candidates for office, hammered on the issue by Democrats, have softened their position, largely abandoning calls for national restrictions.
The GOP needs “to do so much better of a job at earning the American people’s trust back on this issue where they, frankly, just don’t trust us,” Trump’s vice presidential candidate, JD Vance, said on the debate stage this month. What changed his mind, he said, was Ohio’s referendum last year, where voters in the conservative state passed a measure protecting abortion access.
Bringing abortion to the ballot box
The Republican-controlled Montana legislature passed a string of legislation last year to restrict abortion, though the procedure is still available in the state up to a fetus’ viability.
But while ballot measures can be an effective voter shortcut through state legislatures’ action, the strategy of bringing abortion questions straight to residents is quickly becoming more costly and less realistic. There are few states remaining that can mount voter referendums on abortion rights and have not already tried, reproductive rights advocates said. In Arizona, a legal battle over signatures nearly pushed the referendum off the November ballot; in Arkansas, it did.
In 15 states with abortion restrictions, there is no process for citizens to draw up a ballot initiative to challenge the state law.
Anti-abortion groups argue that initiatives like Montana’s CI-128 and efforts in nine other states go far beyond what many Americans endorse. While most Americans say they support abortion access in the first trimester, for instance, that support drops, particularly among Republicans, later in pregnancy. The vast majority of abortions are performed in the first trimester, or first 13 weeks, of pregnancy according to federal data.
“Through carefully crafted language, pro-abortion ballot measures across the country will allow elective abortion in even the seventh, eighth, and ninth months of pregnancy,” said Kelsey Pritchard, Montana public affairs director for Susan B. Anthony Pro-Life America.
Overall, those situations are rare and overwhelmingly occur when the pregnant person’s life is at risk, abortion rights advocates say.
Harris has vowed that she would restore Roe’s national abortion protections if elected to the presidency, while Trump has said the matter should be left to states. But Harris would be unable to do that, unless Congress eliminates the filibuster requiring two-thirds of the Senate to pass a law.
In the meantime, states continue to find themselves in legal limbo over abortion law. A North Dakota judge struck down the state’s six-week ban last month, but there are no providers operating in the state. Wyoming’s two abortion providers are still operating, primarily because courts have halted anti-abortion legislation in the state so far.
Creating consensus on abortion rights
At the Blue Mountain Clinic in Missoula, it’s business as usual behind protective wrought-iron gates. Nicole Smith started the clinic as a women’s health collective in the 1970s and rebuilt it as a two-story family health practice after arsonists firebombed it in 1993. Today, it remains one of the state’s few abortion providers, and also offers family medicine, behavioral health care, and gender-affirming care.
As bans took hold in surrounding states, patients driving and flying from hours away flowed through Blue Mountain’s doors while anti-abortion groups set up protests and candlelight vigils outside. Some protesters are milling about across the street as Tess Fields, Blue Mountain’s executive director of policy, sat down with STAT in the large, sunny waiting room, near a children’s corner with appropriately tiny armchairs for the pediatric patients.
A week earlier, a young woman from Idaho drove hours alone to get to Blue Mountain Clinic, Fields said. She was experiencing intense bleeding and pain, but was “terrified” to seek emergency care in her state, where a total ban penalizes doctors for providing abortions, except when the life of the pregnant person is in jeopardy. That narrow exception has left many doctors and patients confused about when a procedure is protected under the law, as the Supreme Court heard this April. One Idaho hospital has airlifted at least six emergency patients to other states since the ban took effect, rather than face potential legal battles.
“She said ‘I can’t. They’ll arrest me like. I don’t know what’s happening,” Fields recounted. The woman was experiencing an ectopic pregnancy and was rushed into emergency surgery at a Missoula hospital. “It was heartbreaking for our nurses, to watch this young woman go through something so frightening and so painful, and to not be able to just go, ‘I need to call her doctor.’”
Fields joined Blue Mountain this summer after years working in Oregon, one of the states that passed abortion protections and launched resources for traveling patients to find care.
“I didn’t want to stay in a safe state. I didn’t want to be in Oregon, or Washington, or California, or New York. I wanted to get where there was a ballot initiative,” she said.
It’s been common consensus among pollsters and analysts that while reproductive rights motivate voters, they are rarely the deciding factor when someone casts their vote for a political candidate. Just 12% of voters, most of them young and Democratic, say it is the most important issue for them heading into the 2024 election. But the vast majority say they believe there should be national protections, and that support spans across party lines.
“Government interfering with just personal decisions, it gets the ire of quite a few Montanans, no matter what political side of the aisle they’re on,” Johnston, the canvasser, told STAT.
Residents voting down the 2022 referendum underscored that point, said Sam Dickman, chief medical officer for Planned Parenthood of Montana. “It’s not just rhetoric,” when Montanans talk about personal liberty, said Dickman, who moved to Missoula from Texas after that state’s abortion ban went into effect.
Dickman travels to Helena once a week to provide care in the state’s capital. It’s a long drive for him, but nothing compared to those made by patients he has seen from both Montana and neighboring states.
“I had a young woman recently who did a two-day road trip with her grandmother from North Dakota, just to get to Helena for a procedure. And another two days driving home,” Dickman told STAT as he walked to Planned Parenthood’s downtown Missoula office on a chilly Friday morning. “Just to do this straightforward, safe medical procedure that wasn’t available anywhere closer to her.”