Unpaid Idaho volunteers place abortion rights measure on November ballot

Medication abortion access faces separate court pressure

Idaho voters will decide in November whether to adopt Proposition 1, a ballot measure that would lift one of the nation’s most restrictive abortion laws and return the state to the standard set by Roe v. Wade. The measure was placed on the ballot by 1,255 unpaid volunteers who knocked on 66,000 doors and gathered more than 110,000 signatures across Idaho’s 35 legislative districts, an effort organized by Idahoans United for Women and Families.

Proposition 1 asks voters a single question: Should abortion be legal in Idaho? A “yes” vote would restore the framework in place before the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization overturned Roe. Under that framework, the state could regulate abortion after “viability,” or the point when a fetus can survive outside the womb — widely recognized as about 24 weeks’ gestation. Idaho currently prohibits abortion at every stage of pregnancy with an exception only to save a woman’s life, not her health.

The campaign’s lead organizer, Melanie Folwell, said the initiative reflected a view that Idaho-specific remedies were necessary because broader political support was not coming. “We’re not a large population state – we’re a flyover state, we’re a very red state,” Folwell said, “and it’s very easy to forget about a million women and girls.” The campaign raised $3.5 million from approximately 6,000 contributions, almost entirely from inside Idaho, according to Folwell.

Idaho’s strict ban has reshaped emergency obstetric care in practice, with reports of doctors passing a miscarrying woman around like a “hot potato” or airlifting women across state lines for emergency services doctors are too scared to provide in Idaho.

As Republicans delay major action on abortion until after the election, and Democrats focus on issues like affordability, high-stakes reproductive rights battles have faded from national attention. Democrats have had difficulty building urgency around abortion rights as important cases quietly move through the judicial system, leaving a long list of contentious issues — including high gas prices, a war with Iran, ICE raids, a challenging job market and even datacenters — to take top billing.

The Idaho initiative is one of four state ballot initiatives this year that attempt to pin down a specific post-Dobbs framework. Republicans have delayed major federal action on abortion until after the midterm elections, according to Mary Ziegler, a historian and law professor at the University of California Davis. “It would not surprise anyone if there are new national abortion limits in 2027,” Ziegler said, “but the Trump administration understands that’s not a good idea politically. They’ve been doing everything they can to delay those actions until after the midterms.”

While it may be bad politics to push abortion bans nationally, in deep red states where a single party rules, there is little threat of voters crossing party lines, Ziegler argues.

The Trump administration has undertaken a “safety review” of mifepristone, one of the drugs used in medication abortion, despite dozens of studies that have documented the drug’s safety. “The Trump administration asked its own agencies and the courts to hit the pause button until after the midterms,” Ziegler said. “If you’re an average voter you just think, ‘There’s nothing to see.’”

Medication abortions account for 63% of all abortions in states without bans, and access in restrictive states depends on telehealth prescriptions and “shield laws” in California, Massachusetts, and New York that protect prescribing physicians from extradition. Multiple state attorneys general are working to dismantle that system. Louisiana’s attorney general sued the U.S. Food and Drug Administration over its approval of telehealth dispensing of mifepristone; the case is before a select panel of the fifth circuit appeals court, which covers Louisiana. Changes in either the FDA’s assessment of safety or an unfavorable ruling from the fifth circuit could significantly restrict medication abortion nationally. Idaho, Kansas, and Missouri have also sued the FDA over its approval of mifepristone.

Attorneys general in Alabama, Arkansas, and Louisiana have separately sued California, Massachusetts, and New York in an effort to end the shield laws. In Texas, an anti-abortion attorney has brought wrongful-death suits in an effort to revive the Comstock Act, an 1873 indecency law that some conservative legal theorists believe could be used to ban abortion medication nationally.

In Missouri, a separate conservative-led ballot initiative seeks to both restrict abortion rights and ban gender-affirming care for minors in the state constitution. Missouri was the first state to enforce an abortion ban after Dobbs and the first to have its voters overturn such a ban; abortion is now protected in the state’s constitution. James Lawson, campaign manager for Missouri’s anti-abortion referendum, described the measure as “a once-in-a-generation opportunity to bring reform to Missouri on this issue.”

Idaho is also at the center of an active federal lawsuit over whether the state’s abortion ban can survive constitutional review. Dr. Stacy T. Seyb, a maternal-fetal medicine specialist in Boise, sued Idaho arguing the strict ban made it impossible for him to practice medicine; a federal district court ruled the state’s law was unconstitutional. Stephanie Toti, executive director of the Lawyering Project, which is representing Seyb, said: “This is the first case since Dobbs, the supreme court case that overturned Roe v Wade, to argue there continues to be a federal constitutional right to abortion in at least some circumstances, and the district court is the first court to come to that conclusion.”

Idaho’s law remains in effect because an injunction is tailored only to Seyb. Such tailored injunctions were required by the justices in Trump v Casa Inc, a case better known for challenging birthright citizenship. The Court ruled that judges should not enact universal injunctions — orders not to enforce a law that provided relief to people beyond those directly involved in litigation. The injunction is now before an appeals court, which could rule any day.

As of early October, Folwell said the “yes” campaign for Proposition 1 was “neck and neck” with the opposition. Folwell will spend the rest of October campaigning for a “yes,” facing opposition from religious groups such as the Catholic church, but personally buoyed by the bipartisan support the initiative needed to get on the ballot in the first place. “Idahoans are living with these consequences,” Folwell said, “and dying with these consequences.”