For an alternate viewpoint, see “Counterpoint: Let’s Talk About Sex, Baby.

The recent election results in Kentucky, Ohio and Virginia were more than a victory for abortion rights because it was not just abortion that was on the ballot.

The debate over reproductive healthcare is part of a larger conversation about public health itself, and the rights our government should be ensuring to quality, affordable and equitable healthcare that cannot be taken away.

That is what this election was all about, and what the next one must be, too.

Grassroots activists will be showing voters that abortion care is healthcare, and everyone wins when people vote to protect public health.

The 2023 elections added urgency to efforts to get abortion rights initiatives on the ballot next year in Arizona, Nevada, Florida, Nebraska and South Dakota. But those are not the only public health measures that will come before voters.

In California, for example, Gov. Gavin Newsom has put a historic transformation of the state’s mental health system on the March 2024 ballot — a $6.38 billion bond to build behavioral health housing and treatment facilities that will get people off the streets, out of tents and into treatment.

Advocates in Alaska, Nebraska and Missouri are gathering petitions to put paid sick leave on the ballots in those states. Citizens are increasingly seeing elections and the initiative process as a bulwark of protection for their most fundamental rights.

That is because our right to a healthy life is clearly in jeopardy. As previously protected rights like access to abortion care and contraceptives are threatened, the effect on other aspects of public health cascades over the economy, family life and education. It is all connected.

Women who are denied access to abortion care have four times greater odds of living below the federal poverty level. They are more likely to be experiencing high levels of debt, evictions and other economic hardships, according to the Turnaway Study. This study gathered for the first time quality research on the physical and social consequences of unwanted pregnancy for women who were turned away from abortion care.

Before this study, most of the research that was funded focused on whether abortion is responsible for mental health problems such as depression and post-traumatic stress disorder, or drug and alcohol use.

The result? Hardened attitudes and erroneous assumptions that were unsupported by the evidence. The Turnaway study showed that 95 percent of women reported having an abortion was the right decision for them more than five years afterward.

We must change the narrative and focus on the facts about abortion care — not scare tactics, junk science or misinformation — by adding a public health lens to our view of politics.

That is the challenge for 2024, brought into focus by the 2023 elections.

We need to change the political landscape in those states where restrictive reproductive health policies are behind the rise in women giving birth to low-weight babies. The United States already has one of the highest maternal mortality rates in the developed world — with those rates highest in states where abortion restrictions have been in effect.

Why can’t we make our elections about issues like that? Issues that have a real effect on people’s lives?

Women who are denied abortion care are more likely to experience serious complications from the end of pregnancy including eclampsia and death; stay with abusive partners; suffer anxiety and loss of self-esteem; and experience poor physical health for years after the pregnancy, including chronic pain and gestational hypertension.

And being denied abortion has serious implications for the children born of unwanted pregnancy, and for the existing children in the family.

Economists have shown that the expansion of legal abortion care after Roe v.

Wade was decided reduced teen motherhood by 34 percent and teen marriage by 20 percent.

They showed how access to abortion care increases the probability that teenage women of color graduate from high school by 22 percent to 24 percent with a 23 percent to 27 percent increase in the probability of attending college.

The right to one’s own bodily autonomy is so basic that sometimes it seems incredible we have even have to defend it.  But women’s independence, freedom, access to healthcare and other rights are being increasingly politicized.

That is the last thing we need. Public health is basic to the way we live our lives, and to our hopes for the future. That is what we will be fighting to put on the ballot in 2024.