The same hot-button social issues that flared up at the Maine State House in recent months also fueled similar debates in state legislatures across the country.

In many states, legislatures responded by passing laws restricting access to abortions or gender-affirming care. As a result, access to those services has decreased in much of the United States over the past year, according to advocates on both sides of the political spectrum.

Maine’s Legislature went in the other direction.

Lawmakers in Augusta passed multiple bills significantly protecting or expanding access to gender-affirming care and abortion during the contentious legislative session that came to a close Thursday. Gov. Janet Mills is expected to sign the most significant law changes this week.

National culture war issues have often played a role in Maine’s state politics, said Ron Schmidt, a political science professor at the University of Southern Maine. But it’s rare to see so many states take on the same hot-button topics with so much energy, he said.

It’s no surprise that state legislatures were dominated by abortion-related bills this year. In overturning Roe v. Wade one year ago, the Supreme Court passed the buck back to the states, mobilizing the right and the left to act quickly on the issue.

It’s less apparent why gender-affirming care has become such a hot topic in state-level politics. The issue, like the movement to keep books and discussions on LGBTQ+ topics out of schools, has been seized upon by Republican candidates for president, most notably Florida Gov. Ron DeSantis. Schmidt suggested it might be viewed as a new wedge issue to energize voters after Roe v. Wade was overturned.

The combination has led to a slew of new state laws that drastically changed the landscape of abortion and gender-affirming care access over the past year. And although laws were passed both increasing and reducing access to abortion and gender-affirming care, the laws limiting care are greater in both number and strength.

Advocacy and research groups on the right and the left agree that, overall, the nation has restricted access to gender-affirmative care and abortion over the past year.

“From June 2022 to today, nearly half of the states passed more protective, pro-life laws,” said Katie Daniel, state policy director at Susan B. Anthony Pro-Life America. “We’ve very much moved in a pro-life direction.”

“The reality is that since Dobbs, one-third of women live in a state that has no access to abortion care,” said Nicole Clegg, interim CEO at Planned Parenthood of Northern New England.

“There have been all sorts of (gender-affirming care) restrictions enacted and passed into law,” said Gia Drew, the executive director the of LGBTQ+ advocacy organization EqualityMaine.

At least 12 states had enacted laws banning all or most abortions as of June 15, according to the Guttmacher Institute, a national reproductive rights research group. Those include Florida, Idaho, North Dakota, and North Carolina, among others. The laws limit access to abortion in a few different ways, including reducing the legal window to obtain an abortion.

Twenty states now have laws restricting gender-affirming care, according to Movement Advancement Project, a nonprofit think tank advocating for LGBTQ+ rights. Seventeen were passed this year in states including Montana, Mississippi, and Florida. As with laws restricting abortion, not all are the same.

Maine is not the only state to buck those trends. A relatively small number of other states also have expanded or moved to protect access to abortion and gender-affirming care, in part fueled by the actions taken in more conservative states.

Vermont law had already protected abortion access. But, in a November referendum, Vermonters enshrined the right to abortions in their constitution.

Minnesota’s Democratic Gov. Tim Walz signed a law codifying the right to abortion in that state in January, and in April signed additional legislation to protect access to abortions and gender-affirming care.

Colorado’s Democratic Gov. Jared Polis also signed new laws in April that added protections for access to abortions and gender-affirming services in his state.

This past fall, California passed a law protecting those who come to the state seeking treatment for their transgender children or teens from being penalized by other states. Minnesota and New Mexico passed similar laws.

In Maine, Mills is expected to sign bills next week that will expand abortion access and protect access to gender-affirming care.

Mills personally championed the most significant abortion-related bill, which the Legislature’s Democratic majority delivered with a final vote last week despite strong pushback by Republicans and anti-abortion advocates who filled the State House in a 19-hour public hearing.

Once signed, the law will make Maine one of the least-restrictive states by removing a near-complete ban on abortions after 24 weeks. The new law will allow abortions if a doctor deems it necessary regardless of gestational age.

Also awaiting Mills’ signature is a bill passed by the Democratic majority that will allow for 16- and 17-year-olds with gender dysphoria to receive gender-affirming hormone therapy without their parents’ permission under certain conditions.

Under the bill, teens would be eligible to undergo treatment without parental consent if they are diagnosed with gender dysphoria, have received counseling from a licensed medical professional, and are experiencing harm because they are not receiving the therapy. Gender dysphoria is diagnosed when someone’s expressed gender identity is different from the gender assigned at birth for a sustained period.

Mills signed a different bill into law last month protecting MaineCare coverage of gender-affirming care.

Timing played a role in Maine’s responses to national issues.

While Republicans controlled both the Legislature and governor’s office as recently as 2012, Democrats had firm control of both branches of government when the Supreme Court threw the abortion issue to the states. And, as in other states, Democrats made it clear they were moving to protect gender-affirming care because Republican-led legislatures were restricting it in other states.

The legislation that passed in Maine and like-minded states isn’t expected to offset the restrictions being adopted in many others.

While Maine’s law makes it easier to get an abortion after 24 weeks, only 1% of abortions happen after 21 weeks, according to the U.S. Centers for Disease Control and Prevention. Meanwhile, other states limited access to almost 100% of abortions. And while Maine will allow 16- and 17-year-olds with gender dysphoria to get gender-affirming care without their parents’ permission, other states banned gender-affirming care for all minors and banned hospitals that directly or indirectly receive public funds from providing the care.

Still, Maine advocates for abortion and gender-affirming care access said they are proud of what has happened in Maine.

“What Maine did and what other states like Maine will do becomes all more important when other states get rid of abortion. The consequences are so dire in other places, ” said Clegg of Planned Parenthood, who said some patients who can no longer legally access abortion in their states will come to Maine.

“We are celebrating to the extent we can that Maine has gradually improved access to gender-affirming care,” said Drew of EqualityMaine. But, Drew said, “many of us and our community members are paying attention to what is happening across the country. It can be scary to folks who wonder if that might end up happening here and who have friends and families in other states.”