FORT LAUDERDALE, Fla. — Now that a proposed amendment to enshrine abortion access in Florida’s constitution has been defeated, hundreds of volunteers and organizers across the state face the difficult question: What’s next?

Will Floridians of childbearing age continue to live under a six-week abortion ban indefinitely? Could restrictions on abortion become even tighter in the state?

In the days after the amendment’s defeat, reproductive rights advocates considered next steps. Strategy discussions included everything from legislative efforts, to legal options, to rallying around candidates supportive of abortion access in future elections.

At the same time, independent abortion clinics in the state pondered their future and medical experts recognized that finding residents to train in Florida for obstetrics just got more complicated.

Along with the women and families who must continue to abide by the six-week ban, Florida doctors acknowledged their now long-term predicament of increased risk when treating women for pregnancy complications. Some also considered the conversations they will now have with women of childbearing age.

The overwhelming opinion is that taking the fight back to the Floridian lawmakers who passed the state’s six-week ban is not the answer.

“We are going to take a multi-pronged approach,” said Anna Hochkammer, executive director of Florida Women’s Freedom Coalition, which worked to gain support for Amendment 4.

Although the amendment fell short of the 60% threshold needed to pass, 57% of Florida voters did support it. Hochkammer believes that will send a message to state lawmakers.

“Six million people from both parties voted yes on 4, so you would expect the more moderate members of the Legislature would see this as a mandate to walk back some of the more extreme policies on abortion,” Hochkammer said. “We plan to work with the more moderate members of the Legislature to deal with the most egregious concepts of the ban.”

Outside of the Legislature, Hochkammer said reproductive rights advocates also will turn to the courts to provide legal support or sue on behalf of women harmed by the six-week ban.

And lastly, Hochkammer said abortion advocates will begin working to unseat lawmakers who “refuse to accept the wants of their constituents when it comes to abortion rights.”

Florida Senate Democratic Leader Lauren Book, who had rallied Broward voters to support the amendment, vowed she would keep fighting, highlighting that Floridians of all political parties voted for the amendment. However, she doesn’t foresee the Republican supermajority in the Florida Legislature changing its mind about the six-week ban.

“We have to be realistic and pragmatic,” Book said. “The sober reality is this is not going to change. While DeSantis is in the governor’s mansion and while Republicans control the Senate, not much will change. But I am going to be the thorniest thorn in their side, reminding them abortion access is what the majority of Floridians believe in. I am going to make sure the spirit of what the people want is carried out in our state. Our fight will be in small wins.”

Book said it likely will take a death for lawmakers to understand the ban’s effect. “Women will die who can’t receive appropriate care. It’s only a matter of time before it happens here. They will say it’s the doctor or hospital’s fault, but the reality is it’s because of these bans.”

She believes the remedy will come in future elections: “In two more years, when there’s a gubernatorial race, we will fight back and win seats.”

Will Florida women still have options?

At least a half-dozen abortion clinics in Florida already have closed since the state enacted its initial restrictions on abortions of 15 weeks in July 2022, and its six-week ban in May of this year.

Now, more shutdowns are expected.

Elena Senises of the Miramar Women’s Center said her clinic has been open for 28 years and provides care to a diverse population of women in Florida and the Caribbean.

“We are still open, but we have had only one patient this week,” she said. “Everyone was hoping this six-week ban was a temporary thing, but now it’s permanent and I don’t know what the governor plans to do next. He could ban abortion altogether.”

“We are going to do our best to hang on,” Senises said. “It’s taking a toll on us, and it’s taking a toll on patients. From what I have seen here, a lot of women are going to try to take care of things themselves.”

Florida women who seek abortion care after six weeks of pregnancy, including those who discover a congenital deformity after their routine 20-week anatomy scan of the fetus, continue to have two options: travel or the abortion pill.

Women still can travel to states like North Carolina, Virginia or New York, where abortion care is legally available longer into pregnancy.

Abortion funds help cover appointment and travel costs for people who need financial assistance.

Fund operators say they saw an increase in donations this week with the defeat of Amendment 4, but they believe the ongoing need will quickly outstrip their funding — and they worry about what legislative actions could be ahead.

“We got an influx of individual donations (Wednesday) of $10,000,” said Stephanie Loraine Piñeiro, executive director of Florida Access Network. “That’s great, however, only 23 percent of the donations were recurring.”

After Roe v. Wade was overturned in 2022, Florida abortion funds experienced a boost in donations. However, the donations dwindled as time passed, and the need for travel assistance increased.

“We as an organization had been cautiously optimistic about the results of the election,” Piñeiro said. “Now, what’s next is the possibility of clinics closing and the possibility that people doing the type of work we do, helping people travel, will be criminalized.”

“We will be continuing to fund abortion travel as much as we can within the context of the law,” she said.

