Dr. Kristin Lyerly’s placenta detached from her uterus when she was 17 weeks pregnant with her fourth son in 2007. Her doctor in Madison, Wisconsin, gave the devastated recent medical school graduate one option: to deliver and bury her dead child. But she requested a dilation and evacuation abortion procedure, knowing it would be less invasive and risky than being induced. And she couldn’t fathom the agony of holding her tiny dead baby.

But Lyerly’s doctor declined, giving her a direct window into the many ways Americans lack real choice when it comes to their reproductive health decisions. At the time of this miscarriage, Lyerly was getting a master’s degree in public health before beginning her residency. She was able to get a D&E at the same hospital by a different doctor. As an OB-GYN, she soon would learn how much abortion is stigmatized and limited throughout the country, but also regularly sought after and sometimes medically necessary, including among her many conservative Catholic patients in northeastern Wisconsin.

And then, on June 24, 2022, the U.S. Supreme Court ended federal abortion rights, prompting states such as Wisconsin to resurrect dormant abortion bans from the 19th and 20th centuries. Lyerly’s job changed overnight. She stopped working as an OB-GYN in Sheboygan and moved her practice to Minnesota. She became a plaintiff in a lawsuit over an 1849 Wisconsin feticide law being interpreted as an abortion ban, which has since been blocked.

When a congressional seat opened up in a competitive Wisconsin district this year, the 54-year-old mother of four joined the post-Dobbs wave of women running for office to restore reproductive rights, which this election cycle includes another OB-GYN and a patient denied abortion care. Lyerly’s decision to run is emblematic of the nationwide backlash against the Dobbs decision, which altered the reproductive health care landscape, with providers, patients and advocates turning to the ballot box to change the laws to restore and broaden access.

Wisconsin is among seven swing states expected to determine the country’s next president and federal leaders. And in many ways they’re being viewed as referendums on how much the right to have an abortion can move the needle in a tight presidential election.

“What we’ve seen in every election since the Dobbs decision is that abortion is at top of mind for voters — and it’s not just helping voters decide who or what to vote for. It’s actually a turnout driver,” said Ryan Stitzlein, vice president of political and government relations at national lobbying group Reproductive Freedom for All. The group is investing in down-ballot races in conservative districts such as Lyerly’s, buoyed by cash and momentum from Democratic presidential nominee Kamala Harris’ reproductive-rights-focused campaign.

Anti-abortion money is also flowing through the swing states, led by lobbying groups Susan B. Anthony Pro-Life America and Women Speak Out PAC. Some of their messaging, adopted by Republican presidential nominee Donald Trump, and many GOP candidates, often paints Democrats as champions of infanticide, focusing on the rarest and most controversial type of abortions, those performed in the third trimester.

But aside from that rhetoric, many Republican candidates have been quiet on an issue that for years motivated their staunchest supporters.

SBA Pro-Life America declined an interview for this story but shared a press release outlining the organization’s strategy trying to reach 10 million voters in Montana, Ohio and all of the battleground states except for Nevada. The group endorsed 28 House candidates total this cycle, and six of them are in North Carolina. One of North Carolina’s endorsed candidates in a toss-up race is Republican GOP challenger Laurie Buckhout, who does not mention her abortion stance on her campaign website and did not return a request for comment.

“Our field team is talking to persuadable and low propensity pro-life voters to urge them to cast their votes against the party that endorses abortion in the seventh, eighth and ninth months,” said SBA national field team director Patricia Miles in the press statement.

But throughout this election cycle, polls in the swing states have shown bipartisan support for abortion rights, especially when voters are educated about what abortion bans do. Voters in more than half of the states expected to determine the presidential winner have, to varying degrees, lost access to abortion. And abortion-rights activists across these states told States Newsroom they are determined to protect that access, or to get it back.

Arizona sees backlash after GOP upholds Civil War-era abortion ban

In Arizona, the Dobbs decision resurrected a Civil War-era ban that allowed abortions only to save a pregnant patient’s life.

Legislators repealed the law, but abortion-rights supporters fought for more certainty. This fall, Arizonans will vote on a proposed ballot measure that would protect access until fetal viability, around 24 weeks of pregnancy.

Now, two of the judges who upheld the abortion ban — Justices Clint Bolick and Kathryn King— are up for reelection, in races infused with national cash by groups such as RFA and Planned Parenthood. Also on the ballot is Proposition 137, which would give lifetime appointments to state judges. The Republican-initiated measure has garnered controversy in part because it is retroactive to this year’s election, so if approved, any retention bids would be nullified even if the majority votes to unseat the judge.

Ballot organizers turned in more than 800,000 signatures, double the required number, and overcame opponents’ legal challenges to qualify the abortion-rights ballot measure, Proposition 139. Abortion is legal up to 15 weeks of pregnancy, but there are many state restrictions that the Arizona Abortion Access Act would eliminate, such as a ban on any abortions sought for fetal genetic abnormalities and a blocked law from 2021 granting personhood status to fertilized eggs.

