With a Democratic governor whose term is about to expire, a Republican legislature, and several highly contentious races forthcoming, all eyes are on Pennsylvania. The state has become a litmus test in informing and shaping the political geography of the post–Trump era, especially as reproductive health care is facing a reckoning across the country. 

Currently, abortion is legal in Pennsylvania for up to 24 weeks of pregnancy. Gov. Tom Wolf has stated his commitment to maintaining reproductive rights, vetoing three abortion–limiting bills in the past five years with a Conservative legislature. But now that Wolf is set to leave office and the U.S. Supreme Court has struck down Roe v. Wade, the state governor’s race will play a significant role in determining the future of abortion in Pennsylvania. 

Trump–backed Republican nominee Doug Mastriano has vowed to ban abortion—what he calls “science–denying genocide”—in every instance, even in cases of rape, incest, or a threat to the pregnant person’s life. Current Pennsylvania Attorney General and Democratic nominee Josh Shapiro has publicly promised to preserve abortion, making it a focal point of his campaign. As abortion rights hang in the balance, Pennsylvania health care providers and legislators on both sides of the aisle are devoting significant resources to shifting the battle lines. 

Of these key individuals is Lindsey Mauldin, the vice president of public policy and advocacy at Planned Parenthood of Southeastern Pennsylvania, located just three miles off of Penn’s campus. Mauldin says that the November ballot transcends abortion rights, describing the upcoming election cycle as “one of the most important of our time,” and stating that “individuals’ lives are on the line” when it comes to access to reproductive health care. Studies on maternal mortality rates in states that have banned abortion, for instance, suggest greater increases in the number of maternal deaths than previously expected, particularly among minority and low–income communities who are disproportionately impacted by the Dobbs decision, which eliminated the federal Constitutional right to abortion and left regulation in the hands of the states. 

Mauldin also points to S.B. 106, known as the "No Right to Abortion" constitutional amendment, passed in July by anti–abortion lawmakers who gathered in the middle of the night and snuck the amendment into an unrelated bill, with no input from the public or medical experts. Though the legislators in support of this bill claim it does not seek to take away anyone’s reproductive health care, in reality it creates a clear legislative path to put in place harsher bans on abortion. 

This is “just the beginning of an attempt to put forward an extreme agenda that really invades folks' privacy,” Mauldin says, referencing other states that have begun to restrict health care such as contraception and gender affirming therapy. Similarly, the enactment of S.B. 106 could have implications ranging from abortion access to IVF treatment, treatment of ectopic pregnancy, and miscarriage management. Reproductive health–related decisions are among “the most personal decisions one could make,” she says, highlighting a stark contrast between this private health matter and the combative public political discourse that decides its fate. This situation is exacerbated by a related political issue: the lack of affordable health care options. 

AccessMatters, a Philadelphia–based public health nonprofit focused on sexual and reproductive health access, is one local organization working to address the health care affordability crisis. Melissa Weiler Gerber, AccessMatters president and CEO, points to the systemic barriers that can prevent someone from receiving the resources they need. Philly is “the poorest big city in the country,” she says, “and all the things we’re worried about in terms of [reproductive health] access generally are going to be exacerbated for clients here because of our very high poverty rate, which is very correlated with race.” AccessMatters is currently in dialogue with Philly city council members about ensuring increased funding and expanded access to abortion, especially for those left most vulnerable by the Dobbs decision. In addition, they have developed a program in Philly schools that acts as a point of contact for teens facing difficult decisions about their reproductive health and can connect them with the resources they need.

As the grantee of the Title X family planning program, a federal grant that provides the funding for family planning and various preventative services, AccessMatters exists to intervene before people are made victims of the system. They consider themselves “a critical part of the region’s safety net,” reaching around 100,000 people each year across the city and state. With abortion under attack, providing contraceptive services is more important than ever. In fact, post–Dobbs, AccessMatters has seen an increase in calls from patients seeking tubal ligations and vasectomies, as these are the longest–lasting forms of birth control possible. They work with a multitude of local partners to whom they refer patients that call via hotline. For vulnerable teens who may lack the knowledge or resources to seek help, AccessMatters has a program currently in place in local schools which acts as a point of contact for teens facing difficult decisions about their reproductive health. 

They work closely with local organizations like the Abortion Liberation Fund and New Voices for Reproductive Justice, organizations that focus on funding abortions and connecting patients to services on a more local, case–by–case basis. According to Weiler Gerber, the city recently allocated $500,000 to the Abortion Liberation Fund, and organizations like AccessMatters are advocating for that money to become a permanent part of the city budget—not just an emergency measure. 

The fight for reproductive justice is ultimately driven by the conviction that abortion is health care. Yet this medical service has become so politicized that a wide range of activism is necessary to preserve it. Millions of dollars and hours of political organizing were expended so that providers could continue offering a potentially life–saving medical procedure. Eliminating any element of the advocacy that communities have been organizing around for years, whether it be canvassing, mutual aid funds, or specialized clinician training, could be the thing that prevents an individual from getting the crucial care they need. On–the–ground action has been providing the care and community necessary to protect reproductive rights and fuel the fight for change.

Correction: An earlier version of this article stated that AccessMatters could not partner with abortion providers, which we have since determined to be inaccurate. AccessMatters may partner with abortion providers, but they are not able to directly fund abortion services. The article has since been updated to reflect this. Street regrets this error.