Jessica Hatem, executive director of Palm Beach County’s Emergency Medical Assistance, had hoped the demand for travel assistance would ease with the passage of a proposed constitutional amendment allowing abortion in Florida. Now, like Piñeiro, her focus is on fundraising.

“This situation in Florida is incredibly hostile,” she said. “I don’t know if the money needed to meet this hostility is there. For now, we are still here to get people access to care and quality health information, provide wraparound support, and provide logistics to get out of state, and that’s not changing.”

The alternative to travel is mail-order abortion pills. Providers from other parts of the U.S. are shipping abortion medication into Florida every day, according to the Society of Family Planning.

Although Florida law requires an in-person visit to receive abortion pills, women are having telehealth appointments with doctors in states where providers are shielded from prosecution.

In just a three-month time frame this year, between March and May, Florida saw about 400 abortions through mail-order medication provided under shield laws, according to a We Count Report by the Society of Family Planning. Unless federal action limits this option, experts believe the fallout from Amendment 4’s defeat will result in more abortions through mail-order medication.

Access to birth control

With abortion access now limited in Florida for the foreseeable future, doctors say their conversations with patients will change.

“If you are a proactive doctor, you should tell every patient who has the potential to get pregnant that we live in a state where there basically is a total ban,” said Dr. Cecilia Grande, a Miami gynecologist. “They should know that if they are planning to be pregnant and something is wrong, unless it’s fatal, if they choose to terminate, they can’t do it in this state.”

Conversations around birth control may shift, too.

In June, Senate Republicans blocked a bill that would have created a national law allowing access to birth control. States now are left to decide if they will protect access to birth control.

After the Nov. 5 election, some abortion backers expressed concern about birth control access going forward.

Cynthia Plotch, co-founder of Winx Health, which sells a morning-after pill, said women are stockpiling Plan B, which is taken the day after a woman believes she may have become pregnant. “They are worried that under the Trump Administration, bad things are coming,” she said.

Plotch said the day after the election, her company sold six times as many packages of Plan B than the seven days prior. “It’s got an over two-year shelf life, and they are buying it mostly in bulk, she said. “Things happen, and there are so many reasons why having access to a secondary option is so incredibly important right now,” she said.

In Florida, she said, sales also rose this year after the six-week ban went into effect. “When you have to drive 18 hours to terminate a pregnancy, you will do anything you possibly can to not get in that situation,” she said.

Piñeiro said after the failure of Amendment 4, her abortion fund plans to ramp up its free distribution of birth control and Plan B pills.

“We want to make sure people have the tools they need to take care of themselves,” she said.

Medical care and physicians

Dr. Rob Davidson, executive director of the Committee to Protect Health Care, said Florida physicians who supported Amendment 4 want to prevent the rise in pregnant women dying while pregnant, during childbirth, or soon after, which has happened in Texas following the state’s 2021 ban on abortion care.

Going forward, his organization’s strategy is “constant, persistent advocacy” in Tallahassee.

“I think you have to have doctors continuing to tell stories of patients who have suffered because of this ban,” Davidson said. “All we can do is continue to turn up the volume and keep the same level of advocacy going into the next legislative session as we did going into the election.”

Minority groups must rethink their strategy

Reproductive rights organizations representing men, women, Hispanics, and Blacks targeted messages and canvassed neighborhoods to seek support for Amendment 4. Now some of those groups are contemplating how to better educate Hispanics.

“We know we need to be having more conversations with Latinos in Florida,” said Lupe M. Rodríguez, executive director of the National Latina Institute for Reproductive Justice. “When we talked to people in Hialeah, they were with us on the amendment, but they also voted for representatives who don’t support that access. That huge disconnection people have is part of the work of what comes next.”

Rodriguez said most Latinos live in states that have severely restricted abortion. “It means a ton for our future economic prosperity and educational opportunities.”

She said the plan is to knock on doors and educate Latinos on how representation works in the hope that they will make the connection in future elections.

Legal funds form to fight federal laws

Experts say a Trump administration could further limit abortion access in a way that could affect Floridians.

On Thursday, Fatima Goss Graves, president and CEO of the National Women’s Law Center, said her organization will work to make it clear to the Trump Administration that Americans expect adherence to his campaign promise. Trump has said that he wouldn’t sign a federal abortion ban and that states should decide their own policies.

Graves said she is concerned about efforts detailed in the Republican’s Project 2025 to restrict access to abortion pills, especially when they are administered through telehealth or delivered by mail. However, she believes Americans will push back. “There are countless ways to restrict and upend abortion access further in this country. We think the evidence of what happened at the ballot this year, the fact that most ballot measures were so successful, so popular across parties, demonstrates that we have a base to build on to secure reproductive freedom.”

Graves said Florida women also need to know that her organization has a legal defense fund for anyone who needs legal help securing abortion access.

“There are organizations like mine who use the law, who use advocacy, who galvanize people and remind them of their own power because our current system of government actually is a democracy,” she said.

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