Anti-choice lawmakers in state legislatures nationwide have continued a steady crackdown on abortion rights in 2015, while also introducing some never before seen kinds of legislation that would restrict reproductive health care in radical and sometimes unforeseen ways.

The wave of anti-choice bills in 2015 continues a multi-year campaign by state lawmakers to restrict reproductive rights; this effort has in part been coordinated by well-funded anti-choice organizations such as Americans United for Life (AUL) and the National Right to Life Committee.

Since the 2010 midterm elections, when Republicans made massive gains across the country, hundreds of anti-choice bills have been introduced in state legislatures, and more of those bills have become law in that time than during the entire decade prior.

Amanda Allen, state legislative counsel at the Center for Reproductive Rights, told Rewire that the election of GOP majorities in state legislatures and Republican governors during the 2010 midterms are largely responsible for the wave of anti-choice legislation, despite the fact that abortion rights were not a major political factor during those campaigns.

“That election was not a referendum on reproductive health and on abortion,” Allen said. “But we’re still seeing the impacts of those elections today.”

There have been at least 235 anti-choice bills introduced in state legislatures in the first three months of 2015—bills that would place restrictions on abortion providers or erect barriers to abortion access, according to analysis by Rewire.

Thirty-two bills have been voted on and passed by at least one legislative chamber so far this year; 11 of those have been passed by both chambers, and have either been signed by the governor or are awaiting signature.

Almost every state legislature has been in session this year, and so far lawmakers in 39 states have introduced at least one bill to restrict reproductive rights. While there have been a few anti-choice bills introduced in most state legislatures, lawmakers in some states have been busy introducing astonishing numbers of anti-choice proposals.

“In terms of the numbers, we’ve had a pretty good run of it these last few years, and this year we will pass substantive legislation as well,” Mary Spaulding Balch, state policy director for anti-choice National Right to Life Committee, told the Washington Examiner. “At the end of the day, I would bet we’ll have a pretty good year.”

No other state in the country has seen more anti-choice bills introduced in 2015 than Texas, which has seen 25 such bills proposed this year. Lawmakers there appear to be making up for lost time, since the biennial legislature was not in session in 2014.

Legislators in Missouri introduced more anti-choice bills last year than any other state. The state’s lawmakers who are opposed to abortion rights continued their aggressive assault on such rights this year, with 20 anti-choice bills introduced so far in the state.

Voters in Tennessee last year approved an amendment to the state constitution to allow the legislature to consider legislation to regulate abortion, and state lawmakers wasted no time introducing bills to crack down on reproductive freedom. This year a dozen anti-choice bills have been introduced in the state, many of which seek to reinstate laws previously struck down by the state supreme court.

Tennessee’s spate of anti-choice measures was fairly predictable in a state legislature where three in four legislators are Republican.

State lawmakers in Minnesota, Iowa, and South Carolina have also introduced several anti-choice bills: 14, 11, and 12, respectively.

Louisiana is the lone state legislature not to have convened in the first three months of 2015. However, when the legislative session begins on April 13, there will likely be legislation introduced to restrict reproductive rights.

Louisiana lawmakers during the 2014 legislative session introduced several bills to restrict reproductive rights, including the omnibus anti-choice bill HB 388, which was signed into law by Gov. Bobby Jindal (R) and threatens to close three out of the state’s five abortion clinics.

Continued Assault on Providers and Patients

The dozens of anti-choice bills introduced by state lawmakers would restrict reproductive rights in myriad ways. Among the most common types of anti-choice bills are those that would restrict the ability of abortion providers to serve patients, and for patients to access safe abortion care.

Proposed GOP legislation meant to complicate bureaucratic regulatory regimes for abortion providers has been introduced more than any another type of anti-choice legislation in 2015. There have been 47 of these types of bills introduced since January, including targeted regulations of abortion providers (TRAP) laws, physician reporting requirements, and other reporting requirements.

TRAP laws require clinics that provide abortion care to meet medically unnecessary regulations, such as the standards required for ambulatory surgical centers. Others require that the physician providing abortion care has admitting privileges at a hospital within 30 miles of the facility.

Similar laws passed last year in Oklahoma, Arizona, and Indiana, leaving in doubt the ability of reproductive health-care clinics to keep their doors open.

These TRAP laws, however, have regularly faced legal challenges from reproductive rights advocates.

While a lawsuit challenging the Oklahoma TRAP law has been unsuccessful, other legal challenges to such laws have been successful. A federal judge issued a temporary restraining order blocking enforcement of HB 388 in Louisiana, and a federal appeals court struck down a similar law in Mississippi.

A legal challenge of a Texas law that has forced dozens of clinics to close around the state awaits a ruling from the Fifth Circuit Court of Appeals.

