Dominick Williams—The Kansas City Star/Tribune News Service/Getty Images Credit – Supporters and organizers of Amendment 3 and Proposition A, which grant the right to reproductive freedom, celebrate the election results at a party at the Uptown Theater in Kansas City on Election Day Monday , November 5, 2024.

Iin the 2024 presidential election, voters cast their ballots simultaneously for abortion rights and for President-elect Donald Trump. A new Rutgers School of Public Health analysis shows that support for abortion ballot initiatives exceeded support for Vice President Harris in every state where there was a measure.

Given Trump’s past claims of credit for the Supreme Court’s overturning of Roe v. Wade— and given how central abortion was to Vice President Harris’ campaign — the divergence raised many eyebrows. A New York Times the article on the “split screen” result indicates that abortion was not the top priority of voters, compared to immigration and the economy. ACLU Policy Advocacy Officer Deirdre Schifeling noticed a “cognitive dissonance” among voters and Montana State University professor and political theorist Sara Rushing suggested mixed votes were a way for voters to “have (their) cake and eat it too”.

Rushing further notes the impact of Trump’s attempt to soften his stance on abortion during the campaign, an awareness of his political potency. To shut down the debate and distance himself, he asserted the centrality of state-to-state politics, saying on Social Truth: “States will establish by vote or legislation, or perhaps both. At the end of the day, it’s all about the will of the people.”

For voters who took Trump to him (more recent), the election results are not only unsurprising, but also reinforce the bipartisan popularity of abortion rights. From the moment when Dobbs v. Jackson Women’s Health Organization ruling, ballot measures passed in six states, even in unexpected places like Kansas. The 2024 election provided opportunities for 10 more states to have a direct voice. It means that for millions of voters, they didn’t just vote for abortion in their own state, they witnessed fellow citizens across much of the country do the same.

Read more: Why they won abortion rights in three states that voted for Trump

In this context, voters who tuned into the Trump campaign probably saw a system working exactly as they were told. Harris voters have seen continued catastrophe.

Now all abortion advocates must face the reality of how a Trump administration, along with a Republican-led Senate (and possibly the House) — plus a conservative supermajority on the Supreme Court, a dynamic Trump created — would could easily override the will. For the split-ticket voters who helped return Trump to the White House, that means accepting that there is a lot of unfinished business to attend to.

Even if Trump keeps his “word,” the federal government has several ways to ban abortion nationwide. Options range from the Department of Justice reviving long-dormant enforcement Comstock Act (an 1873 law still on the books that prohibits the mailing and receipt of materials used to produce abortions), to the Food and Drug Administration imposing additional restrictions on the prescription of abortion pills. Congress may pursue a national ban or a “minimum national standard.” same effect— which the president could sign or veto.

Separate-ticket voters should be aware that even if their home state protects basic rights, they are not inoculated from the trickle-down effect of other states with bans. Abortion can still be difficult to obtain given the higher demand or lack of significant access in many states even now, especially for abortions beyond the first trimester. All pregnancies in the United States are more dangerous without access to abortion.

The domino effect will occur in the wider health system. Ob-GYNs and midwives have leftist states with abortion bans; as medical students and residents go elsewhere to train, all reproductive care is harder to come by. The people who provide prenatal, labor and delivery, and postpartum care are the same people who provide abortions.

Health insurance policy matters too. Trump’s actions when he was last in office included several attempts to get rid of the Affordable Care Act (ACA), which provided health insurance to nearly 50 million people between 2014 and 2024. Among the services needed are well-being for women and access to free contraception. These national requirements mean that people who have private health insurance also get these benefits. If the protections in the ACA, or the ACA itself, are overturned, the result will be less access to preventive care, including to prevent pregnancy – bringing us full circle back to abortion.

So what needs to happen – now and as the new administration begins?

We can all help ensure access to abortion by understanding the current state in our own state. We can invoke disinformation, which is likely to proliferate. We can give to local abortion funds that help people afford care, including collateral costs like travel. And we can apply pressure and remind political leaders of the numbers in this election: abortion is more popular than they are.

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