Recent deaths reignite controversy over Georgia’s abortion ban

Last month, ProPublica reported on the deaths in 2022 of two Georgia women who suffered rare complications after they obtained mifepristone and misoprostol for early-term medication abortions. Both were trying to navigate a new state law that banned abortions at about six weeks of pregnancy and threatened medical providers with up to a decade in prison.

In one case, doctors at an Atlanta-area hospital refused for 20 hours to perform a routine dilation and curettage, a D&C, to clear the patient’s uterus when her body hadn’t expelled all the fetal tissue. In the other, a woman who had ordered the pills online suffered days of pain at home, fearful of seeking medical care. Both women left children behind.

Georgia’s law permits abortion if the patient’s life is at risk, but medical providers have said the law’s language is unclear, tying their hands and threatening the health of patients who have high-risk pregnancies.

Their cases, which a state medical review committee found to be “preventable,” have galvanized activists in the state.

Harris spoke at length about the women, Amber Nicole Thurman and Candi Miller, at a recent campaign event in Atlanta. She blamed their deaths on Georgia’s law, calling it “the Trump abortion ban,” because the former president appointed three justices he’d promised would overturn Roe v. Wade.

“This is a health care crisis, and Donald Trump is the architect of this crisis,” Harris said. “Understand what a law like this means: Doctors have to wait until the patient is at death’s door before they take action. … You’re saying that good policy, logical policy, moral policy, humane policy is about saying that a health care provider will only start providing that care when you’re about to die?”

Trump has not commented on the deaths. He has repeatedly said this year that abortion access should be left to the states. He has dismissed the idea of a federal abortion ban, but during the presidential debate, he refused to say whether he would veto such legislation.

At a recent rally in North Carolina, Trump addressed “our great women” (a demographic he’s trailing among), saying, “you will no longer be thinking about abortion, because it is now where it always had to be, with the states, and with the vote of the people.”

Abortion was a driving concern in this spring’s qualifying process for Georgia’s 2024 legislative elections — the first opportunity for aspiring state lawmakers to jump on the ballot in response to their state’s severe abortion restrictions.

Melita Easters, the executive director and founding chair of Georgia WIN List, which endorses Democratic women who support abortion rights, was already calling this year’s general election “Roevember” back when President Joe Biden was still the party’s presumptive nominee.

But Easters told States Newsroom that having Harris on the ticket instead has elevated the issue of reproductive freedom even more and “has breathed new life into down-ballot campaigns.” Easters said she is especially encouraged after a Democratic state House candidate in Alabama who ran on abortion rights flipped a Huntsville seat during a special election in March.

Michigan Democrats continue betting on abortion after 2022 successes

Michigan was one of the earliest states post-Dobbs to show that abortion rights could be a strong election-winning issue.

Months after the Supreme Court’s ruling, Michiganders overwhelmingly approved a ballot measure to protect abortion rights in the state constitution; reelected Democratic Gov. Gretchen Whitmer, who vowed to prioritize reproductive freedom; and voted for Democratic majorities in both chambers, giving the party a legislative trifecta for the first time in 40 years. In 2023, the legislature repealed a 1931 abortion ban that was still on the books and passed the Reproductive Health Act, expanding abortion access in the state.

This year, state and national abortion-rights groups have campaigned in toss-up congressional districts across Michigan, warning that a federal ban would supersede the state’s protections.

State judicial races, meanwhile, have attracted millions of dollars, as they could determine partisan control of the Michigan Supreme Court. Democrats secured a slim 4-3 majority on the state Supreme Court in 2020 after Republican-nominated justices controlled the court for most of the last few decades.

Nevada reproductive rights activists hope ballot initiative improves turnout

In Nevada, abortion remains legal through 24 weeks and beyond for specific health reasons. In 2023, the state’s Democratic-led legislature passed a law shielding patients and providers from out-of-state investigations related to abortion care; it was signed by Republican Gov. Joe Lombardo.

Seeking to cement these rights in the state constitution, reproductive health advocates mobilized a ballot initiative campaign, which they hope will drive voter turnout that would affect the presidential and down-ballot races. Constitutional amendments proposed through an initiative petition must be passed by voters twice, so if voters approve Question 6 in November, they will have to approve it again in 2026.

In the state’s closely watched U.S. Senate race, Democratic Sen. Jacky Rosen currently edges Republican Sam Brown, who has had inconsistent positions on abortion and reproductive rights but opposes the abortion-rights measure.

Growing Latino voting bloc in North Carolina

National anti-abortion groups Susan B. Anthony Pro-Life America and Students for Life of America have notably not focused on Nevada in their campaign strategies.

