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Objective In recent years, U.S. states have passed many restrictive abortion policies with a rationale of protecting health and safety, in apparent contravention of abundant scientific evidence on abortion safety. This study explored whether and how state legislators use scientific evidence when deciding abortion policy. Study Design We conducted 29 semi-structured interviews with state legislators and their aides in Maryland, North Carolina, and Virginia in March through July 2017. We recruited via e-mail to members of all health-related committees of the General Assembly in each state, plus sponsors and co-sponsors of 2017 abortion bills, with follow-up via phone and in person. We conducted iterative thematic analysis of all interview transcripts. Results We found no cases of lawmakers’ decisions on abortion being shifted by evidence. However, some lawmakers used evidence in simplified form to support their claims on abortion. Lawmakers gave credence to evidence they received from trusted sources, and that which supported their pre-existing policy preferences. Personal stories appeared more convincing than evidence, with participants drawing broad conclusions from anecdotes. Democrats and Republicans had different views on bias in evidence. Conclusions In this sample, evidence did not drive state legislators’ policymaking on abortion. However, evidence did help inform high-level understanding of abortion, if such evidence supported legislators’ pre-existing policy preferences. This work may help public health practitioners and researchers develop more realistic expectations for how research interacts with policymaking. Implications of this work To increase the utility of research, reproductive health researchers and practitioners should 1) work with established intermediaries to convey findings to lawmakers; 2) present stories that illustrate research findings; and 3) consider the evidence needs of the judicial branch, in addition to those of legislators.