There have been 39 bills introduced in state legislatures that would restrict access to reproductive health care by creating burdensome requirements for women seeking abortions. So-called “informed consent” bills include medically unnecessary requirements to which women seeking abortions must submit, including forced counseling, forced ultrasounds, coercion tests, and waiting periods.

A bill mandating forced counseling has already been passed by lawmakers in Arizona, and has been delivered to Gov. Doug Ducey (R) for his signature or veto. The bill includes a requirement that women seeking abortion care must be informed that the procedure could be reversed, despite no substantiated medical evidence to support that statement.

Another target of the nationwide anti-choice movement: abortion providers having the ability to use telemedicine to offer abortion care to women in rural areas. With telemedicine abortion, women are provided with medication abortion pills at a local clinic after being consulted by a physician via video conference.

“This has been an ongoing trend over the last couple of years,” Allen said. “These are preemptive bans, because in the vast majority of states where these are being proposed, there are no telemedicine abortion services available.”

Telemedicine abortion bans passed this year by lawmakers in Arkansas and Idaho were signed by the states’ Republican governors. Those states will become the 17th and 18th states to institute such restrictions.

There have been at least 11 bills to restrict medication abortion in 2015.

Allen said one of the more “sinister” anti-choice strategies is introducing bills requiring abortion providers to use outdated Food and Drug Administration protocols for medication abortion.

“These bills are incredibly insidious because they require doctors to ignore their own experience and the best and most recent medical evidence,” Allen said. “Yet the proponents are cloaking themselves in the idea that the evidence-based protocol is unsafe, which is absolutely untrue.”

Abortion Bans and Criminalizing Pregnant Women

Lawmakers have also introduced several bills that would ban abortion after a certain point in pregnancy or fetal development. That strategy is hardly new.

Lawmakers have also introduced several bills to ban abortion after or around 20 weeks’ gestation, with the intent of provoking a challenge to Roe v. Wade.

About 1.4 percent of all abortions performed in the United States in 2011 were after 20 weeks’ gestation, according to the Centers for Disease Control and Prevention.

Lawmakers have also pushed 14 bills that would ban abortion based on the determination of gender, race, or genetic anomalies. The justification for these bans is often based on misinformation and harmful cultural and racial stereotypes.

And despite a string of electoral and legislative failures, state lawmakers have this year introduced at least a dozen “personhood” bills, which would criminalize abortion and ban many forms of birth control, in vitro fertilization, and health care for pregnant women.

Such bills so far this year have not had any success: “personhood” legislation introduced in deep-red Mississippi died in committee, and similar legislation introduced in Iowa failed to meet a legislative deadline for consideration during this legislative session.

Bills have also been introduced in GOP-controlled legislatures to criminalize pregnant people, and allow prosecution of those who engage in behavior deemed risky for the fetus. Lawmakers in Mississippi and North Carolina introduced this type of legislation this year.

At least 11 of these and other types of so-called fetal harm or homicide laws have been introduced by state lawmakers so far this year. At at least 38 states have fetal homicide laws on the books.

Old Strategy Used on New Target

While legislation to ban or restrict abortion after a certain number of weeks of pregnancy or fetal development has become a common tactic of anti-choice lawmakers, another tactic has emerged that has adapted a decades-old strategy to ban or restrict a method of abortion care.

Legislation that would ban the procedure called dilation and evacuation (D and E), which is often used during second-trimester abortions and the management of miscarriage, has been introduced by lawmakers in four states.

The bills, model legislation drafted by the National Right to Life Committee, redefine the D and E procedure as “dismemberment” abortion.

“We’ve never seen this language before,” Elizabeth Nash, senior state issues associate for the Guttmacher Institute, told the Kansas City Star. “It’s not medical language, so it’s a little bit difficult to figure out what the language would do.”

The legislative language, which includes graphic and medically inaccurate descriptions of the D and E procedure, is key to NRLC’s strategy. This is similar to the strategy that was employed in the 1990s to successfully pass a federal ban on the intact dilation and extraction abortion procedure known as so-called “partial birth” abortion.

Kansas became the first state in the country to pass a ban on the D and E procedure, but the impact the law will have on abortion care and access is still unclear.

Erin Davison-Rippey, director of public affairs at Planned Parenthood of the Heartland, told Rewire that the legislation is part of a “gruesome” strategy by anti-choice activists and lawmakers to interfere in the doctor-patient relationship.

“When legislatures pick a specific procedure or technique to regulate or ban, they really are reaching into the relationship between a woman and her doctor,” Davison-Rippey said.

Bills to ban the D and E procedure have also been introduced in Oklahoma, Missouri, and South Carolina.