Of the several state abortion-rights initiatives trying to make it to the ballot this November, Arkansas’ is perhaps the most controversial among reproductive justice advocates, as it would reinstate an abortion policy more restrictive than under Roe v. Wade. Attempting to also appeal to the conservative voters of the deep red, heavily gerrymandered state, Arkansans for Limited Government’s proposed Arkansas Abortion Amendment would overturn the state’s current near-total ban, but limit the procedure to 18 weeks post-fertilization, with exceptions for maternal and fetal health conditions and rape and incest.
For this reason, as Slate reported, major national abortion-rights groups have not been involved in promoting or funding the campaign. But the ballot question committee’s director of strategy, Rebecca Bobrow, said she’s “cautiously optimistic” that the committee will meet the 90,074-signature threshold by Friday’s July 5 deadline. On Wednesday, Bobrow said the campaign was approximately 5,000 signatures away from their goal. But what worries her is the steep fundraising climb ahead.
“The 90,000 signatures that we need is not enough for a win in November, so it’ll be a lot of education, and making sure that people are coming to the polls for this,” said Bobrow, who noted support for this amendment spans divergent political views. “We’ve heard from people that are Trump supporters who are saying, ‘I’m going to vote Republican down my ballot in November, but I want this on the ballot. I believe it’s important to protect personal freedoms.’”
Bobrow acknowledged that the law doesn’t go as far as she wishes it did in protecting abortion rights. But she said she thinks, at least for now, it would improve reproductive health care access in a state that has criminalized nearly all abortions for two years. Compounding restrictions, state Attorney General Tim Griffin recently ordered out-of-state providers to stop advertising and selling the abortion pill in Arkansas. But if the amendment passes, Arkansas could become an access point in a part of the country that has almost entirely banned abortion. On June 18, the state House adopted a non-binding resolution opposing the Arkansas Abortion Amendment and encouraged registered voters to vote against it.
“This feels urgent,” said Bobrow, who last year completed a graduate thesis at Harvard University on state abortion shield laws in post-Roe America and began consulting for the campaign in April. “Let’s protect the women and restore access up to this point, and then we can go further. If this is what can pass right now, we shouldn’t not be doing it because we’re trying to get to an ideal.”
The more than 90,000 signatures must hail from 50 counties rather than the previously required 15, which is a new rule currently being challenged in court, but Bobrow said it is actually helping the campaign establish a more robust infrastructure.
One of the campaign’s approximately 800 volunteers is Dr. Dina Epstein, who is also among more than 600 health care providers to sign an open letter in support of the amendment. After her medical residency, the Little Rock native moved back to her home state, where she’s been a practicing OB-GYN since 2019. Between surgeries on a recent Friday, Epstein ducked into a breakroom at a hospital in North Little Rock to talk to States Newsroom about what it’s been like to be a practicing OB-GYN in a state where pregnancy termination is a crime, and why she believes in the Arkansas Abortion Amendment. She said that before Roe v. Wade was overturned in 2022, she was only performing medically indicated abortions, but the abortion ban has changed her practice. She said she signed up to volunteer a few months ago and carries petitions everywhere she goes.
This interview has been edited for brevity and clarity.
States Newsroom: What has it been like being an OB-GYN in Arkansas since Roe v. Wade was overturned?
Dr. Dina Epstein: It has been challenging and scary and heartbreaking, honestly. Before Roe v. Wade was overturned, there were, of course, restrictions in the state of Arkansas as it was, but we were not prevented from doing our jobs properly. And since it was overturned, that has not been the case. There have been so many questions, because there’s almost a total ban, with the only exception being to save the life of the mother when it’s in imminent danger. … It’s tied our hands in a lot of situations so that we can’t keep our patients healthy, that we can’t do what is best for them medically. We have to do what is required by the law or risk having our license taken away, being fined, put in jail, et cetera.
SN: Can you be more specific?
