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Many US states have passed legislation preventing gay marriages performed in Massachusetts from being recognized in their state. However, 19 states specifically banned gay marriage through a constitutional amendment.
The difference between the two approaches has significance mainly in the effort it will take to legalize gay marriage. Although the 43 states defining marriage as 'between one man and one woman' prevent gay couples from approaching the state for recognition, the removal of that definition (which can be achieved through arguments on discrimination) would allow gay marriage.
States that define gay marriage as unconstitutional, however, have placed a more solid barrier between gay couples and the law.
This difference also has two effects: preventing recognition of gay marriage within the state and preventing gay marriage within America altogether. As a requirement of the gay marriage legislation in Massachusetts is that the couple's home state not ban gay marriage, those who live in the 19 states banning it cannot get married in America at all.