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The 2010 midterm elections marked a turning point in state-level legislation limiting access to abortion care in what would later be categorized by historians and political wonks as the backlash to the election of President Barack Obama. That state-level legislation, including dangerous and unnecessary parental notification laws, 20-week gestational bans on abortion, and forced ultrasounds were a direct product of gains that Republicans had made in state legislatures. In the years following, the Republican-led chambers would have a dizzying and circular effect on abortion care legislation: attacks on access to pregnancy termination beggetted further impediments to care. 

With the appointment of Justice Amy Coney Barrett to the Supreme Court, previously out-of-reach goals of overturning the landmark abortion access case Roe v. Wade is looking more achievable. And in preparation for the the day that the Supreme Court does decide to overturn Wade, some states have added explicit language to their governing documents decrying abortion care.

One such state is Louisiana, which voted on Nov. 6 to add an amendment to the state’s constitution vowing not to protect abortion. Amendment 1, for which 62% of voters cast their ballots, adds to the Louisiana Declaration of Rights a single sentence: “To protect human life, nothing in this constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.”

Louisiana is the third state, after West Virginia and Tennessee, to amend its state constitution in this way. And while the added line may have no immediate bearing on legal care available in state, experts say that the move is already confusing and intimidating abortion patients. Moreover, advocates for abortion care, like New Orleans Abortion Fund (NOAF) Executive Director Steffani Bangel, say that the new language sends a message to those living in and out of Louisiana: Low-income women are not protected here. 

Bangel explains that misinformation about abortion access and the codification of anti-abortion sentiment produce a kind of psychological barrier to abortion access. “A lot of people, in the wake of Amendment 1, now believe that abortion is already illegal in Louisiana,” Bangel says.

Abortion restrictions aren’t clustered in the South. In fact, there are only five states in the country without some sort of abortion restriction in place. However, since 1973 Louisiana has passed 89 abortion restrictions, the most of any state in the country, which amounts to 26 more restrictions than the next state of Indiana. 

A constitutional amendment isn’t explicitly an abortion restriction, though it does restrict abortion by confusing patients and deterring them from seeking care. “The day that Amendment 1 passed, three of our active clients who had abortions scheduled and we were supporting in getting [to clinics] called and said ‘hey, what do we do?’” Bangel says. “That is one of the biggest barriers we have to overcome: misinformation [and] an intentional lack of education around these things.” 

Louisiana is sandwiched between Texas, Arkansas, and Mississippi, which means that the three in-state abortion clinics serve the one million Louisianans who could get pregnant as well as out-of-state patients NOAF funds to receive care. Bangel says that the organization provides abortion funds for about 950 people annually, which is about 10% of all abortions provided in-state. According to Bangel, a majority of callers are Black and one-third of callers have health insurance. Even though many patients have access to medical insurance, patients rely on NOAF funding to access abortion care. In addition to the existing ban on the use of Medicaid for abortion care, Louisiana banned abortion coverage on the state health exchanges without offering exceptions for sexual assault, incest, or at-risk pregnancies. 

Justin Hartley, a sophomore at Tulane University who organized against the amendment with a statewide coalition of pro-choice organizations, explains that an abortion can cost anywhere from $450 to $2,500, which is a near-impossible cost burden for the average abortion patient: A mother of at least one child who’s living at or below the poverty line. “Black and brown people in rural areas [are] going to be the most affected by Amendment 1,” Hartley says. Despite the fact that low-income women comprise a majority of the patients served by abortion clinics, Hartley says that low-income women of color are often placed on the margins of society, making their care appear superlative rather than fundamental. 

“By and large, a low-income Black, brown, or Indigenous person who is young, trans, or non-binary, or undocumented, [and] living in the rural areas of Louisiana would have the most difficulty getting an abortion and having a safe procedure,” Hartley says. Some patients can leave Louisiana or travel to an abortion-friendly state for their procedure, Hartley adds, but they say that’s just “not a reality for most women or birthing people in Louisiana.” 

The results of the general election concern Bangel not just for the future of abortion care in Louisiana, but across the U.S. “This amendment was written by national special interest groups and brought to Louisiana,” Bangel says. “I think it’s important to name that this came from external forces because that means it’s not gonna stop in Louisiana.”

Ray Levy Uyeda

Ray Levy-Uyeda is a Bay Area-based freelance writer who covers justice and activism. Find them on Twitter @raylevyuyeda.