Epstein: We try to treat things and we try to keep the pregnancy healthy and the patient healthy. But one of the first things we have to consider is, what if she does need to be delivered before she’s able to get to viability? That is considered an abortion, and that is illegal under the ban. This patient needs to be able to survive. She can’t carry another pregnancy if she’s not alive. She can’t carry this pregnancy if her blood pressures aren’t controlled and the stroke that she has killed her. But to end the pregnancy prior to that happening, it’s not clear when that’s OK, how sick she has to be before we get to the point where that’s a reasonable medical option according to the law.
SN: About how often have these types of situations arisen, where you’ve had to deny care or refer patients out of state?
Epstein: It depends on the facility, but it happens a fair amount. There are times things come in waves, where we’re seeing things all the time, and then we get a little break from it, but I mean, every week there’s something popping up on one of us where we’re having to address this. … It’s certainly disrupted the trust a little bit between patients and doctors, because they don’t know what’s safe to tell us and what isn’t.
SN: How have you been navigating that loss of trust among patients?
Epstein: I’ve had to do some education with my office staff as far as when people call, if they do ask about abortion, what would be appropriate to say. The knee jerk in the past for some people has been to just say we don’t do that here and move on. And that is not an appropriate answer. As far as I’m concerned, as a medical provider who wants to care for my patients, if I can’t do it personally, I will give them the guidance of what we are allowed to do, what we aren’t allowed to do, and what is available in the state, what is not available in the state.
I try to make it clear with my patients when they come in if they’re pregnant, “I’m here for you.” I never assume. … I ask them, “And how are you feeling about this pregnancy?” … Some patients have certainly had a sense of relief, even just being asked and being able to say, “I’m not sure; here’s the situation I’m in,” or, “I’m pretty sure my doctor last time said my heart wasn’t in a condition to do that, but I didn’t follow up, so now I’m scared, but I didn’t want to say it because I didn’t want to go to jail.” There’s just a lot of unknowns, and disrupting that trust has really made it more difficult to operate.
SN: What has canvassing been like? What have the conversations been like?
Epstein: It’s been really nice to realize that it’s not that everyone agrees that this ban is appropriate; it’s that people just know the reality of the ban, but they don’t have the information. They don’t know to think about these instances, that mom might get septic because she ruptured at 14 weeks. They don’t know that her blood pressure might make her so sick that she and the fetus could die. … This shouldn’t be something that the general population has to think about, every complication that can arise during pregnancy.
SN: What are some of the more surprising conversations you’ve had gathering signatures?
Epstein: The people I have been most surprised by — and maybe it’s just a bias on my side — but, the older, rather religious, kind of more conservative members of the community who have come up and said that they couldn’t say it publicly but absolutely do not believe that the government should be making medical decisions for people, and then signing. … I’ve had so many, like grandparent-type people coming up and saying they can’t believe this is happening, and they just want to make sure that the future is better for their children and their grandchildren.
SN: Can you speak to the criticisms that this law is more restrictive than Roe?
Epstein: It’s not inaccurate, but now our hands are tied. We can’t provide even appropriate medical care to our patients. Waiting and hoping for something to change nationally or promoting something that has no chance of passing in this state does not help my patients.
The proposed amendment covers 98% of cases that occurred previously. … There are situations still, just because of the resources that we have available in the state of Arkansas, that we would not be able to do because we aren’t equipped to do that, and those patients would still need to travel out of state, which was the case previously. So again, not necessarily ideal for those patients, but it does improve access dramatically for the majority of patients who would be affected by this.
I mean, Arkansas has the highest maternal mortality rate in the nation. [Arkansas had the highest rate between 2018 and 2021, but including 2022 data, CDC reports 38 deaths per 100,000 live births in Arkansas, well above the national rate of 23 but slightly behind Tennessee, Mississippi and Alabama.] This is not a safe place to be pregnant. … There are so many labor and delivery units closing across the state. And recruiting [doctors] has been made more difficult by this as well. … If you have a choice of where you get to live, do you want to live in a place where you or your daughter can’t get all of the care that should be available to them?
SN: Do you think this amendment has a chance?
Epstein: We are very optimistic. … People are so excited to have this opportunity and are thrilled that this can happen here. People are getting more and more pumped about it as we’re getting closer and closer to the deadline. It seems like it could definitely happen. … But we still need everybody’s signature.