In North Carolina many Democrats are campaigning in opposition to a 12-week abortion ban that the Republican-majority legislature passed last year after overriding Democratic Gov. Roy Cooper’s veto.

In a high-profile race for governor, Democratic Attorney General Josh Stein faces Republican Lt. Gov. Mark Robinson, who has previously said he believes “there is no compromise on abortion,” according to NC Newsline. The lieutenant governor is now facing calls to withdraw from the race over comments made on a pornography website years ago, and Stein has started racking up endorsements from prominent state Republicans.

Iliana Santillan, a political organizer who supports abortion rights, has focused on mobilizing Latinos, a growing voting bloc in the state. The executive director of progressive nonprofit El Pueblo and its political sister group La Fuerza NC told States Newsroom she’s talked to many young women motivated to secure their own reproductive rights, including her college-age daughter. She said the Latinx community faces additional reproductive care barriers such as language and transportation, with immigrants in the country without legal authorization scared to cross state lines without a driver’s license.

Santillan also said there’s a misconception that all Latinos are against abortion because they’re Catholic, when in reality opposition to abortion skews among older voters.

“With older folks, the messaging that we’ve tested that has worked is: ‘We don’t want politicians to have a say in what we do with our bodies,’” Santillan said.

Motivated voters in Pennsylvania

Pennsylvania, with its 19 electoral votes, is the largest swing state and considered essential to win the White House.

In a poll conducted recently by Spotlight PA and MassINC Polling Group, abortion ranked as the fifth most-important concern in the presidential race for likely voters, with 49% naming it as among their top issues.

The issue is far more important to Democrats, however, with 85% calling it a top issue compared with 17% of Republicans. Among those who aren’t registered with either major party, 49% called it a top issue.

In 2022, voters surprised pundits by sending enough Democrats to the state House to flip it blue. Voters were responding to the Dobbs decision, Democratic Gov. Josh Shapiro told Pennsylvania Capital-Star at a recent Harris campaign event.

Shapiro also won in 2022, and so far his administration has supported over-the-counter birth control pills and ended the state’s contract with a network of anti-abortion counseling centers. He said his administration would not defend a current state law that prohibits state Medicaid funding from being used for abortions.

Abortion isn’t protected under Pennsylvania’s state constitution, but it remains legal up to 24 weeks’ gestation, and clinics there have seen an influx of out-of-state patients.

Wisconsin abortion services resume

After more than a year without abortion access, reproductive health clinics in Wisconsin resumed abortion services in September 2023, shortly after a judge ruled that the 1849 state law that had widely been interpreted as an abortion ban applied to feticide and not abortion. A state Supreme Court race a few months earlier saw Justice Janet Protasiewicz win in a landslide after campaigning on reproductive freedom.

Seven months later when Republican U.S. Rep. Mike Gallagher announced his resignation, Lyerly threw her hat in the ring, running as the only Democrat in the 8th District. She now faces businessman Tony Wied. Although in the past it was considered a swing district, it has leaned conservative in recent election cycles. With the redrawn maps and national support, Lyerly said it’s a competitive race.

“We have the potential to really fix, not just reproductive health care, but health care,” Lyerly told States Newsroom. “Bring the stories of our patients forward and help our colleagues understand, build those coalitions and help to gain consensus that’s going to drive forward health care reform in this country.”

Wied’s campaign website does not mention abortion or his policy proposals related to health care, though the words “Trump-endorsed” appear prominently and abundantly throughout the site. Wied hasn’t said much about the issue beyond it should be a state issue. His campaign declined an interview.

Currently the only OB-GYNs who serve in Congress oppose abortion. If Lyerly wins in November, she would not only change that (potentially alongside Minnesota Sen. Kelly Morrison ) but also could help flip party control in the U.S. House of Representatives.

Most Wisconsin voters oppose criminalizing abortion before fetal viability, according to a poll this year by the University of Maryland’s Program for Public Consultation.

Patricia McFarland, 76, knows what it’s like to live without abortion access. For more than 50 years, the retired college teacher kept her pre-Roe abortion a secret, having grown up in a conservative Irish Catholic family like many of her suburban Milwaukee neighbors.

McFarland told States Newsroom she has been politically active most of her life, but the Dobbs ruling dredged up the physical and emotional trauma from the illegal procedure she had alone in Mexico City. Now, McFarland rarely leaves home without her “Roe Roe Roe Your Vote” button, engaging anyone who will talk to her about the dangers of criminalizing pregnancy.

The mother and grandmother said she’s been canvassing and doing informational sessions with her activist group the PERSISTers, as well as the League of Women Voters. As she has warned fellow Wisconsities about the federal power over their reproductive freedom, she said the enthusiasm for abortion rights in her state is palpable.

“For women my age,” McFarland said, “we don’t want our grandchildren to lose their ability to decide when to become a mother.”

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Georgia Recorder’s Jill Nolin contributed to this report.

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